It's Going To Be Tough

[Guest]

I watched an interesting hour-long panel discussion on CNN last night. The moderator was Maria Bartoromo and the panelists included: Michigan Governor Granholm, Michael Milkin, two doctors who head major clinics (Cleveland Clinic was one), CEO's of two insurance companies, former Senator (and doctor) Bill Frist and the CEO of a major drug company.

After an hour of active and knowledgeable debate, there didn't seem to be very many specifics that the panel agreed on. Those that they did agree on were couched in terms that were difficult (for me anyway) to understand. If I had to summarize the main conclusions that the panel reached, they were:
The U.S. must reform it's healthcare system or be at risk of the cost of care overwhelming the country.
Doctors should be compensated based on "results", not the frequency of service.
Americans should be incented by the re-formed system to live healthier lives.
The re-forming must result in healthcare coverage for all Americans.
There are tremendous opportunities for cost reductions in the current system.
Whatever the solution is, it almost certainly should include both public and private options for healthcare.
Some of the discussion was predictable. The "corporate types" on the panel and Bill Frist resisted the idea of a "public option" vigorously, arguing that a re-formed system should be based solely on for-profit providers, not the government. The other panel members were equally effective in defending the need for a cooperative system, including a public option, not significantly different than we have today with Medicare.

Ever the politician, Bill Frist defended that massive expenditures on advertising by drug companies as their "first amendment right". He was also critical of Medicare or the idea that any public option should be included in a new plan. Among the panelists, he seemed to have the fewest specific ideas on what should be done.

Predictably, the two insurance company CEO's defended the current system. The drug company CEO similarly defended their business model, drug prices, and even the need for the extensive advertising of prescription drugs.

Michael Milkin kept hitting on the idea that Americans must live a healthier lifestyle and that alone would reduce healthcare costs dramatically. He noted that we are "too fat" and "smoked too much". His suggestion was to "incent Americans to live healthier". To me, that was a thinly-veiled suggestion that people who were overweight and/or smoked would pay dramatically higher insurance premiums than those that did not. He argued that the funding of healthcare should be placed on those who contributed most to it's cost.

Governor Granholm repeatedly used the experience of the auto companies as an example of why healthcare reform is needed. She argued that failure to act now would weaken our entire economy even more in the not too distant future. She noted that about $1,500 of the cost of every GM car was for healthcare benefits for workers and retirees. One of the panelists related the story of a phone call from Lee Iaccoa when he was Chrysler CEO. He was bemoaning the fact that the cost of healthcare for his employees and retirees had reached the point where he was spending more for insurance premiums than for the steel, glass, plastic and other materials used to build the cars and trucks. He observed that he knew how to cut materials costs, but was clueless on how to control healthcare costs.

The doctors argued that physicians should be paid more for the quality of care than the frequency. Both noted that, while it would be difficult to achieve legally, there was a distinct advantage to having doctors work as salaried employees rather than "independent contractors". They noted that doctors in some of the best healthcare facilities in the world--Mayo Clinic, Cleveland Clinic and a couple others they named--had worked for salaries for years. Of course, they noted, doctors in almost every other country in the world worked for salaries as government employees and were producing results superior to the U.S. They also noted the need to compensate primary care physicians more generously, as they were the only doctors who could be effective in providing preventative care.
------------------------------------------------
The bottom line was that this group of knowledgeable panelists didn't present anything close to a consensus set of solutions. In fact, some of the solutions they did present were couched in words that are difficult for the public to understand ("pay doctors for quality not quantity"--sounds good, but what the hell does that mean?)

I shudder to think what will come out of a Congress which is far less knowedgable and which has a greater commitment to their own self-interest and those of the special interests who pay them than to the public. And when they get finished, who's going to explain it to us in understandable terms?

http://i275.photobucket.com/albums/jj316/Villages_Kahuna/GoodBlueDog-Small.jpg

[Guest]

Interesting synopsis, VK. Thanks. I did not see that on CNN, but I will look for it now. CNN sometimes repeats things.

I have to admit that you sent me scurrying to Google when I saw Michael Milken's name. I thought, "Are we talking about Michael Milken, racketeer?" Yes, I know he is a financial genius. And when I looked at his website and quickly glanced through his biography, I saw no mention of that incident from his past. Did I just miss it on my quick read or was history rewritten a little? But I suspect that I really am living in an Orwell novel.

