Comments on: The Wrong Way to Constrain Health Care Costs

By: Robert Berry, MD

Robert Berry, MD — Tue, 29 Sep 2009 23:50:53 +0000

John,

Doctors should not contract or recontract with Medicare. They shouldn’t sign the contracts and play the Medicare game. They should just contract with patients – that way they can take care of the patient’s problem in one visit rather than over several visits and the system becomes rational, centered around the patient’s needs and not some bureaucrats set of criteria, because it is the patient calling the shots.

By: Devon Herrick

Devon Herrick — Tue, 29 Sep 2009 16:42:58 +0000

This is another example of pitting one constituency against another. There are far more patients (i.e. voters) than doctors — so politicians give patients relatively free access to see physicians. For the part, doctors are free to see the same patient about as often as the patient is willing to drop by. But to hold spending down, politicians cut reimbursements, which results in a version of rationing by waiting. Many of the Medicaid programs with the broadest eligibility are administered this way. Everybody is eligible but enrollees cannot seem to find providers willing to treat them. When patients do, they are rushed through like cattle through a corral.

By: Art

Art — Tue, 29 Sep 2009 14:45:53 +0000

You stop too soon in your analysis!

Now you add 20% more patients and cut fees again, so it becomes impossible to add any more patient visits and to provide more unneeded services to patients to stay in business. What happens? More physicians either quit or go to the specialty practices and fewer new physicians become general practioners and those who remain won’t be able to cope.

Some will say that most of these “new” 45 million patients will just pay into the system and not use services as they haven’t in the past. But if you make people pay for health insurance you can bet they will use it. American consumers are not stupid!

By: Jennie Fiedler

Jennie Fiedler — Tue, 29 Sep 2009 00:11:12 +0000

Makes sense to put healthcare back in the hands of patients and practitioners. Should we ever go single payer by way of HR676, then I would sincerely hope that Medicare beauracrats and doctors could work out TOGETHER how best to compensate and administrate.

By: Dan S

Dan S — Mon, 28 Sep 2009 21:16:28 +0000

The paper from Cutler and Feder reads like it was produced by the South Park underpants gnomes:
1)Pass $1 trillion health care reform bill
2) ?
3) Enormous savings and longevity

By: Bob Blades

Bob Blades — Mon, 28 Sep 2009 20:35:31 +0000

There are some very good responses. I wish alot of you were in Congress. The conclusion is that costs are too high yet they think taxes reduce costs as a percentage of GDP.
The patient needs to be accountable and not abuse the system. One way is higher deductibles. We need to be responsible for our own health care ie weight.
Portable insurance will help as well as tort reform.
With 85% of Americans happy with their insurance we don’t need to trash the system. Doctors should be paid appropriately and given incentives.

By: Frank Timmins

Frank Timmins — Mon, 28 Sep 2009 19:27:55 +0000

John’s post is a good explanation of how Medicare works, and the suggestion that anything the current government is working on for the rest of us will be “managed” the same way is certainly a foregone conclusion.

I think part of the problem is that most people approach the healthcare issue from a flawed assumption, and that is the assumption that it must be “managed” by some third party (government or insurance company). Put another way, why is healthcare approached by economists as something that should be “budgeted”? We don’t budget the national expenditure on food, housing, automobiles or just about any other consumable product or service.

Of course, the simple response by those ideologues of the left is that “healthcare” is a “right” and therefore must be guaranteed by the government, and that then makes it something that needs to be managed (or budgeted). This is where everything starts going downhill. If someone would just realize that we don’t need to budget, manage or guarantee coverage for everyone to get everyone under the umbrella of healthcare. Simple tax incentives will get the vast vast majority of people in the system. Those few that remain outside the system can still access limited government funded healthcare, and the great majority of the population can be made “individual managers” of their own healthcare.

That will surely be a helluva lot more efficient than anything bureaucrats and HMOs can do to contain costs.

By: Mark Kellen

Mark Kellen — Mon, 28 Sep 2009 19:18:57 +0000

The proper arrangement is for the physician to be the consultant and give the patient the options. The patient then weighs the risks, benefits, and costs of all the options and makes a choice. Anything else will fail.

Mark Kellen, MD

By: Glenn Clark

Glenn Clark — Mon, 28 Sep 2009 19:16:16 +0000

Yes, health care reform will be painfull. My question is who will suffer that pain? If B.O. gets his way, it will be seniors on Medicare, doctors providing service, taxpayers and our children, who will have to live with and service HUGE debt. Why do countries live way beyond their means? Because we let them! Next election, find out who the good ones are and THROW THE REST OF THEM OUT!

By: Chris ewin, MD

Chris ewin, MD — Mon, 28 Sep 2009 19:11:33 +0000

Mark P. is so correct….
It’s a lot easier for physicians to set their own prices and let the consumer make the decision on value and quality…..Those of us who don’t accept third party fees have cut their overhead tremendously.
And, the patients couldn’t be happier.
If Obama tries to make us “work” for the government….Docs can make a choice to comply,
quit their day job or find other work….It would be a travesty to see the exodus of even more physicians…