The AMA’s statement to the President about Health Care Reform

Here’s a .pdf file of the statement, signed by the President of the AMA and several professional organizations and specialty boards.

It is well written and well intentioned.  It’s also just filled with the gobbledygook that comes from big groups that don’t get the problem.  It’s ideal from a big-group perspective, in that all but one or two of the goals is already underway, and the hardest one isn’t under their control (interoperable EMR’s).

As the letter is 3 1/2 pages long I could spend a lot of time analyzing every aspect (several of which I agree with), but I’m going to focus on the thing that jumped out at me.

…We are committed to creating a cultural transformation that better supports delivery of the highest quality care for individual patients and communities and which, among other strategies, will allow for a more appropriate allocation of finite resources.  These two elements are extremely important, and we hold ourselves accountable to achieve them.

Buzz-words: “cultural transformation” and “appropriate allocation of finite resources” are the two that make me cringe, but feel free to find your own.  What does ‘cultural transformation’ even mean?  There’s no vision for changing any culture in the document (it’s a nice list of goals to increase efficiency, but that’s not a ‘cultural transformation’).  It talks about being patient centered then talks about all the things medicine needs to do, and nothing about the patient.  It’s patently dumb to continue to see the self-contradictory statements ‘highest quality care for the individual’ and ‘appropriate allocation of finite resources’  jammed together unironically.  As a physician my duty is to my patient, not some theoretical need of another patient or patients with the same or different concerns.  The idea individual docs will act paternalistically about the husbanding of resources while engaging in a true beneficent relationship with their patient makes no sense (thanks, mandatory ethics class).

You know what would be a cultural transformation? Cost transparency in medicine, linked to patients spending their own money on their care*. It’s irrelevant what an MRI costs if you’re not paying for it directly.  Think there wouldn’t be some competition in the marketplace then?  Of course, to do that you’d have to get the government and insurance companies out of the way, let doctor groups negotiate just like every other industry, etc.  There’s a culture change.

Free=more.  There is no Nirvana where people get everything they want for free that doesn’t cause shortages and skyrocketing costs.  There has to be some moderator on the continuous and enormous increase in healthcare spending, a point everyone agrees on.  In the current model prices are invisible, payment is unfathomably byzantine and not borne directly by the patient (unless you’re uncovered, then you’re really in a tough spot), so there’s little reason not to get another MRI, CT ‘just to be sure’, etc.  Prices spiral.

So, give us a market, get Uncle out of the way (mostly), and let people decide on their care based on a true cost/benefit ratio.  There’s a real cultural transformation.

* Yes, I am aware most people with health insurance pay through payroll deductions, and it can be a very very big number; yes, you are paying for your care but in a very inefficient way, paying monthly and probably not using care monthly.  Additionally, what you’re paying usually isn’t the entire cost your employer pays.


Comments

  1. Huzzah!

  2. Here’s some cost transparency. Please post this everywhere:

    Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-threatening insurance denials.

    HEALTH INSURANCE COMPANY PROFITS IN 2007:
    1. UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
    2. WellPoint — $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
    3. Aetna Inc. — $ 1.831 BILLION
    4. CIGNA Corp — $ 1.115 BILLION
    5. Humana Inc. — $ 834 million
    6. Coventry Health Care — $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
    7. Health Net — $ 194 million

    The huge insurance company profits—BILLIONS EACH YEAR—could provide quality healthcare for millions of people, and to pay physicians adequately for their work.

    We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.
    The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/

    FOR MORE INFORMATION: http://www.insurancecompanyrules.org/learn_more/the_roster/ and http://www.pnhp.org/

  3. WHO’S LOOKING AT THE COMPENSATION OF THE HEALTHCARE INSURANCE EXECUTIVES?

    The health insurance companies have played a major role in our current healthcare crisis. They make huge profits and their CEOs make millions, while the rest of us are denied care.

    ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECUTIVES (2006 and 2007 figures):

    • Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
    • H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
    • David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
    • Michael B. MCallister, CEO, Humana Inc, $20.06 million
    • Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
    • Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
    • Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
    • Jay M. Gellert, President/ CEO, Health Net, $16.65 million
    • William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
    • Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
    • James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
    • Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
    • Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
    • Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751
    • Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
    • Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
    • Michael F. Neidorff, CEO, Centene Corp, $8,750,751

    This executive compensation could be used to provide quality healthcare for millions of Americans! We need to get the insurance companies and their lobbyists OUT of healthcare. NON-PROFIT, SINGLE-PAYER IS THE ONLY OPTION.

