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[Alaska Darin]

no, you try again. how do you approach this looming shortage or do you not see a problem?

Of course there's a problem but the same old solutions aren't going to solve them. You're the supposed "visionary" but the only "solutions" you've offered are pretty much the causes of the problem or tired crap that isn't working as advertised elsewhere. As I said before, you obviously don't know the meaning of the word visionary.

 

Wake the !@#$ up, Chachi.

[Pine Barrens Mafia]

Chachi.

 

 

[birdog1960]

Of course there's a problem but the same old solutions aren't going to solve them. You're the supposed "visionary" but the only "solutions" you've offered are pretty much the causes of the problem or tired crap that isn't working as advertised elsewhere. As I said before, you obviously don't know the meaning of the word visionary.

 

Wake the !@#$ up, Chachi.

these are not the same old solutions. what is being proposed in the long run is a complete overhaul of the system. since it is so radical it can't occur in 1 or 2 steps. it will have to be incremental and insidious (except in 2014 when major change will occur). the entirety of the current piece work method of reimbursement needs scrapping and rebuilding as does the ratio of specialists to primary care. there are examples of success using these methods ie: better outcomes at lower cost. i won't lower myself to name call.

and before you question my vocabulary again or misinterpret: insidious is meant to mean:"developing gradually as to be well established before becoming apparent" in this instance.

[Magox]

no, you try again. how do you approach this looming shortage or do you not see a problem?

How would Single Payer increase the amount of Primary Care physicians? COnsidering that doctors make less in Nationalized health care systems than they do here and one of the big reasons why doctors are shunning this field is because of pay, how would a system that lowers the payments to doctors which of course in turn lowers their pay encourage people to want to become Primary Care physicians? Can you answer this please?

[birdog1960]

How would Single Payer increase the amount of Primary Care physicians? COnsidering that doctors make less in Nationalized health care systems than they do here and one of the big reasons why doctors are shunning this field is because of pay, how would a system that lowers the payments to doctors which of course in turn lowers their pay encourage people to want to become Primary Care physicians? Can you answer this please?

last time i looked, a gp in england averaged 160k pounds. in the us, about $180k. even at current exchange rates the brits do better.

[Alaska Darin]

these are not the same old solutions. what is being proposed in the long run is a complete overhaul of the system.

Bull. What is being proposed are things that don't address the real reasons health care is so expensive.

since it is so radical it can't occur in 1 or 2 steps.

More bull. It's radical in that it gives Washington bureaucrats control over a huge amount of money.

it will have to be incremental and insidious (except in 2014 when major change will occur).

Interesting choice of words. "Operating or proceeding in an inconspicuous or seemingly harmless way but actually with grave effect". Those who don't understand history are doomed to repeat it.

the entirety of the current piece work method of reimbursement needs scrapping and rebuilding as does the ratio of specialists to primary care.

Neither of which seem to be addressed by the abortion that is the new legislation, though since it's 2500 pages there may be a tidbit or 2 in there. I somehow doubt you've read it.

there are examples of success using these methods ie: better outcomes at lower cost.

Let's see some supporting documentation that specifically cites these successes and compares them directly to portions of the legislation.

i won't lower myself to name call.

Good, because I'd kick your ass at that. I've got serious street cred.

and before you question my vocabulary again or misinterpret: insidious is meant to mean:"developing gradually as to be well established before becoming apparent" in this instance.

Not fair going to the medical dictionary, though the irony of word choice shouldn't be lost on anyone.

[DC Tom]

and before you question my vocabulary again or misinterpret: insidious is meant to mean:"developing gradually as to be well established before becoming apparent" in this instance.

 

I'll question it anyway. Sounds like someone needs to learn the difference between "connotation" and "denotation".

[Magox]

last time i looked, a gp in england averaged 160k pounds. in the us, about $180k. even at current exchange rates the brits do better.

Must be nice to be able to make up your own facts

 

The IT system used for assessing their income based on these criteria is called QMAS. A GP can expect to earn about £70,000 a year without doing any overtime, although this figure is extremely variable. A 2006 report[9] noted that some GPs were earning £250k per year, with the highest-paid on £300k for working alone across five islands in the Outer Hebrides. These potential earnings have been the subject of much criticism in the press for being excessive.[10] However, a full time GMS or PMS practice partner can now expect to earn around £110,000 before tax, while a salaried GP earns on average £74,000.[11]

[Doc]

FYI: AARP doesn't sell medigap policies. United HealthCare does, and they pay handsomely to use AARP's name.

Thanks for the clarification, but the point remains the same.

[Alaska Darin]

Must be nice to be able to make up your own facts

I was holding onto that. !@#$er.

[Pine Barrens Mafia]

Not fair going to the medical dictionary, though the irony of word choice shouldn't be lost on anyone.

 

So, he's advocating that the government implement these changes without the approval and consent of the people in private environment? Just checking.

