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Specialists are a key component in any health care system. The US has come to use GP's as gate-keepers over access to this second tier care. This may not be the best plan once insurance underwriters start edging GP's out of the process. But never fear, there is always a conspiracy theory out there somewhere that will suffice to explain everything.
Specialists are a key component in any health care system. The US has come to use GP's as gate-keepers over access to this second tier care. This may not be the best plan once insurance underwriters start edging GP's out of the process. But never fear, there is always a conspiracy theory out there somewhere that will suffice to explain everything.
All specialists have done is created a foundation for skyrocketing profits.
No one looks at the actual "health" of Americans. It is p-ss poor. We are the sickest of the first world countries. More doctors and more insurance has not improved Americans' health, in fact it has made it WORSE.
It's a shame how ignorant people are who believe just because they have insurance and see a bunch of doctors that means that they are "healthy" and "taking care of themselves." Um, no, if you are healthy you have no need for medical care.
Health insurance + doctors does NOT necessariy = health.
By "too much healthcare" I take it to mean that healthcare has unlimited access, that is, there is no economic incentive for a patient to not use any and all healthcare services. That is a problem - people being who and what they are, will gorge on healthcare, and indeed with our insurance system that is what is happening in the US.
A telling statistic is the use of CT Scans and MRI - the US uses those tests at a significantly higher rate than any other country, yet based on quality of healthcare metrics, we have inferior healthcare than those other countries. The reason is, since insurance pays for almost all CT scans and MRI tests, they are handed out like candy. They are expensive but the patient doesn't "feel" that expense since insurance covers it.
So to answer the OP question - Yes, it is possible to have too much healthcare, if that healthcare is provided at a no-cost service to all people. They have to feel an economic incentive to only use healthcare services that they really need. Because most people don't know when they need some services, they rely on their doc to tell them. But the doc has no skin in the game so he/she will always over-prescribe, especially when the doc could face a malpractice suit for not ordering a test that would have detected a serious disease. So, the economics of healthcare usage is being driven as much by fear of lawsuit as it is by patient choice. That is an unfortunate situation.
Healthcare is a tangled mess in the US. Obamacare has tried to solve the access problem but did nothing for the problem of reining in costs. It really needs to be over-hauled top to bottom to fix it. It has become big business, more focused on making money than helping people.
If we need to reduce the amount of healthcare, how should it be done? People already pay too much in copayments for hospitals and specialists. Their copayments are often very low for their primary care, but, primary care involves mostly referrals to expensive specialists and expensive tests, so they don't really save much by low primary care copayments.
But if copayments aren't a good way to motivate a reduction in the amount of healthcare, what is? One of the schemes I mentioned sounds workable to me, but is it really?
My wife lived in the UK and raved about their health care. You get screened by a nurse first. If you've just got a cold, flu, or minor injury, etc...Often you don't go past that nurse, or you see another nurse who specializes in your problem before seeing a doctor.
It all happened very fast too, within a few minutes of checking in to a walk in clinic. The total bill even for a non-citizen was less than visit to the clinic here.
If we need to reduce the amount of healthcare, how should it be done? People already pay too much in copayments for hospitals and specialists. Their copayments are often very low for their primary care, but, primary care involves mostly referrals to expensive specialists and expensive tests, so they don't really save much by low primary care copayments.
But if copayments aren't a good way to motivate a reduction in the amount of healthcare, what is? One of the schemes I mentioned sounds workable to me, but is it really?
I tend to think that free-market principles will solve some but not all healthcare issues. For a free-market to work, there has to be total transparency in pricing to the patient. It currently is almost impossible for a person to shop around for say, the best deal on a knee replacement. The SEC (Security Exchange Commission) has fixed the problem of transparency for the financial markets by requiring dealers in stocks and bonds to meet certain reporting criteria. We need something similar for healthcare.
But I don't think that a free-market environment is sufficient. Healthcare is full of providers that have patents on devices, procedures, or drugs and they use those to scalp people. Healthcare also needs to be treated somewhat like a utility in which the public has oversight on prices to guard against scalping.
Lastly, I think it is totally unfair that providers (docs, hospitals, etc.) charge different prices depending on who you are or what insurance you have. That would never work in any other business. Providers should be required to pick a price they charge and that is it for everyone. The provider can pick any price within the limits of the above mentioned oversight group, but once they pick it, that is it for all their patients.
