Yes, there is something to encourage supply, but it will be swamped by the need to restrain costs and therefore payments to providers—some people will get through med school/internship/residency or nursing programs with less debt than now, but their earning potential will also be far less.

If the law doesn’t prohibit it, some will “go rogue” and provide care outside the govt system, but the market for that will be small (in part because high taxes to pay for all this scheiss will make it hard for people to save enough to afford such care) and most providers and patients will just be stuck.

Again, don’t concentrate on the trees, concentrate on the forest. Total societal cost will soar, supply will be pinched, and the govt will become (even more than it already is) a pension and health care provider, with a few other, fiscally minor functions like defense, regulation, justice and parks. All the rest of these bills is just kicking dirt in the CBO’s and your eyes.

Much like the joke about Ford or GM a few years back, when they noticed employee and retiree benefits were their biggest expense items: a health care plan that also made cars.

THE HILL: Hoffman “Unconcedes” in NY-23. It’s getting close as they count the votes….: THE HILL: Hoffman… http://bit.ly/3RJ0Je
7 minutes ago from twitterfeed

I’m not disputing the insanity of the bill, just pointing out that if anyone can come into the ER, then anything can come into the ER and there’s no telling what something that appears simple by description will turn out to be. Like I said, $1000 for an ER visit is close to the lowest charge I have heard. It’s crazy, but it’s also how things are. I’m all for changing that, but then again, I’m only the one guy.

Norm, sounds to me like you are just starting your transformation from “conservative” to “radicalized ex-conservative.” The term “radicalized conservative” is an oxymoron. I’d bet that back when you were a “conservative”, you were too busy working your tail off to acquire the wherewithal to provide necessities and a very few luxuries for your dependents, playing by the rules, paying your own way, and generally living a quiet and peaceful life. Probably the only thing you wanted from The State was sufficient law enforcement and justice to deter the rapacious from plundering what you had worked so hard to acquire. That was essentially the Social Contract the Federal, State, County and Municipal Governments signed with the citizens: You pay your taxes, don’t cause problems, don’t make waves, and Government will protect your life, libery and pursuit of happiness.

Governments are reneging on that deal.

If Government is no longer bound by the Contract, why are you?

Run down this list of 198 Methods of Nonviolent Action. You will likely find most of them crap that only lefty activists would consider, but some of them you could really do.

“Nonviolent” does not necessarily equate to “legal”, but who still has the legitimacy to differentiate the “legal” from the “illegal”?

If they had looked at me and said “We will charge you $200 to have an Intern (he may have been a Resident or a 4th year Med Student, one never knows) look at it, or you can go to the Municipal, which is it?” I would have said “Fine, go ahead” and paid for my folly. If I needed a stitch they could have looked at me and said, “A stitch will cost you $100. Do you want us to do it or will you go elsewhere? You’ll live so either is medically OK.” That would be OK also. By not giving up front pricing information and then quoting a price they knew they wouldn’t collect they were making me a party to their perpetration of fraud against the Medicare system.

…lost in the fact that THEY have to PAY FORTY DOLLARS.

I broke my left arm in a fall this past March. ER visit, surgery, and about 30 hours in the hospital afterward came to a total bill of $45,000, of which Humana paid $11,500, I paid $2000 and the hospital wrote off the rest. Medical billing is Kabuki theater of the worst kind. Your bill is outrageous because higher write-offs likely benefit the hospital in some way, the insurance companies can say to their insured “We got you a 65% discount!” and the hospital folks can say “We wanted X, so we set our charges at 3X and negotiated back to X. Mission Accomplished!” A person who intends to pay cash is not a part of the equation. They will likely write off your bill eventually, though they have to make an effort to collect because if they don’t then they can be prosecuted for Medicare fraud — they cannot bill anyone less than they bill Medicaid.

My radiology practice would do just as well to charge $40 cash for any procedure, from finger films to angiography. Patients are frequently insulated from the BS that is medical billing, and so they don’t care. The idea that paying $40 is a better deal than they or their insurance company would get otherwise is lost in the fact tha

This is all true but it does not take into account one of the major distortions in the pricing system that we face. The cash prices assigned to people who do not assign their bills to a 3rd party are simply divorced from the actual value of the services rendered. A few months ago I shared with the Club how I went to a local ER for a cut finger, that turned out to look bad but only needed Bacitracin™ and a bandage. Unlike most people who walk in uninsured I honestly showed my ID. The result is a bill for $1,100 that may sit out there until I take a dirt nap.

If you walk into a restaurant and they don’t show you a menu before you ask a cup of coffee but then hand you a bill for a thousand dollars people would say “No way.” That doesn’t happen anywhere in America anymore outside of a hospital. Even the hotel minibar has a price list warning you before you drink the bottled water. You hear stories like that from people who ate the peanuts in a bar in Japan.

