Family doctors: An endangered breed

[rb336]

Rb...the dynamic I described refers to how things would work in a market driven system. You can see some examples in elective fields today...examples? Take a gander at the cost for corrective eye surgery today compared to 15 years ago...guess what the direction of cost has been...try "not up"

ahhh, a single anecdote. the cause for the decrease in price? increased availability and an increased market - the old economies of scale thing. has nothing to do with standard medical care. Interesting that you should have to stray so far from the topic to find one very poor example

[elganned]

A free and just market and selfishness results in the highest quality of service at the lowest cost...always.

Do you ever have anything to offer beyond tired re-statements of right-wing economic dogma offered as if it were established fact?

[oladub]

I would prefer that people be thoroughly pre-screened prior to being allowed to go to med school narrowing it only to those that actually believe in helping others.

those that are found later to be in it specifically for the money and show their practice as a turnstile meat market should have their licenses revoked,prosecuted and tossed into jail for it.

I disagree. My suggestion was to double the number of med school opportunities to create something approaching a surplus of medical personel, competition for jobs, and thus a supply/demand equation resulting in lower compensation. I really don't care what a person's alleged motivation, religion, philosophy, etc, is as long as they are competent. My suggestion would make it less possible to make huge earnings in medicine so the really greedy would be less attracted to the field.

I have another suggestion to reduce physician cost. In some counties, doctors do not have a bachelors degree component in their education. They take nothing but medical related courses. This allows them to get through school a couple of years earlier to begin practice. We should also allow this option as well as design programs that would allow nurses and medics a streamlined path to become doctors. These options would make becoming a doctor less expensive.

I would even consider state licensing exams to funtion more like bar exams. If a person passes, they can be employed as a doctor. This would allow doctors from counties such as Cuba and Russia to be licensed here without monkeying around with two years of liberal arts. I keep hearing about underserved medical communities. We need more doctors. I don't care if they are aspiring saints or saving up for a yacht. If there were more doctors, you could better shop around for the most empathetic doctor. I could shop around for the most competent doctor. We might wind up at the same doctor's office but maybe not.

[mjs]

Granted, there are no doubt some there for the money. Would you rather they went to law school or were bankers getting bonuses from Bush and Obama? One of the obvious things that Med schools could do to lower what doctors charge is to train twice as many doctors. Its not like there is a shortage of med school applicants. Double the number of doctors and they wouldn't be able to sell their services for as much as much because of increased competition. It wouldn't necessarily even cost the taxpayers anything.

I can't verify if the AMA works like the ABA, but I suspect it does and one of the most aggravating things of bar associations has been that they feel one of their roles is to limit competition. For example, all state bar associations except California require bar applicants to have attended a school approved by the ABA and the ABA limits the number of applicants a school is allowed to accept. One of the things that limiting competition and training facilities creates is high tuition because the expected ROI is high. As a result, a great deal of attorneys feel they are unable to take lower paying public service and nonprofit jobs. Another result is that it creates a system where attorneys either work a ton of hours for large firms or go off on their own. Often, the people on their own started off working a ton of hours for others so they could pay off their debts. Sounds like our medical profession to me. Debt ridden individuals forced to work long hours in an undermanned field.

I've never heard of engineering organizations telling schools that they can't have an engineering department or business organizations telling schools that can't offer MBAs. If a school can train people to pass the medical exams and make it through their residencies, let them train whoever can qualify.

[mjs]

Oladub, we must have been typing the same basic idea at the same basic time. You identified another way the ABA and AMA rules seem similar. Unnecessary academic requirements that seem to be put in place just to limit competition and justify higher salaries. I went to law school. It requires a bachelor's degree but it doesn't matter what the degree is in and has no prerequisites. So, why does it require a bachelor's degree then? Drop the bachelor's requirement and add a year of generalized classes to the attorney curriculum and you have yourself a four year bachelor of arts. Charge bachelor of arts tuition and bam, everyone can have affordable legal access. And, just like medicine, cheaper access is earlier access and earlier access will save alot of bigger problems down the road.

[elganned]

Another suggestion which hasn't hit the forum yet is to level the playing field in yet a different way.

I just listened yesterday to a news story which revealed that the Mayo Clinic, which all acknowledge as providing some of the best care in the country, does so at a cost 28% below the national average.

One of the reasons? All the physicians are on salary. This removes the economic incentive to order unnecessary and/or irrelevant testing and procedures, allowing the physician to concentrate on producing good outcomes.