    If you want to learn more, go to:
    http://www.insurancecompanyrules.org/learn_more/the_roster/

  4. Here’s my idea… ” Universal health care ” How about walk-in clinics, sliding scale fee based on income, staffed by Dr’s, NP’s, & health care professionals who ‘volunteer’ their time in exchange for a tax break or a credit on student loan payments.
    The problem would be no continuity of care, but I’m guessing 90% of visits to these clinic would be one time problems. Could use the VA system to do the paperwork and the military system to “Champus Out’ the long term, really sick people. Just an idea…

  5. This is a subject near and dear to my heart. Having spent most of yesterday in the ER with my grandma to learn that her time here is probably very short – this post is very timely.

    Even though I don’t necessarily agree with some of what you say, I find your perspective invaluable to me. I have a couple of thoughts today:

    1. We live in a small rural area. Would your plan impact the availability of expensive diagnostic equipment in these areas? Would people refuse ct scans and MRI’s for the cost factor, making the equipment unaffordable for smaller hospitals? I know right now we are all paying for it in a round about way via insurance premiums. (and thus making insurance itself unaffordable for some) The more ct scans the hospital does means a better ROI for purchasing the equipment, right?

    2. It was a battle to get my grandmother the care she needed yesterday because she was concerned about the cost. (and she has medicare – how much worse would it have been if she felt personally responsible for the cost?) We had to convince her to have the CT (which ultimately revealed something we did not expect and changed the entire course of the evening) She was more concerned with not creating any unnecessary expenses.

    I’m an outsider to the health care system, but someone who has been uninsured most of my adult life. I am interested in hearing your perspective.

  6. Free=More. I love that! I think I’ll use that sometime. LOL.

    Actually, I posted today about the lack of transparency in myTSH Lab Draws

    Simply Outrageous

  7. Interested Consumer says:

    There is a current option which gives the patient/consumer a stake in cost: HSAs. They are normally used in conjunction with a high deductible plan, and, until that high deductible is met, the consumer decides how their own money and the money in the HSA is spent. Ask anyone who’s got one: HSA’s definitely make you examine the cost of care (and generally bring those health insurance premiums down).

    And, it helps when the doctor knows the score here. After my son had CT scans at 2 different hospitals – with two very different prices – I asked the urologist to send us to the lower cost facility next time. She had no idea how different the prices were, and was glad to find out.

  8. I am a fan of the HSA. I hope to see them become much more popular.

  9. Isn’t medicine wonderful? I think this is the only business where the consumer (patient) can ask the company (hospital, health care provider) what the cost of a product is and my answer? Shrug. I don’t know. How much does a visit to my ER cost and how much will I charge you for my service? What a way to run a business…

  10. Care4All,

    Why don’t we just make everything free for everybody? With ice cream! And a pony!

  11. @Thales – so basically you don’t have anything of substance to add to the conversation, but just couldn’t resist posting?

  12. wait till you get a chronic illness and you won’t be such a fan of the HSA’s. HSA’s are great if your young and healthy. Lose your job and have a preexisting condition and see if you get icecream and a pony. Health care cost are out of control. Employers, consumers, insurance companies have tried everything to control costs and yet the costs spiral out of control.. maybe it’s time for the health care professionals to shoulder some of burden by getting thier salaries inline with every one elses. Real wages have dropped for american workers except for health care professionals. One out of four people in texas do not have health insurance. One of your family memebers, relative, or friend probably doesn’t have health insurance. The health care industry is a racket and the costs need to be controlled and since the Industry won’t voluntarily control it’s costs, to the detrement of consumers, I don’t have any problems with the government stepping in and trying to sort out the mess. This industry has been an uncontrollable burden to business and the US ecomony and needs to be fixed now!

  13. Wellll, I’m sorry that you could not figure out the substance behind my sarcasm. The substance is that I think that slogans like NON-PROFIT, SINGLE PAYER IS THE ONLY OPTION are about as realistic as free ice cream and ponies for everybody. The simple fact is that health care is expensive, nearly everybody will want it desperately at some point, and practically nobody will be able to afford as much as they want.

