Give us health care savings accounts, all of us, so we can pay for our care ourselves, and decide for ourselves what is worth the money and what isn’t

There’s plenty of room for a wide variety of healthcare delivery systems some of which have not come to fruition because healthcare is not allowed to operate as a free market. If it were, Dr. Douglas could innovate a practice that aligns with his personal philosophy and meets the needs of patients. Have you sought opportunities that might fulfill your desire to operate as a public servant? You know you can work for the US government in underserved areas, make about $120,000 AND have your malpractice insurance covered by the government? Or, you can volunteer for Smile Train where your services would change the lives of many around the world. Better yet, you could start your own foundation, raising funds from philanthropic organizations, setting your salary and providing services to the uninsured and underinsured. America is the most generous nation on earth after all.

There was a time when medicine provided charity care but that was before medicine became so litigious. Dr. Douglas, your vision for healthcare is just that–yours –so go out and fulfill it but, don’t expect others to fall in line behind you.

Patients will always be customers, no matter how you look at it. And what is wrong with that?

Skepticus, shouldn’t you direct this comment to the american people who balk over a $20.00 copay? As stated above by some posters, there is a complete disconnect between what that patient acutally pays (directly) and what things actually cost. Hence, the patient wants everything (he doesn’t directly pay for it), there is no incentive for the doctor NOT to order everything (in fact given the medical-legal climate there is incentive to order everything) and thereafter insurance costs continue skyrocket. The situation doesn’t take an economist to figure out, the issue to the solution.

Money should not be mentioned, directly or indirectly, because health care, at any level, cannot be equated in dollars and cents.

As long as medical care has a cost that is more than trivial, money does come into the equation.

Suppose a patient has a condition for which there are two treatments, one of which costs $N and has an 80% chance of success, while the other costs $10N and has an 81% chance of success.

Do you think that the patient and doctor will make the same choice between treatments if the patient were self-paying, versus if the patient’s care were fully paid by a third party in the immediate case (even if the patient eventually pays indirectly through insurance premiums or taxes or pay foregone due to having insurance premiums paid by his/her employer)? In the third party payment case, do you think that the third party might have some interest in how the money is spent (especially if the third party is the government, funded by everyone who pays taxes)?

Given that many of the doctors who provide us health care are often running a form of small business, they end up dividing their attention between payment collection and practicing their skills. Reducing the overhead in tracking every billable service provided and dealing with different insurers would allow them more time to provide patient care with less effort and thus less cost.

It is in neither the patient’s interest nor the doctor’s to be trying to argue with a health insurer to obtain permission from the insurer to pay for a procedure or medication. This interaction takes time that comes out of the pocket of the doctor and ultimately the patient while at the expense of the patient’s health. These delays in patient treatment can lead to further health problems that result in greater health care expenses for the patient later on.

That said, cost containment must definitely be in the equation as it is the one real weakness in the Canadian and British systems. These systems provide excellent care, but because even those who don’t take an active interest in their own health are treated equally , costs are constantly a problem. However, this is better than a system where people who are otherwise looking after themselves can be rendered bankrupt through factors they cannot control.

The sooner you all wake up to the reality that healthcare security is a vital factor in social and economic functioning the sooner you can accept it as a rightful public utility that needs proper planning.