(10-07-2014 09:46 AM)Owl 69/70/75 Wrote:  

(10-07-2014 09:24 AM)Redwingtom Wrote:  I don't believe was purposeful deceitful.

I do.

Of course it was, the man is a politician, isn't he?

(10-07-2014 09:46 AM)Owl 69/70/75 Wrote:  

(10-07-2014 09:24 AM)Redwingtom Wrote:  I don't believe was purposeful deceitful.

I do.

How could it not be when NOTHING in the plan addresses QUANTITY of care?

How can you 'keep your doctor' when he has 20% more demand on his time and we've already argued for decades (Obama himself argued this) that we don't have enough doctors? How can you base all of your expectations of 'success' on delivering MORE primary care if you don't take one single action to CREATE more primary care.

This isn't a matter of opinion, it's a matter of logic. Not just Obama but every single Democrat who supported the ACA and every single contributing analyst and pundit... are you telling me that DESPITE the fact that the right (and doctors groups) was screaming this in their ears, not ONE of them considered that adding 40mm new people without adding more physicians might be a problem? That cutting reimbursement might lead to greater, not fewer problems? That's disingenuous. These complaints were out there from day one... EVEN the CBO told them it was a problem before he was elected, and they intentionally chose to do nothing about it.

(10-07-2014 11:24 AM)Hambone10 Wrote:  

(10-07-2014 09:46 AM)Owl 69/70/75 Wrote:  

(10-07-2014 09:24 AM)Redwingtom Wrote:  I don't believe was purposeful deceitful.

I do.

How could it not be when NOTHING in the plan addresses QUANTITY of care?

How can you 'keep your doctor' when he has 20% more demand on his time and we've already argued for decades (Obama himself argued this) that we don't have enough doctors? How can you base all of your expectations of 'success' on delivering MORE primary care if you don't take one single action to CREATE more primary care.

This isn't a matter of opinion, it's a matter of logic. Not just Obama but every single Democrat who supported the ACA and every single contributing analyst and pundit... are you telling me that DESPITE the fact that the right (and doctors groups) was screaming this in their ears, not ONE of them considered that adding 40mm new people without adding more physicians might be a problem? That cutting reimbursement might lead to greater, not fewer problems? That's disingenuous. These complaints were out there from day one... EVEN the CBO told them it was a problem before he was elected, and they intentionally chose to do nothing about it.

And by reducing reimbursement which reduces physician pay leading to fewer of the best and brightest opting for a career in medicine

(10-07-2014 09:43 AM)Owl 69/70/75 Wrote:  

(10-07-2014 08:58 AM)BobL Wrote:  I dont think anyone ever argued we have some of the best doctors, surgeons and researchers in the world. The problem has always been cost and access.

Duh. Those things cost money. You have three choices--quality, access, cost. You can't emphasize all three at once, there are tradeoffs. Only if you're damned good can you even emphasize two. We have chosen to emphasize quality. Guess what, if you push quality, then cost and access suffer. What we need is some way to improve access and reduce costs without major sacrifices in quality. The Bismarcks do a better job of that than any other systemic approach. They are almost polar opposites from single-payer/single-provider, and share very little in common with Obamacare except for a few words--which Obamacare defines differently from , so only the words and not the ideas are reflected.

I'm guessing our government can't even do one right. That will be the legacy of Obamacare. We will sacrifice quality without improving cost or access. We will ultimately pay more to wait longer for worse health care. The laws of economics say no other result is possible.

Quote:I am going to paraphrase one argument.. "we already have the ER's these costs exist so reducing patients just reallocates these costs that hospitals have"....

That's how the system works. The system, by the way, that was foisted upon us by Medicare and Medicaid, and which the insurance companies agreed to follow because it was cheaper and easier to do so than to come up with a separate system. It's not the free market. That's the system we had before. This procedure would not exist without the government's regulatory sledge hammer.

