Speaking of Healthcare Reform...Follow

Which I'm sure is why he's so vehemently opposed to socialized care.

Numbers for malpractice suits in the past indicated that they aren't a major factor. Also I highly doubt there are very many if any family doctors that really have to worry about malpractice suits, but I could be wrong. I do think the ease of litigation in the states is silly.

From your post Gbaji, it seems that essentially you're saying that insurers only allowing their clients to see certain doctors is the biggest factor in hurting small private practice in the states. That's not a problem with socialized medicine though, but I see it used again and again as an argument against it. Just to be clear, I don't remember specifically if you've used the argument of government bureaucrats deciding who you can and can't see, so I'm not pinning this on you. The majority of doctors operate as private practice in Canada. Private practice with a single payer can work very well, and make it far easier to be an independent.

In the context of the entire cost of the health care system? You're correct. But in terms of the effect of getting most doctors to make sure they're attached in some way to an organization which can cover their costs and settle cases for them? It's pretty significant. You're also just looking at the tip of the iceberg. Medical practitioners spend far far more on diagnosis and tests than they would otherwise as a means of avoiding potential malpractice suits. It's hard to measure how much of an effect that has, but when you're a doctor who works for a large health care provider, you can just expense the costs, which get passed on to the insurers, which in turn gets passed on to the government and the employers, which in turn gets hidden in either taxes or loss of potential salary.

The entire system is crafted to maximize the costs of health care.



I can only speak anecdotally, so take this for what it's worth. A friends father was a doctor, with a private practice. He was sued on several occasions. He was not a bad doctor, and the suits were frivolous, but it didn't matter. The costs to defend against them were pretty tough. He eventually was forced to join a larger provider organization for that reason (and lack of patients). He did a lot of work with poor women who needed prenatal care and eventually retired early because he was disgusted with the way the system worked (or failed to). He made more money by working the system paperwork wise than by actually treating patients. If he could drive up the costs for tests and work the justification, he (and the group he worked for), made more money. When he was a young doctor, and a poor woman came to him, he'd do everything he could to minimize costs and help out as much as possible. They made due with what they had and he never had any major problems. It wasn't until the health care system got so bloated and expensive that everyone had to come to him via some sort of "system" that it got unworkable. The paperwork became unmanageable for a private doctor, the lawsuits for silly things started appearing. Back in the day, patients were happy to get care, and thanked their doctors for helping them even when things didn't work out 100%. But over time, they realized that if the slightest thing went wrong, regardless of fault, they could make money by suing.

Obviously, there are several factors involved, but it's been a process that has led us to where we are. It's pretty undeniable that there are far far fewer private practitioners today than there were back in the 1960s and 70s. It's become an industry, heavily regulated by the government, with all the problems that entails.




It's one of the factors, yes. Insurers work with specific health care providers. Those providers have member doctors and hospitals and clinics which actually do the work. If you aren't working in one of those groups, you're not going to get patients from an insurance carrier, because they don't have an agreement to work with you. Well, technically you can, but the paperwork to file a claim is ridiculous.




I'm not saying it is. I'm saying that this was done deliberately to our "semi-private" health care system in order to make it as expensive and inefficient as possible, so as to make it possible to convince an American public which is naturally very distrustful of large socialized institutions to more readily accept fully socialized medicine. I absolutely acknowledge that these problems would not exist if the government simply managed health care directly. But that's the point. These problems were created in the private system via government regulation specifically to make that contrast.




The problem is that in the US, the majority of the people don't believe that the whole should have to foot the bill for everyone's health care. I shouldn't say that's a "problem" because I happen to agree with it. Why it creates a problem is that those who do want us to go to a system in which we simply collect taxes and pay from those taxes to provide all health care have realized that the best way to do this is to "break" the private health care system so badly that their solution will look great in comparison.


And Canada isn't perfect either. It works well as long as you don't contract some rare illness, or the tests needed fall inside those already defined by the government as covered. The doctors aren't going to do anything they can't get reimbursed for. What you lose in that system is flexibility and competition. In theory, a private system with different insurers and providers all competing to provide the best rates and service should result in the best outcomes. But what has happened is that the US government has so regulated the health care industry so as to mandate coverage levels and care standards that there is no competition. Insurance companyA can't really offer anything different than companyB, C, or D. Thus, as Nobby correctly points out, they simply become a middleman which increases the cost. Add in the layer of health providerA, B, C, and D, who also don't really compete in any meaningful manner, and then perhaps even "PlanA, B, C, and D" consisting of groups of businesses collectively purchasing insurance, and you end up with a system in which the negatives of privatization (more hands in the soup) are there, but not enough of the benefits (competition and innovation).


This is absolutely the result of government regulation on the industry. And accidental or not, it's been a bad thing. Just look at the process of health care reform this last couple years. Total mess. Nothing really resulted except increased costs. That's not much different than all the other health care reforms we've had. Each has just increased the size and cost of the system, without really addressing the problems. I suspect this is intentional to some degree, but even if it's not, it's still the wrong way to go with this.

I'm having an experimental treatment done tomorrow, and my doctor is not going to charge me (or the insurance company) for it. And, if it works, it could really help a lot of people.

And... if it doesn't work... things will most likely get worse for me. But that's a whole other story.

I believe you mean profits.

Both. I fully accept that the middlemen are milking the current system. The government regulators *and* the insurance industry *and* the big health care providers *and* the health plan administrators all have a hand in this. The point I'm trying to make here isn't that the private industries involved will attempt to make a profit (of course they will!), but that we shouldn't craft our regulations in a way that makes the most profitable methods those which make health care less available and affordable to the public.

All those middlemen exist *because* the government regulated them into existence. You can't blame the private industries for working within the framework they're given to make a profit. That's a natural response. The blame lies with the government regulations which created that route to profit in the first place. If I pass a law mandating that all restaurants must provide free desert with any meal, is anyone going to be surprised if every restaurant prices "meals" on their menus higher in order to cover the cost? The net effect is that everyone's meal will be "better" (it'll automatically come with desert), but the minimum price for a meal will be higher. And who's fault is that? The restaurant industry for reacting to the regulations? Or the government which created them?