Taking power away from distant federal politicians and giving it to individual states would do a lot of good.

The principles of COMPETITION and ACCOUNTABILITY would both thrive and whenever there is more competition and more accountability, overall quality increases.

This is actually how this nation was originally set up before some gradual shady political maneuvering amassed more power into the hands of a central federal govt.

That said, the best solution would be for states to experiment and do as their local citizenry asks. I’m with you – and in fact, aside from national defense and some interstate issues, that is what we should be doing in lots of areas.

We talk so much of marketplace competition to produce health care reform, why is there no talk of state-level competition to initiate reform? If Georgia creates an excellent system for patients, but a poor one for physicians, then docs leave and Georgia is forced to reevaluate and fix it. Florida could create a great system for physicians and leave patients out to dry, causing an exodus of elderly patients from Florida to Texas, forcing Florida to reevaluate their system. Why is this not a tremendously better idea than a Federal, one-size-fits-all system?

I realize the massive complexity of this whole healthcare infrastructure, but if we were to try our utter best to explain things to a 7th grader, how would you say that these reform bills in any way, would make things overall better for people?

Before you answer, I might have you ask yourself if you are just stating a fact of reality:
“Healthcare is expensive”
“People are getting sick who don’t have coverage”
“Doctors and/or pharma and/or insurance companies and/or lawyers are greedy”

If so, that’s not really an answer as to why these changes would necessarily make those things any better. I would be open to hearing, for my own growth and education, something along the lines of how anything in these bills could represent an overall superior way of letting things run.

Paul, that is THE BEST description of the great divide I’ve heard in a long while.

Right now, Philipa’s questions remind me of a scene from “Interview With A Vampire”, in which an angry (relative newbie) vampire, Louis de Pointe du Lac, argues with the 400 year-old Armand about their origins and chides him for not giving him any answers . . . Armand shoots back,

“But you asked the wrong questions!”

Apart from the massive sense of entitlement on the part of huge segments of society, the biggest PROBLEM that we have right now is that too many outsiders to the professsion . . . with their own selfish agendas . . . are LITERALLY RUNNING IT . . . without asking the right questions of the doctors and nurses in the trenches and on the front lines . . . people with the actual experience (and scars) from fighting the good fight (and for most of us, it IS a good fight).

What makes it exponentially worse is that these people really running our show do not care about us. It’s only about buying power and votes . . . or making their next bonus . . . and giving away our labors “for free”.

And/so, I guess what I’m saying is that the way you get things started is to ASK THE RIGHT QUESTIONS of the people who are actually doing the job/providing the service (that would be doctors & nurses). You don’t shut doctors out of the process or rob them of their voice.

Economically and practically speaking, it is NOT all about the consumer. There have to be good reasons for providers to stay in the game that you, Philippa, left.

And (here’s a thought) you do whatever you can to make their jobs easier and more productive. I daresay you could save trillions by giving medicine back to the people who practice it (and their patients) . . . by taking some of the middlemen/suits OUT of the picture.

You do not dictate. You do not bully. You do not micro-manage – or regulate doctors to death.

You actually work to define many things about the laws we already have which have been left to chance or interpretation.

You also start simply, and progress in steady increments . . . not with some monster bill that will create far more problems that it solves, and will have far more “unintended consequences” than we can imagine

I did grow up in the Peoples’ Republic of Massachusetts and am more in touch with the sentiments of those who are not part of the corrupt nepatistic political system or their employed minion.

There are many who were insulted by the idea that the vacant Senate seat BELONGED to Ted Kennedy. Trust me, he was NOT universally loved and admired. There are many, mostly independents, who are outraged at the arrogance of the Democratic leadership in Washington. This election result was a reforendum and not an aboration as some would like it to be portrayed.

I firmly believe that the spoiling of the Democrat supermajority is a good thing for the country. We, in medicine, are still trapped between the left (who hate us) and the right (who doesn’t want to pay us). Ultimately, if medicine goes to hell, I would rather fall on my own sword than sit back and be stabbed by the intentions and will of a wrong thinking congressional majority.

Reform is needed on how to address and allocate a scarce resource. It needs to address supply and demand factors. When CVS offers simplified healthcare for routine vaccinations and simple illnesses, that is reform from the marketplace. When robotic surgery becomes more commonplace, that too is reform. When medical tourism becomes more widely known , that also is reform. Yes, some of us may not like it, but that is the wisedom of the marketplace speaking.

The American populace does not want the top-down reform from Washington. That should be clear. What they are asking for is Washington to get out of the way, give consumers and patients and medical professionals more freedom. That is the message.

Special Interest Groups and lobbyists are acting, of course, in their own self interest – and that impedes market based reforms. Haven’t you heard the people complaining about the politics of healthcare, the special interest groups, the lack of freedoms, the restrictions, etc? The public does not want a govt managed healthcare system. They know about govt run projects and costs and bureaucracy.

HSA’s. They are now 20% of the private insurance market with no government assistance except getting out of the way. They really do “bend the cost curve”, year after year, insurance company after insurance company, the data’s out there. Not only were they deliberately ignored, but the prople who claimed to be “reformers” actually worked to kill them with this surrent debate. Rockefeller from West Virginia as just one example.

Want to take the next step? How about a Shadegg-type bill, allow people to buy insurance across state lines? Yes, I know the theoretical objections. Fine. Let’s find out. If it fails, it can be repealed.

No, why make incremental steps, when we can wipe out the entire system, put clauses in the law to make it impossible to repeal, kill the private market entirely, and ruin the country in the process?

I can dream, can’t I??

However, I AM intrigued by the notion (and I say with all sincerity that I AM paying attention to your words and chewing on them) that you equate universal access to decent healthcare alongside women’s and blacks’ rights to vote, considering that this isn’t even questioned in most European countries.
It highlights for me one of the mysteries that I haven’t fully grasped, despite my 25+ years in the US — that there really IS an American mindset that needs to be respected and taken into account. It was alluded to in this post by another physician:
http://medinnovationblog.blogspot.com/2010/01/middle-class-unrest-and-massachusetts.html
Problem is, if this is indeed true, then what happens to those in this country who are for whatever reason unable to tap into “self-reliance, economic progress, private independence, religion, historical traditions, social activism, decentralization, and distrust of government elites telling them what constitutes the “public good” or “common good.” “?
Perhaps the next ML King of Healthcare is due to surface – I guess that is what I am hearing.

With respect Philippa this isn’t going to happen on anything meaningful. The GOP voted to a man and woman against what is really modest reform. History tells us that in the western world things like votes for women and blacks, and workers’ rights, were only gained through huge struggle and sacrifice. Those with power and money do not as a rule sit round a table and give it up politely.