If that's the conclusion that you have made from everything that I've written, then you have a serious reading comprehension problem. It would be like watching "King Kong" and coming that to conclusion that you've seen a wonderful documentary about a spotted owl.
First of all, the Democratic Congress did address the issue and the result is this ill conceived law that does nothing it promised to do other than make people buy health insurance, paying for benefits they will never need, pay premiums, high deductibles and out of pocket costs for insurance that will likely only pay 10% of their annual medical costs due to the high deductible and out of pocket. And, the private insurance companies participating on the exchanges are offering policies with fewer in network doctors and facilities and less covered medical procedures/surgeries. The transparency is questionable, virtually no better than before as many of our patients are told the treatment they need will be covered only to be told it is not after they receive it. And as a physician, our office staff is also told it will be covered and then the company refuses to pay our fee. They get away with it. It is worse now than before PPACA. If you don't believe me, your choice. But this is the truth and I have no reason to lie.
I didn't make that conclusion from what you've written. I knew the American healthcare system was broken years ago. I was just making a point.
So what was your point? What lead to the health care system being broken. Who now are the winners and losers. You have an idea?
Well for one thing, the losers are the American people and the winners health insurance companies and pharmaceutical companies. Sad hey?
The point that you are trying to make is based on absolutely nothing factual. Even the citation that you provided disagrees with your point. If the American healthcare system is broken, then paper that you cited demonstrates that it is no more broken that any country in Europe, Australia, or New Zealand.
Are you saying that doctors can prescribe appendix removal twice? Or they can perform bypass surgery every week? Or may be doctors can force patient take pills twice as much as required. Defensive medicine is baseless excuse to protect interest of Medical Cartel. If it absolute nonsense from scientific point of view. No human can consume more of the medical services than it is necessary. The bottom line is, that overall U.S. far behind other developed countries. Picking data selectively and twisting it for better statistics does not really explain why so much money is spent by the government and private corporations on mediocre health care. The answer is actually very simple, all medicine in U.S. is a government sponsored private monopoly. As any monopoly it cannot deliver anything better than second rate service.
I think system is not broken, it is built nicely and work very well transferring at least 40% of the government budget into the private pockets. Is not it a good thing that millions of ordinary people can make rich even richer?
If I already know what I can charge for a service, and I lower my overhead, what is my incentive to reduce my charges? Do I ever have an incentive to reduce my charges? I'm thinking tort reform will have a negligible impact on costs to patients.
Agreed. Illusory savings. It doesn't follow that saving some on overhead will result in me passing those savings through to my clients/patients. But it could be the first time in the history of capitalism.
Agreed. If savings actually went to patients it would be a first. Costs however are always passed on unless the govern,ent is involved.
I'm not going to dignify this nonsequitur with a response (in fact, I'm not sure that I could even if I wanted to). What?! What in G-d's name are you talking about here? Well given the fact that politicians, insurance companies, and trial lawyers have FAR more control over the healthcare system than physicians and nurses, this mythical "Medical Cartel" that you speak of sounds pretty impotent. True cartels have real power. And far from being a "baseless excuse," defensive medicine is a proven reality that costs around $650,000,000,000 every year. You are free to debunk the evidence if you'd like. http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf http://medicaleconomics.modernmedic...ensive-medicine-has-caused-healthca?page=full http://www.forbes.com/sites/realspin/2013/08/27/defensive-medicine-a-cure-worse-than-the-disease/ So if a healthy 24-year old male goes into the emergency room for a stuffy nose, you would consider this "necessary" (even though he is obviously wasting resources)? Again, this comment is belied by the facts. I'm using that data that YOU supplied (http://www.commonwealthfund.org/~/m...rt/2014/jun/1755_davis_mirror_mirror_2014.pdf), and now you are calling it "picking data selectively." Wow, you and your anti-logic are on a whole different level. The elephant in the room is defensive medicine, which easily accounts for the difference in healthcare spending between the USA and every other country in the world. Since you would like to side with the Trial Lawyer Cartel, you seem to ignore this obvious answer. Then why is more government the answer? Logically, giving more government control over the healthcare system would only cause this so-called "government sponsored private monopoly" to grow further. Again, as the data that YOU provided demonstrated, US healthcare is on par or superior than that of any other country in the world. Thus, to say that it is "second rate" is to ignore the data that you referenced.
