Comments on: Health reform needs to end fee for service medicine

By: jenga

jenga — Thu, 04 Mar 2010 17:37:27 +0000

If the problem is nine physicians you’ve seen, maybe you would be better off without one. Alot of us didn’t sign up to be government employees, which is what medicare for all does. I won’t participate in such a system. One third of physicians are over 55 and a whole lot of them won’t either, which means next time you go to an ER with an orthopedic complaint this doctor won’t be on call.

By: Pearl Korn

Pearl Korn — Thu, 04 Mar 2010 16:43:54 +0000

You got that right.
The Canadian system was modeled on our Medicare and is called Medicare.It is similar to the system that H.R.676 would create here. When there have been difficulties with the Canadian system it is because it has been underfunded. Yet, if you ask Canadians if they would want to opt out of their system the answer is a resounding NO.We must do a better job of educating docs on what could be.

By: Vox Rusticus

Vox Rusticus — Thu, 04 Mar 2010 16:24:33 +0000

Honestly, I wouldn’t mind the Canadian system at all. The specialists in my field are busy, seem adequately compensated, have nice offices, plenty of vacation time.
Where can I sign up?

Sell Canadian-style taxes to Americans. Remove the sacred cow of mortgage interest deductions. Bring on the VAT or GTA or whatever they call it now. Bring on Canadian gasoline prices. Subsidize university study the way the Canadians do and give me the same retirement and medical coverage, and a judicial system that is free of buccaneering lawyers. You can’t do the Canadian medical care system without all the rest, sorry to say.

By: buckeye surgeon

buckeye surgeon — Thu, 04 Mar 2010 16:21:32 +0000

What is it that you wanted done differently? No one put a gun to your head to go see all these specialists. Were you having pain or symptoms? Or were you just bored and felt like taking a jaunt to the local neurologist/neurosurgeon/orthopedist? I don’t get it.

By: Pearl Korn

Pearl Korn — Thu, 04 Mar 2010 16:20:51 +0000

Your second paragraph stating “doctors don’t get paid unless they achieve what they say they’ll do”. Nice idea, except I have never heard a doctor make a promise or guarantee about an out come,especially where surgery is involved. A warranty like on a clock or t.v. for 90 days is a nice idea.
I am all for ACCOUNTABILITY.

By: rezmed09

rezmed09 — Thu, 04 Mar 2010 15:29:03 +0000

I don’t think it is all black and white.

Canadian docs are not treated like postal workers. From what I understand, they are paid based on their patient load – bit salaried. Right now they are well compensated. PCP’s are making more than their US counterparts and seem to be happier. Primary care is not dying in Canada as it is in the USA. Specialists in the USA might not like that system – and they are the majority of the US docs.

By: skeptikus

skeptikus — Thu, 04 Mar 2010 14:55:27 +0000

Agreed. Warranties would come with differential pricing. This would have to come with consumers in fact paying for their care. But, again, this is good. People with better health would get cheaper warranties. (The opposite of insurance . . . )

Doctors should assume the role of underwriters to the extent possible. They are the best ones to calculate risk . . .

By: Vox Rusticus

Vox Rusticus — Thu, 04 Mar 2010 14:39:04 +0000

No problem with that, as long as I am allowed to charge whatever I see fit, and not have any form of caps from any third party entity, including the government. No limits. And I get to decide how the warranty is serviced, just like any other warrantor.

“Warranties” are nothing more than bundled insurance policies, Their costs are wrapped in the prices for the warrantied goods we buy. And most warranties are capped at either return of goods for price paid or replacement at the discretion of the manufacturer, not endless services or repair for the life of the product.

At present, most surgical services come with a de facto 90-day warranty. Most re-operations in that period are “ncluded” in the payment for the initial procedure (or are denied as such, whether they really should be or not.) Extending that period imposes extra liabilities, which have costs that must be paid. That is a job for underwriters. But they must be paid for.

I, for one, will not take that on without being paid for the costs. Voters can vote for whatever they want, but you don’t get to have free labor for the price of your vote.

By: skeptikus

skeptikus — Thu, 04 Mar 2010 14:09:53 +0000

Trial lawyers don’t get paid unless they win. Accountants routinely cover representation before the IRS if taxes get audited. Refractive surgeons often give guarantees and warranties . . . .

Why don’t we adopt this model wholesale. Doctors don’t get paid unless they achieve what they say they’ll do. That’s accountability and that’s economic efficiency.

By: Pearl Korn

Pearl Korn — Thu, 04 Mar 2010 13:23:37 +0000

French doctors are salaried and quite happy with the system. They use a non profit system of insurance delivery. The United States Health Care Act (H.R.676) is an IMPROVED AND EXPANDED MEDICARE bill, with 89 members of congress who support it. Doctors would once again be able to deliver the kind of care that brought them into medicine in the first place, without checking the clock .It would become patient centered.
The passage of this bill would provide better health care at lower costs. Our nation could save $400 billion per year going to this system, while providing over 2 million jobs.