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The entire premise of this thread is flawed because healthcare doesnt operate in a free market and never has.
Consider this -- in a free market, increasing the number of doctors leads to lower costs because the doctors compete against each other to lower prices.
So explain to me why healthcare costs are HIGHER in places that have more doctors? For example, big city areas with lots of doctors have much higher costs than in rural areas where there are very few doctors. The cost to going to a doctor in the big city is also higher than going to a doctor in a rural area. If healthcare was a free market, then that wouldn't happen.
So now that we've agreed that healthcare is NOT a free market, let's consider what happens when we increase the number of doctors.
Increasing numbers of doctors leads to HIGHER costs, not lower. More doctors = more people selling procedures that patients don't need. Consider that in areas with high numbers of plastic surgeons, utilization rate of plastic surgery among population goes up. That's proof that plastic surgeons are not responding to a free market, they are CREATING a new market and inducing higher demand.
If you flood the country with doctors, healthcare costs would skyrocket, not decrease.
I largely agree with this post. I don't think the "free market" will ever solve the problem of high medical costs because none of the conditions that economists use to describe free markets apply to healthcare.
The title of the thread describes one of the barriers--medical licensing. However, who really wants to go see an unlicensed doctor? I don't. Eliminating licensing is too high a price to pay for a reduction in costs. The shoddy and substandard health care that would be delivered would be overwhelming. Bad would drive out the good and the loss of confidence in the medical field would be overwhelming.
Other barriers exist though that keep medicine from being a truly free market. Lack of information keeps many people from making informed choices. The level of expertise necessary to understand medicine is simply beyond the majority of people.
Costs make it difficult to enter the field. Hospitals require huge investments and must have the very latest technology. I suspect the delivery of medical care in rural areas is particularly expensive when it is figured on a per capita basis. Many rural hospitals don't make money despite high charges. It is why many have closed or are in the process of closing.
It would be better to face the fact that the free market has either failed or is not an acceptable model for delivering a scarce and precious resource like medical care. It would be better to create some kind of system that is more like the way we regulate public utilities in this country. Medical providers would accept more limited reimbursement from a national health insurance system in return for guaranteed payment. All Americans would be covered and would pay taxes much the way we pay taxes right now to fund Medicare and Medicaid.
The free market works well when it comes to things like selling tv sets or computers. It doesn't work so well when products or services are complex and poorly understood.
Recently, I was thinking why it cost so much see a medicial professional and why often there is such a long wait time. It should be obivious there is not doctors, nurses or medicial professions needed to meet all of America's demand.
Free Market Principle to alievate demand is to increase supply. If there greater supplier of medicial professional than demand you would see healthcare cost and wait time fall drastically.
In fact, there numerous other have researched and some have found it could improve healthcare and make it readily accessable instead of harming patients with more bad doctors.
Complete elmination of licensing isn't quite needed however there can be improvement can made. For example, look at Medicial Exam certificating and making easier to pass. Even allow people with on job medicial training instead of formal training to start taking some medicial certifcation for Nurses, doctors, etc. As well people who work at pharmacy without a degree can take and become licensed pharmacist easily. Another simple way is increase acceptable rate of Medicial school to say 75% or 80% instead of pathetically low rates currently.
The idea is simple once you start increase medicial professions where more supply of them then patient demand prices will start dropping. The higher ratio of medicial providers to patients low the cost. Depending how cheap patients want healthcare to be, the more agressive steps are needed to increase supply of providers.
It's actually a much simpler issue than this. The problem is just that there are not enough medical residency positions due to federal penny-pinching. As a result, the number of new doctors coming through the pipeline each year is severely constrained.
It's actually a much simpler issue than this. The problem is just that there are not enough medical residency positions due to federal penny-pinching. As a result, the number of new doctors coming through the pipeline each year is severely constrained.
This is the heart of the issue on shortages of medical labor. There are not enough training slots. Goes beyond residency - med school, nursing programs, dental school, OT/PT/ST, PsyD, etc. all turn away many qualified applicants. Only major thing with adequate slots is PharmD and pharmacy dispensing costs are well contained and there are few access to care issues on the dispensing side; that's not a coincidence.
Quote:
Originally Posted by platon20
The entire premise of this thread is flawed because healthcare doesnt operate in a free market and never has.
Consider this -- in a free market, increasing the number of doctors leads to lower costs because the doctors compete against each other to lower prices.
