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Re: Beyond Single Payer
Submit responseAs a retired provider, sick of fighting both disease and HMOs, I now have time to study molecular medicine. From that perspective it is clear that internist will be critical if he is better educated and patients can feel safe obtaining genomic profile. There is no way around it, this requires and end to FOR PROFIT health care. It cannot be considered insurance, for as your house has little chance to go on fire, you take insurance, just in case. But everyone will at some point fall ill so there is no insurance just health care provision. At that point, just as jungle predators pick off young, ill, or aged, for profit health care exhibits cannibalism-- for it is making us prey to corporate predators of our own species. Besides information technology to provide easy access to patient data, doctors in Americaneed time to study and inculcate their studies into practice. They need time to coordinate with colleagues in specialize and to properly investigate patients. Police may interview a suspect for many hours. History taking is sometimes just as demanding. The current scene allows MDs little time to keep up with diseases and with patients. TIME needs to be made NOT into money but into care.
Conflict of Interest:
none
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Beyond Single Payer
Submit responseWe agree that a system of Medicare for all would reduce fragmentation in the American health care system and achieve sizable savings. Yet a single payer is not necessary to gain a large part of those savings. Costs can be controlled with multiple payers—if payment policies are coordinated and system-wide spending targets are set. If there are multiple payers, however, there must be much more stringent regulation than most advocates of preserving our current private insurers appear to contemplate. Moreover, having a publicly sponsored public plan compete with private insurers would be very helpful to cost control efforts.
Conflict of Interest:
None declared
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Disruptive Innovation
Submit responseThe authors correctly argue that "embrac(ing) price restraint, spending targets, and insurance regulation" must be part of "credible cost control".... at least within our current system.
If we were able to make a transition to a fundamentally different system, a system where health care would still be delivered through our existing network of providers, but which would be financed through a single financing mechanism, however, the goals articulated by the President and by the authors would be more easily achieved.
A great component of our health care expense is created by the waste and inefficiency of our balkanized system of public and private programs, each catering to a different "market segment" or "categorically entitled" group. Elimination of this confusion, eliminating the costs of administering a multitude of private and public programs, eliminating the need for marketing, advertising, underwriting, cost allocation, and billing innumerable payers would go a long way towards cutting costs.
Conflict of Interest:
None declared
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controlling costs
Submit responseAmong "community" physicians there is a significant volume of expensive studies ordered to cover our tails. Until the attorneys are deleted from the equation, this will continue. In polling my contemporaries, we would estimate perhaps as much as 1/3 of health care costs are involved. I have not seen this issue addressed by these thinkers and movers, probably bsecause they are not out here in the trenches with us.
Conflict of Interest:
None declared