Again, the 45% comes from a sample of NINE people. Are you getting it yet?

This is very true. However, the simple reality is that there are many people who cannot afford the American healthcare system as it stands not because they are cheapskates, but because the prices (out-of-pocket costs OR insurance premiums) are too high for them. As I said earlier, I don’t believe this to be the physicians’ fault, or a social ill for which they should pay. But it IS a social ill nonetheless. The status quo has been terrible for both physicians and patients, and that is because the insurance industry and government have a captive market in the American people. Insurance companies, HMOs and government (through medicare/aid regulations) have been dictating to doctors how to do their jobs, and doctors toe the line because, let’s face it, if the HMOs and insurers left the market, there will not be enough out-of-pocket payers to keep the system going at anything close to its current level. Patients are left with no choice but to pay what the insurers set (if they can’t get on medicare/aid) because it’s not like they have access to some other healthcare system.

If insurers were forced to compete with both domestic (cross-border) and international players, they would finally get the poke from the Invisible Hand they need to streamline their activity and offer more varied products.

Unfortunately for those who seek medical care, they cannot simply stop being sick, or change countries if they cannot afford the healthcare. This is obviously not the doctors’ fault or problem, but it is a serious one nonetheless, and the crux of this impasse, in my opinion.

The health insurance business grew in America to address a simple market problem: People couldn’t afford catastrophic medical care out-of-pocket. Doctors (rightfully) charge enough to earn a living, pay off their student debts, and make whatever premium the market allows on their skills. Pharma companies (rightfully) charge enough to recoup R&D costs, run their business, post a profit, and all before patents run out. Citizens (rightfully) pay what they can afford.

One problem that arises from this, however, is that physician and patient are now separated by insurer. Whatever savings the insurer gets by negotiating collective care with the provider need not be passed on to the subscriber. On the physician’s side, since most of their business comes from the insurance companies and medicare/medicaid, they are increasingly constrained to provide the care of which these middlemen approve.

The difference is that while the doctors can vote with their feet, the citizens cannot.

When insurance costs got too high and payouts too low, Americans began trooping to Canada to get drugs. Well, that’s illegal. But that’s really the citizen’s only equivalent of leaving the American health system, along with health tourism.

The US Government feels it can dictate to the healthcare providers because it has created a captive market for them: the US public.

I believe there should be freedom for both the citizen and the doctor. Let the docs charge what they want; let the insurers offer whatever plans they want. Open up a national market for insurance. Once this is done, I am in support of a “public option” that works in the following ways:

-waivers for those who cannot be insured in America to import whatever drugs they need. If you apply for a waiver, you are forced to get on the Insurance Market. If no insurer will take you, you get your waiver (with expiry date).

-opening the US market to international insurers offering health tourism options. This will reduce pressure on both the US insurers and the public. If people can “opt out” of certain procedures in their domestic coverage and get these covered by the health tourism option, it will make their profiles more palatable to the domestic insurer, and that may lead to net lower premiums. If doctors can leave America, and manufacturing jobs can cross the border, why can’t patients outshore their insurance?

Type “A” doctors are going to be happy having a government-type job: they’ll do their 9-5, M-F, and they will be happy not having to make life and death decisions, because – hey – those things are already made for them by the government. They won’t feel any stress about whether they’re doing the right or the wrong thing, because “it’s just a job”.

Type “B” doctors are the ones who will move out of country, or quit, or do something else. Or go to a no-insurance-accepted system. And those are the doctors *I* want to go to (I’ll let you all have all the type “A” doctors you want – I’ve seen them in action).

Those who haven’t decided their career will look at the tradeoffs, and not go into medicine. Over time, all the dynamic people who made US medicine the leader in the world will just not be there.

Personally, I expect Obamacare to pass, and two things to happen:
a) non-insurance practices pop up.
b) some bright Mexican billionaire will build a “hospical-city” near the Copper Canyon (for people who need/like dry air and the desert), and another near Cancun. Labor is cheap in Mexico, both for building the hospitals and the general staff. American docs could go down there and live like kings comparatively speaking, and the good ones would.

Before you express an opinion on what doctors think, how about actually asking a couple of them?