So explain to me why healthcare costs are HIGHER in places that have more doctors? For example, big city areas with lots of doctors have much higher costs than in rural areas where there are very few doctors. The cost to going to a doctor in the big city is also higher than going to a doctor in a rural area. If healthcare was a free market, then that wouldn't happen.
So now that we've agreed that healthcare is NOT a free market, let's consider what happens when we increase the number of doctors.
Increasing numbers of doctors leads to HIGHER costs, not lower. More doctors = more people selling procedures that patients don't need. Consider that in areas with high numbers of plastic surgeons, utilization rate of plastic surgery among population goes up. That's proof that plastic surgeons are not responding to a free market, they are CREATING a new market and inducing higher demand.
If you flood the country with doctors, healthcare costs would skyrocket, not decrease.
Quote:
So explain to me why healthcare costs are HIGHER in places that have more doctors?
They are not. Total costs tend to be higher in rural areas where providers have more pricing power, despite the absence of academic medical centers doing high volumes of high cost procedures and any reduced use due to access to care issues caused by inadequate medical professionals. Not across the board, but that's the pattern more often than not.
We do not have a system of health insurance in this country. We have a system of all-you-can-eat pre-paid health care that is mis-named "health insurance." We do ourselves a disfavor when we call it insurance, as it does not operate the way insurance operates.
Insurance only pays out for the unforeseen, not the foreseeable. For example, a woman knows approximately 9 months in advance when she will give birth to a baby. We should not finance childbirth via insurance, as it is perfectly foreseeable. Similarly, we should not finance routine colonoscopies and mammograms - which are perfectly forseeable - via insurance, as insurance is for the unforeseen.
When you look at the handful of medical procedures that are not covered by insurance, their quality has gone up while their prices have gone down. LASIK eye surgery is the obvious example. With minor exception, LASIK is not paid for by health insurance. Over the past several decades, the price of LASIK has plummeted, and its quality has improved exponentially.
We all have automobiles and car insurance. We wouldn't dream of asking Geico or State Farm to pay for a brake job or a new battery every 4 years, yet somehow we think it is right to have Aetna or UnitedHealthCare pay for checkups and procedures that are needed simply because each of us is alive.
Last edited by RationalExpectations; 04-23-2023 at 09:43 AM..
We do not have a system of health insurance in this country. We have a system of all-you-can-eat pre-paid health care that is mis-named "health insurance." We do ourselves a disfavor when we call it insurance, as it does not operate the way insurance operates.
Insurance only pays out for the unforeseen, not the foreseeable. For example, a woman knows approximately 9 months in advance when she will give birth to a baby. We should not finance childbirth via insurance, as it is perfectly foreseeable. Similarly, we should not finance routine colonoscopies and mammograms - which are perfectly forseeable - via insurance, as insurance is for the unforeseen.
When you look at the handful of medical procedures that are not covered by insurance, their quality has gone up while their prices have gone down. LASIK eye surgery is the obvious example. With minor exception, LASIK is not paid for by health insurance. Over the past several decades, the price of LASIK has plummeted, and its quality has improved exponentially.
We all have automobiles and car insurance. We wouldn't dream of asking Geico or State Farm to pay for a brake job or a new battery every 4 years, yet somehow we think it is right to have Aetna or UnitedHealthCare pay for checkups and procedures that are needed simply because each of us is alive.
Your post in general is spot on. Doctor visits for colds or flu should not be insured events. We do disagree on colonoscopies and the like since that is preventive care. But otherwise that's a quibble.
For-profit free-market (FPFM) health care can only succeed in mostly large urban areas where there the population density can support the major investment in hospitals construction and operation.
Even in heavily populated areas, I don't always feel that my FPFM providers are doing all they can for me by pushing me out the door while barely awake from sedation. IIRC they push new Moms and newborn infants out the door asap. If people in the urban areas were polled I bet many would say they feel under-served by the status quo and their pill-pushing gatekeeper GPs, and long waits for almost everything. Back in Northern Virginia, near DC, with Kaiser, it took my wife MONTHS to get a PAP smear scheduled and took me six weeks to get anything scheduled. She had a hairline fracture in her foot and Kaiser wanted her to wait SIX WEEKS to see a specialist. She said no to that, picked up the phone, called a Podiatrist up the street, a block from Kaiser's huge facility, and had an xray and cast the next day. AFAIC that FPFM model does NOT work for us. We're on Medicare now and we love it, and wish all Americans had Medicare.
For years we've seen the flip side of FPFM in the closing of rural hospitals which neither make a profit nor attract the specialists needed to support the communities out there.
