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Old 08-01-2012, 02:25 PM   #61
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Except the problem is Joe has explained this at length and refuted it in previous posts, Jason. What you are trying to claim has very little basis in the reality of the situation.

I guess I can go down your post point by point because I haven't, although Joe did.

With that said, I think you are right in that the medical system is too expensive. I don't disagree at all with you there. In fact, I would even go so far as to say you are right about the US needing more GPs and less specialists (Well, Joe, you, me, everyone in this thread really on that point). Where I think you are wrong is what you attribute to said shortages and expense. Remember, doctor expense *is a very minimal* part of our system. The last numbers I saw were $58 billion towards doctors paychecks in the entire system. It sounds like a lot, I admit...

Except that it's a fraction of a fraction of the total cost of medicine for us. I'll go into this later in this post and explain why this is so important.

Quote:
Originally Posted by JasonC SBB View Post
You missed a major step in the free market dynamic. When demand outstrips supply which increases the prices of a service, the latter extra profit attracts new entrants which will lower prices back down. With market competition, there is an incentive to figure out how to do things better and more cheaply.
I don't see how I can disagree with this statement or am missing it. I mean, in the past, I've always agreed with this. This is covered in depth later.

Quote:
Re: AMA.

What do you think would have happened to the medical education industry if the AMA wasn't able to get a law passed barring the practice of "medicine" without a gov't issued license (which the AMA designs)? Would there be more doctors or fewer doctors? Would the salaries of doctors be higher or lower?

Might there have been multiple competing certification medical education agencies, just like there are for Product Safety and scuba education? Would said competing agencies have figured out ways to become more competitive by decreasing the cost of eduction while increasing quality? Would it not be in the interests of hopsitals to figure out which educational certification produces better doctors? Would it not be in the interests of said high quality education agencies advertise "look for this logo certificate when you visit a doctor"? WOuldn't it be in the interest of the insurance industry to figure out which educational agencies produce high quality doctors?
The AMA was only one factor in this, Jason. You are trying to attribute a great deal of primary factors of medical expense to a single source which neither has the power nor has the influence to do this.

First off, as to the shortage, you are wrong. Doctor shortage: Why can't we just churn out more physicians? - Slate Magazine This explains in detail as to why - the AMA had little to do with the shortage. The medical schools themselves, not the AMA or government, predicted a surplus of doctors and reduced enrollment. They were wrong. However, they have increased enrollment by 30% since 2002 - now, this segues into the next question.

You are free to create a medical school if you want. There is nothing stopping you from creating a new medical school if you are 100% dead set on your beliefs about it. However, if you want to argue that medical schools control supply instead of the AMA, I would have to agree with you. Unfortunately, your argument about the AMA falls apart on this point - anyone can create a medical school so long as they fulfill *state* and *federal* guidelines on it, *not* AMA guidelines. This means that, *if* we really had a shortage, it would be due to medical schools actively collaborating as a whole to reduce supply, and state medical boards, *state* not federal, collaborating with them, and the federal gov't turning a blind eye to ogliopolistic practices. If it was just the federal gov't and the AM involved, yeah, I'd be inclined to agree with you. But not when it's 50 states, plus all the medical schools, plus the federal gov't, plus numerous organizations that include the AMA - it doesn't pass the smell test. With all of that said, I do think it's a load of horse ---- that medical schools can limit students based on projected need, but schools do that in other professions too - and the alternative is to have the federal government come in and force regulations on them, considering you can already start a medical school yourself and ignore the student quota. In fact, 8 new ones have been created in the past decade with up to two dozen more looking to be created in the next few years (See: http://www.nytimes.com/2010/02/15/ed...edschools.html ). This alone makes your argument fall apart.

As for multiple certification agencies and practicing without a license, the states are free to do that if they so desire. In fact, a state could today say "Okay, we're no longer directly licensing medical doctors, and leaving it to any certification agency that meets our standards." This is solely a state right (Licensing doctors), and the AMA or any type of organization like it or the federal government has no influence over that right. To try to argue otherwise is to argue against state rights and (likely) in favor of federal rights, Jason, which I do not feel that I mischaracterize you in saying that you are ardently against doing. Hell, theoretically, a state could say "You don't need licenses to practice medicine, go do whatever you want". This is something controlled by the states and is exclusively a state power, so please stop arguing to take it away from the states if you really believe in states rights. Everything you postulate *could be done by a State if a State wanted to do it*! It's not a federal power, it's not an AMA power, it's solely a State power!