Just a thought.

[ccbatson]

Need more examples? Cosmetic surgery, bariatric procedures...essentially elective services paid for directly by the consumer...reversing the trend of increasing costs and decreasing quality as is seen with entitlements.

[Detroitej72]

Another suggestion which hasn't hit the forum yet is to level the playing field in yet a different way.

I just listened yesterday to a news story which revealed that the Mayo Clinic, which all acknowledge as providing some of the best care in the country, does so at a cost 28% below the national average.

One of the reasons? All the physicians are on salary. This removes the economic incentive to order unnecessary and/or irrelevant testing and procedures, allowing the physician to concentrate on producing good outcomes.

Just a thought.

I see we were both listening to NPR. I hope that story opened up a few eyes on the nay-sayers.

[East Detroit]

ED, Those codes have something to do with classifying diseases according to Wikipedia. How do they relate to Bats' contention that "A free market would help the primary care folks most of all."?

They are used in part by insurance companies and the government to mandate a specific payment [[no more) for a specific diagnosis. Particularly the DRGs. So, doctors and hospitals spend a lot of time trying to find as many of the codes as possible to pin on a patient so they can try to make money. Patient broke an arm, thats a code that pays $x... but he also looks thirsty so let's stick on the code to say he is dehydrated and add $y to what we get... etc.

CCBatson's "free market" would eliminate such groups, probably eliminate poor people getting care, and allow medical care to work purely as a capitalist mechanism. Doctors charging the highest rates that people will pay... and those on the bottom not being able to afford it. Win/win for those who consider themselves Darwin's best.

Meanwhile, medical practitioners that care more about patients than cash perhaps would help all those who couldnt afford the "market prices." Or perhaps they wouldnt.

[ccbatson]

Almost there East Detroit....just step back a few more steps. If Medicine is a field of business that holds promise for people to make money, then young people will endeavour to become providers and compete for the business. In a free and just market, this creates incentive not only to provide the highest quality care, but the lowest prices. Even if some slant in the direction of quality and ignore price, if a market exists [[and it does) someone else will fill the need for, and slant in the direction of lower cost/value.

Free markets are self regulating.

[rb336]

Need more examples? Cosmetic surgery, bariatric procedures...essentially elective services paid for directly by the consumer...reversing the trend of increasing costs and decreasing quality as is seen with entitlements.

exactly, all cheaper because, being unnecessary, the consumer has no gun to his/her head and can turn around and walk out if the price is too high. Then again, there has been a marked increase in serious errors in elective procedures you have outlined, another symptom of increasing volume to make up for lower costs

[Maxine1958]

I'm not professing to an expert in any of the matters or opinions on this thread, but as an ordinary citizen in the mix, here's my opinion based on what I've read here.

What if those individuals willing to become GP or family doctors, could skip the BS degree and simply take the required medical training. This would apply for nurses or other 'trained' medical professionals as well. Now, if a person wanted to specialize, then they would have to 'flesh' out their degrees. The reason being we have now, or will soon, a shortage of 'primary care physicians.' A physician's assistant or even some RN's could fulfill this position in theory, but not to satisfy most insurance requirements. We seem to have, in my opinion, a wealth of specialists. If we make it more time consuming to get that specialist notation, perhaps we could level out the playing field.

Just my thoughts. Carry on . . .

[ccbatson]

Shortages are actually more acute in the specialties than for GPs right now.

[firstandten]

As you know, the President is trying to make health care, he says, $1T more expensive. Others are saying $2-3T. Since someone will have to bare those costs, it is another example of government causing health care to become less affordable. If it doesn't show up on someone's doctor bill, it will show up as some new tax.

It doesn't have to be this way. If Michigan simply adopted Ontario's system health care costs would decline. However our topic is about what our government has done and now plans to do.

But Oladub, we are already paying 2.5T on private health care insurance and the cost is going up! You are focusing on Obama's cost but what about the cost of doing nothing. Obama's cost assuming its $1T won't be on top of what its costing us already. If gov't is making health care unaffordable then private insurance companies are going to make health care unthinkable and we can just start dying in the streets.

