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An NP needs a "supervising physician" behind them; that's not compe ion.
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.
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.
An NP needs a "supervising physician" behind them; that's not compe ion.
My wife is an RN and she still needs a doctor's signature on a RX...
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)
True; and more visits != better care. "follow ups" used to be in case they were needed, now docs schedule them for most everything automatically.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.
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
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.
FWIW, there is NO difference in charge whether the provider who saw the patient was the NP or the doc. Again, compe ion fail. Multiplier indeed.
I believe you, but I'm lost. So if not NP's, what's this (below) about?
And this 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 bull .
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.
esp. when each revisit requires some sort of test. Too many people on too many maintenance drugs.
Gotcha. Makes sense.
so, in effect, lower the requirement and medical knowledge necessary to be a GP?
Yes - most things most of the time can be handled by a nurse - 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.
No . 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...
http://www.governing.com/topics/heal...increases.htmlAmong 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.
venerate the "free market" and it screws you OVER AND OVER AND OVER for your entire life.
your fantasy, not mine
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.
facts are facts, not premises or hypotheses
RISE THE PROLETARIAT!
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 ed up when you get taxed for trying to do the right thing by your employees and don't get taxed for telling them to off and get your own insurance.
that does seem a perverse incentive.
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