Why national health care is not the answer for America
 

Here are my reasons why NHI (National Health Insurance) is not something Americans want

1. Its immoral.-

Would the government ever decide how much one can charge in any other business? What if the government decided the computer industry was essential to the rights of Americans and forced apple and microsoft to sell their products at the price the government demanded. Obviously people would never go for that but with Healthcare you have doctors and hospitals that would be forced by law to have prices what the government decided.

2. Its would perpetuate the inefficiencies that are already evident in the half government half market model we have today (Health care in america is not a free market its the most regulated industry in the USA) -

For example, Downtown detroit has been shrinking for years and the hospitals down there want to shift some of their business to the growing suburbs. To do this one must fill out a huge licensure process with the state that will take years to make the move (Certificate of Need). Can you imagine if a bank was in downtown detroit and did an analysis that they could get better customers in the suburbs but the state of michigan forced them to stay downtown because they thought the need was better down there?

3. Inefficiencies compounded cont -

Health care would become a game of favors and a "who has the best lobbyist"
not who is the most efficient and best run. This is good if you are John Haddow but terrible for everyone else You already see evidences of this . In detroit the Henry Ford Health system (HFHS) wanted to open a hospital and move beds to a rich suburb. so did St. Johns (SJHS) and so did the Detroit Medical Center (DMC). HFHS had the best lobbiest (must have been haddow)and was permitted to open up a 300 bed hospital right only 5 miles from Beaumont hospital which is a 1000 bed hospital (1000 bed hospitals are the biggest kind like the university systems). Beaumont then wanted to move some of its beds to another growing area but was denied (as was DMC) due to it not receiving authority from the state.

4. Rationing health care -
too blue can spin it all he wants but Canada rations health care. The government decides when it is appropriate for you to have surgery. What this does is cause a nice black market. People who can afford surgery but are on a list will just go to somewhere that will take their money. Poor people will be worse off. India right now has an emerging market of medical tourism. People from Europe go there for surgery because they are US trained doctors working in lavious suites. I know it was worth 4 million a year for windsor Canada patients to come over and self pay for surgeries at the hospital I used to work at. I can only imagine the windfall buffalo hospitals get from toronto.

5. Moral Hazard -

this is an insurance concept that if you have insurance you will use it. for example, everyone will go to the doctor for every little ailment. you think getting into the doctor is hard now... just wait

Immoral? LOL ..... I'm going to laugh for weeks about that one ... lol! Comparing health care to a commodity such as computers and software lol!

I find it immoral for the government to decide how much I may charge at my own business... maybe the canadian government can decide how much you should charge for consulting work

btw here is a definition of Immoral from dictionary.com

im·mor·al /ɪˈmɔrəl, ɪˈmɒr-/ Pronunciation Key - Show Spelled Pronunciation[i-mawr-uhl, i-mor-] Pronunciation Key - Show IPA Pronunciation
–adjective 1. violating moral principles; not conforming to the patterns of conduct usually accepted or established as consistent with principles of personal and social ethics.

I'm curious as to whether national healthcare is Constitutional. I'm no lawyer but it seems like it's pushing the tenth amendment. Anybody know?

Mike, the Hippocratic oath be dammed, I’m jacking up the price on PsychMike version 2.0 due out this Spring!

Social ethics being key here!

by the way i compared it services like banking as well...

Health care is one area I don't believe simple free market economics will drive to a positive solution for all.

I wouldn't mind seeing some alternatives that involved government policy, but I haven't studied Hillary's or anyone else's proposals to have an opinion.

The first thing that needs to happen is that regulations should be lifted and HMO's should be squeezed and malpractice litigation should be managed so that the consumer has more alternatives. A simple ear infection or strep throat shouldn't cost >$100 to treat. We need more flexibility in the hospital model so that we're not covering huge, expensive hospital overhead to treat the majority of what is treated at a hospital that could be moved to lower tier institution. We need more doctors. More medical schools accepting more students. We need more nurse practicioners. An extra couple years of school and a standard deviation higher IQ shouldn't justify a salary 6 X the national average.

Where do you come down on price gouging? If I own a store and my town gets hit by a hurricane, what right does the government have to tell me that I can't sell toilet paper for $10 a roll and water for $20 a bottle? If I own an oil company, why does the government have the right to tell me I can't get together with the owners of all the other oil companies and agree that everyone should sell gas for $10 a gallon? Is the government acting immorally in those cases?

then the AMA and CMS are immoral
 

Rates are already highly regulated in the US through the pricing structure established by CMS (Centers for Medicare and Medicaid Services) and the AMA (through its CPT list of procedure codes). Aren't most insurance reimbursements linked to these rates?

As with the Indian medical tourism you mention, medical care is becoming globally commoditized. US hospitals and doctors are quite fortunate that travel for sick patients and the myth of the "greatest health care in the world" are such barriers.

Hey Mike... Wouldn't you be happy to start your own practice only to have the government decide how much you can charge? hey there is nothing about that... that is just a sacrifice you should be willing to make..

I have your response tomorrow ... the wife and kid want to go to dinner..