Quote:This is silly. You are suggesting subsiding health care companies (Advocate, Humana, etc.) because the costs are already there. This is rewarding glut and inefficiency. Perhaps this would force them to become more efficient? Or perhaps they just shut the doors.

No, I'm not suggesting subsidizing anyone. I'm suggesting letting the free market work. That's something we haven't had in medicine in this country since about the 1960s. There are free market universal health systems--at least a lot freer than what we had before Obamacare, much less after. They are called Bismarck systems.

Quote:As I stated in another post in my area, there are currently 4 hospitals within a 10 mile radius with a 5th under construction. Personally I dont see how this is sustainable.

Your facts are insufficient to support your conclusion. Are they specialty hospitals or general purpose? How big are they? Where are they? 4 or 5 hospitals in a 10-mile radius might be overkill in Manhattan, KS. But probably not in Manhattan, NY. There are many areas that are woefully underserved. A freer market would inevitably allocate resources better and eliminate some of these problems. And didn't you start your post by sating that access was a problem? How does reducing the number of hospitals improve access?

What you need to do is take off your consumer blindfold and look at the problem equally from the producer/provider perspective. Lefists don't know how to do that.

The Bismark system requires that everyone be covered without condition, the insurance companies are non profit and costs are tightly regulated by the government.
Sounds familiar to me.

You say let the free market work...ok then, to me that means anyone can go see a doctor of their choice regardless of insurance as long as they pay. Have you ever tried to see a doctor(now mostly owned by those health care groups that own the hospitals) without an insurance card? It is next to impossible to see anyone even if they have a card on file. Try making an appt to see a dr and tell them you dont have insurance up front. They wont schedule an appt. Why is insurance mandatory to see a doctor? Why cant i just pay like a pay for all other services?

My area is 45 miles NW of Chicago, mostly suburban with some rural area. None of the 5 hospitals I referred to are specialty hospitals. Ill be happy to name them if you like.

(10-07-2014 11:45 AM)Brokeback Flamer Wrote:  
And by reducing reimbursement which reduces physician pay leading to fewer of the best and brightest opting for a career in medicine

Don't disagree at all... further logic... The only reason I don't talk about it is because it provides a convenient 'target' for them to ask you to 'prove it'.

Medical schools have been expanding (because unlike Democrats, THEY know it takes more Medical school graduates to create more doctors) but many of these have gone into research and supplements which pay well and don't require years of residency or malpractice insurance and can't practice medicine...

so while it is logical that they would be discouraged from applying, you can't show that they actually aren't.... because they remain capped out and/or we won't know for years where they will practice.

(10-07-2014 01:41 PM)BobL Wrote:  The Bismark system requires that everyone be covered without condition, the insurance companies are non profit and costs are tightly regulated by the government.
Sounds familiar to me.

Where? Doctors here still aren't required to treat you... even if you have insurance... only hospitals are.

Quote:Why is insurance mandatory to see a doctor? Why cant i just pay like a pay for all other services?

This isn't true.... It's just that you and people like you consider 'a promise to pay' as good as cash and it isn't. If you provided your doctor with a guarantee of funds and/or prepayment (assuming it covered everything they might need to do) then they would see you. Unfortunately, Insurance companies are the most common provider of such 'letters of guarantee.' When a physician agrees to see you, there are certain legal obligations that they take on not limited to the cost of an office visit.... so even prepaying for the visit often won't be enough. I can't tell you precisely what that amount is, but not many people do this... especially people who can't afford insurance, because that is all such a letter of guarantee is.

Quote:My area is 45 miles NW of Chicago, mostly suburban with some rural area. None of the 5 hospitals I referred to are specialty hospitals. Ill be happy to name them if you like.

7 hospitals have also closed in Chicago and others are being sold because they are losing money (like Our Lady of the Resurrection). It is entirely likely/probable that the reason they are building new hospitals has to do with changing regulations, aging of buildings and reacting to demographic changes (i.e. following the flight of the population) or also because it is cheaper to sell the older downtown property and build a new one in the burbs as opposed to trying to maintain the old one... and they need to save money because of Obamacare...