Now, if you feel that they should provide their services for near-free, don’t bother – you’re living in your illusions.

Over the last 15 years I’ve had one accident which was my companys fault. A fender bender which did $75 damage in parts to my truck. I got sued for $250,000 and my insurance carrier paid it without an investigation. No ambulance at the scene. She stated she had a trick hip. Her over paid lawyer probably received $80,000 for his time.

I cant even imagine what a doctor has to tread through to earn a buck.

We need lawyer reform. Lets start here. Make tort reform the # 1 agenda we want.

Oh, by the way all of you libtards, we all go to work to make a living and earn for our families. The doctors are not the ones who need to be scolded, it is the lawyers. Plain and simple.

In my business the fear of being sued or dealing with the court system is non stop. A person who wants to bring suit over a piece of 2″ bark being knocked off her tree by a worker who was carrying a 2 x 4. The court listens and allows damages, just so the plantiffs lawyer will get paid. The judge and the lawyer probably play golf together on the weekend.

If I were a doctor I would change my business plan. Treat only the wealthy. Cash payment when seen. You want treatment, I will see you tommorow.
If you think that waiting lines for care are not coming you are truely a LIBTARD.

The “Executive Summary” is this: Don’t expect notions about someone’s vocation to “cure and heal” to fill the huge expanse occupied by modern medicine, in this world. Don’t expect that the notion of artificially restricting the Healthcare segment of the economy, will allow for the same rate of technological advancement in Healthcare. Don’t expect that this notion of artificially restricting the Healthcare segment will provide for the same or better healthcare, delivered in a timely manner, in hygienic, safe, well-maintained facilities, with ready access.

1. “Curing” and “healing” are the functions of miracle workers, not health care providers. Physicians, nurses, health technicians work within the real world and the real world economy to ameliorate the effects of disease, injury and aging. Health care providers can only use their training, talents, efforts, along with the resources they have at hand. The resources are the technology, materials, diagnostic discoveries provided step by step by ongoing research, engineering, technological advance and production/manufacturing within the economy in which the health care system operates. In this current age of medicine, it is this technology and its surging momentum, that represents a large part of the increase in health care costs. Who is going to tell the engineers, technicians, production workers, mechanics, assemblers and other workers at Westinghouse, GE, Siemens, etc, that their segment of the economy has suddenly, arbitrarily, even capriciously been isolated from the rest of the economic activity and scheduled for wage and price controls? Who will ensure, and how will it be ensured, that the technological momentum and productivity will be maintained while arbitrarily being price-controlled, and thus deprived of natural compensation for the goods that are brought to the community as a whole?

2. And what are the goods delivered to the marketplace? The needs, and demand met? The largest part of the increase in needs and demand is for more health care for the aging population. 300 years ago, 40-45 was aged. Check the average age at death statistics, even for the wealthy, 300 years ago, and compare it to the statistics of today. That aging population, by the way, includes the aging workforce. Today, people at this age are mid career. For labor involving significant physical exertion, 40-45 is definitely aged. That workforce,n order to keep working, requires treatment, including surgery, for a variety of combined age and injury-related conditions New techniques and technology have made this treatment available, more effective and with more rapid recoveries, and this new Healthcare capacity is being used, in a big way. Is this new capacity supposed to come at no new cost? How!?

3. The workforce ages not just because people live longer, but also because some people live more actively, and because the time devoted to professional and technological training and education and necessary experience increases as technology moves forward and related economic activity increases. The more highly trained, skilled, experienced workers, as they move through their career, must have medical care for certain age-related, inherited conditions. Besides providing for reasonable comfort and satisfaction in life, the care must be delivered in an effective enough manner to help the person to continue working, being productive for themselves, their families and their communities. These workers also play other roles in the community, in sports, recreation, the arts, politics. They have maladies that interfere with these roles. All these maladies continue to demand amelioration – ie. “Healthcare”. This “HealthCare” also involves the application of new techniques, technologies, materials, at increased cost. Or, if not at increased costs, how!?

