Obviously, I was incorrect (who’da thunk that?!)

So, it looks like you have to register to leave a comment. But, it’s a pretty painless process [ed: nice alliteration]: just click on the “Blogger” icon in the upper left corner. It’ll walk you thru the process (it’s a little weird, because it also asks if you want to set up a blog yourself). You can register with a throw-away email (e.g. mail.com, juno.com, hotmail.com, etc).

I really want to have people leave comments, to get a dialogue going. So….Please don’t be intimidated, go ahead and sign up!

In response to some emails, I’ve changed the settings for comments so that anyone can post one, not just registered folks.

Don’t know how long I’ll let that go; I’m new to this, so I’ll play it by ear.

Meantime, it costs nothing to register (just click on the “Blogger” icon in the upper left-hand corner and it’ll walk you thru), and it may help avoid hassles for folks later if/when I change the comments settings back to “registered users only.”

I am a little confused by the above post. Mr.Bandsma seems to both think doctors are overpaid and that their liability is too high, causing those same potentially overpaid individuals from taking up the profession and causing a shortage. I can’t make out what disallowed “market forces” he thinks would resolve these issues.

He is right about our overspending as a percent of GDP and what we get for our money. But among the most wealthy countries we are most definitely not suffering a shortage of physicians per capita. In per capita terms We have almost triple the number of doctors as Canada, 35% 0 40% more than France or Germany, almost 3-1/2 times the number of the UK. (These are rough, but I just looked this up on the UN Development index last week and it was shocking.) In Canada and the UK the claim is that poor pay discourages doctors from practicing there. That may well be true. When I worked in Detroit we had an astonishing number of doctors crossing the international border to practice on the American side. Americans have heard plenty of horror stories about Canada’s physician shortage and long waits for care. The long waits may be true but on every indicator that matters, Canada does much better than we do in outcomes. So, maybe doctors aren’t the problem or the answer.

I am not sure about what percentage of the American health care dollar goes to doctors. 25% seems high, especially once one looks at what insurers actually pay per visit as opposed to what physicians’ offices bill. Maybe it’s a big city thing, but the physicians here in the city of Chicago seem far more concerned about their patients’ inability to access care than they are about malpractice insurance premiums, Which is the thing we heard so much about in the last election cycle. Talk about a manufactured crisis when there is a much more deadly one afoot. Without insurance getting care IS possible but it is difficult, slow, time-consuming, frustrating and frightening. An example: Last March I knew I was overdue for a mamogram. It was mid-May before I could get in to see the primary care doc. who could write the order. It was July before I had the test. Another set of pictures was needed. Got those, end of July. A biopsy is needed. It is now November 3rd, 8 months since I started this process. I will not have a biopsy and know the results until Thanksgiving. So much for early detection and treatment.

I also knew last March that I needed physical therapy for a damaged tendon. My 1st appointment after going through the proper managed-care channels of the county system? Mid-November again. The day after the biopsy. Do I DARE postpone?

Drug costs in this country are staggering. So are insurance premiums for those of us with chronic conditions. Just one of my Arthritis meds cost over $1400.oo per month retail. There was a period of time, before my life savings were wiped out, when I was paying out of pocket over $2000.00 per month, just in insurance and meds – and that was AFTER I stopped taking the pricey drug mentioned above, which was probably the one that helped the most. All that spending and I was still only partly treated.

Then there is the whole new bureaucracy that has arisen – and which we also pay for with our healthcare dollars– which exists mainly to put in place the “limits” on spending that the consumer is unwilling to place upon herself. An entire apparatus of billing co-ordinators and specialists, coders, reimbursement specialists, claims specialists, etc. has developed and grown exponentially since 1980 when the insurance industry began to be deregulated by the government, only to produce its own gargantuan internal reimbursement regulation apparatus. The amount of person-hours spent on fruitless phone calling to get claims reimbursed or approved or re-submitted is staggering. For every doctor’s order that is written, there must be at least a dozen people that it has to pass by before the order is transcribed, filled, billed, submitted, approved, entered as paid and, hopefully, finally reimbursed at some reduced rate negotiated on the other end by the insurer. Then there are the glitches- when something doesn’t go as it should — which happens often when dealing with 3rd party insurers and hospital billing systems that are patched together and poorly understood by half the people who use them. I am still battling over two visits from 7 years ago that I paid out of pocket because I knew insurance wouldn’t cover them, only to have the hospital submit them to the insurer anyway and have them denied. So, they re-billed. Using different codes and cost centers, making it virtually impossible for me to prove I did NOT make two emergency visits to a clinic I never set foot in.

Then there are the tricks of the insurers, seemingly designed to wear down the supposedly insured. My last policy refused to pay for standard bloodwork + liver and kidney function tests – a necessity periodically for people on long-term meds.
It also did not pay for a pap smear. the reason: pre-existing condition. “Well, yes,” I said to the unable-to-help, $10.00 an hour “customer care” person who got my call after 12 tries of getting busy signals and 25 minutes on hold, “I did have a uterus, kidneys & liver before that labwork was done, but as far as I know they were all ‘conditionless.’” His supervisor was also unable to help. Someone would call me back. It never happened. I tried calling back several times but I never got to speak to a live person again. The claim was still denied.

How on earth does this make sense?

The other belief is that we have to spend an inordinate amount of money to train only the best qualified doctors and that those doctors should be held punitively accountable for their inevitable mistakes, as well as thinks that are outside the control of a doctor. The result of that belief is that doctors are not as plentiful as they should be. Therefore supply and demand plus the costs of being a doctor (liability insurance and schooling costs) dictate that doctors salaries will be high. As a result 25% of health care spending is to pay doctor’s salaries. Being a doctor is the highest paid profession in the US. It need not be. It’s not the case in most other countries.

Unless we address these underlying beliefs how we distribute health care will matter little. Already 14% of our GDP goes to health care spending where in other western countries it’s usually more like 7-8%. I would not be concerned with that number if we actually got what we paid for. But looking at medical statistics such as life span, cancer survival rates, infant mortality, etc. it hardly seems like we are. But even switching to a government administered health care system will not bring down the cost and bringing down the cost is what will make universal health care possible. To put it another way there are two specific areas where market forces are not allowed to limit the rise of costs and as a result they have risen precipitously. The people who are hurt by this are the people at the lower end of the economic ladder (or those who are too stupid to realize who easy it is to game the system).