Answer me this one question

[Jarid in Cedar]

So the administration who says they won't get involved in rationing is lying?

Is a politicians mouth moving?

[doctorcoug]

Robin:

1) the AMA doesn't cap the number of doctors, since they have no control over the AOA. To be price fixing they would have to collude with each other. At the rate of AOA accredited schools opening up, I can promise you there is no discussion between the two bodies.

2) nurses do lots and lots of procedures. In fact, they do a heck of a lot more procedures than I do. Nurses place casts, give injections, start IVs, put in foleys, do wound management. These are all things that I know how to do, but I work at the top of my license and they work at the top of theirs.

[RobinFinderson]

Robin:

1) the AMA doesn't cap the number of doctors, since they have no control over the AOA. To be price fixing they would have to collude with each other. At the rate of AOA accredited schools opening up, I can promise you there is no discussion between the two bodies.

2) nurses do lots and lots of procedures. In fact, they do a heck of a lot more procedures than I do. Nurses place casts, give injections, start IVs, put in foleys, do wound management. These are all things that I know how to do, but I work at the top of my license and they work at the top of theirs.

I'm just pointing to what I have read a long time ago. I will refer to Wikipedia on the AMAfor now, since I have no idea where I read/heard this info in the first place:

Profession and monopoly, a book published in 1975 is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States. The book claims that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals. It points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA's influence on hospital regulation was also criticized in the book.

Regarding nurses, of course they perform many procedures, but they do so under the direction and supervision of a medical doctor, even if all that really means in most situations is that a doctor looks at a chart and collects a fee. If you want to control medical costs we need doctors to collect fewer fees for fewer services that they don't actually perform, but for which the AMA has lobbied what amounts to required kickbacks for services performed by nurses and PA's.

[New Mexican Disaster]

how will universal healthcare for everyone reduce healthcare costs? It's estimated it will cost $1 Trillion over 10 years but will be paid for by cost savings. How?

By tamping down healthcare inflation that is running at over 10 percent a year as opposed to regular inflation which is running at a rate more like 2%.

Of course there will have to be rationing and all interested groups would have to give up something for reform to be effective.

[doctorcoug]

I'm just pointing to what I have read a long time ago. I will refer to Wikipedia on the AMAfor now, since I have no idea where I read/heard this info in the first place:



Regarding nurses, of course they perform many procedures, but they do so under the direction and supervision of a medical doctor, even if all that really means in most situations is that a doctor looks at a chart and collects a fee. If you want to control medical costs we need doctors to collect fewer fees for fewer services that they don't actually perform, but for which the AMA has lobbied what amounts to required kickbacks for services performed by nurses and PA's.

Robin:

You are partly wrong about the AMA. DO physicians are set to be about 20% of the graduating physicians in 2020. The AMA has absolutely no control over that. The AMA, however, may have some finger on allopathic medical schools, though I don't know to what extent.

Also, you are wrong about nurses. I don't get paid when a nurse places a foley, a flexi-seal, or gives an injection in the hospital. When a nurse places a cast in the ER, the doctor makes no extra dollar.

I'm interested in seeing what procedures you think they should do that a physician shouldn't do. I'm really having a difficult time thinking of something that is done often enough to actually make a dent to our healthcare costs. It sounds more like a talking point.

Circs? I'd never allow a nurse to do that.

Knee injections? Nope.

Vaginal deliveries? most of the time, any old joe on the street could do it. However, for those 0.1% of the time, you better be darn glad that a physician is in the room.

Cryotherapy for skin lesions? This one I might be able to understand. However, diagnosis still needs to be made by a physician.

Colposcopy? Nope, this is a skill that requires a lot of experience.

Pap smear? Sure, I could see this procedure.

Suturing? Maybe. The skill is not that challenging to acquire, just as long as they understand the risks.

I'm trying to look at the most common stuff. I'm not seeing how a nurse performing common procedures that they can do with their training could make a dent. There just isn't too much they can do.

[doctorcoug]

By tamping down healthcare inflation that is running at over 10 percent a year as opposed to regular inflation which is running at a rate more like 2%.

Of course there will have to be rationing and all interested groups would have to give up something for reform to be effective.

Two reasons for the inflation:

Defensive Medicine
CT imaging at all hospitals

[Hallelujah]

By tamping down healthcare inflation that is running at over 10 percent a year as opposed to regular inflation which is running at a rate more like 2%.

Of course there will have to be rationing and all interested groups would have to give up something for reform to be effective.

And therein lies the problem. Why would the 85% who are getting healthcare through insurance want to give up anything?

Then the administration has to be honest with the public and say 'yes, we will all have to sacrifice and it will involve rationing on our part'. How do you think that will fly?

[Hallelujah]

Robin:

You are partly wrong about the AMA. DO physicians are set to be about 20% of the graduating physicians in 2020. The AMA has absolutely no control over that. The AMA, however, may have some finger on allopathic medical schools, though I don't know to what extent.

Also, you are wrong about nurses. I don't get paid when a nurse places a foley, a flexi-seal, or gives an injection in the hospital. When a nurse places a cast in the ER, the doctor makes no extra dollar.