[Rob's House]

Single payer is awesome if you have the sniffles and want the Dr. to give you a note for work. However, if you need a knee replacement, a spinal fusion, an MRI, or any other number of procedures to relieve agonizing pain, regain mobility, or prevent agonizing !@#$ing death, you are likely to find yourself SOL on a long waiting list.

 

Then you better hope you're rich enough to pay 100% out of pocket or grin and bear it while you wait for the compassionate government to get around to you. Hope you don't get cancer.

[OCinBuffalo]

i see a combined total of 85% medicare + medicaid. avg. pt load per week = 110.

So, regardless of what happens, things can only get better for you, because you are looking at the very top, from the very bottom. No wonders you have this attitude. You literally have nothing to lose.

and yeah, it doesn't surprise me that an anesthesiologist won't be happy with the changes a comin. their will be winners and losers with reform and specialty and subspecialty providers won't be celebrating victory.

And it's not the government's job to pick winners and losers in "commerce". Like it or not, that's the justification the government is using for it's intrusions...the "commerce clause". Well, they aren't supposed to be deciding which businesses win and which lose, that is for the market to decide. The last time we had bureaucrats picking winners and losers was Jimmy Carter...how well did that work out?

primary care docs in the single payer british system actually make more than their us counterparts (on average).

Horeschit. I don't even have to look this up. I say again: Horseschit.

Hence the looming critical shortage of primary care docs in the us.

Also Horseschit. The reason we don't have primary care docs is no mystery: you make more and have to put up with less crap if you are a specialist.

i'm satisfied with what i earn now so any more would be a bonus. btw, i haven't sherked my "administrative responsibilities. i'm one of those dinosaur docs that actually hung a shingle and own my own business. but this is more about universal, equitable access to care than it is business. the best route there is single payer

When you are talking about single payer and reimbursement, how in the F is that not about "business"?

 

This about EVERYTHING, all of it, and fixing ALL of it. Single payer does not solve 80% of the problems in this industry, and there are serious questions about the 20% it does address, and whether it causes more problems than it solves.

 

My simple premise: We can't possibly know what is wrong, if we can't measure what we do consistently, and compare it to what we expect to do. We can't possibly know what things truly cost, if we can't measure the cost consistently, and compare it to what we expect it to cost. We can't possibly know if we are doing a quality job, if we don't measure what we do, all the time, consistently, and compare it to what we expect.

 

If you look, you will find that this premise is undeniable, especially when it comes to Health Care. Nowhere, NOWHERE, is this addressed by Obama, or his people, or his supporters, or anybody that supports single payer.

 

Obamacare does not measure costs properly, so it has no hope of containing them.

Obamacare does not measure quality properly, so it has no hope of ensuring it.

Obamacare does not demand accountability, on any side, so it has no hope of enforcing it.

[birdog1960]

Must be nice to be able to make up your own facts

mea culpa..so sue me...i must have remembered 160K pounds (why do you have a pound symbol on your keyboard?) after conversion with exchange rate. as far as me being at the bottom, just not true, especially regarding the things that i hold as most meaningful. when you frame the discussion in purely monetary terms, everything changes. i choose not to frame it that way. regarding flaws in the reform bill, there are many. my belief is that this is just the first act. time will tell.

[Magox]

mea culpa..so sue me...i must have remembered 160K pounds (why do you have a pound symbol on your keyboard?) after conversion with exchange rate. as far as me being at the bottom, just not true, especially regarding the things that i hold as most meaningful. when you frame the discussion in purely monetary terms, everything changes. i choose not to frame it that way. regarding flaws in the reform bill, there are many. my belief is that this is just the first act. time will tell.

I wasn't just trying to bust you for the sake of busting you. You argued or implied that having a single payer system would help solve the looming crisis of shortages of primary care physicians.

 

Now that we have established that doctors make much less in a nationalized health care system.

 

my question was:

 

How would Single Payer increase the amount of Primary Care physicians? Considering that doctors make less in Nationalized health care systems than they do here and one of the big reasons why doctors are shunning this field is because of pay, how would a system that lowers the payments to doctors which of course in turn lowers their pay encourage people to want to become Primary Care physicians? Can you answer this please?

[Doc]

I wasn't just trying to bust you for the sake of busting you. You argued or implied that having a single payer system would help solve the looming crisis of shortages of primary care physicians.

 

Now that we have established that doctors make much less in a nationalized health care system.

 

my question was:

Most believe that the money that went to specialists will end-up going to primary care docs. When the reality is, money will be taken from everyone and used to try and fund the ever-increasing costs and doctors will be powerless to negotiate rates.

 

So apparently it does involve "maximizing profits," or more precisely, some believe it will, even though they may claim otherwise. There's always an angle.

[birdog1960]

I wasn't just trying to bust you for the sake of busting you. You argued or implied that having a single payer system would help solve the looming crisis of shortages of primary care physicians.

