Health care premiums will surpass median U.S. incomes by 2033: study

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Originally Posted by 101A

Yes; but that is a relatively small subset of docs. Medicare does the same thing, to an extent. However, to truly control costs, schemes such as in Germany or Japan will have to be the rule of thumb. In those countries, doctors don't enjoy the automatic ascension to upper-middle, and truly upper classes our docs get.

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It would need to be applied across the board, like most every country not named the US does. Including drugs, equipment, personnel, etc. I'm not sold you need to do this with high end medicine though. Just targeting basic care should result in substantial savings, and frankly, there's nothing magical in treating basic care needs: flu, cold, a fracture, asthma, allergies, etc. Yet we pay a disproportionate larger amount for common ailments like those than other countries do.

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Originally Posted by 101A

Hell, allow an RN's with a couple of extra certifications to write Rx's, and see patients, and you could control costs rapidly! Docs not gonna let that happen. We've damn near deified them in this country - most people, certainly including the docs themselves, see doctors as a superior person "my daughters dating a DOCTOR!" "We have a DOCTOR in the family!" etc...etc...

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Take this for the anecdote it is, but I was shocked by the little time you actually spend with a doctor on a visit in this country. Interacting with an RN is actually a rarity too. The bulk of the work is done by PAs, then the doctor walks in and out. Since we work with doctors, I discussed this with some of them, and it boiled down to seeing as many patients as they can to keep up with the same earnings they used to have pre-HMO, etc.

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Originally Posted by coyotes_geek

Aren't we already doing this? Nurse practitioner, right? I know they exist because there's one on staff at my kid's ped clinic.

Just a Texas thing maybe?

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An NP needs a "supervising physician" behind them; that's not competition.

My wife is an RN and she still needs a doctor's signature on a RX...

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Originally Posted by ElNono

It would need to be applied across the board, like most every country not named the US does. Including drugs, equipment, personnel, etc. I'm not sold you need to do this with high end medicine though. Just targeting basic care should result in substantial savings, and frankly, there's nothing magical in treating basic care needs: flu, cold, a fracture, asthma, allergies, etc. Yet we pay a disproportionate larger amount for common ailments like those than other countries do.

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Most of the healthcare dollars spent by a person are spent in the last 6 months of their lives. "High End" or heroic, or experimental or whatever you wish to call it accounts for a great deal of the expenses in healthcare. Shoot people in the head diagnosed with terminal illnesses and you have solved the healthcare crisis. (not recommending, just saying)

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Take this for the anecdote it is, but I was shocked by the little time you actually spend with a doctor on a visit in this country. Interacting with an RN is actually a rarity too. The bulk of the work is done by PAs, then the doctor walks in and out. Since we work with doctors, I discussed this with some of them, and it boiled down to seeing as many patients as they can to keep up with the same earnings they used to have pre-HMO, etc.

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True; and more visits != better care. "follow ups" used to be in case they were needed, now docs schedule them for most everything automatically.

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Originally Posted by 101A

An NP needs a "supervising physician" behind them; that's not competition.

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Right, but you could have a practice with 5 NPs and 1 doctor. and the doctor never actually sees patients. It's like a medical multiplier effect. lol

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Originally Posted by 101A

Most of the healthcare dollars spent by a person are spent in the last 6 months of their lives. "High End" or heroic, or experimental or whatever you wish to call it accounts for a great deal of the expenses in healthcare. Shoot people in the head diagnosed with terminal illnesses and you have solved the healthcare crisis. (not recommending, just saying)

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Don't disagree, but at the same time I think a lot of that is exacerbated due to avoiding to see the doctor until it's too late. At the current cost (provided you don't have insurance) seeing the doctor for something like prevention or even a yearly checkup is literally a luxury, instead of what it should really be: a necessity.

But there's a lot of wrongs here. Medicare is basically stuck with this high risk group, instead of being able to negotiate in volume for the entire population. Heck, Medicare can't even negotiate with BigPharma, IIRC.
Just too many things going backwards, none addressed by Obamacare.

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Originally Posted by Drachen

Right, but you could have a practice with 5 NPs and 1 doctor. and the doctor never actually sees patients. It's like a medical multiplier effect. lol

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FWIW, there is NO difference in charge whether the provider who saw the patient was the NP or the doc. Again, competition fail. Multiplier indeed.

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Originally Posted by 101A

FWIW, there is NO difference in charge whether the provider who saw the patient was the NP or the doc. Again, competition fail. Multiplier indeed.

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I believe you, but I'm lost. So if not NP's, what's this (below) about?

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Originally Posted by 101A

Hell, allow an RN's with a couple of extra certifications to write Rx's, and see patients, and you could control costs rapidly!

