Thursday, January 31, 2008
Paying to remain uninsured
My opinion on individual mandates is "evolving" (as they say in politico-speak). I previously supported an individual mandate approach to universal care, as practiced in Massachusetts. At the time, it was a preferred alternative to the other solutions, such as single-payer or Medicare-for-all. The focus on personal responsibility and encouraging the consumer to contribute to health care costs appealed to me.Seeing California's attempt fail miserably, and analyzing what's going on in Massachusetts has altered my stance. No, I still do not support single-payer. However, this scenario is ridiculous - some would rather take the penalty than pay for insurance:
Uninsured folks who don't qualify for government help really get pounded. Before the hike, the cheapest plan for uninsured couples in their 50s cost $8,200 annually. Now, unless government bureaucrats hand them an exemption, they might well find it cheaper to pay the penalty -- up to half the price of a standard policy -- than purchase insurance. That is, pay to remain uninsured. This is legalized extortion: TonySopranoCare.The government responds by capping insurance premiums, which then forces insurers to strip down coverage. This leads us down the path of saying "no", which is unfortunately unacceptable to the politicians. And so it goes.
I maintain that the focus on the uninsured is misplaced. Although important, it is not as vital as controlling costs. And that starts with primary care. As Massachusetts is finding out, the primary care system isn't ready for a bolus of newly insured patients. This paradoxically increases costs:
With a primary care shortage, many patients have to turn to subspecialists for their primary care needs, leading, in turn, to increases in health care costs while undermining the true intent of the Massachusetts Health Care Reform Plan, according to officials.Ensure the system is ready first before tackling universal coverage. Reconcile the salary difference between specialists and generalists, and forgive all student loans for graduates who elect to practice primary care.
Without adequate primary care, universal coverage won't be worth the card it's printed on.
Posted by Kevin |
link
| Comments (4)
| 
Comments:
Isn't it time to face reality? Insurers (particularly the government) aren't going to increase the income of primary care physicians. What they will do is to replace the GPs by nurse practioners, physician's assistants, and eventually practical nurses. Vide the British National Health Service.
In the not too distant future, primary care will be provided by sales clerks in the stores that house the retail "clinics" at which patients will be required to receive primary care.
In the not too distant future, primary care will be provided by sales clerks in the stores that house the retail "clinics" at which patients will be required to receive primary care.
# posted by 
: 12:20 PM
: 12:20 PM
Anonymous has a point. The trend seems to be to use "cheap" labor to fill the primary care void.
Back in the 90's there was a huge push to get medical students into primary care (and rural medicine). Even the US News added primary care rankings of med schools. What was the result? There are still probably 3 to 1 applicants for every derm spot as for every family med spot. How many internal medicine residents at least apply for if not matriculate into GI or cards fellowships? Why? I would argue money (no cynicism implied).
Truly I think it is a laudable goal to reward physicians for working hard and caring for patients, whether medical or surgical. But to call for parity between specialists and generalists sounds like magical thinking. How do you envision such a transformation?
Great post by the way, it is nice to see you argue.
Back in the 90's there was a huge push to get medical students into primary care (and rural medicine). Even the US News added primary care rankings of med schools. What was the result? There are still probably 3 to 1 applicants for every derm spot as for every family med spot. How many internal medicine residents at least apply for if not matriculate into GI or cards fellowships? Why? I would argue money (no cynicism implied).
Truly I think it is a laudable goal to reward physicians for working hard and caring for patients, whether medical or surgical. But to call for parity between specialists and generalists sounds like magical thinking. How do you envision such a transformation?
Great post by the way, it is nice to see you argue.
So Kevin says to "bolster" primary care before mandating coverage. Isn't that a market manipulation? And I thought the market was the solution.
Sorry Kevin. You and all the folks who think the system can be tweaked are delusional. It is horribly broken. At least from my perspective. 18 yrs of office FP medicine. That's why I quit. I didn't want to participate in a farce.
At least I think it's broken. But if you read P.Levy's blog HE doesn't think it's broken. He's just slightly questioning the $2 million he spends annually MARKETING his radiologists and Orthopods.
So perspective is crucial. I don't think the public thinks it's too broken. They are just worried about their cable bill.
I have enjoyed watching your(Kevin's) perspective "evolve". Mine still is. I am frequently tempted to think it is time for a revolution.
http://poemd.blogspot.com/2007/02/terrorist-in-white-coat.html
But get some politico so spout that...
Sorry Kevin. You and all the folks who think the system can be tweaked are delusional. It is horribly broken. At least from my perspective. 18 yrs of office FP medicine. That's why I quit. I didn't want to participate in a farce.
At least I think it's broken. But if you read P.Levy's blog HE doesn't think it's broken. He's just slightly questioning the $2 million he spends annually MARKETING his radiologists and Orthopods.
So perspective is crucial. I don't think the public thinks it's too broken. They are just worried about their cable bill.
I have enjoyed watching your(Kevin's) perspective "evolve". Mine still is. I am frequently tempted to think it is time for a revolution.
http://poemd.blogspot.com/2007/02/terrorist-in-white-coat.html
But get some politico so spout that...
Time to stop trying to fix the "system" and accept that there is no universal cureall "fix", being sick sucks and is expensive, and always will be.
In a free society, we are all responsible for finding our own fixes and have the responsibility to do so. I think that, without an even much heavier hand of government, we are going to continue to have multiple models running in parallel. Some people will be happy with what they are in and some will not be. Some will have the sense, money, and autonomy to change and some won't.
I think the future of primary care physicians is likely as a trainer and supervisor of non-physicians and as a direct provider of care only as a boutique practice for those who pay for their own care. Recognition of that is one reason so much of the general public are wary of reforms which take away their choice.
Saving primary care physicians as the primary provider of basic medical care is contingent on reform of the centralized payment systems that undervalue cognitive services with their non-market soviet syle centralized price fixing---and that isn't likely anytime soon. Ideally physicians would be paid like other professions--a dollar rate per hour measured in fractions of an hour with the docs setting the dollar rates they want to try to charge.
Post a Comment
In a free society, we are all responsible for finding our own fixes and have the responsibility to do so. I think that, without an even much heavier hand of government, we are going to continue to have multiple models running in parallel. Some people will be happy with what they are in and some will not be. Some will have the sense, money, and autonomy to change and some won't.
I think the future of primary care physicians is likely as a trainer and supervisor of non-physicians and as a direct provider of care only as a boutique practice for those who pay for their own care. Recognition of that is one reason so much of the general public are wary of reforms which take away their choice.
Saving primary care physicians as the primary provider of basic medical care is contingent on reform of the centralized payment systems that undervalue cognitive services with their non-market soviet syle centralized price fixing---and that isn't likely anytime soon. Ideally physicians would be paid like other professions--a dollar rate per hour measured in fractions of an hour with the docs setting the dollar rates they want to try to charge.
# posted by : 7:10 PM
: 7:10 PM