About Big Pharma, I could weigh in on that one from a couple of different angles. Big Pharma has buttered my bread and so it could be seen as ironic that I think the way I think about what Big Pharma has been up to. (And I just bought a little jnj.)

But about those drug prices........

Remember when we used to save our receipts and send them in to our insurance companies. We paid for our prescriptions up front. No big deal.

And then.......

Enter the little card. So convenient. Slap it down on the counter and pay the co-pay. No pesky receipts in a shoebox. No envelopes and stamps and trips to the post office necessary. How convenient???? That's all consumers cared about. Convenience.

Remember the Trojan Horse. The drug card was a Trojan Horse. We were slaughtered in our sleep after we passed out from the celebration of the convenience of not spending our "own" money up front. The prices went up and up and we did not pay attention and we did not know. No reason to know or even think about it. We had our little cards and our co-pays. We had consumer convenience.

I want to see affordable access to health insurance for Americans. I do not want socialized medicine.

Why can't they just take baby steps. Allow those who want or need to retire before age 65 to BUY in early to Medicare when they have no access to good affordable plans. That would not only save on the costs of stress related illness but would open jobs for younger people. Seems like a good step to me. Maybe because I know so many people who could benefit.

But they just can't seem to take it a step at a time. It is a quagmire. And both sides of the aisle are up to their ears in lobbyists.

Anyway, I will look for this program to be repeated on CNN. But I will probably end up yelling at the television like I used to yell at Alan Greenspan when he started giving money away.

Boomer

And btw, I heard a book title the other day, "It Takes a Pillage." I know nothing about the book. I just thought the title was right on the money.

[Guest]

Interesting synopsis, VK. Thanks. I did not see that on CNN, but I will look for it now. CNN sometimes repeats things.

I have to admit that you sent me scurrying to Google when I saw Michael Milken's name. I thought, "Are we talking about Michael Milken, racketeer?" Yes, I know he is a financial genius. And when I looked at his website and quickly glanced through his biography, I saw no mention of that incident from his past. Did I just miss it on my quick read or was history rewritten a little? But I suspect that I really am living in an Orwell novel.

About Big Pharma, I could weigh in on that one from a couple of different angles. Big Pharma has buttered my bread and so it could be seen as ironic that I think the way I think about what Big Pharma has been up to. (And I just bought a little jnj.)

But about those drug prices........

Remember when we used to save our receipts and send them in to our insurance companies. We paid for our prescriptions up front. No big deal.

And then.......

Enter the little card. So convenient. Slap it down on the counter and pay the co-pay. No pesky receipts in a shoebox. No envelopes and stamps and trips to the post office necessary. How convenient???? That's all consumers cared about. Convenience.

Remember the Trojan Horse. The drug card was a Trojan Horse. We were slaughtered in our sleep after we passed out from the celebration of the convenience of not spending our "own" money up front. The prices went up and up and we did not pay attention and we did not know. No reason to know or even think about it. We had our little cards and our co-pays. We had consumer convenience.

I want to see affordable access to health insurance for Americans. I do not want socialized medicine.

Why can't they just take baby steps. Allow those who want or need to retire before age 65 to BUY in early to Medicare when they have no access to good affordable plans. That would not only save on the costs of stress related illness but would open jobs for younger people. Seems like a good step to me. Maybe because I know so many people who could benefit.

But they just can't seem to take it a step at a time. It is a quagmire. And both sides of the aisle are up to their ears in lobbyists.

Anyway, I will look for this program to be repeated on CNN. But I will probably end up yelling at the television like I used to yell at Alan Greenspan when he started giving money away.

Boomer

And btw, I heard a book title the other day, "It Takes a Pillage." I know nothing about the book. I just thought the title was right on the money.

I wish I had the little card.....still have to pay up front and send in the receipts

[Guest]

..."Are we talking about Michael Milken, racketeer"Yep. Milken was the inventor of junk bonds and did almost all of the financing of the leveraged buyouts during the 1980's. He was convicted and did jail time for insider trading having to do with his (actually Drexel Burnham Lambert's) underwriting of the junk bond portion of financing of companies being purchased or taken private. Kind of a long way from being a "racketeer", but he was guilty in much the same way as Martha Stewart was, but on a much bigger scale.