I'm interested in seeing what procedures you think they should do that a physician shouldn't do. I'm really having a difficult time thinking of something that is done often enough to actually make a dent to our healthcare costs. It sounds more like a talking point.

Circs? I'd never allow a nurse to do that.

Knee injections? Nope.

Vaginal deliveries? most of the time, any old joe on the street could do it. However, for those 0.1% of the time, you better be darn glad that a physician is in the room.

Cryotherapy for skin lesions? This one I might be able to understand. However, diagnosis still needs to be made by a physician.

Colposcopy? Nope, this is a skill that requires a lot of experience.

Pap smear? Sure, I could see this procedure.

Suturing? Maybe. The skill is not that challenging to acquire, just as long as they understand the risks.

I'm trying to look at the most common stuff. I'm not seeing how a nurse performing common procedures that they can do with their training could make a dent. There just isn't too much they can do.

Robin's just regurgitating what he has heard or thinking of a solution from an academic point of view. Thanks for pointing out reality from a doc's point of view. Perhaps Robin believes Obama when he says a doctor gets paid thousands for amputations. That's the problem. Dr. Obama is a fraud and knows nothing about medicine except what his liberal advisors have fed into his brain.

BTW, you mention a solution to the physician shortage. More DO's. I know they are very common in the midwest. Not so much in the west or east coasts.

[Hallelujah]

Two reasons for the inflation:

Defensive Medicine
CT imaging at all hospitals

Absolutely correct on defensive medicine. Thus we need tort reform. Every hospital has to have an MRI, CT, etc. to be competitive and entice docs to come practice there.

[New Mexican Disaster]

And therein lies the problem. Why would the 85% who are getting healthcare through insurance want to give up anything?

Then the administration has to be honest with the public and say 'yes, we will all have to sacrifice and it will involve rationing on our part'. How do you think that will fly?

Because their employers will give it up for them due to rising costs or they will take home less pay to keep up with rising insurance premiums or they will get rationed by the fact that their insurance company will only pay for certain procedures.

This is at the heart of the problem. The annual increases that the 85% with insurance pay dwarf inflation and productivity gains in other sectors of the economy and having basic healthcare takes an ever increasing piece of the pie. this is in no small part due to the fact that 15% are uninsured and frequently do not pay anything at all and pass those costs on to everyone else.

[New Mexican Disaster]

Two reasons for the inflation:

Defensive Medicine
CT imaging at all hospitals

Yes..and...

Fee for service payment structure

Huge administrative costs

High salaries for medical personnel

Lack of preventive care leading to overuse of Emergency rooms

Persons who pay nothing for the care

Lack of price transparency for procedures

etc.

[Hallelujah]

Because their employers will give it up for them due to rising costs or they will take home less pay to keep up with rising insurance premiums or they will get rationed by the fact that their insurance company will only pay for certain procedures.

And you honestly believe that will improve with the government running the healthcare industry? I don't. They screw up everything they touch. Talk about administrative overhead!

[Mormon Red Death]

How about eliminating doctor shortages by allowing nurses to perform more simple procedures and by preventing the AMA from capping medical school enrollment? Some free market. You have a bunch of doctors with a very strong lobby who prevent nurses from doing simple procedures without some doctor getting a cut of the action, and they limit the number of people who can enter the profession, creating artificial shortages that maximize their earning potential. Sheesh, as a free-marketeer I would think this stuff would drive you nuts.

Robin Nurse Practicioners and PAs already do this.

[New Mexican Disaster]

And you honestly believe that will improve with the government running the healthcare industry? I don't. They screw up everything they touch. Talk about administrative overhead!

Is our government worse than the governments of the countries that already do this? Their administrative costs are dramatically lower than ours, they spend less on healthcare as a percentage of GDP, their expenditures grow at a lesser rate than ours do, and they generally have better outcomes, at least in terms of life expectancy.

It is hard to argue that our system is not a system that could use drastic reforms.

[Jarid in Cedar]

Because their employers will give it up for them due to rising costs or they will take home less pay to keep up with rising insurance premiums or they will get rationed by the fact that their insurance company will only pay for certain procedures.

This is at the heart of the problem. The annual increases that the 85% with insurance pay dwarf inflation and productivity gains in other sectors of the economy and having basic healthcare takes an ever increasing piece of the pie. this is in no small part due to the fact that 15% are uninsured and frequently do not pay anything at all and pass those costs on to everyone else.

This is the fact that the private solution camp does not want to discuss. In fact, I would guess anyone who does not run a business that offers medical insurance to their employees understands the impact this has on most business models. We offer a modest plan with a $1000 deduct, 20% co-insurance and medication plan. Our costs have increased 100% over 5 years. My policy on the plan has gone from $550/month to around $1300/month in 4 years. These type of increases are unsustainable and if they continue, I would guess we will drop the benefit in the next 2-4 years, adding another 20 families to the uninsured roles.

Exie, I challenge you to offer up a private model that solves that problem. When you can, you can keep railing on a public model. Until then, stop