    Attempts to evade simple economic realities are what have gotten health care into the mess it’s in and further such attempts will make the mess bigger. Attempts to evade the market and pricing mechanisms in the apportionment of health care resources will inevitably lead to rationed care meted out by faceless, incompetent, insensitive, bureaucratic hacks.

    The politicians who will ensure that result are the same ones who benefit from the illusion they foist onto a credulous electorate that they will provide something for nothing, as politicians have always done.

    Sorry for the pessimism.

  14. @Thales – I apologize. I stand corrected. I totally skimmed that post and did not see the ONLY OPTION part. Carry on, and if I may, I’d like to join your pessimism. I thought you were making fun of the situation in general, which is something I am pretty passionate about.

    Anytime someone says something is the only way… I start twitching.

    @Trebor – I do have a chronic illness that has landed me in the hospital several times. I’d dang sure rather do it with a catastrophic insurance policy in place than uninsured like I have done. Or worse.. have the ER doc call me at home the next morning to make sure I was OK because he couldn’t sleep from worrying about me, but he couldn’t admit me because of my insurance status.

    HSAs reward me for finding new and better ways to manage my illness.

  15. TheNewGuy says:

    Trebor,

    You can drop the class warfare crap. Physician salaries have basically been flat since the 1990’s… sometimes not even keeping up with inflation. This is despite seeing increasing numbers of patients, seeing them faster, and joining together into groups to take advantage of various economies of scale.

    Physician salaries also only make up about 10-15 cents of the health care dollar.

    If you’re looking for blood, you’re going to have to find another turnip to squeeze.

  16. Hey newguy, good try.. I didn’t bring up class warfare.. you certainly did. Now your going to tell me that physician salries have basically been flat since the 1990’s? You have got to be kidding?? Do a google search on “physician salaries” and then come back here and eat some crow.. or turnips, whatever.

  17. wait a minute.. wait a minute….. “newguy”.. explain the class warfare quip? It rolled off your fingers pretty easy and was paramount in your post so you must have some deep thoughts on this so .. enlighten me? Why did you bring that up in this discussion? Perhaps here we have discovered a fundamental problem with the mindset of some health care professionals.. class warfare crap. wow!

  18. TheNewGuy says:

    maybe it’s time for the health care professionals to shoulder some of burden by getting thier salaries inline with every one elses. Real wages have dropped for american workers except for health care professionals.

    Don’t let my injection of straight-from-the-medical-trenches reality get in the way of your “OMG!! Doctors R teh r1ch!!11 LOL!” rhetoric.

    Doctors have been working harder and harder for less and less reimbursement for years, and lots of inefficiencies have already been shaken out of most medical practices. If you’ll cease your defensive posture and objectively look at the numbers, you might see that there is no way to balance the health care budget on the backs of physicians by decreasing their salaries… the potential savings just aren’t there. Also, doctors aren’t going to wade through the BS, endure the educational grind, the debt, and the stress, just so they can work for peanuts on the orders of some bureaucrat. If you expect there to BE qualified providers to care for our aging population, you might want to rethink your strategy.

    Then again, it makes a nice, easy, envy-based talking point to rail against the caricature of the rich, fat-cat doctors, sitting on the golf course, sucking the system dry with their lavish salaries.

  19. Trebor;

    It appears that you are ignoring one of those basic economic realities that I alluded to. It’s called the law of supply and demand: If the price of a commodity or service is artificially reduced, the demand will go up and the supply will go down. In other words, if you forcibly reduce the salaries of doctors (or anyone else) the number of doctors in practice will go down and everybody will stand in line A LOT LONGER or be denied care entirely.

    This is readily seen in Emergency Rooms across the United States over the last twenty years since the passage of EMTALA (if you don’t know what that is, wiki it). Emergency physicians are an endangered species; they will become extinct soon if prompt and intelligent corrective action is not taken. They are retiring or changing careers in droves and new ER docs are not training at anywhere near replacement rates. The same thing is happening to Emergency Rooms.

    This is the sort of thing that frequently happens when people “don’t have any problems with the government stepping in and trying to sort out the mess.”