My overall assessment, nationwide, is that FPFM health care is failing us -- when measured as a national whole. Are we one nation or a two-faced nation of haves and have-nots? The few rural / remote areas with any health care of any note is usually the Indian Health Service, largely out here in the West on Indian Reservations.
At least 20 years ago I read how NY state deliberately constrained the number of students allowed into Medical schools. The intent was to keep doctor incomes high by limiting the supply of doctors. IMO that's one reason why we see so many foreign doctors here; health care providers have had to tap the world's supply of doctors, and even nurses, to cover the deliberate shortfall of licensed professionals. I've tried in vain to find that old article and if I ever do then I will post it here.
In part of my civilian employment with the Army, I participated in scrubs of personnel rosters to determine which jobs are inherently in the government lane and which jobs are commercial in nature and could be contracted out to private industry. One example was the entrance gate to Army bases, especially the USMA at West Point. My view was that West Point hosts many bus trips of NYC school kids on field trips and entry gate guards at West Point are their first glimpse of the Army. My opinion was we should have a crisp-looking uniformed soldier at the gate for visitors to see, like we see at the Tomb of the Unknown Soldier in Arlington Cemetery and not Fat Phil the rent-a-cop, like Paul Blart the mall cop. I didn't win that discussion and the gate guards at West Point were slated for civilian contractors. IIRC from my time in COLO SPGS, the USAF Academy there always has USAF MPs at their entry gates. FWIW, the Army G1 officer leading those personnel scrubs was BG Ray Odierno, who went on to become a 4-star and Army Chief of Staff. Yes, he was fully bald even back in 2001.
So, all that being said, is health care in the government lane (universal single payer) or is it not? The crux of this issue is that FPFM health care can only succeed in major urban areas. I'd support a hybrid approach that the Federal government, via the Public Health Service, or the Veteran's Administration, be charged to provide care in all those parts of rural America which have been forsaken by the FPFM model.
But wait, there's more. The FPFM model, in order to maximize profit, has cut facilities and staff to the bone, to include the nursing home "business." There's little room left for large medical emergencies like the recent massive workloads with the pandemic. What would happen if some lunatic pops a nuke on any large city, it will make any horror movie you've seen pale by comparison.... Ronald Reagan worked to increase the amount of available hospital and medical care in case of a national emergency but I'm sure that safety pad has long since been cut out of our hide.
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Last edited by Mike from back east; 04-23-2023 at 01:37 PM..
My overall assessment, nationwide, is that FPFM health care is failing us -- when measured as a national whole. Are we one nation or a two-faced nation of haves and have-nots? The few rural / remote areas with any health care of any note is usually the Indian Health Service, largely out here in the West on Indian Reservations.
Another problem is that what medicine can do for us, and the cost of the needed facilities, has exploded. These problems can be solved if we devote a huge portion of GDP to health care. For example, Mickey Mantle got a (futile) liver transplant. Can we afford a transplant for every failed liver, kidney or heart?
A ore typical problem is the elderly. My mother, who I loved dearly, at age 75, in 2008, had a hysterectomy for endometrial cancer, followed by X-rays. She fell and broke a knee owing to her bone structure being weakened by X-rays. Chemo followed later. In late 2011 dementia began setting in. So did a recurrence of the cancer. Another operation in January 2012, and more chemo. Notwithstanding, she died, demented and miserable, in December 2014. She was on "hospice" from February 2014 on. The distractions were part of what caused me to lose my job (I am re-employed and happily since 2017). My mother is hardly an extreme case.
For these reasons, the problem of health care is basically insoluble. We can bankrupt society, have a "tale of two cities" or leave matters to chance. I don't know what's best.
Another problem is that what medicine can do for us, and the cost of the needed facilities, has exploded. These problems can be solved if we devote a huge portion of GDP to health care. For example, Mickey Mantle got a (futile) liver transplant. Can we afford a transplant for every failed liver, kidney or heart?
A ore typical problem is the elderly. My mother, who I loved dearly, at age 75, in 2008, had a hysterectomy for endometrial cancer, followed by X-rays. She fell and broke a knee owing to her bone structure being weakened by X-rays. Chemo followed later. In late 2011 dementia began setting in. So did a recurrence of the cancer. Another operation in January 2012, and more chemo. Notwithstanding, she died, demented and miserable, in December 2014. She was on "hospice" from February 2014 on. The distractions were part of what caused me to lose my job (I am re-employed and happily since 2017). My mother is hardly an extreme case.
