Comments on: Cutting health care costs http://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Mikehttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77861 Mike Thu, 19 Jul 2007 02:18:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77861 What a bunch of buttplugs the people advocating less credentialing are. Being a doctor isnt like caring for a car. If the car dies, no one gets blamed for killing anybody or dragged into court. Death/stroke/MI/etc are things here there isnt any second chance. And while much of outpt medical practice isn't these things, when it happens, I think we would all like our MD's to be aware of them and capable of dealing with them.<br/><br/>So is the goal to punish MD's who make a living? I've got news for you..it costs like 10 times as much to live in NYC as other palces. So we should make LESS??? Or just get the hell out.<br/><br/>Medicine used to be aprofession where at least you got some respect. Now its like you spent 10 or so years of your life busting your ass for no pay so you can be treated BELOW a mechanic or plumber.<br/><br/>Of course, when someone calls crying "I have to see you right away!" or "I just check my pressure, its high, and I'm lightheaded...", then suddenly in those moments were useful.<br/><br/>Factor all of that into your god%&$# macroeconomic equations. What a bunch of buttplugs the people advocating less credentialing are. Being a doctor isnt like caring for a car. If the car dies, no one gets blamed for killing anybody or dragged into court. Death/stroke/MI/etc are things here there isnt any second chance. And while much of outpt medical practice isn’t these things, when it happens, I think we would all like our MD’s to be aware of them and capable of dealing with them.

So is the goal to punish MD’s who make a living? I’ve got news for you..it costs like 10 times as much to live in NYC as other palces. So we should make LESS??? Or just get the hell out.

Medicine used to be aprofession where at least you got some respect. Now its like you spent 10 or so years of your life busting your ass for no pay so you can be treated BELOW a mechanic or plumber.

Of course, when someone calls crying “I have to see you right away!” or “I just check my pressure, its high, and I’m lightheaded…”, then suddenly in those moments were useful.

Factor all of that into your god%&$# macroeconomic equations.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77809 Anonymous Tue, 17 Jul 2007 21:20:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77809 ;) ;)

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77808 Anonymous Tue, 17 Jul 2007 20:01:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77808 So, should I take everything that preceded the word "but" in agreeing with my statement regarding the fallacious nature of the New York example? So, should I take everything that preceded the word “but” in agreeing with my statement regarding the fallacious nature of the New York example?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77798 Anonymous Tue, 17 Jul 2007 18:39:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77798 Yes, but then people would stop entering the profession because why work so hard to be a car mechanic when I could easily go to law school school or get an MBA. Yes, but then people would stop entering the profession because why work so hard to be a car mechanic when I could easily go to law school school or get an MBA.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77789 Anonymous Tue, 17 Jul 2007 14:58:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77789 Even the most saturated domestic market is a poor example when it comes to representing a situation in which competition would exist. One must cross a certain threshold of suppliers for there to be a sufficient number to actually engender competition. When providers become as prevalent as auto mechanics, then we will have a system in which competition would be present. Even the most saturated domestic market is a poor example when it comes to representing a situation in which competition would exist. One must cross a certain threshold of suppliers for there to be a sufficient number to actually engender competition. When providers become as prevalent as auto mechanics, then we will have a system in which competition would be present.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77785 Anonymous Tue, 17 Jul 2007 11:24:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77785 This supply side case is just ridiculous. It presupposes easy increases in supply (of providers providing) which, as others note cannot happen unless you either spend a whole lot of money training doctors or allow people who are not trained to prescribe. This is a simplistic parlor game based on imaginary worlds and elementary economic theories, neither of which work in the real world market for medical services. There is demand inelasticity (just try even getting a co-payment), and even that is not uniform and there is non-uniform supply elasticity (easier to get more nurse practitioners than internists). There are real barriers to entry, both in need to obtain training and in need to meet government-imposed licensing qualifications and again in need to obtain capital investment (can't practice on a street corner, need an office with staff and equipment, too.)<br/><br/>The article just illustrates how little its writers actually understand about economics, business, health care, human behavior and everything else that actually influences how medical care is bought and sold. This supply side case is just ridiculous. It presupposes easy increases in supply (of providers providing) which, as others note cannot happen unless you either spend a whole lot of money training doctors or allow people who are not trained to prescribe. This is a simplistic parlor game based on imaginary worlds and elementary economic theories, neither of which work in the real world market for medical services. There is demand inelasticity (just try even getting a co-payment), and even that is not uniform and there is non-uniform supply elasticity (easier to get more nurse practitioners than internists). There are real barriers to entry, both in need to obtain training and in need to meet government-imposed licensing qualifications and again in need to obtain capital investment (can’t practice on a street corner, need an office with staff and equipment, too.)