In other words, you're trying to show a link that you can't really prove... and even if it is in your area, your experience isn't evidence that Obamacare is working generally.

San Pablo DMC (just north of San Fran) is going to close and those patients will be routed to other hospitals that don't currently have the capacity for them. They might well build a new hospital or at least a new wing to accommodate the population, but because they are where THEY are and not where DMC was, nobody will be closer to care (because the other hospital was already there) but many will be further from care... and that costs lives.

Just as anecdotal as yours, though I can specifically point to demographic changes that are the specific result of Obamacare.... They are that DMC was somewhat like rural hospitals in that it was essentially set up around the model of providing hospital and clinic care to the uninsured... and they had just enough reimbursement from Medicaid and their insured to stay afloat... but now that these people have insurance, Kaiser (who only operates clinics and not emergency rooms) has 'recruited' these people.... so DMC still has the risk of the ER, but it doesn't have the clinic patients to offset their risk and keep the ER open.

(10-07-2014 02:11 PM)Hambone10 Wrote:  

(10-07-2014 01:41 PM)BobL Wrote:  The Bismark system requires that everyone be covered without condition, the insurance companies are non profit and costs are tightly regulated by the government.
Sounds familiar to me.

Where? Doctors here still aren't required to treat you... even if you have insurance... only hospitals are.

Quote:Why is insurance mandatory to see a doctor? Why cant i just pay like a pay for all other services?

This isn't true.... It's just that you and people like you consider 'a promise to pay' as good as cash and it isn't. If you provided your doctor with a guarantee of funds and/or prepayment (assuming it covered everything they might need to do) then they would see you. Unfortunately, Insurance companies are the most common provider of such 'letters of guarantee.' When a physician agrees to see you, there are certain legal obligations that they take on not limited to the cost of an office visit.... so even prepaying for the visit often won't be enough. I can't tell you precisely what that amount is, but not many people do this... especially people who can't afford insurance, because that is all such a letter of guarantee is.

Quote:My area is 45 miles NW of Chicago, mostly suburban with some rural area. None of the 5 hospitals I referred to are specialty hospitals. Ill be happy to name them if you like.

7 hospitals have also closed in Chicago and others are being sold because they are losing money (like Our Lady of the Resurrection). It is entirely likely/probable that the reason they are building new hospitals has to do with changing regulations, aging of buildings and reacting to demographic changes (i.e. following the flight of the population) or also because it is cheaper to sell the older downtown property and build a new one in the burbs as opposed to trying to maintain the old one... and they need to save money because of Obamacare...

In other words, you're trying to show a link that you can't really prove... and even if it is in your area, your experience isn't evidence that Obamacare is working generally.

San Pablo DMC (just north of San Fran) is going to close and those patients will be routed to other hospitals that don't currently have the capacity for them. They might well build a new hospital or at least a new wing to accommodate the population, but because they are where THEY are and not where DMC was, nobody will be closer to care (because the other hospital was already there) but many will be further from care... and that costs lives.

Just as anecdotal as yours, though I can specifically point to demographic changes that are the specific result of Obamacare.... They are that DMC was somewhat like rural hospitals in that it was essentially set up around the model of providing hospital and clinic care to the uninsured... and they had just enough reimbursement from Medicaid and their insured to stay afloat... but now that these people have insurance, Kaiser (who only operates clinics and not emergency rooms) has 'recruited' these people.... so DMC still has the risk of the ER, but it doesn't have the clinic patients to offset their risk and keep the ER open.

People like me?? WTF
Call it what you like the fact remains without insurance you will not get an appt. so therefore the folk who own these dr practices now also own the hospitals and are essentially saying we will treat you but only where it is 10x the cost.