Milken made gazillions of dollars for himself and his firm. He was always a very generous philanthropist and continued that after he got out of prison. Sometime in the middle of all his legal travails, he got prostate cancer. He was cured, or put in remission, and began to accelerate his philanthropy.

Milken co-founded the Milken Family Foundation in 1982 to support education and medical research (http://www.mff.org/index.taf); he is chairman of the Milken Institute, which hosts the annual Global Conference, which is attended by more than 3,000 thought leaders and decision makers from nearly 60 nations; and he is the founder of the Melanoma Research Alliance, FasterCures (Center for Accelerating Medical Solutions), and the Prostate Cancer Foundation.

I'm guessing he was included on the panel because of his involvement in medical research and his involvement with so many opinion-makers thru his annual Global Conference.

[Guest]

http://www.youtube.com/watch?v=NxNXv1Aspj8&eurl=http%3A%2F%2Fviralfootage.com%2F%3Fp%3D2773&feature=player_embedded

[Guest]

Listen to the doctors! They are on the front lines & know what works. There is no need for some huge new program as the facts are right in front of us, but it seems no one wants to see them. There are many large institutions that have only salaried physicians. Mayo Clinic, Cleveland Clinic, Kaiser-Permanente, the armed services (including the VA), to name a few. All have at least as good an outcome record as anyone, some a lot better. All also have a lower cost per patient than any fee for service practice. The physicians are paid by performance (outcome) not by how many tests and procedures they order & perform. Only a physician can practice medicine and order all of these procedures. It is estimated that 30% of all medical procedures are not necessary. I am a retired physician and I believe that it is much closer to 50% that is not necessary. I have seen the way it works in real life- put the physicians on a salary and per patient costs will drop 40-50% almost immediately. There are many additional issues involved, but there will be no meaningful cost reduction under the existing fee for service system.

Steve S

[Guest]

It's really a lost cause. Some are, have and will turn their lives willingly over to the government. Thank God there are still some fighting the good fight for those of us who want to remain free and don't buy into the pack of lies from the BO administration and the far left Democrats. Especially the propaganda on CNN and the other state run media outlets.

BO's health care takeover along with Cap-n-tax, trillions of debt and God only knows what other programs they will ram through will crush the economy.

We are still loosing hundreds of thousands of jobs every month and they just don't give a damn.

It doesn't take a rocket scientist to understand the government is already broke, tax receipts to the government are down 50% and we will never climb out of this massive debt BO and dropped on our backs.

[Guest]

For the first time in my adult life, I am disappointed in my country.

[Guest]

BO is not fixing a thing or even trying. He's getting even with America and people stand by, make excuses and even cheer. It's disgusting.

[Guest]

Yes, and BO is wanting everything pushed thru very quickly, for reasons we are all aware of, yet it took him months to decide what dog to choose for his family. hmmmmm.:confused:

[Guest]

You Tube "Prove to me it'll work video"That's a decent argument, Keedy. But unfortunately, the question "prove to me it'll work?" has no real answer. The entire system won't be known until well after the reform legislation is passed. As has been said, the details will be created well after the fact by career bureaucrats. How can one "test" something that doesn't exist?

But we know quite well what doesn't work. Our current healthcare system costs roughly twice as much as those of the other developed countries and still leaves 40-50 million people without healthcare insurance. That cost is growing at a rate that will require that money be spent on healthcare in the future that otherwise should be invested in growing our economy. The cost is high now, and will be impossible to afford in a decade. Having said all that, our system has produced health of the population that ranks around 25th among the developed countries, even though it costs twice as much! We know what doesn't work.

So, as much as we have hesitancy, we're going to be faced with trusting both our elected government as well as the career bureaucrats who will actually design the details of the reforms of our healthcare system. Unless our Congress chooses to do nothing--which will "break" our economy in ten years or so and doesn't appear to be either a political or economic alternative--we will have to have some trust without a "proof" that it works.

[Guest]

Listen to the doctors! ....I am a retired physician...put the physicians on a salary and per patient costs will drop 40-50% almost immediately. There are many additional issues involved, but there will be no meaningful cost reduction under the existing fee for service system.Assuming that our principal purpose here is to understand more about what is going on politically, your response, Steve, is very valuable. It is essentially what the doctors on the CNN show were saying, and they were both salaried physicians.