By all estimates defensive medicine is about 2 - 8% of the cost. Where are the other 92 % of extra cost goes? e.g. http://blog.academyhealth.org/the-cost-of-defensive-medicine/ Government, at least in theory can break a monopoly. I.e. government can provide public option (public health care) that would compete with private Health Care system. Competition is a basis of free market capitalism, and that is good thing. Right now, Medical Cartel is only one government body that decide how many doctors are allowed to be on the market. If that power is shared with the state government, state would allow more doctors to server public. And that, in turn will eliminate defensive medicine. Why anyone go to the hospital with running nose when doctors are readily available.
Actually, defensive medicine costs are estimated to be 26% of healthcare costs http://www.jacksonhealthcare.com/med...book_final.pdf This is weak data. The study involves a survey of only 36 physicians in 3 hospitals in 1 geographic location. But even if we take this study at face value, it still states that defensive medicine accounts for $46 billion in healthcare costs. Wouldn't you want that money spent on useful and meaningful things related to healthcare, rather than being wasted? If so, then you should also agree that we need substantial tort reform to stop trial lawyers from causing this wasteful spending. Government itself is a mega-monopoly and has far more power than any private enterprise. I agree. That's why we should have less government involvement, less insurance involvement, and less trial lawyer involvement in the medical system. This fantastic "Medical Cartel" only exists in your mind. The only thing that determines how many physicians are allowed is the number of medical school and residency positions, and neither individual physicians nor physician-run organizations have any power over this. The amount of residency spots, for example, is determined purely by government organizations, such as Medicare, that fund such programs. I don't think that you understand what defensive medicine is. An example of defensive medicine is an ER physician ordering a head CT scan on a 90-year old patient with very advanced dementia who had an unwitnessed fall in a nursing home, even though there is no sign of head trauma on the physician exam. The ER physician is essentially forced to order the CT of the head because, if the patient is discharged to the nursing home and dies the next day, an unreasonable family member and unscrupulous trial lawyer can sue the ER physician, claiming that the patient wasn't worked up thoroughly enough, and it is possible the fall caused an intracranial hemorrhage that resulted in his death. The only thing that will eliminate costs of defensive spending, which again is around $650 billion, is reforming the broken civil legal system. It is unfortunate that you believe in this fantasy "Medical Cartel," but neglect to recognize the very real cartel of trial lawyers that is destroying this healthcare system.
Defensive medicine is actually not a proven reality. All three sources rely on polls of physicians who are not exactly a disinterested party. There is no actual data involved and no evidence that states that have tried tort return have reduced medical testing or specialist referrals.
So instead of polling physicians about whether or not they practice defensive medicine, what profession do you think should be polled about defensive medicine? Plumbers? Teachers? Astronauts? Strippers? It's lunacy to think that polling physicians is biased when the topic of the poll exclusively involves physicians, especially because the physicians polled have nothing to gain for answering the affirmative response. First, there is plenty of data, from Gallup and Jackonhealthcare polls, that you simple choose to ignore merely because it contradicts your unsubstantiated argument. Second, I have already told that you significant tort reform has not been enacted in any state. Texas did pass very meager tort reforms, and the CBO predicted (using your link in post #67) that even these very meager tort reforms would save $11,000,000,000 annually. Thus, if the most meager tort reforms imaginable can save $11 billion, then logic would dictate that actual tort reform would essentially eliminate the vast majority of defensive medicine spending, and could potentially save over half a trillion dollars every year. Why are you sticking up for these parasitic ambulance chasers? What is the downside in enacting tort reform and potentially saving $650 billion annually? Please explain this to me.