The Bismark model requires everyone have insurance...that is point one in my book and always has been. You want a true open and free market in "health care" then everyone needs insurance.

My point about the hospitals in my area has nothing to do with Obamacare, I used it as an example of over saturation due to excessive competition among the health care corporations in my area that will result in even more costs passed along to us in the end. These healthcare corporations are trying to win "customers" by being more convenient, closer to home, and opening urgent cares everywhere. I maintain there are not enough "customers" in my area to sustain this thereby increasing costs. I also stated this has been going on long before ACA.

Ya you work in health care...I look at it from my point of view as the "customer".

FWIW My sister inlaw lived in Germany for 3 years, her hospital stay when her daughter was born(1994) was 2 weeks, that a normal pregnancy, no complications for baby or mom. The Bismark system was developed and still used in Germany. I'd be happy for it here, but then that would be another government mandate....everyone must be covered!

(10-07-2014 03:12 PM)BobL Wrote:  

(10-07-2014 02:11 PM)Hambone10 Wrote:  

(10-07-2014 01:41 PM)BobL Wrote:  The Bismark system requires that everyone be covered without condition, the insurance companies are non profit and costs are tightly regulated by the government.
Sounds familiar to me.

Where? Doctors here still aren't required to treat you... even if you have insurance... only hospitals are.

Quote:Why is insurance mandatory to see a doctor? Why cant i just pay like a pay for all other services?

This isn't true.... It's just that you and people like you consider 'a promise to pay' as good as cash and it isn't. If you provided your doctor with a guarantee of funds and/or prepayment (assuming it covered everything they might need to do) then they would see you. Unfortunately, Insurance companies are the most common provider of such 'letters of guarantee.' When a physician agrees to see you, there are certain legal obligations that they take on not limited to the cost of an office visit.... so even prepaying for the visit often won't be enough. I can't tell you precisely what that amount is, but not many people do this... especially people who can't afford insurance, because that is all such a letter of guarantee is.

Quote:My area is 45 miles NW of Chicago, mostly suburban with some rural area. None of the 5 hospitals I referred to are specialty hospitals. Ill be happy to name them if you like.

7 hospitals have also closed in Chicago and others are being sold because they are losing money (like Our Lady of the Resurrection). It is entirely likely/probable that the reason they are building new hospitals has to do with changing regulations, aging of buildings and reacting to demographic changes (i.e. following the flight of the population) or also because it is cheaper to sell the older downtown property and build a new one in the burbs as opposed to trying to maintain the old one... and they need to save money because of Obamacare...

In other words, you're trying to show a link that you can't really prove... and even if it is in your area, your experience isn't evidence that Obamacare is working generally.

San Pablo DMC (just north of San Fran) is going to close and those patients will be routed to other hospitals that don't currently have the capacity for them. They might well build a new hospital or at least a new wing to accommodate the population, but because they are where THEY are and not where DMC was, nobody will be closer to care (because the other hospital was already there) but many will be further from care... and that costs lives.

Just as anecdotal as yours, though I can specifically point to demographic changes that are the specific result of Obamacare.... They are that DMC was somewhat like rural hospitals in that it was essentially set up around the model of providing hospital and clinic care to the uninsured... and they had just enough reimbursement from Medicaid and their insured to stay afloat... but now that these people have insurance, Kaiser (who only operates clinics and not emergency rooms) has 'recruited' these people.... so DMC still has the risk of the ER, but it doesn't have the clinic patients to offset their risk and keep the ER open.

People like me?? WTF
Call it what you like the fact remains without insurance you will not get an appt. so therefore the folk who own these dr practices now also own the hospitals and are essentially saying we will treat you but only where it is 10x the cost.

The Bismark model requires everyone have insurance...that is point one in my book and always has been. You want a true open and free market in "health care" then everyone needs insurance.

