Excellent analysis. I have also seen what happens in the ‘efficient’ VA hospitals, to nurses and physicians, and it is ugly. Private systems actually do care about the patient (read, customer).

Yep, it’s called a paycheck. I have a family to feed and I need an incentive to get up and go to work each day because I have a lot of other choices. Every hour I spend seeing patients is an hour I cannot be doing something else like spending time with my children or working at another job. Maybe for $100K a year, I’m willing to work 9-5 M-F. Plenty of time for my family and for other opportunities. But for $50K a year I’m only willing to work 20 hours a week, or maybe not at all in that job as I could earn more in my old construction job. On the other hand, for 200K a year, I might be willing to work 7-7 M-Sat. and for $300K a year, I might be willing to also take calls on my cellphone 24/7 from premium patients. The question becomes, will the market accept it? I personally would like to have a free market system so that I could find out. The doctors who want to churn patients through quickly making money off volume could be matched up with patients who like a cheap and quick office visit while other doctors who want to do hour long consultations could do so and be matched up (by the invisible hand of the market) with patients wanting that in depth care for a higher price. Just like any other good, some will want the cheap but less quality model and others will want the more expensive luxury model and they’ll vote with the pocketbook.

I spend a small amount of time working in a VA hospital and have seen first hand what happens to physicians are nothing more than 9-5 salaried workers. My patients love me because they can actually still get a hold of me “after hours” since I treat them just like my private patients, while other doctors check out physically and mentally at 430pm. I was covering a shift in the VA ER and a clinic doctor wanted me to admit his patient for him because it was 445pm. He’d seen the patient in clinic, lab work had come back abnormal (renal failure) and he wanted the patient admitted. Because it was after 430, he wanted me to call the patient, explain the lab abnormalities, have him come to the ER and have me call an Internist to admit him.

You’re right “It’s just a job,” which is why we need incentives to do it, just like EVERYONE ELSE. BTW, welders can unionize and go on strike. Doctors, for legal and professional reasons, can’t.

At minimum 11 years of training and around $200,000 worth of education and you don’t think that’s special? Go do it, and then we’ll talk.

Nothing doctors learn how to do is so special that they need some sort of special system used to employ them. It’s a *job*, not some mythical impossible work.

Docs should be paid on salary like most other healthcare workers do and be happy that the personal economic incentive to provide more quantity of care to more patients (rather than better quality care) is removed for them.

What an insightful set of comments here, and a perfect display of why doctors need to be reined in as one of the spiraling, out-of control costs of the U.S. healthcare system.

I thought I had addressed the profit issue already, but for a more philosophical answer to your questions of what is wrong with the current system read “Why we are moving towards socialized medicine?” – link below

http://www.aynrand.org/site/News2?page=NewsArticle&id=23957&news_iv_ctrl=1021

Getting something for your efforts, labor and time input, is a strong motivation for majority of people. These are the people who get things done. If you disincentivize(?) them, then they will either do less or do something else that offers them fair compensation for their input.

Or, is the current system ok and we don’t need to do anything?

Thank you.

I have worked in both australia and the USA (a socialist system vs our own). anybody who thinks that kind of system will work here is crazy optimistic. I work in the er, here and there. i have sent patient home with subdurals (no ct available at night, return in the am for your scan, evidence states you are low risk, but then you turn out tobe the one in a million), seen people die with CVA (nope, cant give the thrombolytics, no CT available after hours to make the three hour deadline). MI allowed to die (too old and no quality of life, no money should be spent on them). if that is to happen here, and it will happen here, people would revolt, and worse, sue.

I am not adverse to giving this quality of care if that is what the US system and consumer wants to demand, but I have not heard anybody telling people that universal coverage means these sacrifices.