For these reasons, the problem of health care is basically insoluble. We can bankrupt society, have a "tale of two cities" or leave matters to chance. I don't know what's best.
Sad that your Mom had to go through that, and that your family had to watch her suffer through this.
Such cases get directly at the heart of the Death With Dignity (DWD) effort. I've written about DWD in many forums, here and elsewhere. In ten states, with advance planning, a terminal patient may choose DWD rather than the prolonged suffering your Mom endured.
Basically DWD involves documenting your wishes in advance directives and then having our doctor prescribe a couple of pills we can take to die peacefully without the drawn out agony many of us have seen some of our elder generation endure. Each of us has to make a choice for ourselves, and I hope AZ adopts a DWD law in the not too distant future.
About a third of all Medicare spending occurs in the last year of life, and in many cases these extreme and/or futile expensive measures could be avoided if we had a simple DWD law nationwide. In my scheme of things DWD would be a part of any Medicare for all. The dreadful agonies many aged people endure in their final weeks and months is not health care, it's cruel and unusual punishment. We treat our dogs better.
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Sad that your Mom had to go through that, and that your family had to watch her suffer through this.
Such cases get directly at the heart of the Death With Dignity (DWD) effort. I've written about DWD in many forums, here and elsewhere. In ten states, with advance planning, a terminal patient may choose DWD rather than the prolonged suffering your Mom endured.
Basically DWD involves documenting your wishes in advance directives and then having our doctor prescribe a couple of pills we can take to die peacefully without the drawn out agony many of us have seen some of our elder generation endure. Each of us has to make a choice for ourselves, and I hope AZ adopts a DWD law in the not too distant future.
About a third of all Medicare spending occurs in the last year of life, and in many cases these extreme and/or futile expensive measures could be avoided if we had a simple DWD law nationwide. In my scheme of things DWD would be a part of any Medicare for all. The dreadful agonies many aged people endure in their final weeks and months is not health care, it's cruel and unusual punishment. We treat our dogs better.
I heartily agree. The trouble with DWD is that applies only to death expected within six months. Even in January 2012, at the time of a clearly not-worthwhile operation, there was no projection of longevity. Further, and another issue not addressed with DWD is other reasons an elderly person may wish death. My uncle (my mother's brother), now 94, went demented about a year ago. Even when he was 91 he was complaining that he had outlived all of his friends. Many people have a major fear of outliving their money as well because even delayed retirement has very few people working into their 90's.
I heartily agree. The trouble with DWD is that applies only to death expected within six months. Even in January 2012, at the time of a clearly not-worthwhile operation, there was no projection of longevity. Further, and another issue not addressed with DWD is other reasons an elderly person may wish death. My uncle (my mother's brother), now 94, went demented about a year ago. Even when he was 91 he was complaining that he had outlived all of his friends. Many people have a major fear of outliving their money as well because even delayed retirement has very few people working into their 90's.
Food for thought?
Most certainly food for thought.
Here's a story from 2018 about a 104-year-old man, David Goodall, who had outlived all his peers, wasn't terminal, but did not enjoy the grind of living at 104 and wanted to die peacefully. So he went to Switzerland where, under some circumstances, one may receive assisted-suicide. He went blissfully to sleep as Beethoven's "Ode to Joy" played in the background.
We need it here, nationwide. It would stop people from all sorts of dreadful suicides, including suicide by cop, jumping off a bridge or in the path of a train, or as in most cases, shooting themselves and making a hell of a mess and biohazard situation that may traumatize any onlookers.
Excerpts:
"In accordance with his plan, Goodall died Thursday at an assisted-suicide clinic, putting an end to a life that, he said, had become increasingly difficult to live. Around midday, an IV was placed into Goodall's arm, allowing him to turn a wheel to let the lethal drugs to flow into his bloodstream, according to Exit International, an Australian nonprofit that advocates for the legalization of euthanasia. "David fell asleep within a few minutes,” Exit International said....
In most countries, euthanasia and physician-assisted suicide are illegal. However, a handful of nations — including Belgium, Luxembourg and the Netherlands — have legalized one or both of the practices, according to the nonprofit group ProCon.org. For years, Australia has banned such practices, but in November, the state of Victoria became the first to pass a euthanasia bill, which, by summer 2019, will allow terminally ill patients to end their lives."
This practice should be allowed within our medical business, with safeguards to assure it is used in a totally voluntary manner.
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Last edited by Mike from back east; 04-23-2023 at 08:40 PM..
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