Doubly lastly, I think that insurance should be single payer but that the providers should be open market. So we all have the same insurance, but we get to choose where we go for treatment. By having the transparency I mentioned above, we can make the choice of how to best use the insurance coverage we get. You can go to a more expensive provider but you will have to pay the additional costs yourself. It is your choice. This is somewhat how Medicare works.
For example, if there were no malpractice lawsuits, and if all medical costs were paid by the government, and all medical decisions were made by doctors following guidelines set by panels of medical experts and cost experts, then there might be too little medical care, because people might have a hard time getting the medical care they needed.
But, in our present system, people get too much medical care, because doctors worry that if they don't do every possible test and try every possible approach to every medical condition, they might get sued. .
This is very far from the reality. The reality is that many people can't get doctors to take their concerns seriously at all. Doctors tell patients they're "fine", nothing's wrong, or they tell them to see psychiatrists. And that's just for relatively common concerns like hypoglycemia and other blood sugar disturbances, thyroid (insurance refuses to pay for the thyroid disease blood tests that many thyroid patients need), parasites, food allergies, and a variety of other easy to test for and treat conditions. For more serious and somewhat more rare issues, doctors simply refuse patients altogether.
I'm starting to suspect that doctors are trained to deny testing and any serious discussion of medical concerns to patients as a way to keep costs down.
Doctors, even some specialists, are very poorly informed about basic facts within their field of study. Endocrinologists are very limited in what they tread: only diabetes and thyroid, and they don't even do a good job of those, let alone anything else in the endocrine realm.
That aside, a lot of money could be saved if insurance companies operated on a non-profit basis, and if hospitals and clinics did the same. Insurance has become a cash cow to a lot of doctors and physical therapists, so private for-profit clinics are burgeoning, right when the public and policy-makers are talking about cutting costs.
Last edited by Ruth4Truth; 10-07-2016 at 11:11 PM..
Lastly, I think it is totally unfair that providers (docs, hospitals, etc.) charge different prices depending on who you are or what insurance you have. That would never work in any other business. Providers should be required to pick a price they charge and that is it for everyone. The provider can pick any price within the limits of the above mentioned oversight group, but once they pick it, that is it for all their patients.
Doubly lastly, I think that insurance should be single payer but that the providers should be open market. So we all have the same insurance, but we get to choose where we go for treatment. By having the transparency I mentioned above, we can make the choice of how to best use the insurance coverage we get. You can go to a more expensive provider but you will have to pay the additional costs yourself. It is your choice. This is somewhat how Medicare works.
Most people think that the uninsured are the biggest burden on healthcare costs. They aren't.
Insurance companies are. They low ball and low ball, force contracts for care and completely undermine the pricing. They are the WORST payors into the system. They "owe" the most, but will never pay that balance because they have set the "pricing." It's why no doctor will spend more than 2 minutes face time with a patient. Every extra minute is cutting into that doctor's salary.
For one thing, Americans in general do not like to go to the doctor. You have to harass them to get them to do as much as getting an annual physical exam or taking such basic precautions as periodic eye exams or colonoscopies after 50. Under-consumption of health care here is a far more serious problem than over-consumption. Don't forget that the US still has one of the worst rates of death from treatable causes among developed nations.
As for imaging technology, there are many more imaging machines per capita in Japan than in the US and utilization rates there are high. An imaging session in Japan however costs about one-fifth of what it costs in the US. Japan has no problems with crushing health care costs.
The purposes of GP's are to treat small problems, to maintain a baseline of your general health status, and to do referrals to specialists when the need for one arises. A GP after all is a generalist. He or she has some knowledge about a lot of things. It is specialists who have the deep knowledge of one or just a few things, and those are the people you want to see when you have one of those things.
Market principles are only effective in markets. Markets require that there be substantial consumer information in order to be efficient. But health care consumers are apt to have little if any information at all. We end up choosing doctors we are personally comfortable with and then doing whatever they tell us to do. This is how the system operates and how it is supposed to operate. A system that required everyone to do several years of med school would not be functional at all.
Though the rates of increase have slowed, health care costs amount to a little more than 17% of GDP. Nobody is unaffected by medical cost factors. At the extreme, a person could attempt to drop out of health care altogether, but that would not be likely to last for very long. Most of us are meanwhile quite well aware of what health care costs are, even those who have good insurance.
Last edited by Pub-911; 10-08-2016 at 06:47 AM..
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