You just brilliantly described what a Medical Cartel is. Health Care in U.S. system is strictly private since it managed by private organizations like AMA, FMSB, COGME etc, but for some unknown reason U.S. Government (public entity) decides how many doctors allowed to be on the market. That is exactly what a Cartel is - merger between government and private corporation. An existence of a cartel always means exorbitant prices and mediocre service, and it is exactly what is happening in American Health Care. Your links about defensive medicine has no value since content is licensed under artistic license. General consensus (summation of all internet references) is 5-10%. No matter how bad defensive medicine is so far it is our only out defense against uncontrolled representatives of American Health Care monopoly
Agree it is time for action. That action should include revisions of the current PPACA. Whether by Obama or Congress. I can only hope the next President elected is a Republican, moderate or libertarian that will attempt to reform the law to make it fair for all people. Not just the "poor".
You have again proven that you know absolutely nothing about how the healthcare system is managed. First, the Federation of State Medical Boards (FMSB) and the Council on Graduate Medical Education (COGME ) are not physician-advocacy groups and are not made up of physicians. In fact, the U.S. Department of Health and Human Services approves the vast majority (14 out of 17) of the members of the council of COGME. Thus, the Obama White House has essentially full authority over COGME. Second, the FMSB makes money on every physician applying for a license, so it would make no logical sense that they would be advocating for less physicians. Lastly, though the American Medical Association (AMA) is indeed an advocacy group for physicians, it is well known for being the most impotent of any advocacy group and has a long history of lobbying for reforms against the interests of its members. For example, the Affordable Care Act had nearly a 60% disapproval rating among physicians (https://www.jacksoncoker.com/cmscontent/Emails/Surveys/ACA/images/Physician-Survey-Obamacare.pdf), and yet the AMA voiced its support of Affordable Care Act to the dismay of its members. The reason for the high prices is, again, due to our broken civil legal system that forces physicians to unnecessarily order a million-dollar workup because of fear of ridiculous lawsuits. Mediocre service? You've got to be kidding me: I have treated multiple patients from Canada and Europe and every time I am complimented on the short wait times in the emergency department relative to the wait times in Canada and European countries. In fact, the publication that you referenced http://www.commonwealthfund.org/~/m...rt/2014/jun/1755_davis_mirror_mirror_2014.pdf contradicts your argument, showing that the US ranked #3 in Effective Care, #4 in Patient-centered care, and #5 in Timeliness of care. Thus, if the USA has "mediocre service," then so does the rest of the world. Gallup polls have no value?! I guess you have resorted to putting your head in the sand. So 5%-10% of US healthcare costs is still $150-300 BILLION dollars annually Are you now going to back off on this data that you supplied? I bet you are. Again, the American Healthcare monopoly that you describe is a figment of your imagination, while hundreds of billions of dollars wasted to defensive medicine due to our broken civil legal system is very real. I find it utterly amazing that you appear to be condemning life-saving physicians while going out of your way to defend parasitic, ambulance chaser lawyers.
Apparently you do not understand what is going on. But thanks for confirming my point of view. You just admitted that so called private health care is managed by U.S. government in conjunction with private business. I hope you know the basics of economics, if number of medical providers depend on the OPINION of the government that means that supply side is fixed. It really does not matter who controls whom. If supply is fixed it will never match the demand, as a result prices goes up, quality of service goes down. It is just simple as that. No sure why you bring up individual cases of quality if we discuss Health Care in general. Of course rich Canadians and Saudis can afford American surgeons, but it is absolutely irrelevant. Defensive medicine will go to less then 1% once Health Care become affordable to anyone. There will be no reason to file lawsuit if access to health care providers is readily available. Right now Legal system is only defense against Health Care system, so we have to keep it until power of Medical cartel is reduced.
The downside of enacting tort reform is that the legal system seems to be the only thing that actually has any effect on bad doctors and bad medicine. Perhaps if the medical profession were even remotely self policing external controls might not be as necessary, but don't count on the medical profession ever policing itself. Here is a better idea if you want to eliminate unnecessary testing. Pass a law that says if a doctor prescribes a test that comes out negative charge the doctor for the test.