Becoming a doctor is hardly just two years of extra school.

It's basically a minimum of seven, and can go up easily past 12.

All for bright people that have friends who are making 6 figure incomes many years before they are making anything.

Now one legit issue is whether we should be importing so many doctors (from India, etc.).

you will notice that I mentioned that we have a half gov/half market system. Most insurances use DRGs (Diagnostic related groups) for inpatients and Cpt-4 codes for Outpatients. they negotiae their own rates for all that info. There are some that still base their payments on % of Charge.

My rule of thumb is that anytime the government gets involved things gets worse....

If a store chooses to raise their price due to catastrophe that is their choice. However, after a crisis would you ever go to a place that did that raised their prices like that?

In michigan after 9-11 the governor gave a whole bunch of speeches about how she was going to get all the price gougers.... Not one of them were tried (apparently its pretty hard to prove .

There was a gas station by my inlaws house that raised their gas prices to $10 a gallon. A couple weeks after 9-11 there were people protesting outside the gas station. That place soon went out of business.

I say let the market decide...


As for the oil companies getting together ... well wouldn't that just mean that the car companies would come up with more electric cars or steam cars or whatever... people would take more public transportation

I guess I could go on and on but I am going to bed...

Lol, what gov't program over the last 70 years hasn't?

Jay Santos: A lot of med students are in school or training until they are ~34-37 years old. My path is a little longer since I'm doing a PhD plus an MD, but it's not unusual for training to take about this long even without a PhD. During the last 5 years I'll be making ~40,000 a year while working 80 hour weeks. Most med students end up with $100K-200K debt on top of that. If salary is a motivation for career choice, there are much quicker and less painful ways to make six figures. On top of that, many specialists have a very difficult lifestyle throughout their career.

Do you really think doctors don't deserve a 6 figure salary with this kind of lengthy training?

Think about it this way: for many specialties, the period from high school graduation to private practice is longer than the entire period of kindergarten to high school graduation. For me, I'll have been in school and training for 17 years since high school graduation (not counting my mission)...versus the 13 years from kindergarten to high school graduation.

A couple responses:

1. Many types of doctors are making $300,000 much sooner than your 17 years post high school. I do believe that number is artificially high due to the supply choke on # of doctors U.S. medical schools can produce.

2. It shouldn't take 17 years of post high school training to treat more than 50% of what you end up treating, if you go into private practice. We need a more flexible model where most issues are treated with people with master's degrees making <$100K per year. More complicated issues can be handled by doctors, and with the decrease in demand and increase in supply, prices will go down on that stuff too. Same kind of reform needs to take place on the facility side as well. It shouldn't cost $500 to set a broken bone after hours.

They already have people with "master's degrees" who treat patients, handle easier cases, set broken bones, etc. Those people are called Physician's Assistants. They make less than 6 figures, just like you prefer.

My first choice for reform would be to eliminate insurance companies altogether and replace them with a government middleman who doesn't make a profit.

Yeah I'm familiar with PA's. I take my kid into the "doctor", wait an hour, see a PA for 5 minutes, and pay him almost a hundred bucks. That's not what I have in mind.

Nothing personal against doctors. If I had my way, you'd still make triple the national average, you just wouldn't make six times the national average.

I used to work for an HMO. I understand the financial landscape. I think a lot could be done to make things more affordable and serve the consumer better.

Jay, if a plumber charges $100 for an hour of work, I think $500 to treat a broken bone is quite reasonable.

Insurance companies make very small margin: 5-10%. They cut costs by managing the docs. With a government middleman, costs would rise way more than the cost insurance companies add.

5-10% is huge, in my opinion. The insurance companies also cut their own costs by denying good claims for bad reasons. I'm going to have to disagree with you on this one. I think a government middleman could be much more reasonable and fair--and not make a profit.

Your industry is actually a good model to follow. You have LCSW's that are a dime a dozen that insurances can send a lot of patients to for $50 an hour, then you have psychologists that make more, then you have psychiatrists who only end up doing the high value added work. This is also probably why psychiatrists are at the low end as far as avg salaries for doctors.

Correct me if I'm wrong, Mike, but I think psychiatrists are at the low end because the specialty doesn't have procedures, and generally the doctors who make the most money, do the most procedures. I don't think this is necessarily a fair arrangement either.

A gov middleman would still have the SG&A costs, they just wouldn't require the 5% profit. You save 5% profit but costs balloon because no one is managing them.

It would be good for you in the sense that you're not being told you can't do a surgery when you want to, but it certainly wouldn't cut total health care costs to the consumer.

The reform I'm lookin for is in cutting costs, not in giving more power to docs.

the worst paid psychiatrists are ones that do therapy and ones that do research.

An experienced psychiatrist in town usually charges $150 for an hour of therapy. Usually cash only. But if he can do 4 med checks, 4 x 70 = 280.

So the highest paid guys are the medication mills.