 

Now that we have established that doctors make much less in a nationalized health care system.

 

my question was:

several encouraging issue for primary care in reform: establishment of medical home with reimbursement for oversight services. increased pay for primary care visits (slowly phased in and paid for by reductions in reimbursements for procedures and technology-btw, "the market" had little to do with the massive discrepancies between cognitive reimbursement and procedural) and finally medicaid payment on par with medicare (important for those who currently see medicaid patients). in general, the reform bill at least pays lip service to the value of primary care. the model cannot work without its robust presence.edit: lastly 13 million new patients though most of us can't handle any more.

[Rob's House]

Most believe that the money that went to specialists will end-up going to primary care docs. When the reality is, money will be taken from everyone and used to try and fund the ever-increasing costs and doctors will be powerless to negotiate rates.

So apparently it does involve "maximizing profits," or more precisely, some believe it will, even though they may claim otherwise. There's always an angle.

 

Then why is it all the best doctors flock to countries with single payer systems? er... uh. Nevermind.

[keepthefaith]

several encouraging issue for primary care in reform: establishment of medical home with reimbursement for oversight services. increased pay for primary care visits (slowly phased in and paid for by reductions in reimbursements for procedures and technology-btw, "the market" had little to do with the massive discrepancies between cognitive reimbursement and procedural) and finally medicaid payment on par with medicare (important for those who currently see medicaid patients). in general, the reform bill at least pays lip service to the value of primary care. the model cannot work without its robust presence.edit: lastly 13 million new patients though most of us can't handle any more.

 

There is so much wrong with the health care and health care insurance market that I don't know where to start. A couple things that don't get much air time that drive me crazy are these:

 

1. All the parents that run their kids to the emergency room for the smallest things and the same that take their kids to the doctor whenever they get the sniffles or a fever. There are a lot of them that I know. They're idiots.

 

2. Most people want their health care to be FREE. If you're low income, you want it for free. If you're employed, your employer should pay for a cadillac plan. If you're old you want medicare to cover everything. People need to have skin in the game and insurance should not provide "FREE" care for every little thing. People need to have a financial stake in their own health IMO.

 

3. There is a pill for everything now and I'm amazed at how many people young and old are on meds for every little thing real and imagined. ****, Viagara is an insurance scam. Too many people and too many doctors are pill happy. If people had a financial stake in their prescription plans, they might make different and better decisions.

 

4. There is a procedure for everything and it's abused by both doctors and patients. I know someone that is elderly that has a lot of wrinkly skin around the outside of their eyes. Not terribly attractive. Now that he and the doctor have decided that the skin is affecting his peripheral vision (which is bull **** in this case) the surgical procedure will be covered. Again, no skin (pun intended) in the game so we go on a spending spree.

 

5. End of life expenses are horrific and this needs to be addressed, but it needs to be addressed head-on and not through cuts and complicated language buried in a health care bill. It needs to be debated and resolved out in the open.

 

When we start "insuring" necessary and expensive treatment only, we'll see insurance rates come back to reality. Until then, it'll remain mostly free for everyone at great expense.

[birdog1960]

There is so much wrong with the health care and health care insurance market that I don't know where to start. A couple things that don't get much air time that drive me crazy are these:

 

1. All the parents that run their kids to the emergency room for the smallest things and the same that take their kids to the doctor whenever they get the sniffles or a fever. There are a lot of them that I know. They're idiots.

 

2. Most people want their health care to be FREE. If you're low income, you want it for free. If you're employed, your employer should pay for a cadillac plan. If you're old you want medicare to cover everything. People need to have skin in the game and insurance should not provide "FREE" care for every little thing. People need to have a financial stake in their own health IMO.

 

3. There is a pill for everything now and I'm amazed at how many people young and old are on meds for every little thing real and imagined. ****, Viagara is an insurance scam. Too many people and too many doctors are pill happy. If people had a financial stake in their prescription plans, they might make different and better decisions.

 

4. There is a procedure for everything and it's abused by both doctors and patients. I know someone that is elderly that has a lot of wrinkly skin around the outside of their eyes. Not terribly attractive. Now that he and the doctor have decided that the skin is affecting his peripheral vision (which is bull **** in this case) the surgical procedure will be covered. Again, no skin (pun intended) in the game so we go on a spending spree.

 

5. End of life expenses are horrific and this needs to be addressed, but it needs to be addressed head-on and not through cuts and complicated language buried in a health care bill. It needs to be debated and resolved out in the open.

 

When we start "insuring" necessary and expensive treatment only, we'll see insurance rates come back to reality. Until then, it'll remain mostly free for everyone at great expense.

agree with all points but #5 is political suicide (pardon the pun). no one has the gonads for that. and while viagra is meant to evoke images of niagara, it is spelled uniquely.