The doctor-panelists did say that there were some "legal impediments" to moving from a fee-for-service physician business model to a salaried model. I'm assuming that would have to do with "forcing" physicians who were "sole proprietors" or had only 1-2 partners in a practice to become salaried. That wouldn't be a small problem, but I suspect it could be resolved with a payment schedule that would essentially force physicians into a salaried form of business organization.

But it's good to hear confirmation of something we've all suspected from a doctor who knows first-hand what the potential savings might be.

One question: would the "salaried doctor" model be what is meant by "paying for quality, not quantity"? I've heard people discuss needed reforms and use a term like that and I have no idea what they mean.

[Guest]

For the first time in my adult life, I am disappointed in my country.Be careful, Keedy. Michelle Obama said something like that and was pilloried for months.

But if you're not running for office or married to someone who is, don't worry about it.

[Guest]

BO is not fixing a thing or even trying. He's getting even with America and people stand by, make excuses and even cheer. It's disgusting.

This should be interesting, getting even for what?

[Guest]

This should be interesting, getting even for what?

Hmmmmm.....Your back..I thought your alter ego was through with us?;)

[Guest]

Be careful, Keedy. Michelle Obama said something like that and was pilloried for months.

But if you're not running for office or married to someone who is, don't worry about it.

Yes, it was satire....but I don't think she was "pillloried" by the mainstream media, although I think she acted "stupidly" by making that statement.;)

[Guest]

[QUOTE=Villages Kahuna;
But we know quite well what doesn't work. Our current healthcare system costs roughly twice as much as those of the other developed countries and still leaves 40-50 million people without healthcare insurance. That cost is growing at a rate that will require that money be spent on healthcare in the future that otherwise should be invested in growing our economy. The cost is high now, and will be impossible to afford in a decade. Having said all that, our system has produced health of the population that ranks around 25th among the developed countries, even though it costs twice as much! We know what doesn't work.

If you think health care is expensive now...what till it is free.

[Guest]

Hmmmmm.....Your back..I thought your alter ego was through with us?;)

Oh, I've been here all of the time. I've decided to take away all of your fun and NOT give the satisfaction of participating in the game. You'll have to admit, - pretty good profiler aren't I?

[Guest]

This should be interesting, getting even for what?

I was wondering about that too.

[Guest]

Oh, I've been here all of the time. I've decided to take away all of your fun and NOT give the satisfaction of participating in the game. You'll have to admit, - pretty good profiler aren't I?

Don't know where you are coming from but I advise that you get some serious help.:jester:
You seem more of a "baiter" then a participant.

[Guest]

Yes, it was satire....but I don't think she was "pillloried" by the mainstream media, although I think she acted "stupidly" by making that statement.;)

Keedy's absolutely right. The extreme right wing media and talking heads jumped all over this comment- not the legitimate media.

No different than flag pins, birthers, **********, and no different than the current group of neo-nazis disturbing town hall meetings about health insurance reforms.

They have no interest in creating a better life for their children or the rest of America. Their only interest is in stereotyping and petty pick-a-parts, since they have no agenda of their own, only the agenda of the corporate lobbying groups they unknowingly shill for.

They still don'g get it. Americans, real Americans are tired of the politics and party of "NO"

[Guest]

Keedy's absolutely right. The extreme right wing media and talking heads jumped all over this comment- not the legitimate media.

No different than flag pins, birthers, **********, and no different than the current group of neo-nazis disturbing town hall meetings about health insurance reforms.

They have no interest in creating a better life for their children or the rest of America. Their only interest is in stereotyping and petty pick-a-parts, since they have no agenda of their own, only the agenda of the corporate lobbying groups they unknowingly shill for.

They still don'g get it. Americans, real Americans are tired of the politics and party of "NO"

1) Why do you use that expression "tea-bagging?" "teabagging" is a derogatory term to belittle legitimate anti-tax protesters and I'm surprised that someone on this forum would use that term. The original Tea Parties was a protest against taxation without representation. It was the foundation and rallying call to form this once great Nation. Tea-bagging is a sexual term that the media thought was cute but the "inside joke" is that it is predominately used by the homosexual community.
2) Are you saying that the founding father's were "neo-Nazi's"? Are you saying it is anti-american to wear the American flag. (flag pins)
3) No interest in creating a better life for their children? Is creating the biggest deficit ever for the next generation to pay..a better life for them?
4) More name calling by the left. Neo-Nazi disturbing town meetings. You people throw that word around real loosely. Let me remind you of a charismatic leader of the 30's who promised "change" The resemblance is frightening.
It seems to me that Alinsky's Rules for Radicals, especially the one where "Ridicule is man's most potent weapon" is alive and well on TOTV.