The problem isn’t with the physicians but with the regulated administrators. There should be standard costs for common services published by region and any deviation from those fees should be prominently advertised before any services are rendered. We need more daylight on the costs being charged. That is the opposite of a controlled government system that increases the distances between consumers, practitioners and payers.

Blogged under the title “The Peanut Bar”

It is optimistic to believe that the truly terminal will be allowed in hospitals once their diagnosis is made. The NHS is all about declaring people ‘terminal’ and then withdrawing money, I mean, care. The name of the protocol, the Liverpool Care Pathway, tells you that this is the product of “comparative effectiveness research”, intended to broadcast best practices and see that they are implemented. Things like the Liverpool Care Pathway are a feature, not a bug, and we may well see the LCP be among the first things to be adopted, once the research behind it can be duplicated by a US provider. It may be called the ‘Livermore Compassion Plan’, but the function will be the same. And you are absolutely correct about people still voting for FDR. Shortly before he passed away in 2003, my wife’s arch-conservative grandfather announced that he was not going to vote straight-ticket Democrat any more, he was going to vote for the candidate he liked better. He also didn’t believe that Al Gore was pro-choice in 2000, so I’m not sure that was a particular advance for him.

1. Increase the number of medical schools and expand the number of graduates. This can still be done without diluting the quality. — Batman

This assumes that medicine remains an optimal choice for the best students. I would argue that the loss of autonomy implied by state imposition will decrease the applicant pool, at least the quality of the applicant pool, by some margin. And when you increase the number of positions you increase the number of people in medical school who otherwise wouldn’t have been in medical school. You will pick up a few folks who were inappropriately overlooked by the admissions process, and collect up a bunch of people who for various reasons shouldn’t be in medical school. Both of these forces will act to decrease quality. Not only that, but people with MD degrees are dangerous until they can be further trained, so you have to increase the number of residency and fellowship training positions as well. Both this and the construction of new medical schools come at significant cost, and academic physicians are already in fairly short supply — to have more students you need more teachers, and those are also hard to come by.

Everything else you say is spot-on, especially this: “The very fact that women can ramp down or up on their hours during their “mommy” years makes it extremely attractive for female physicians. But that also reduces, perhaps by as much as 30%, the total patient hours they work during their career.” Absolutely true, and the glaring hole in physician supply for the last ten or more years. In terms of FTEs, a class of 200 that is 80/20 male-female works out to 188 FTEs, a class that is 55/45 female-male works out to 167 FTEs. Our training system is no less expensive, but now measurably less efficient. The medical schools are awarding degrees, but the number of providers is lower. Increasing medical school classes will only increase the number of medical school graduates, the downstream effect on the number of medical providers that are active will be lower than expected and most medical schools can’t handle a 30% increase in student volume.

But we do have differential premiums for life insurance; why not for medical care insurance? — Jim Nicholas

There should be, but making it harder for unhealthy people to get insurance means they are less likely to get insurance — and they will continue to become less healthy, making their impact on the system much greater when they finally present for treatment. Quite frankly, risk pools depend on people who are healthy to subsidize the unhealthy, risk pools need people to pay for insurance and then never use it. Risk pools are unaffected by people who are unhealthy and don’t have insurance, but providers tend to get hit disproportionately by the resultant costs of the uninsured.

The glaring strategic error in any national health care system is first-dollar coverage. When there is no penalty, some people will overuse the system. There are some patients well-known to me simply because they are ER Frequent Fliers, when their name pops up on the PACS I recognize them even if I do not see them face to face. When people have to pay cash up front, they show up when they are sick. A regular health maintenance visit with a PCP should be covered up to every six months, but everything after that should come with a cost.

Phil Gramm said it best: “If I only paid 5% of my grocery bill, I would eat differently and my dog would, too.”

More dollars chasing around existing health services can only mean prices will rise. — Cowboy.

This presupposes the ability to balance bill, or charge more than a health insurance plan provides. In 1986, the province of Ontario passed the Balance Billing Act, and eliminated the right of physicians to set their own fees AND accept payment from OHIP, the single-payer provincial health system. Physicians could opt-out of OHIP, but OHIP (the only insurance anyone in the province had) would not pay them a dime. Their patients would have to pay the full physician fee.

There is a similar opt-out for Medicare, but opting-out for even one patient means you cannot accept Medicare payment for ANY patient for a two-year period. Balance billing is required for prices to rise, but Medicare pretty much disallows it and opting-out is a fairly drastic step, many seniors have no health insurance other than Medicare.

Basically, it’s even worse than you think it is.