Your assumption that polling physicians to get accurate information on whether they practice defensive medicine is laughable. You claim they have nothing to gain by an affirmative response, That assumes it would not be in the physicians interest to have tort reform which would reduce their insurance costs and thus line their own pockets. The party that has noting to gain from tort reform is the patients who would undoubtedly not see the savings passed on in the form of lower medical bills. Suggest the cause of unnecessary testing is that there is no cost to the physician to ordering unnecessary tests. In fact ordering more test probably save the doctor time since they really don't have to spend significant time trying to actually understand the symptoms and eliminate possibilities. Just ordering more tests is a lot faster than having to do the mental work required to understand the symptoms and then rule out the less probable causes of the medical problems. And if the meger ( to use your term) tort reform in Texas has saved any money I am sure you will be able to provide the proof. If it s supposed to save $650 billion annually significant savings should have occurred in Texas.
Basically the percentage is roughly 60% government 40% private. Health care costs are greater for the aged so with boomers getting old, like me, they will need more care driving spending up. All the suggestions for tackling spending have been proposed before but were swept under the rug for more government takeover of healthcare spending. Since actual costs have gone up because of SCOTUScare actual costs will now be the next democrat agenda but the same coalition that came together for SCOTUScare like doctors and hospitals that benefited from greater participation, will not be in this coalition. Since government has a stranglehold on healthcare, it can now use it's inherent force to do what it wants, damned the unintended consequences.
So after I proved that you have no idea what you were talking about regarding the COGME, FMSB, and AMA, you respond by saying that I "do not understand what is going on," but provide zero information explaining where my error is. Excellent rebuttal. The private businesses that the government is working with are insurance companies and ambulance chaser lawyers, not physicians, as you have falsely stated. Again, physician-run organizations have no power whatsoever regarding the number of residency and medical school spots. It's really as simple as that. To show that healthcare is Europe and Canada is not superior. I am not a surgeon, and the Canadian and European patients that praised the care that they received in our emergency department were not rich. The only irrelevant thing here is your statement above. Your statement above makes no logical sense. Defensive medicine will not change one iota unless significant tort reforms are made. As long as doctors can be sued for looking at patients the wrong way, they will continue to order unnecessary tests to please patients and their families. Your statement above shows your ignorance on this subject. People and lawyers sue physicians because we have a broken civil legal system and physicians are extremely easy prey to greedy parasitic lawyers. Tell me, should this ER physician have been sued http://www.erbook.net/frivolous_lawsuit.htm? You could not have it any more wrong: YOU are the one who is defending the Cartel that is destroying this healthcare system and causing USA's per capita healthcare costs to be the highest in the world by a very significant margin.
What are you taking about? How will forcing lawyers to prove beyond a reasonable doubt that a physician's failure to adhere to the standard of care led to an unfortunate outcome protect bad doctors and "bad medicine?" The motto of our legal system is supposed to be "Innocent until proven guilty", but somehow this only applies to mass murderers and other vermin facing a criminal trial and not to life-saving physicians facing a frivolous malpractice suit. Right now we have a system where innocent physicians that have done nothing wrong are preyed upon by unscrupulous lawyers (e.g. http://www.erbook.net/frivolous_lawsuit.htm). This forces all physicians to order unnecessary tests to protect their own butts. For example, let's say a healthy 35-year old with no family history of cardiac disease goes to an ER for chest pain. He states that he was bench pressing heavy weights 2 days ago, and, for the past day, he has begun to experience chest pain that is described as soreness at the right side of his chest that is worse with movement of his right arm and is tender when pressed upon. His vital signs are all normal. Now, you do not have to be a physician to know that the type of pain that this guy is describing is not typical at all for cardiac-related chest pain. However, since it is possible (albeit unlikely) that this guy may be having atypical cardiac related pain, he will undoubtedly get an EKG and two sets of cardiac enzymes, at the very least. If a D-dimer is ordered with the cardiac labs and is elevated, then he will even get a CT-scan of his chest. All of these tests are done not because the ER physician truly wants to order them, but because if this patient didn't have these tests and was sent home by the ER physician and did have a heart attack, then the ER physician would surely be sued by a the patient and his bottom-dwelling lawyer. Hence, the ER physician is forced to do them to protect his own behind in the rare likelihood that this patient is have an acute coronary syndrome. Are you really this foolish? You are now requiring all physicians to be omniscient. I'm not going to waste any more time "debating" you if this is really the garbage that you are suggesting.