My point about the hospitals in my area has nothing to do with Obamacare, I used it as an example of over saturation due to excessive competition among the health care corporations in my area that will result in even more costs passed along to us in the end. These healthcare corporations are trying to win "customers" by being more convenient, closer to home, and opening urgent cares everywhere. I maintain there are not enough "customers" in my area to sustain this thereby increasing costs. I also stated this has been going on long before ACA.

Ya you work in health care...I look at it from my point of view as the "customer".

FWIW My sister inlaw lived in Germany for 3 years, her hospital stay when her daughter was born(1994) was 2 weeks, that a normal pregnancy, no complications for baby or mom. The Bismark system was developed and still used in Germany. I'd be happy for it here, but then that would be another government mandate....everyone must be covered!

Uhhh, you aren't going to attract many new "customers" for anything by raising costs. Saturation will necessarily mean lower prices.

You think Burger King moves in across the street from McDonalds the smart move for MickieD's is to raise the cost of their burgers?

(10-07-2014 01:41 PM)BobL Wrote:  The Bismark system requires that everyone be covered without condition, the insurance companies are non profit and costs are tightly regulated by the government.
Sounds familiar to me.

Bismarck is a mix of private and public, profit and non-profit, competing with each other. The non-profit part works pretty much as you describe. The profit-seeking part tends to be more like a free market.

Quote:You say let the free market work...ok then, to me that means anyone can go see a doctor of their choice regardless of insurance as long as they pay. Have you ever tried to see a doctor(now mostly owned by those health care groups that own the hospitals) without an insurance card? It is next to impossible to see anyone even if they have a card on file. Try making an appt to see a dr and tell them you dont have insurance up front. They wont schedule an appt. Why is insurance mandatory to see a doctor? Why cant i just pay like a pay for all other services?

Why not? Because we don't have a free market for health care, and haven't in decades. That's my point.

Quote:My area is 45 miles NW of Chicago, mostly suburban with some rural area. None of the 5 hospitals I referred to are specialty hospitals. Ill be happy to name them if you like.

No need to name them. Don't know exactly where you are, and don't know exact population density, but a mix of suburban and rural probably has sufficient population density to justify 5 hospitals. Would have to look at specific economics to have a better idea. And obviously, how big the individual hospitals are would affect any determinations of whether there is overkill or not.

(10-07-2014 03:12 PM)BobL Wrote:  People like me?? WTF

Yes, people like you who think that a promise to pay is the same as cash.

Quote:Call it what you like the fact remains without insurance you will not get an appt. so therefore the folk who own these dr practices now also own the hospitals and are essentially saying we will treat you but only where it is 10x the cost.

This is even MORE factually inaccurate. You ignore the cost of insurance when you compare prices for insured vs uninsured. Yes, your insurer pays far less for your care than you would, because your insurer can't declare bankruptcy to avoid paying your claims (there is a fund to pay them if they do). In fact, doctors that are part of HMOs essentially schedule you far enough in advance so as to avoid many appointments... you often get well or lose the symptoms before you can see them... because they get paid the same whether or not they see you or you show... as long as they see #X patients per period. You're not even describing a current business model.

No, doctors didn't have to take you... and they still don't. Yes, you have more options as a result, but only by taking that appointment time away from someone else. There isn't a glut of physicians out there with empty waiting rooms. Instead of having to go to the hospital sponsored clinic, you can now go elsewhere. Good for you, bad for the hospital because THAT care covered much of their overhead.

Quote:The Bismark model requires everyone have insurance...that is point one in my book and always has been. You want a true open and free market in "health care" then everyone needs insurance.

Nobody said it wasn't. Health Insurance is worthless without providers to deliver the care.

Quote:My point about the hospitals in my area has nothing to do with Obamacare, I used it as an example of over saturation due to excessive competition among the health care corporations in my area that will result in even more costs passed along to us in the end. These healthcare corporations are trying to win "customers" by being more convenient, closer to home, and opening urgent cares everywhere. I maintain there are not enough "customers" in my area to sustain this thereby increasing costs. I also stated this has been going on long before ACA.