[Guest]

They still don'g get it. Americans, real Americans are tired of the politics and party of "NO"

Real Americans don't want to be railroaded into a government health care system. Real Americans are proud, independent, and interested in the strength and stability of our great nation. There is NO strength in debt to China for liberal spending, NO stability in a Socialistic leaning government. No pride in apologizing for Americas strengths and NO stability in our Nation if it doesn't have secure boarders. If that's what you mean by the party of "NO" , then your right.:swear:

[Guest]

party first philosophy.

Until such time as we the people return to the founding fathers intents of of the Constitution, return to majority rules and put America first, there will be no progress and a continuation of the ongoing tit for tat, derogatory, non thinking, partisan school yard bantor.

btk

[Guest]

Real Americans don't want to be railroaded into a government health care system. Real Americans are proud, independent, and interested in the strength and stability of our great nation. There is NO strength in debt to China for liberal spending, NO stability in a Socialistic leaning government. No pride in apologizing for Americas strengths and NO stability in our Nation if it doesn't have secure boarders. If that's what you mean by the party of "NO" , then your right.:swear:

:beer3: Right on!!!

[Guest]

party first philosophy.

Until such time as we the people return to the founding fathers intents of of the Constitution, return to majority rules and put America first, there will be no progress and a continuation of the ongoing tit for tat, derogatory, non thinking, partisan school yard bantor.

btk

The problem here is that majority rules doesn't mean actual majority, but simply political majority. Right now the political majority is close to a 50/50 split, so the urge to weight ones positions needs to be strong to move the political scales. Politicians by nature are self serving, putting getting elected/ vote gathering before "Country First" As far as tit for tat, derogatory, non thinking, partisan banter, IT"S FREE SPEECH. Not everyone is an intellectual, heavy thinking, somber, perusing knowledge seeker. A lot of people just want a release of their frustrations about government and political forums provide that release. It doesn't mean that they don't have real concerns about the governance of our country, just that they are testy about what they feel are slights against their party or beliefs. POST ON EVERYONE!

[Guest]

Polls show the American people don't want this and yet the people we employ want to ram it through anyway. 78% of Americans are happy with their current plans. What is BO getting even with? America. He is no patriot and he does not believe in American exceptionalism, capitalism or anything else American. Ever hear him say anything good about the American people?

He is a liar and is breaking every single one of his promises that got him elected.

They are meeting a tremendous about of opposition not only from the GOP but their own constituents. And still they ram rod as fast as they can.

Now they are running ad spots against Americans who oppose his forced takeovers and call them organized mobs… those would be some of his employers… American tax payers.

IMO the government is totally and completely out of control. They no longer represent the will of the people, only the will of themselves. They are not doing what’s best for America, only what’s best for them. Government of the people, by the people, for the people is for the moment is dead. They talk about health care costs must be brought under control. How about bringing government costs back under control first? Sorry, that’s way too logical.

There is a provision in the Constitution to deal with an out of control government.

Does this not worry anyone? No red flags? The government is broke? Not doing anything to create jobs? Everone ok here?

Gezzz.. :shrug:

[Guest]

Polls show the American people don't want this and yet the people we employ want to ram it through anyway. 78% of Americans are happy with their current plans. What is BO getting even with? America. He is no patriot and he does not believe in American exceptionalism, capitalism or anything else American. Ever hear him say anything good about the American people?

He is a liar and is breaking every single one of his promises that got him elected.

They are meeting a tremendous about of opposition not only from the GOP but their own constituents. And still they ram rod as fast as they can.

Now they are running ad spots against Americans who oppose his forced takeovers and call them organized mobs… those would be some of his employers… American tax payers.

IMO the government is totally and completely out of control. They no longer represent the will of the people, only the will of themselves. They are not doing what’s best for America, only what’s best for them. Government of the people, by the people, for the people is for the moment is dead. They talk about health care costs must be brought under control. How about bringing government costs back under control first? Sorry, that’s way too logical.

There is a provision in the Constitution to deal with an out of control government.

Does this not worry anyone? No red flags? The government is broke? Not doing anything to create jobs? Everone ok here?