As for the logo, humorously, the AMA and it's competing organizations *already do that*. In fact, the AMA and it's competing organizations are an *extraordinarily* close analogue to the very system you want to create. And yet, you are ardently arguing against them, which confuses the hell out of me.

The insurance industry, though, yeah. That's the part I've been waiting to hit. Joe has already explained why the insurance industry has largely destroyed GPs - we have a surplus of doctors as a whole right now, if you just look at numbers. We have tons of specialist doctors, a ridiculous amount, but have a shortage of GPs. This is tied to the insurance industry, however, and not the AMA. This is Free Market principles at work - you can make big bucks ($300k/year, $400k/year or more!) as a specialist, whereas GPs only make $100k-$150/year typically.

And what makes it worse? GPs aren't salaried. They are paid based on tests performed and such due to how insurance companies reimburse hospitals - which is a major reason for our over utilization of our medical system. The more tests and more procedures a GP performs, the more money they make due to how the insurance companies structured it. You tell me what happens in this situation in a free market, Jason - especially when if a GP wants to make, say, $150k a year, he has to perform $1.5mil to $5mil in tests and similar work due to how the insurance companies structured it!
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Old 08-01-2012, 03:12 PM   #62
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Some excellent points being made here, as well as great use of visual aids, but one area not touched on in which both corporations and the Federal government exert significant influence:

Taxation of health insurance.
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Old 08-01-2012, 04:15 PM   #63
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Damnit Scrappy, you killed the argument and made everyone run away in terror.

Bad Scrappy, BAD!
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Old 08-01-2012, 08:48 PM   #64
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Wait a minute.

I can't believe I missed this earlier!

Let's back up a page or so to where Jason said the following, in his own words (not quoting someone else's blog), in three four separate posts:

Quote:
Originally Posted by JasonC SBB View Post
Gov't "regulates" by granting monopoly to AMA.
Quote:
Originally Posted by JasonC SBB View Post
You can't start a group that competes against the AMA. It's illegal. Gov't protects the AMA.
Quote:
Originally Posted by JasonC SBB View Post
If anyone were to try to compete with the AMA, they would find that the AMA would lean on the government to block competition.
Quote:
Originally Posted by JasonC SBB View Post
Re: AMA.
(...)
Might there have been multiple competing certification medical education agencies

Three words for 'ya, bro: American Osteopathic Association.





This whole time I'd been paying so much attention to attacking the other false statements you'd been making, and I totally spaced out on this one. The AOA is in DIRECT COMPETITION with the AMA, and they have been since 1897.





The Department of Health & Human Services (aka, The Government) recognizes the AOA as an accrediting organization for medical schools, and the physicians which they certify are recognized by the medical boards of all 50 US states (and all ten Canadian provinces, and 54 other countries) to practice medicine and surgery. There are, at present, 29 schools in the US accredited by the AOA.






Of course, like the graduates of AMA colleges, the graduates of AOA colleges have also been increasingly choosing to enter specialty fields rather than primary care in recent years. Specifically, here's the percentage of students at AOA schools who claim that they intend to enter general practice:


(Dark blue is 4th year students, light blue is 1st year students.)

In fact, today only one in five DO graduates actually enters a family medicine residency. ONE IN FIVE! Can you guess why? (Hint: the answer involves money.)






So, to recap:
  • The AMA is not a government-protected monopoly. They are in direct competition with the AOA, which is also recognized by the State and Federal governments as an accreditor of medical colleges.
  • There is not a shortage of physicians in the US. Market forces are simply driving physicians away from less profitable fields of practice and towards more profitable fields, which is exactly what's supposed to happen in a free market.
  • OH SNAP!


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Last edited by Joe Perez; 08-01-2012 at 09:39 PM. Reason: Added fourth instance of Jason claiming Govt-sponsored AMA monopoly
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Old 08-02-2012, 12:39 PM   #65
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You are correct, I have been reading up on the AOA since starting my arguments. They compete against the AMA. Like chiropractic, they have been fighting an uphill battle.
You keep saying "shortage", I explained to you there are fewer doctors than if gov't didn't meddle and create a licensure process. Do you deny the last part?

Now.
The AMA has been attacking the AOA by using the gov't:

AMA Commits to Renewed Attacks on AOA-Backed Provider Non-Discrimination Law | American Optometric Association
AMA Commits to Renewed Attacks on AOA-Backed Provider Non-Discrimination Law

Which supports my more fundamental premise - guilds and cartels use gov't to defend their position. In this particular case, the AMA wins some and loses some. And again, if gov't were NOT allowed to write economic interventionist laws, the market would sort out certification and regulatory issues. Instead, the gov't will operate on "whoever has the best lobbyist gets what they want", and we get screwed.