The article just illustrates how little its writers actually understand about economics, business, health care, human behavior and everything else that actually influences how medical care is bought and sold.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77781 Anonymous Tue, 17 Jul 2007 05:35:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77781 INcreasing supply of doctors WILL NOT reduce costs because that only works in a free market and healthcare is NOT a free market.<br/><br/>NYC has the highest number of doctors per capita in the world. Surely you'd expect their salaries to be lower than in other large cities of the US, since they are all competiting against each other.<br/><br/>Right?<br/><br/>Wrong.<br/><br/>NYC docs have some of the HIGHEST incomes compared to their other urban counterparts, because doctors dont compete against each other, they just increase the total # of billings by insurance and medicare.<br/><br/>More doctors = more billings. INcreasing supply of doctors WILL NOT reduce costs because that only works in a free market and healthcare is NOT a free market.

NYC has the highest number of doctors per capita in the world. Surely you’d expect their salaries to be lower than in other large cities of the US, since they are all competiting against each other.

Right?

Wrong.

NYC docs have some of the HIGHEST incomes compared to their other urban counterparts, because doctors dont compete against each other, they just increase the total # of billings by insurance and medicare.

More doctors = more billings.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77780 Anonymous Tue, 17 Jul 2007 04:50:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77780 >.OK, boys, settle down. First, by my count, naturopaths can only prescribe in 10 states and 2 Canadian provinces. Big whoops. <br/><br/>I'm in one of them. I get a lot of requests to "co-manage" or "collaborate" from optometrists, naturopaths, chiropractirs, etc.<br/><br/>What they want is my license. They want me to run labs, take the medicolegal responsibility for the testing, take the economic hit for the testing (overuse of resources), while they skate on any responsibility for their work. Much like my thyroid person.<br/><br/>The patient really did complain. Complaint was ignored by naturopathic board. I've seen physicians censured for a lot less. >.OK, boys, settle down. First, by my count, naturopaths can only prescribe in 10 states and 2 Canadian provinces. Big whoops.

I’m in one of them. I get a lot of requests to “co-manage” or “collaborate” from optometrists, naturopaths, chiropractirs, etc.

What they want is my license. They want me to run labs, take the medicolegal responsibility for the testing, take the economic hit for the testing (overuse of resources), while they skate on any responsibility for their work. Much like my thyroid person.

The patient really did complain. Complaint was ignored by naturopathic board. I’ve seen physicians censured for a lot less.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77769 Anonymous Tue, 17 Jul 2007 02:07:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77769 What is the point of having this discussion? Everyone involved knows that no significant percentage of Americans is interested in this happening. Re-legalization of unlicensed practice of medicine has never happened anywhere and will never happen. How 'bout we talk about something a little more realistic than Libertarian Paradise? What is the point of having this discussion? Everyone involved knows that no significant percentage of Americans is interested in this happening. Re-legalization of unlicensed practice of medicine has never happened anywhere and will never happen. How ’bout we talk about something a little more realistic than Libertarian Paradise?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/07/cutting-health-care-costs.html#comment-77768 Anonymous Tue, 17 Jul 2007 02:00:00 +0000 http://clients.emmense.com/kevinmd/2007/07/cutting-health-care-costs.html#comment-77768 OK, boys, settle down. First, by my count, naturopaths can only prescribe in 10 states and 2 Canadian provinces. Big whoops. <br/><br/>Second, I'm sure some naturopaths screw up, but given the number of medicine/dosage mistakes hospitals make (what does the Institute for Medicine say, 1.5 MILLION a year?), you guys don't have much of a leg to stand on.<br/><br/>And, that's the point. Once we eliminate credentialing requirements, we can run randomized studies and see whether naturopaths are as bad as doctors, or the other way round. Now, you doctors are just dictating policy by anecdote and self-interest. OK, boys, settle down. First, by my count, naturopaths can only prescribe in 10 states and 2 Canadian provinces. Big whoops.

Second, I’m sure some naturopaths screw up, but given the number of medicine/dosage mistakes hospitals make (what does the Institute for Medicine say, 1.5 MILLION a year?), you guys don’t have much of a leg to stand on.

And, that’s the point. Once we eliminate credentialing requirements, we can run randomized studies and see whether naturopaths are as bad as doctors, or the other way round. Now, you doctors are just dictating policy by anecdote and self-interest.

]]>