  20. This is getting comical.. Richnewguy, you went from turnips to peanuts in a “heart beat”.

    I guess we could could do this, back and forth, for a very long time. Nonetheless, their are some valid points in all our postings in my humble opinion and we are crossing the rubicon in this matter soon.

    best of health to all

  21. OK I’ll bite – EMTALA is a bad thing? I think I’m missing something. Should we be turning those people (I’ve been one) away? What am I not considering?

    *trying to learn to ask for clarification before jumping in with both feet*

  22. EMTALA was a good thing for patients: if you have an emergency you cannot be turned away without a medical screening exam, and any/all stabilization needed despite your ability to pay.

    It was a much-less good thing for hospitals, as it effectively made any hospital a County hospital.

    It was a tough thing for Emergency Physicians in particular, and for any doctor called to help in an Emergency, as there is a requirement to treat but no pay for doing so. It’s the biggest unfunded mandate ever foisted on medicine, and probably anywhere.

  23. Are ER physicians paid per patient, or they are paid less because of overall reduced profitability of the ER dept, or hospital in general? (really asking.. not being snotty)

    I can see the unfunded part being a problem. Something I hadn’t thought about is how much time and resources are spent on screening and treating people who aren’t emergent.

    But what do we do about the ones that are? Do we let them die? I wasn’t just lazy. My husband and I were both working jobs that did not offer benefits (him in construction, me as a waitress while in school) Throw in a pretty severe case of asthma and pneumonia – it’s not pretty.

  24. Post-EMTALA, patients do not even have to provide identification or proof of citizenship at the ER, and they cannot be turned away. The same goes for emergency transport (ambulance) service. Consequently, people take the ambulance to the ER, pretending to have an emergency, when they do not want to pay out of their own pocket for non-emergent health care. The ER cannot refuse to see them and, for liability/defensive medicine reasons, must conduct a genuine and usually expensive effort to rule out a real emergency. If the ER patient provides a false name and no ID it cannot be ascertained if they actually CAN pay.

    It is not the least bit rare, for example, for young women who suspect that they are pregnant, but who do not want to pay for transport to Wal-Mart to buy a pregnancy test kit, to feign severe abdominal pain and call the ambulance to go to the ER. If they are good at feigning an emergency, they end up costing the ER/hospital/EMS as much as five thousand dollars for a plethora of tests, including a pregnancy test which ought to cost about ten dollars. They are often very disappointed when the ambulance won’t take them home again, stopping at Target and McDonalds on the way. The hospital is required to provide emergency service, but is not compensated for it. That is an unfunded mandate.

    The same general sort of phenomenon unfolds in many and diverse ways. Drunks, drug abusers, drug seekers, street people, hypochondriacs, lunatics, deadbeats, etc., etc. If you look around this and other ER blogs, you will see many, many anecdotes. Emergency rooms have become major cost centers; they hemorrhage huge amounts of money. They make hospitals overcharge for other services to compensate. They have become a major liability for hospitals, threatening their solvency. So that is how EMTALA is causing ER’s to shut down. It is self-defeating, has betrayed its goals, and it has caused a great deal of collateral damage. This is what happens when politicians promise us pie in the sky and give us smoke and mirrors.

    Of course if our society pretends to be civilized and humane it needs to provide for medical emergencies. We do not really want to see people being badgered for their credit card numbers and banking references as they bleed to death. But that provision needs to be fair and equitable to everyone, including hospitals and doctors, and needs to demand fairness and equity from everyone, including patients; even indigent patients. It needs to be practical, and it needs to pay due respect to the aforementioned economic realities. If it does not, it will find a way to fail.

    And people wonder why health care is so expensive.

  25. “This is what happens when politicians promise us pie in the sky and give us smoke and mirrors.”
    Really? This is the politians fault? Not the lazy degenerate abusing the system?

    “But that provision needs to be fair and equitable to everyone, including hospitals and doctors, and needs to demand fairness and equity from everyone, including patients; even indigent patients. It needs to be practical, and it needs to pay due respect to the aforementioned economic realities.”
    Do you have a possible solution? Because that sounds a lttle pie in the sky to me. Now you’re seeing my pessimism coming out. Of course I would love to see your idea come to fruition, because it’s the only fair thing. But realistically, unless we can force people to take personal responsibility for themselves, it’s not going to happen.

    In one respect, I feel unqualified to criticize. I am not in health care yet. I am not being slapped in the face with it repeatedly all day long. I’m not being forced to treat people who are only sucking resources away from others who need it.