More later, I'm helping Reverant with my special injector circuit
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Old 08-02-2012, 12:55 PM   #66
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Quote:
Originally Posted by blaen99 View Post
The AMA was only one factor in this, Jason. You are trying to attribute a great deal of primary factors of medical expense to a single source which neither has the power nor has the influence to do this.
I never even said it was the "major" source of costliness. I first pointed out that gov't intervention is the reason for Braineack's quote on page 1 and that it raises the salaries of doctors.:

Quote:
Originally Posted by via Braineack
The Association of American Medical Colleges estimates that in less than three years the country will be almost 700,000 doctors short.
Quote:
Originally Posted by Blaen
From your own link, Blaen:
Quote:
Although residency programs aren't big enough to satisfy the nation's need for doctors, medical schools aren't even cranking out enough graduates to stock them
The AMA effectively limits the number of grads via its control over the schools. In the name of "quality".
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Old 08-02-2012, 02:54 PM   #67
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Quote:
Originally Posted by JasonC SBB View Post
The AMA effectively limits the number of grads via its control over the schools. In the name of "quality".
Joe and I have already busted your allegation, Jason.

This would only make sense if and only if the AMA is a government sponsored monopoly that has complete control over the schools and the medical system as you originally tried to allege, and was quickly disproven.

Or are you trying to say numerous agencies that you -also- claim the AMA is in a knock-down drag out fight with in trying to get them shut down...are you trying to say the AMA is colluding with all of them, and all of the medical schools, and all of the states, and the federal gov't to limit students? And yet, all it takes to disprove what you are trying to claim is the creation of new schools. That's it. 8 have been created in the past decade, and two dozen more are busy in the midst of being created. Another point where your claim is very easily disproven is the competing agencies to the AMA which also operate schools. Yet another point where it is disproven is numerically, we don't have a ------- shortage of doctors, Joe provided air-tight proof of this - we only have a shortage of doctors in certain very specific areas for free market reasons, not AMA reasons. The AMA isn't the bogeyman you are trying to make it out to be, and your allegations fail on numerous points Jason.

You are quickly getting into paranoid conspiracy theory territory with your blind insistence that the AMA is the source of all the ills in the medical system. Actually, let me rephrase. This entire "The AMA is the source of all of our medical ills!" is stupid and is a paranoid conspiracy theory. We /have/ a surplus of doctors in other fields, but for free market reasons they don't go into fields where we have a shortage. That's all there is to it, we have a shortage of doctors in an area that pays like ---- (due to insurance companies) and has severe risk (again, due to insurance companies), and a surplus of doctors in areas that pay extremely well (Due to insurance companies) and has little risk (Again, due to insurance companies).

Or is it that the AMA is colluding with insurance companies to create a shortage of the most shittily paid doctors?

Last edited by blaen99; 08-02-2012 at 03:31 PM.
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Old 08-02-2012, 06:23 PM   #68
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Blaen, I never said "AMA is the source of all ills". I never said "shortage", that was the terminology of the articles I linked. YOU are erecting a strawman.

I explained: "shortage" means "relative to that if the market were free-er".

Now pls. answer: Would there be more, lower paid doctors had the gov't not granted the AMA what it lobbied for, which is, state licensure requirements?

Granted the AOA is providing competition to the AMA, and given their increasing number of grads, I'd expect that they are making a dent. I also linked to an article from the AOA, which says something I pointed out: "AMA attacks AOA". Now "attacks" means "use gov't". So they are lobbying, and using lawyers, etc. Which again supports my point - Guilds and corporations use gov't to stifle their competition, in the name of safety. Agree or disagree?
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Old 08-02-2012, 06:30 PM   #69
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Wow, Jason.

You whine and complain about me strawmanning your argument, then proceed to either strawman everything Joe and I have been saying and/or completely come from left field with stuff that was never said. I'll sum it up very simply for you.

We have a surplus of doctors in some areas, and a shortage in others. The allocation of doctors is determined by free market principles - this is to say that the places we have surpluses of are highly paid areas, and the ones we have shortages of are in low paid areas. This pay is not determined by the AMA, but rather insurance companies.

No more dodging and evading, agree or disagree?

Further, assuming we get more medical doctors, free market principles will still distribute them as we currently are seeing because of how the insurance companies compensate the doctors.

Agree or disagree?
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Old 08-02-2012, 11:36 PM   #70
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Quote:
Originally Posted by JasonC SBB View Post
I never said "shortage", that was the terminology of the articles I linked.
Actually, it was the very first thing you said in this entire thread.