I agree with you about Ontario's and Canada's health care system. Obama is trying to come up with a public option that keeps all the major players in the game or a unique American plan. These players lobby our politicans donate money etc. The politicans know reform is needed but they want to keep the money coming. Obama knows he can't get universal single payer health care passed, a political impossiblity so he does the next best thing. disgusting ! Next item on the agenda after health care refom, should be campaign finance reform then maybe the system will start working for "we the people"

[oladub]

But Oladub, we are already paying 2.5T on private health care insurance and the cost is going up! You are focusing on Obama's cost but what about the cost of doing nothing. Obama's cost assuming its $1T won't be on top of what its costing us already. If gov't is making health care unaffordable then private insurance companies are going to make health care unthinkable and we can just start dying in the streets.

I agree with you about Ontario's and Canada's health care system. Obama is trying to come up with a public option that keeps all the major players in the game or a unique American plan. These players lobby our politicans donate money etc. The politicans know reform is needed but they want to keep the money coming. Obama knows he can't get universal single payer health care passed, a political impossiblity so he does the next best thing. disgusting ! Next item on the agenda after health care refom, should be campaign finance reform then maybe the system will start working for "we the people"

The cost increases are largely due to government regulations and restrictions on competition. The major players, of course, do not mind the elimination of their competition. Obama shouldn't be trying to come up with a system that keeps major players in the game. Canada has no health care system but its provinces do. Obama should, instead, be encouraging states to develop their own affordable health care systems. I make no assumption that Obama's numbers are correct. I am assuming a $2T, and probably more, increase in costs. This I base on Medicare and federal drug program projections which fell far short of reality. I think on purpose to make the programs more palatable. I don't believe in Santa either.

As palatable, and off-topic, as campaign reform sounds, it has been a failure so far and will probably remain so as well as an attack of freedom of speech. The McCain-Feingold law has turned into an incumbancy protection act and keeps non status quo voices out of the arena.. Too bad. In theory, it sounded great. I prefer to research candidates on opensecrets.com.. If I notice that , say, Goldman Sachs is on their top twenty list of contributors, I assume they are crooks and don't vote for them. I concede, though, that this information would probably not be available without a measure of campaign finance legislation.

[ccbatson]

We are largely voluntarily paying for health care at the moment....Obama is proposing permanent mandatory payment, absent choice, and under threat of force.

The current system is broken because of anti market force regulations and the coexistence of Medicare and Medicaid driving costs up and quality down.

If this is the problem, then the solution is to phase down the costly unnecessary regulations and phase out the entitlements in favor of a privatized system.

[jams]

We are largely voluntarily paying for health care at the moment....Obama is proposing permanent mandatory payment, absent choice, and under threat of force.

The current system is broken because of anti market force regulations and the coexistence of Medicare and Medicaid driving costs up and quality down.

If this is the problem, then the solution is to phase down the costly unnecessary regulations and phase out the entitlements in favor of a privatized system.

Who is "we"?

What quality of health care does one receive, when the choice is to see a doctor or buy food for the kids?

But, we understand, Cc, not everyone learned to milk the system of public education, Federal and State grants, and receipts of Government money to fund one's business.

[ccbatson]

We are the citizens of the United States.

Is it someone else's responsibility to provide the food you speak of? Why not?

[jams]

Trying to dodge the question?

If it is a question of feeding the kids or seeing a doctor, in most cases food wins.

Not everyone has had the advantage of two generations of government paychecks.

[Detroitej72]

The current system is broken because of anti market force regulations and the coexistence of Medicare and Medicaid driving costs up and quality down.

I suggest you do your part to fix this system by refusing payment for any patient who uses Medicaid and Medicare. Then you will have taken a stand, much like the radical tea-baggers whom the right deify on a regular basis.

Once you've done this for 6 months, let us know how its working out for you!

[ccbatson]

That would not work as you realize..What has a chance is to speak out loudly and persistently in large numbers to effect political change in the direction I am suggesting.

[jams]

That would not work as you realize..What has a chance is to speak out loudly and persistently in large numbers to effect political change in the direction I am suggesting.

I'm sure a "Call to Arms" by you, here would bring out many that will do just that.

[ccbatson]

It is definitely happening with a dramatic impact. I like to think that I have contributed to the process.

[rb336]

It is definitely happening with a dramatic impact. I like to think that I have contributed to the process.

god, you really are delusional, on both counts

[East Detroit]

It is definitely happening with a dramatic impact. I like to think that I have contributed to the process.

By posting [[in a confrontational manner) on a Detroit web forum?

I don't know if I've seen anyone yet tell you that you helped change their mind or bring them to your own form of enlightenment.