    I come from the standpoint of being pissed off because those people are killing the system I need. They are making it almost impossible for the working poor (who ARE hard working, responsible people) to get the care they need.

    But how do we balance that?

  26. It is the politicians’ fault because they are the ones who drafted and passed legislation that is obviously unfair and defective, and that would obviously encourage people to be lazy degenerates and to abuse the system. Suppose Congress enacted a law that required restaurants to feed people and landlords to house people without compensation. Would not the ensuing chaos be easily and obviously predictable?

    People cannot be forced to take responsibility for themselves, but they can be encouraged to do so with incentives. Why do you think insurance plans have copayments and deductibles? Wiki “moral hazard” just for fun.

  27. There are a host of non-core trained docs moving into cosmetic medicine and opening ‘medical spas’ to take some of the heat off. The system’s going to break at some point.

  28. Thales – what do you suggest to fix it?

  29. I suggest that the American people pull their heads out of their butts and quit watching Laverne and Shirley reruns long enough to pay attention to the issues, and to the history and actions of their representatives. I suggest that the American people study history a little bit and educate themselves on what constitutes practical, sustainable and just government. I suggest that the American people notice when their representatives promise pie in the sky and deliver only smoke and mirrors, AND CALL THEM ON IT, DAMMIT!

    Again, I apologize for the implicit pessimism. Watch the economy over the next year or two. It’s going to be really ugly.

  30. Thales – that’s not an answer. It’s a buck passing cop out.

    Calling them on it is going to change everything? I don’t think so.

    All we have to do is pay attention to our representatives, call them on their BS and *poof* the healthcare problem is fixed?

    I see your pessimism and raise you my cynicism.

  31. TheNewGuy says:

    Allow me to open the dark, fetid, seething well of my own cynicism.

    This isn’t just the fault of representatives, or frequent fliers, or physicians, or hospitals. Everyone wants something for nothing, and as long as somebody else is paying the bill, AND you cannot turn anyone away (or can’t turn them away without risking a rapacious assault by a phalanx of attorneys), people will continue their pathological behavior. Period. Full stop.

    There are no disincentives built into the EMS system in any way, shape, or form… particularly for the ER abusers. They keep coming, no matter how many times you try to discourage them… and you can’t tell them “No!” without having somebody like John Edwards crawl up your ass with a microscope.

    As for physicians controlling cost, THE most expensive piece of medical equipment in existence is my pen. There are plenty of lawsuit-related, cost-inflating incentives for physicians to work up patients, and absolutely zero incentive to die on the cross of “cost-saving, minimalist care.” You want to force me to “control costs”… but you simultaneously want me to shoulder all the legal risk that entails? Ummm… no.

    Hospitals want to stay in business (and even make a profit), and so they’re going to cut/pare things that are taking away from their bottom line. Even non-profit hospitals have to keep the lights on and the staff paid. If that means closing their ER, they’ll do it, further eroding the system, and shifting the burden onto the remaining dominoes that haven’t yet fallen.

    As for our representatives… why should they jump into this? It’ll cost an astronomical sum of money that the taxpayers can ill-afford in our current economy, and that’s also money that congress can’t use for pork, or to build their own constituencies. They can pass the financial buck to the hospitals via EMTALA, and posture/preen that they “care” and are “doing something.” They’ll undoubtedly weep/wail and rend their garments when the whole thing craters, all while blaming everyone else (primarily greedy CEOs, doctors, and hospitals).

    Much of this is cultural, some political, some legal, some financial…

    From this physician’s perspective, medicine is a wonderful humanitarian endeavor… you get to help people… you get to save lives… you get to comfort the grieving and dying… there are fantastic human opportunities in this profession… but it’s a damned lousy business, and getting worse every day. I’m steadily losing the illusion that I’ll be able to put in a full career in Emergency Medicine. I think it’ll become untenable long before that happens.

    You want to know what I really think? There it is.

  32. I do love me some good cynicism, and you gave me some gems.

    My fave? “You want to force me to “control costs”… but you simultaneously want me to shoulder all the legal risk that entails? Ummm… no.”

    That’s good. I’m thinking you may have completely nailed it there.