In what business world does excessive competition lead to higher costs?

The urgent care centers opened because they get ER-like reimbursement (higher than your PCP) for providing PCP-like care. Unlike the ER, they don't have to treat you. MOst of that extra expense comes from people who CHOOSE to see that facility because they can charge you the $50-100 ER copay rather than the $15-$35 PCP copay for the same care.... but they get the same amount from the insurer as the PCP, which is less than the ER. It lowers, not raises overall costs... and the more there are, they more they have to compete on 'copay'. They may see somewhat higher acuity patients so a study might show they get paid slightly more for their 'average' patient than a PCP, but if the PCP saw that same acuity, the reimbursement would be the same... and less than the ER.

Quote:Ya you work in health care...I look at it from my point of view as the "customer".

I have 2 college age children that I support on my own. I look at it as a consumer as well.

Quote:FWIW My sister inlaw lived in Germany for 3 years, her hospital stay when her daughter was born(1994) was 2 weeks, that a normal pregnancy, no complications for baby or mom. The Bismark system was developed and still used in Germany. I'd be happy for it here, but then that would be another government mandate....everyone must be covered!

My son's fiance is a German national and her parents are EXTREMELY liberal. (her mother won't travel, even for their wedding if she can't make it some sort of 'humanitarian' trip). We've had this discussion numerous times.

The biggest difference by far is that virtually nobody in the country is more than a few hours from a major city so they can consolidate many services in those cities and share overhead. We aren't set up that way and it is difficult to imagine a way we could be. Even the VA (which best I can tell was essentially modeled after this or is at least as close as we have come) outsources their care to HMOs in rural areas of this country.

I ran across this article today and thought of this thread.

Is Obamacare A Real World Success in Year One?

Quote:Put another way, the fact that President Obama misled everyone about getting to keep our own doctors is a now feature, not a bug. This may be considered a policy success, but it is also a political failure. Furthermore, as Klein acknowledges, the CBO does not believe the insurers’ cost containment is sustainable. Klein, though relying on the CBO’s rosy new projection, rejects their pessimistic one, because that is how wonks roll, apparently. Klein fails to explain how Obamacare simultaneously adds millions of new enrollees while maintaining narrow networks of low-cost providers (which is the CBO’s concern).

Quote:Naturally, Klein also touts the fact that the uninsured rate appears to have dropped. However, whether one looks at the Gallup polls or the Census Bureau’s larger ACS polls, it appears that Year One of Obamacare may have reduced the uninsured rate roughly 1 percent from pre-recession levels. That is almost certainly good news for those who are newly insured through the exchanges (a number we cannot quantify). But it is also a milder form of the “if it saves even one child” argument. Obamacare comes with an enormous price tag, no matter how calculated. It is at the very least debatable that this cost, along with the other disruptions to people’s lives it has brought, was worth insuring a few more people. Progressives have great hopes that the program will insure millions more, but given that working- and middle class people gave it a pass in Year One, it is difficult to presume they will be happy if they are forced into it in the future.

(10-07-2014 05:14 PM)Hambone10 Wrote:  

(10-07-2014 03:12 PM)BobL Wrote:  People like me?? WTF

Yes, people like you who think that a promise to pay is the same as cash.

Quote:Call it what you like the fact remains without insurance you will not get an appt. so therefore the folk who own these dr practices now also own the hospitals and are essentially saying we will treat you but only where it is 10x the cost.

This is even MORE factually inaccurate. You ignore the cost of insurance when you compare prices for insured vs uninsured. Yes, your insurer pays far less for your care than you would, because your insurer can't declare bankruptcy to avoid paying your claims (there is a fund to pay them if they do). In fact, doctors that are part of HMOs essentially schedule you far enough in advance so as to avoid many appointments... you often get well or lose the symptoms before you can see them... because they get paid the same whether or not they see you or you show... as long as they see #X patients per period. You're not even describing a current business model.

