(12-01-2015 10:42 AM)Max Power Wrote: What's funny is that I hear all the time that poor doctors are being forced to do "defensive medicine" out of fear of evil trial lawyers like me, then I hear crap like this complaining about doctors being prevented from doing those same screenings on healthy people. Which is it?
It's both. Doctors have been forced to practice defensive medicine to avoid evil trial lawyers like you (you meant "evil" sarcastically, I suppose, but I didn't). What Obmacare is doing is using economic force to try to get them not to do so, but still leaving the malpractice liability in place. What happens ultimately is that the resulting risk versus reward calculus will become unappealing to our brightest and best, who will go become ambulance chasers or something. That's fine if you don't care about quality, and single-payer/single-provider systems typically don't.
Quote:Obamacare has cost controls that punish hospitals with high readmittance rates, or do unnecessary screenings on patients to drive their bills up. Given that we spend almost twice as much per capita on health care than other first world countries, with no better health outcomes (in many areas, worse), and far higher uninsured rates with tens of thousands dying each year for lack of health care access, I'd say it's not the worst idea.
Your "given that" statement is actually quite misleading. By the criteria applied in some academic studies, there is some suggestion that what you say might be true. But let's look a bit closer at the reality. Single-payer and single-provider systems typically do a better job of keeping well people well, but a poorer job of treating sick people. And at the end of the day, you get more bang for the buck for giving tetanus shots than for performing open heart surgery. That part of centralized systems is good. Their level of care for sick people is not. That's why I like Bismarck, which is the only approach that does good jobs in both areas. And it's cheaper than the US--more expensive than single-payer/provider, but that's because they are actually doing some health care and that costs money. Another point is the way those statistics are kept. In a single-payer/provider system, you go to the doctor, you need heart surgery, they tell you to take a number and come back in 18 months. If you die before that date, then you were not in the system when you died, and therefore you are not counted as a bad outcome. In the US, we try to do the surgery, and if you don't make it, then that's a bad outcome.
One other thing, a lot of the sound bytes criticizing the US system reference the WHO study that ranked the US "37th best" in the world. Actually, no it didn't. That study wasn't about being the best, quality was actually a very minor (roughly 20%) component of the ranking. What's perhaps more interesting is that whatever it did measure, it was biased heavily toward small, even tiny, systems. The top 10 included Andorra, San Marino, Malta, Singapore, and Oman, and Monaco was 13th. And on the other hand, the US ranked 1st among countries over about 125 million population (including some single-payer/single-provider systems that ranked behind us), 2nd among countries with over 80 million, and 4th among countries with over 60 million. And the three ahead of us at that point (Japan, Germany, France) are all Bismarcks.
Quote:If a patient really wants it the doctor won't be penalized.
Under Obamacare, actually no. And not under single-payer/provider. True under Bismarck. The doctor-patient relationship exists under Bismarck, but has been replaced by edicts of unaccountable bureaucrats in the others.
Quote:The MD should explain the positives and negatives and let the patient make an informed choice. Given the harsh side effects the doctors shouldn't make it routine however.
Agree. That's not what happens under single-payer/provider, and that's not what will happen under Obamacare. It is what happens under Bismarck. That's why they are the best systems in the world.