Your exact words were:
Gov't "regulates" by granting monopoly to AMA. Which is a barrier to entry for individuals wanting to enter medicine. Result: Fewer, more expensive doctors. Proposed solution: more regulation aka Obamacare, which will impose price controls. Result: Shortages.
It wasn’t a quotation or a link. Rather uncharacteristically, you were speaking in your own words. (emphasis added by me.)
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Old 08-03-2012, 02:24 AM   #71
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I could be wrong, Joe, but that paragraph reads to me as if the final, conclusive "shortages" refers to the result of Obamacare and price controls, not to the result of the AMA's influence.
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Old 08-03-2012, 01:37 PM   #72
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Joe, don't argue like Blaen. I have clarified my position (and adjusted it after considering the AOA). (and mgeoffrau is correct above)

The bottom line is:

- gov't writes economic interventionist laws with the influence of special interest groups such as Guilds and corporations, in the name of "safety" or the "common good".

- licensure laws reduce the supply of doctors because they are barriers to entry (reduced as compared to if said laws were absent)


I reckon you would agree to the above.

And then here is what we should be discussing:

- society would be better off without such meddling, e.g. licensure laws. A free society solves problems (such as the problem of patient safety) without threat of violence (which is what happens when you have a guy with a gun, either a dictator or a "democratically" chosen guy), outside of protection of individual and property rights, and prosecution of fraud.
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Old 08-04-2012, 01:07 AM   #73
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Originally Posted by JasonC SBB View Post
Joe, don't argue like Blaen. I have clarified my position (and adjusted it after considering the AOA).
Sorry. It's hard to know where the thread is going when the target of the attacks keeps changing. It would help me to focus my responses if you'd pick a specific point of view and stick with it, rather than adapting your argument to fit whatever apparent gap in the facts seems to exist at any given point in time.



Quote:
Originally Posted by JasonC SBB View Post
- society would be better off without such meddling, e.g. licensure laws.
I guess it really boils down to a philosophical question, as to whether it is important to have a large number of poorly-paid doctors, or a consistent high standard of quality among doctors.

I’m familiar with your argument that, in the absence of regulation, every business will naturally tend to seek a high standard of quality. This is, of course, almost unbelievably naïve. There is virtually no regulation at all in the journalism industry, and I think we can all agree that the quality of commercial journalism is not uniformly high. You yourself have pointed this out on many occasions, and as a member of the broadcast industry myself, I wholeheartedly agree.

The commercial media (both print and broadcast) is actually a pretty good metaphor for American business as a whole. While the technical aspect of broadcasting is heavily regulated, the content of media as a whole is almost completely unregulated. You’re not allowed to broadcast pornography or obscenity (this does not apply to cable or satellite), and you’re not allowed to commit libel, but apart from that it’s pretty much a free-for-all. There are absolutely no regulations or licensing procedures at all concerning who may be a radio or TV personality, who may be a newspaper reporter, what they must (or must not) report on, etc.

And as a result, the whole commercial journalism business has very swiftly raced to the bottom.



It is important to remember that the concept of regulating the licensing of doctors (as well as the pharmaceutical industry) came into being during a time of great quackery in medicine. During the latter years of the 19th century, all sorts of snake oil was being passed off as healthful and medicinal. Most of it was harmless, some of it contained opiates and other narcotics, and some was actually downright lethal (eg, potions containing radium.)

It cannot be denied that after the establishment of licensing and regulation of both the medical and pharmaceutical industries, the overall standard of care improved, and the probability of a person being harmed by an incompetent “doctor” was greatly diminished.

So why do you believe that matters would be any different today? Just check your email client’s spam folder and check out the number of folks offering to help you lose weight, enlarge your *****, smuggle cash out of Nigeria, etc. The number of fraudsters is no less today than a hundred years ago, they’re just less harmful because of regulation. But can you imagine legitimizing these folks by allowing them to perform surgery or prescribe drugs?

You’ve already stated that one of the functions of the government is to protect the safety and security of its citizens. In fact, you seem to consider that to be one of the only and primary functions of government. Given that, I can’t understand why you seem to be proposing that “the government” abandon that role in this specific regard.

I, for one, vastly prefer to know that whatever the circumstances, I may visit any any clinic in the US (or pretty much any other country) and know that the doctor who will be treating me has been certified to meet a minimum standard of competence. When I’m injured and being rushed to the hospital in the back of an ambulance, I don’t exactly have time to whip out my phone and start checking online reviews. I also don't think it's reasonable to expect my 92 year old step-grandmother to buy a computer and learn how to use Angie's List just so she can be reasonably certain that whichever specialist she has been referred to on any given day has gotten good reviews.