No, doctors didn't have to take you... and they still don't. Yes, you have more options as a result, but only by taking that appointment time away from someone else. There isn't a glut of physicians out there with empty waiting rooms. Instead of having to go to the hospital sponsored clinic, you can now go elsewhere. Good for you, bad for the hospital because THAT care covered much of their overhead.

Quote:The Bismark model requires everyone have insurance...that is point one in my book and always has been. You want a true open and free market in "health care" then everyone needs insurance.

Quote:Nobody said it wasn't. Health Insurance is worthless without providers to deliver the care.

Quote:My point about the hospitals in my area has nothing to do with Obamacare, I used it as an example of over saturation due to excessive competition among the health care corporations in my area that will result in even more costs passed along to us in the end. These healthcare corporations are trying to win "customers" by being more convenient, closer to home, and opening urgent cares everywhere. I maintain there are not enough "customers" in my area to sustain this thereby increasing costs. I also stated this has been going on long before ACA.

In what business world does excessive competition lead to higher costs?

The urgent care centers opened because they get ER-like reimbursement (higher than your PCP) for providing PCP-like care. Unlike the ER, they don't have to treat you. MOst of that extra expense comes from people who CHOOSE to see that facility because they can charge you the $50-100 ER copay rather than the $15-$35 PCP copay for the same care.... but they get the same amount from the insurer as the PCP, which is less than the ER. It lowers, not raises overall costs... and the more there are, they more they have to compete on 'copay'. They may see somewhat higher acuity patients so a study might show they get paid slightly more for their 'average' patient than a PCP, but if the PCP saw that same acuity, the reimbursement would be the same... and less than the ER.

Quote:Ya you work in health care...I look at it from my point of view as the "customer".

I have 2 college age children that I support on my own. I look at it as a consumer as well.

Quote:FWIW My sister inlaw lived in Germany for 3 years, her hospital stay when her daughter was born(1994) was 2 weeks, that a normal pregnancy, no complications for baby or mom. The Bismark system was developed and still used in Germany. I'd be happy for it here, but then that would be another government mandate....everyone must be covered!

My son's fiance is a German national and her parents are EXTREMELY liberal. (her mother won't travel, even for their wedding if she can't make it some sort of 'humanitarian' trip). We've had this discussion numerous times.

The biggest difference by far is that virtually nobody in the country is more than a few hours from a major city so they can consolidate many services in those cities and share overhead. We aren't set up that way and it is difficult to imagine a way we could be. Even the VA (which best I can tell was essentially modeled after this or is at least as close as we have come) outsources their care to HMOs in rural areas of this country.

Quote:In what business world does excessive competition lead to higher costs?

My point is that if in fact the market is glutted and these places start closing their doors these costs will be passed on...so yes ostensibly increasing overhead and costs.

Quote:Nobody said it wasn't. Health Insurance is worthless without providers to deliver the care.

I have stated elsewhere in this thread my thoughts on this. the fact remains that to say "why give health insurance to people if there are not enough docs to provide care" is a silly argument at every level. Everyone gets treated today...we should see a switch from ER to PC which I see as a good thing.

So yes more primary care professionals will be needed and we will see more and more PA's and NP's taking on alot of the that responsibility. I dont see this as a reduction in the quality of care but an increase in the efficiency in care. I see this as a needed "level" in the medical profession. Realistically there is no need for an MD to come in spend 30 minutes with someone to tell the they have strep throat, an ear infection, some virus, etc.

So yes more primary care professionals will be needed and we will see more and more PA's and NP's taking on alot of the that responsibility. I dont see this as a reduction in the quality of care but an increase in the efficiency in care. I see this as a needed "level" in the medical profession. Realistically there is no need for an MD to come in spend 30 minutes with someone to tell the they have strep throat, an ear infection, some virus, etc.


Excellent points here.