(06-29-2012 06:03 PM)Hambone10 Wrote:  

(06-29-2012 05:33 PM)Owl 69/70/75 Wrote:  

(06-29-2012 05:25 PM)greyowl72 Wrote:  Physicians finishing training programs today actually want a life ( can you imagine?) They want predictable hours. Set call schedules. Time with their families. ( This younger generation is going to the dogs!!). Hospital employment provides this. But at a cost.. Somewhat less salary. And, ultimately loss of autonomy. I wouldn't do it. But I'm way out of touch and becoming obsolete. The new physicians expect it.

This would actually dovetail pretty nicely with some attributes of the French system. Basically, if a prospective doc agrees to spend so many years (I think 10) working for a salary in the "free" system, then med school is free. Once you work off your indentured servitude in the "free" system, then you bare free to move to the "pay" system which operates pretty much like ours now.

"but if you like your doctor, you can keep him." Seems to me that you would end up with a rolling bevy of inexperienced physicians

In the "free" system, you betcha. You don't really get to have relationships with docs except in the "pay" system. Although you can pretty much see the same doc every time by paying attention to schedules. "Free" side works a lot like military docs. Most Americans really would not like the "free" system, but the "pay" system works a lot like here.

(06-29-2012 03:36 PM)greyowl72 Wrote:  I think Barrett is correct.
...

Illuminating stuff, Grey. Thanks so much.

I think in a " mature" delivery system there would be 2 parallel forms of delivery. A government sponsored and mostly tax supported system.. And a more traditional system with fee for service.. Supported with traditional insurance, higher co-pays, etc.
The differences would be obvious. Faster physician response times. Perhaps more up to date drugs and procedures. More responsive system, in general with the second system. But both systems would deliver a quality medical care just in different ways. These types of parallel systems are common in England and some other European countries.
As we said in residency: you can pay with time, or you can pay with money.

(06-29-2012 08:13 PM)greyowl72 Wrote:  I think in a " mature" delivery system there would be 2 parallel forms of delivery. A government sponsored and mostly tax supported system.. And a more traditional system with fee for service.. Supported with traditional insurance, higher co-pays, etc.
The differences would be obvious. Faster physician response times. Perhaps more up to date drugs and procedures. More responsive system, in general with the second system. But both systems would deliver a quality medical care just in different ways. These types of parallel systems are common in England and some other European countries.
As we said in residency: you can pay with time, or you can pay with money.

France moreso than England/UK, from personal experience and experience of friends. The fee for service form is not so robust in UK as in France. And because it gets much less volume, it tends to be very expensive. Tony Blair wanted to make UK more like France but could not get it done. The attitudes are a bit different. Brits are conditioned to rely on NHS except as a last resort. French are more like, "Oh, I have to wait six weeks for the free system? I'll just walk across the street and get it done this afternoon.". As I have understood it, the French are much more into buying supplemental insurance, and employers providing it as a benefit, to cover those trips across the street.

Agree that this is the best approach. Not where Obamacare is leading us at all.

Just something to consider..in 2010 Harris County Hospital District paid around $170 Million for care of Illegal Aliens. Bexar is around $200 million.

Since illegals are not subject to ObamaCare and IRS enforcement, the taxpayers are still going to be paid for these uninsured expenses. And these expenses are just going to increase

According to the Comptroller's office Texas has a net gain of taxes paid to services used by illegals, including health care.

http://www.window.state.tx.us/specialrpt/undocumented/

Owl75, if I'm reading your link right, though, isn't the net cost to local governments larger than the net gain to the state?

Although the ACA has a number of flaws, the exemption for participation by illegal immigrants is one of the biggest. I think, originally, they were supposed to be included.. But the sponsors realized that it's slim chances of passing would be dashed if illegals were included in the bill.
The fact of the matter is that illegal immigrants presenting for acute medical care will ALWAYS receive care. That care will be provided by the citizens of Harris, Dallas,Tarrant,Midland,(insert your county's name here) county. The designers of the bill knew that. They also knew that most of the conservative legislators would never vote for a bill that allowed federal funds to be used for that kind of coverage. But if the federal money is denied, the county and local money will be used. It's a fact.
A more practical approach would be to include these people for both acute and chronic medical care. We are going o take care of them...might as well be the cheapest way possible.