Last edited by Joe Perez; 08-04-2012 at 02:34 AM. Reason: Grammarama
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Old 08-04-2012, 01:09 AM   #74
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As an FYI, I am heading out on a three-week roadtrip tomorrow morning, and I'm gong to be sort of off-the-grid. So if I don't respond to some specific false statement for a few days, don't read it as a sign of acquiescence, I'm probably just nowhere near an internet connection.
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Old 08-09-2012, 10:18 AM   #75
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Very interesting, but very long read about a pretty interesting case study on the cost of healthcare. It focuses on McAllen County in Texas, a state with some of the toughest tort reform on the books. They look at McAllen versus El Paso, which shares very similar demographics but much lower cost of care.

In fact, medical spending per person in McAllen outpaces the average income per person.
The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles.

They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits.

The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Read more McAllen, Texas and the high cost of health care : The New Yorker
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Old 08-09-2012, 10:22 AM   #76
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Originally Posted by Scrappy Jack View Post
The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

It's probably a good thing, then, there's a medicine shortage in the US...problem solved.
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Old 08-09-2012, 11:24 AM   #77
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Originally Posted by Joe Perez View Post


Since everybody, including Jason (especially Jason?) missed the point of this thread, here it is in convenient Reader's Digest formay:

The reason I got this check was because my insurance company (Anthem) violated the 80/20 rule (aka, the Medical Loss Ratio rule) in 2011. Put simply, this is a provision of the Affordable Heathcare Act which requires that a private insurance company must spend at least 80% of all premium revenues on actual healthcare, and may spend no more than 20% of it on administrative costs, salaries, profits, etc. If it exceeds this ratio, the balance in excess must be refunded. So, since Anthem only spent 79.99% of its revenues on healthcare, it had to refund 0.01% of revenues back to its policyholders.

Now, this is a stupid idea, and the reason why has nothing to do with the administrative cost of mailing out eighty-four cent checks.
My insurance company sent me a letter saying that they didnt need to pay me, wasting time and money telling me things I dont care to know. eff the ACA.
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Old 08-21-2012, 01:51 PM   #78
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Scrappy, what that article misses as an important contributing cause of the high medical usage in McAllen is the decoupling of cost from the consumer. They are spending other people's money. This phenomenon is addressed in this article:
How American Health Care Killed My Father - David Goldhill - The Atlantic

If the consumers/patients had a yearly deductible (in say, an HSA) and a participatory % in the bill (even a sliding scale, say 10%, decreasing to 1% as the bill climbs) then they would be more sensitive to costs and would do more research or get more opinions before consenting to pricey procedures.

The author blames "profit seeking", but doesn't realize that part of the free market is that consumers have to vote with their wallets.
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Old 08-21-2012, 01:56 PM   #79
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Joe,

My turn to go on a 2 week trip

Here's my response.

Journalism is high quality when not related to anything political. For example, sports journalism, or CNET reviews of plasma TVs. It's usually stuff that's politically charged that has poor or biased coverage. Why do you think that's so?

One article, by a journalist, claims that journalists who cover politics are dependent on gov't sources. If they start being harsh or critical of gov't, they lose their news sources.

Re: FDA - here's a good article on how and why privatization of drug testing and certification could work. Note: The gov't "privatizing" and choosing one company is not "free market" - there needs to be competition, and the customers have to be able to vote with their wallets:

Replace Fda Regulation Of Medical Devices With Third-Party Certification
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Old 08-21-2012, 03:04 PM   #80
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Originally Posted by JasonC SBB View Post
Scrappy, what that article misses as an important contributing cause of the high medical usage in McAllen is the decoupling of cost from the consumer.
That is not an accurate description. It's a long article so I understand if you overlooked the relevant sections. Also, they were lightly touched upon. Here are two examples:
Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care.

[...]

The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies: “They’d have more of their own money on the line, and that’d drive them to bargain with you and other surgeons, right?”

He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
I will admit that is a grossly oversimplified dismissal, but so is saying that a person who just had a heart attack or a major car accident is in a position to price shop what hospital they want to be taken to for emergency care.


Quote:
The author blames "profit seeking", but doesn't realize that part of the free market is that consumers have to vote with their wallets.
I would love to see more price discovery and consumer accountability in medicine, particularly primary care, but I have not heard any compelling discussion on how this would work with emergency care.

Last edited by Scrappy Jack; 08-21-2012 at 03:11 PM. Reason: Fixed indent tag
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