    Isn’t that really the problem with EMTALA? As an ER doc, if you could give someone a quick check to rule out emergent need of care, and treat appropriately, wouldn’t that do a world of good? But I understand why you can’t. You have to give a whole workup because heaven forbid you miss something, and the lady coming there instead of walmart for a preg test sues you.

    OR would that cause the frequent fliers to just get more creative with their “complaints”?

    I enjoy having new things to ponder instead of doing my homework :)

  33. I alluded to insurance deductibles and copayments and referred to “moral hazard” as a topic of concern to anyone who is interested in designing a way out of our current national health care mess.

    In those countries with universal health care or national health plans, the designers and planners discovered very early on that without disincentives, abuse of the system was rampant. The majority of the European plans include deductibles, copayments, “access fees”, and service limits, which are variously apportioned among the different health care services offered.

    With regard to the ER crisis in the USA, there are several things that need to be implemented soon if a collapse is to be avoided:

    ERs need to be able to assess some sort of access fee or deductible as a disincentive to abuse.

    There needs to be some method for compensating ERs for treating patients, especially indigent patients, especially those who fall through the cracks; who do not receive Medicare or Medicaid benefits. Requiring ERs to treat patients for free without somehow compensating them is not merely unfair, it is so impractical that it is causing the system to crash.

    ERs need to be able to insist on reliable identification of patients, for a variety of reasons.

    Tort reform is essential. The costs of professional liability insurance, malpractice payments, litigation, attorneys’ fees, etc., are large, but they pale in comparison to the costs of defensive medicine. Defensive medicine is probably the single biggest avoidable expense in the American health care system today.

    If the public wants universal access to emergency medical care, it should expect to pay for it.

    Why should our legislators get into this? Well first, they have created a significant part of the problem. Second, they are the only ones who are in a position to do anything about it. No one else can; not the doctors, not the hospitals, not the insurance companies, not the trial lawyers, etc. The fact that the legislators may be disinclined; that they might actually have to do their jobs instead of throwing trillions around randomly really should not be much of an obstacle. They can be fired.

    BTW, Whimsy, don’t you have any positive suggestions?

  34. I don’t know if I have any positive ideas worth hearing.

    Tort reforms need to happen. I know that. We’ve got to take so much of the burden off of the doctors.

    What I have wished for in my own life is some kind of “group” I could join for health insurance. Buying an individual policy is crazy expensive. But what do you do if you can’t get into an employer based group? Heaven help you if you have a pre-existing condition. Or have a child with one. The times I worked the budget to be able to afford insurance, I was quickly told we didn’t qualify because I have a daughter with a heart defect and one with epilepsy.

    I will admit that there were times we went to the ER for treatment instead of the doctor, because the hospital let us set up payments. Given the choices I had at the time, it was still the right one.

    Personally, I think HSA’s are going to be part of the answer. But they still don’t help when you don’t have the cash to take your baby to the doctor.

  35. “Thales – that’s not an answer. It’s a buck passing cop out.”

    Actually it isn’t, Whimsy, and I wish you would take the time to think things through before making such characterizations.

    I have not seen any evidence at all that anyone has actually gone to and read the link cited by Care4All in post #2; the one about H.R. 676. This is the post that motivated my first comment in this thread.

    This resolution promises pie in the sky, and it is not capable of delivering more than smoke, mirrors, and utter chaos. Why? If you do not see why, read it again.

    Pay attention to the part where it says that no deductibles or copayments are permissible (encourages abuse). Pay attention to the part where it promises coverage for all aspects of health care services from chiropractic to cholecystectomy, from dentistry to defibrillation (insures the uninsurable, drives up costs) . Pay attention to the part where no private health insurance is permitted (government monopoly eliminates freedom of choice for both providers and “beneficiaries”). Pay attention to the part where it says this will cost $1100 per year per family of three (switches resource allocation method to rationing).

    In my family of four, we pay out of pocket about $1200 per year for glasses and contact lenses alone, at Costco. I guess everything else will be paid for by a hypnotic gesture from our Beloved Leader.

    This proposal clearly suffers from the worst faults of all the socialized medicine systems in the world. If you like waiting in line at the DMV, or waiting on hold to talk to the IRS, and the cheerful, speedy, sensitive treatment you get, then you will just love waiting in line for your appendectomy.