In two states, you don't even have to be a MD to prescribe psychiatric medications. Psychologists with no real experience or supervision are allowed to prescribe. That's how bad things have gotten. It bodes poorly for the profession. Already it's hard to get people to go into psychiatrty. It's' only going to get worse. Watch--you are going to take a relative to see a psychiatrist because he just tried to kill himself. And you will be shocked to find that the psychiatrist in your plan doesn't speak the good english.

that's true. Psychiatrists are in the ballpark of FPs and Internists.

Why would you assume that the government wouldn't regulate what doctors could do in various situations? I don't think the government would necessarily give doctors more freedom.

Let me give you an example of how my HMO regulated my claims when I was on the verge of death from Crohn's disease...

HMO: "Your doctor's last name is the same as yours, so we are denying your claim on the basis that he is your relative."

SoonerCoug: "But we aren't related. He's from Kansas, and I'm from Utah."

HMO: "We don't hear you."

Me: "Really. He's not my relative. See! I have my family tree back to the 13th century!"

HMO: "OK, well, we can't pay your claim anyway because it was a pre-existing condition."

...I could go on and on. They do this with the hope that people will eventually give up, and it's a load of crap. I don't call that regulation. I call it crap.

insurance companies make a more than 10%

What if the government provided free medical schooling and you did not have to incur such debt? That would ease the burden and drive down the "necessity" of earning a high salary.

I agree that this would be a good thing.

Actually, the government already does pay for the medical schooling of people who also do a PhD degree (like me), in order to encourage MDs to enter research and academia. You don't have to have a PhD to do academic medicine, but it can be helpful especially for basic science work.

The point is--academic MDs make less money than private practice docs, and so the government funds these MD/PhD programs. In addition, the government will pay 35,000 dollars a year of med school debt for two years of post-graduate research to lessen the debt burden on academic docs.

Here is a question: how much has the free market driven up physician salaries? I mean--if you want to go to an accupuncturist to treat your cancer or heart disease, you could do this, and it'd probably save you money. Would it help with the disease? Not likely, unless you have an interesting placebo effect.

If you want to actually solve the problem, you need to go to someone who has significant expertise. Should there be more of these people in the country in order to drive up supply and thereby also drive down salaries? I think the answer to this question is related to access to physicians. Is there a problem getting access to a doctor? It's supply and demand, right? How difficult is it to get an appointment with a doctor if you're very sick? Compared to other countries, it's pretty darn easy to get an appointment in the states. In Canada, you might have to wait 6 months, and the doctor makes much less money. I think that reasonable access suggests that the supply of doctors is adequate, for most specialties (not for dermatology, though).

My point is: I don't think this is a supply and demand issue. I think it's a question of how valuable is the service that is being provided.

govts already subsidize medical education to the tune of millions of dollars per school.

I paid around 8k per year for my med school. Trust me, the actual cost was much higher than 8k per year.

the reason that I ask is to gauge the feelings of physicians about an even greater governmental subsidy. I had a political science class on governmental policy systems, and I learned that in Germany there is a total subsidy of medical school ( I am uncertain whether this includes living expenses, but I assume that it does). This helps young doctors make it more easily in the early years, but also, it tends to put a ceiling on what doctors earn there, since there is an oversupply.
The German model , in which you have compulsory insurance is worth a look to fix our medical system. I think that we definitely ought look at other health care systems to see what they do that works, in order to drive our health care spending down, and also, to make the system more efficient in providing more preventive access, etc.
i am not with Mormon Red Death in thinking that governmental involvement in an area ALWAYS equals a problem, but I do think that the less intervention is better in almost every area. But Health Care might very well be one of the few areas in which governmental is not only necessary, but smart. The truth is that continuing on the same path is unlikely to produce better results, and health is not an area to be trifled with.

Good ratios for a health insurance company is a 15% med loss ratio, which is 1 - health care cost/revenue, similar to gross margin.

And then SG&A of 7-10% which equates to 5-8% OI.

Those are also important issues. I'm not passionate about those issues, but they are very important.

I'm interested in lowering health care costs. Health care costs have grown at triple inflation for the last 10-15 years. That's a big problem.

So why have health care costs gone up?

Physician salaries have VERY little if anything to do with recent increases in health care costs.

I think the main reasons for increased health care costs result from:
1) New, expensive medications--including biologics (physicians don't get any money for prescribing more expensive medications)
2) Doctors playing defensive medicine (or sometimes lazy medicine)... i.e. doing an MRI either because a patient knows about the high tech stuff and demands it, or because a doctor is afraid of getting sued if he or she doesn't order the MRI, or maybe even the doctor being lazy and sending the patient for an unnecessary procedure. I'd argue that for anything unnecessary, the government could regulate this just as well as an HMO. But this defensive medicine thing doesn't increase physician salaries. I also think HMOs often cut costs by decreasing quality of care or denying a claim unfairly to very ill patients--and that's a very bad thing to do.
3) New, expensive high tech diagnostics (a doctor would only rarely get a cut from these kinds of diagnostics--if theyr'e a part owner of something)

I don't think physician salaries have increased more than inflation....and Medicare and Medicaid compensation have not even kept up with inflation.

I work specifically in the medical recruiting industry. Know the industry very well.

It is wrong to say that Physician salaries are the problem for insurance rates. In fact it's so off it's not even funny.