Originally posted by: colossus
Originally posted by: sandorski
Originally posted by: Hayabusa Rider
Originally posted by: mattpegher
To clear up a bit of the above, I will continue to argue with sandorski, that health policy cannot be narrowed down to a number of statistical charts and accountants estimations of what facets of spending have impact. I have been in the practice of the analysis and application of scientific data for 20 years now and I will assure you that any study can be biased especially those dealing with public health. I have seen many double blind randomized control studies that contradict prior studies of equal strength. I certainly am not going to want to believe every study out there about how americans should follow the paths of other nations.
We live in a different environment than other countries. We Americans wish to retain many rights that are foriegn to other countries. And to be honest, a great deal of the dollars spent by me in the evaluation of a patient are on tests designed to prove to the patients and lawyers that my clinical assessment is correct. Americans demand a certain type of care that includes many expensive diagnostic test and I don't see that changing in my lifetime. They demand the newest drugs and the newest tests even when there may be no proven benefit. They cannot tolerate even the smallest period of illness, demanding that whatever measures needed to make them well as fast as possible be utilized. They even refuse to accept that often no medication is necessary (ie antibiotics for viral illnesses)and that the course of illness cannot be changed. All this costs money.
Lastly to clear up Sandorski's portayal of my credentials, I have been practicing internal medicine and emergency medicine for 12 years, following 4 years of residency and 4 of medical school. I have worked in many different facilities, from level 1 trauma center to rural emergency rooms to private offices and Urgent care centers. I am currently on staff at 3 facilities, hospital ER and 2 urgent care centers and am intimately intouch with the revenues that each facilities bill out and recieve. I have taught residents and students and believe that I can see trends in healthcare quite well.
Although I welcome some reform, I will continue to beleive that this reform must consider one undeniable fact: Hospitals are losing money, physician are losing money and seeing more patients less well to maintain their incomes, and Insurance companies are making huge profits and becoming bigger and bigger. All the factors that may be affected by goverment control of health care must be considered and no matter what system we choose the forces of a capitalism and human nature cannot be easily changed.
I believe that blindly approaching a complex system as health care is foolish. And ignoring the fact that we are attempting to socialize a part of our society while leaving the remainder free to follow capitalist pressures cannot be approached without serious scientificly derived predictions. And Sandorski- your data is neither scientific or unbiased. And a good scientist always recognizes the biases that effect his position.
Welcome to the debate, however your experience and knowledge of health care count for nothing when put up against the formidable wisdom of those who may have stayed at a Holiday Inn Express. As I've said in the past, no one knows your job better than someone who's never done it, and judging from what we've heard there's a lot of that out around. Never ask to see details. It's too tedious.
Rubbish. His Experience, as I've stated repeatedly, is only a small part of the much larger System. I really don't understand how you guys can't comprehend this.
I actually forced myself to watch the video on KCET last week (before this posting). The bias in the interview was obvious (almost like leading a juror) but the points the guest wanted to make were clear and not coerced. What wasn't discussed was who would pay for UHC - but that's another issue I guess.
Not all docs practice the same way. Some docs can go through 40 years working for Kaiser or an HMO/IPA and not have a clue where the money trail is. I'm guessing Matt is an ER doc. ER docs (especially if they've worked in a trauma center) usually know more about health care costs and how the system works better than most docs - they are the gatekeepers to acute hospital stays. So I will back up Matt's small "niche" experience with my own experience as a family practice doc who does almost all Internal Medicine (in-house). I DO KNOW what each procedure gets reimbursed for and how hospitals and physicians get reimbursed. I have to say I agree 100% with what Matt is saying.
There was a previous post about UHC where I made a good rant about about it (pro and con). I won't rehash it - but basically until America improves its primary care infrastructure the notion of UHC is laughable. You can't just push an extra 50 million people into the offices of primary care docs and not have the infrastructure for it. I'm surprised not one politician has mentioned this (although I've seen enough MPHs say the same thing).
I personally feel Americans are not ready for the lower level of care that UHC will provide (well lower for those who are supporting the system currently). My income would actually go up quite a bit and I wouldn't never have to worry about chasing after bills on my own (I don't even bother billing uninsured people now since I never receive a single response) but I can just imagine all the uproar in the waiting rooms.
Long before this country can talk about UHC it needs to implement a standardized electronic medical record and pump out enough primary care docs/nurses/PAs (even if it means subsidizing their education by the gov) to support those people.