4. Comments have been made here, repeatedly, implying that a physician or other health care professional, technician or worker should train and work to simply or even mainly to “cure and heal”. Where they have implied no need for attention to just compensation, these comments are devoid of any ethical or practical weight. Such a comment can only reasonably be directed to individuals with a strictly religious vocation, such as priests, monks, nuns and sages on the mountain top. Physicians, nurses, health care providers, healthcare workers of every stripe live in the material world. They have ethical, moral obligations to their own health and well being, to their immediate and extended families, and to their community. This obliges them to bring other talents to the table of humanity, including the table of social commentary and political debate. Physicians and other healthcare providers who don’t do so in at least some way risk becoming less able to even see the reasonable goals of treatment for their patients. Beware of those medical care givers who don’t participate, who don’t reasonably consider their own well-being and the well being of their loved ones. So removed from the experience of the average citizen, such a caregiver may drift into an egomania or other distance from reality. Even with good intentions, this distancing can move medical caregiving and medical decision-making in a dark and damaging direction. Even such a caregiver’s input into the associated political arena of healthcare planning can become darkly affected – it has happened before.

5. Imagine, as a high school student, presenting a lender or risk-bearer with a business plan for a medical career. How might it be funded? As we all know, without substantial family wealth, the debt incurred for a highly competent course of college-level and professional education and training runs into the hundreds of thousands of dollars. This reality, along with physical and mental skill requirements, is part of the “Barrier to the Market”. At any time during this course, disease or injury could eliminate or deeply impair the ability to repay this debt. By the time the individual makes it into medical practice, he or she has worked innumerable hours, including overtime and double time hours at no wage or a wage far below any legal minimum wage. The individual now has debt repayment requirements on top of having deferred years of earnings into taxation at one of the highest tax rates. A growing family is probably also part of the financial, physical and emoitional load in this picture. This doctor must be able to work effectively enough and long enough to at least repay the debt in this scenario. This is not an attractive business plan for a lender. By the way, subsidizing this education and training with taxpayer dollars doesn’t eliminate the cost, it just shifts the cost, and eliminates some important incentives.

This reality is why the posts above regarding medicine as a “good job” in this economy, represent a totally inadequate analysis of the physician’s reality. This is also why many physicians in primary care, at mid-career have less net worth than, for instance, a firefighter, or a skilled laborer ( such as a skilled welder) at the same age. Surgeons do better, sometimes, much better. Not many surgeons drive a Rolls Royce, but many surgeons do drive a BMW, a Lexus or an Acura. I also know plenty of x-ray technicians, or other health care technicians, who drive a BMW. a Lexus or an Acura.

And again, a surgeon’s training and skill is anywhere from substantial to truly remarkable. I have worked with professional athletes, musicians, fighter pilots, other professionals with substantial skills, so I have some basis for comparison. As other posters here have noted, who do you want working on you?

The best physician or nurse is one who is skilled and focuses on resources, the circumstances at hand, and an understanding of limitations,. Focus, skills upkeep, knowledge and skills in new technology, are all strongly aided by a decent personal financial situation – a financial situation that hopefully provides a reasonable road to meeting family financial needs, and can also cover retirement or disability retirement needs that may arise. In this regard, the intention to “cure and heal” alone doesn’t cut it.

5. What are the relative economic values of a skilled attorney, a highly skilled and trained athlete or an entertainer? How does one compare this to the value of a highly skilled and trained surgeon – with a modern, well maintained office, excellent, well-trained and adequately paid office staff and operating room staff and modern, safe, hygienic facilities?. What is the value of high technology electronic entertainment equipment and recreational equipment, compared to the application of high technology medical equipment? Why is there suddenly an advantage to taking the valuation of medical services and resources out of the marketplace of other goods, services and ideas that we value highly?

Again: Don’t expect notions about someone’s vocation to “cure and heal” to fill the huge expanse occupied by modern medicine, in this world. Don’t expect that the notion of artificially restricting the Healthcare segment of the economy, will allow for the same rate of technological advancement in Healthcare. Don’t expect that this notion of artificially restricting the Healthcare segment will provide for the same or better healthcare, delivered in a timely manner, in hygienic, safe, well-maintained facilities, with ready access.