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And this shit about "maintenance" type prescriptions only being good for three months max so you have to go back and pay your bribe to the doctor to get three more months is total bullshit.

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Originally Posted by coyotes_geek

I believe you, but I'm lost. So if not NP's, what's this (below) about?

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DON'T require them to have a doctor backing them; allow trained people with less than MD's or DO's to compete with primary care physicians - not just be a "multiplier" of PCP's. The nurses (willing to work for less than the docs), thus end up costing just as much, because the doc takes the difference.

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Originally Posted by CosmicCowboy

And this shit about "maintenance" type prescriptions only being good for three months max so you have to go back and pay your bribe to the doctor to get three more months is total bullshit.

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esp. when each revisit requires some sort of test. Too many people on too many maintenance drugs.

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Originally Posted by 101A

DON'T require them to have a doctor backing them; allow trained people with less than MD's or DO's to compete with primary care physicians - not just be a "multiplier" of PCP's. The nurses (willing to work for less than the docs), thus end up costing just as much, because the doc takes the difference.

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Gotcha. Makes sense.

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Originally Posted by 101A

DON'T require them to have a doctor backing them; allow trained people with less than MD's or DO's to compete with primary care physicians - not just be a "multiplier" of PCP's. The nurses (willing to work for less than the docs), thus end up costing just as much, because the doc takes the difference.

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so, in effect, lower the requirement and medical knowledge necessary to be a GP?

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Originally Posted by Drachen

so, in effect, lower the requirement and medical knowledge necessary to be a GP?

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Yes - most things most of the time can be handled by a nurse - hell I can't remember the last time I went to a doctor and came out with a different diagnosis or treatment than what I figured I, or my children, were going to get when we went in.

I also don't subscribe to the belief that doctors are all that, or should be put on a pedestal. They are people who were educated in their mid to late twenties, and passed a test. Some have kept up with advances/changes in medicine - but many have not.

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Originally Posted by CosmicCowboy

And this shit about "maintenance" type prescriptions only being good for three months max so you have to go back and pay your bribe to the doctor to get three more months is total bullshit.

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No shit. They actually will check your blood pressure and weight in order to be allowed to charge your insurance for an "office visit" even though you just needed a prescription...

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Among the many hopes expressed for the Affordable Care Act (ACA) was that it portended to slow the inexorable and exponential rise in health insurance premiums every year. Yet, in many states, it’s still business as usual. According to The New York Times, in California, Aetna proposed rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent in 2013—and there wasn’t a thing that the state insurance regulators could do about it. Other states have seen rates rise by at least 20 percent for some policyholders. These double-digit increases are hitting small businesses and the self-employed particularly hard.


This is happening even though, under the ACA, state insurance regulators are required to review any request for a rate increase of 10 percent or more. So what gives? It turns out that “reviewing” a request is not the same as being able to stop it, because that power was actually removed from the final ACA bill. And that’s the rub, according to California Insurance Commissioner Dave Jones, who said, “This is one of the critical missing pieces of national health care reform,” in his 2011 inaugural address.


Some advocates had hoped that the ACA would extend to all state insurance commissioners the power to kaibosh unreasonable increases in premiums. Rather, it left intact the current system, whereby state legislatures decide whether or not to hand that right to their commissioners.


Most states have chosen to do just that. However, in California and 14 other states, all insurance commissioners can do is review increases, but they can’t actually do anything about them. In contrast, New York State’s Insurance Department has the authority to reject excessive hikes, and so was able to keep rate increases in the individual and small group markets to below 10 percent in 2013.

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http://www.governing.com/topics/heal...increases.html

venerate the "free market" and it screws you OVER AND OVER AND OVER for your entire life.

your fantasy, not mine

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Originally Posted by Winehole23

your fantasy, not mine

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not a fantasy, another simple statement of fact that you will not, cannot refute

why should I bother? you undermine yourself by arguing for your premises as given.

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Originally Posted by Winehole23

why should I bother? you undermine yourself by arguing for your premises as given.

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facts are facts, not premises or hypotheses

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Originally Posted by boutons_deux

venerate the "free market" and it screws you OVER AND OVER AND OVER for your entire life.

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RISE THE PROLETARIAT!

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Originally Posted by boutons_deux

facts are facts, not premises or hypotheses

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your sweeping generalizations about the world at large are not facts. they are opinions.

I can believe it. I'm paying over $16,000 a year per family on my group policy renewal. Of course $650 of that is my new obamacare tax for providing that family with insurance.

It's pretty fucked up when you get taxed for trying to do the right thing by your employees and don't get taxed for telling them to fuck off and get your own insurance.

that does seem a perverse incentive.