    This proposal would spread all of the shortcomings of EMTALA, and more, across the entire health care system of the US. It would turn an excellent health care system into a train wreck. It is a simple fact that if the electorate does not watch our politicians like a hawk and call them on their mistakes, idiotic proposals like this will become law and chaos will ensue.

    I guess it’s pretty tough being a citizen of a free republic. If the political system betrays us, it’s our fault.

  36. I’m not a fan of socialized health care, yet when I talk to my friends in Canada and Britain, they are dismayed by our healthcare system. They feel like they have the better system. Do they have some horror stories? yep, but so do we. Just a different broken. I don’t think it will work here though. We are Americans and our mindset it just different.

    Aren’t we already paying for the uninsured? Aren’t we letting decisions be dictated by insurance companies and ambulance chasing lawyers?

    I still think your first answer was more pointing fingers than a solution and I actually did think it through before I posted my response. I thoroughly enjoyed reading this last post. Actual substance for me to think about.

    EMTALA does help people – but it’s hurting a lot as well. As the scale is tipping more toward hurting, we have to re-evaluate. That doesn’t mean it wasn’t a step in the right direction. It just means it’s not a forever answer. We aren’t going to find the perfect solution. We will try things that work, some that don’t, and try to figure it out from there.

    We have to move past the “it’s all their fault” mentality. This is our mess. We are the greatest country in the world. If anyone can fix it. It’s us. But we are going to have to start listening to each other.

  37. “I still think your first answer was more pointing fingers than a solution”

    So which answer was that? And why?

    I do not care whether or not you are a “fan” of socialized health care. I am, however, interested in your considered opinion about how a socialized health care system (like Medicaid or Medicare) can attain desirable and realistic goals at a realistic and desirable expense.

    The trouble with a free democratic republic with economic freedom and choice is that the people must be responsible. Communist, socialist, monarchist, and fascist systems do not expect or demand that their people be politically or economically responsible. They do not expect them to be reasonable and responsible. We do. They expect the people to be venal, lazy, greedy, deceitful, manipulative, covert and hostile. That is their undoing. We don’t, or should not. That is our strength. To the extent that our people fail in that regard, our republic and our happiness will fail

    You may have noticed that it is not very easy to be economically and politically responsible. It takes constant vigilance and effort, even risk. There is always an available opinion to the effect; “Just let somebody else do it. Let the government do it. It’s close enough for government work. Nobody will ever notice. I’ll take care of it and it will cost you nothing. We’ll give you free stuff! (universal health care). Just vote for my ticket and I’ll take care of it for you. That’s George’s department. We’ll fix the deficit soon. You don’t have to worry about that. If you vote for me I’ll get a job for your worthless brother in law. Vote for me and there will be a chicken in every pot. Vote for me and I promise you universal health care!”

    This is sort of thing that responsible citizens must always be on guard against, and which they must always be on guard against if our republic is to survive and prosper.

    Do you get it yet?

  38. Do I get what? That you like to use a condescending tone? Yeah, I got that.

    You seem to think that because I don’t agree with you, that I don’t understand your premise. I do. We do not have to agree, for a conversation to be beneficial.

  39. So… you have offered no rational arguments or suggestions and you resort to name calling.

    I guess you must be disappointed about not getting that free pony.

  40. Nothing will happen until doctors decide that the current third party compensation model, which pays them very well, is not worth the trouble. If they don’t, we continue the march to government health care.

  41. I am new to blogs. I hope to start a dialogue about the origins of our problems. I don’t see solutions yet until we come to an agreement on what is wrong and on how we got to this mess. I like the directions of the comments and hope others will join in my search for causes. Clifton Meador, MD

    PS i have watched medicine for over 50 years and there is a history that got us here. That needs to be examined.

  42. Mike G M.D. says:

    Stop complaining about the insurance companies. Physicians have been the stewards of health care spending and are ultimately to blame. It started when we decidied that patients had the right to make choices about their healthcare and we stopped being paternalistic. we turned healthcare into a commodity and made it consumer based. We have spent billions defending ourselves from lawsuits while placing our patients in financial ruin with little added improvement in their care. our bumpersticker should read “no tort reform, no healthcare reform” As for perspective, we spend 21 billion annually on hemodialysis patients and 210 billion annually on “defensive medicine”. The insurance companies are by no means innocent but lets take some responsibility here.

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