Gezzz.. :shrug:

So now we know
Change

More Debt
More taxes
More Welfare
More Regulation
More Government
More Wasteful Spending
More Corruption
Thanks Mr. President.

[Guest]

The problem here is that majority rules doesn't mean actual majority, but simply political majority. Right now the political majority is close to a 50/50 split, so the urge to weight ones positions needs to be strong to move the political scales. Politicians by nature are self serving, putting getting elected/ vote gathering before "Country First" As far as tit for tat, derogatory, non thinking, partisan banter, IT"S FREE SPEECH. Not everyone is an intellectual, heavy thinking, somber, perusing knowledge seeker. A lot of people just want a release of their frustrations about government and political forums provide that release. It doesn't mean that they don't have real concerns about the governance of our country, just that they are testy about what they feel are slights against their party or beliefs. POST ON EVERYONE!

Very true. Last breakdown of registered voters I saw, in late 2008, it showed something like nationally 37% Independent, 36% Democrat and 27% Republican. So for me as a registered Independent it is disheartening, especially now where one party has total control and is basically dictating their beliefs.

[Guest]

Assuming that our principal purpose here is to understand more about what is going on politically, your response, Steve, is very valuable. It is essentially what the doctors on the CNN show were saying, and they were both salaried physicians.

The doctor-panelists did say that there were some "legal impediments" to moving from a fee-for-service physician business model to a salaried model. I'm assuming that would have to do with "forcing" physicians who were "sole proprietors" or had only 1-2 partners in a practice to become salaried. That wouldn't be a small problem, but I suspect it could be resolved with a payment schedule that would essentially force physicians into a salaried form of business organization.

But it's good to hear confirmation of something we've all suspected from a doctor who knows first-hand what the potential savings might be.

One question: would the "salaried doctor" model be what is meant by "paying for quality, not quantity"? I've heard people discuss needed reforms and use a term like that and I have no idea what they mean.

Salaried equates to employees. Every physician I know is an employee of an LLC or PA or INC already. So, the question is going to be how will the LLC, PA or INC be compensated for services rendered? The staffing within the LLC, PA or INC is a business decision for the entity, and how the LLC, PA or INC distributes moneys within itself is going to be darned difficult to legislate into any fixed model. I don't know if it's even going to be possible without total nationalization and all licensed medical personnel becoming federal or state employees.

Most medical practices have a significant net worth. Nationalization zeroes that value. I can already imagine the court cases on that.

These are indeed "interesting times." and there will be unexpected (and expensive) consequences.

[Guest]

...Most medical practices have a significant net worth. Nationalization zeroes that value. I can already imagine the court cases on that....That might be the primary obstacle to getting doctors to work for a salary. It may well the the "legal impediments" that the doctors on the CNN show were referring to.

It can be done, but it would take fairly large groups of doctors to organize a combined practice, taking all the insurance payments into a central pool and then paying the doctor-members a salary. If I understand correctly, the way the Mayo Clinic and the Cleveland Clinic work is that they provide the service and hand the patient the bill. The patient pays the bill and collects what he can from his insurance company and/or Medicare. It seems to me that's the only way the economics of a "salaried system" might work, unless all the doctors agreed to take a pretty significant cut in income when they went to a salary. That may be in the offing, as well. My understanding is that U.S. doctors have income levels that may be double what they are in countries with nationalized medicine.

http://i275.photobucket.com/albums/jj316/Villages_Kahuna/GoodBlueDog.jpg

[Guest]

That might be the primary obstacle to getting doctors to work for a salary. It may well the the "legal impediments" that the doctors on the CNN show were referring to.

It can be done, but it would take fairly large groups of doctors to organize a combined practice, taking all the insurance payments into a central pool and then paying the doctor-members a salary. If I understand correctly, the way the Mayo Clinic and the Cleveland Clinic work is that they provide the service and hand the patient the bill. The patient pays the bill and collects what he can from his insurance company and/or Medicare. It seems to me that's the only way the economics of a "salaried system" might work, unless all the doctors agreed to take a pretty significant cut in income when they went to a salary. That may be in the offing, as well. My understanding is that U.S. doctors have income levels that may be double what they are in countries with nationalized medicine.

The kicker is the "value of the business" for each medical office. These medical offices are businesses incorporated under state law, and to terminate these corporations by a federal act and require individuals with state-issued professional licenses to work according to a federal mandate is no light-hearted legal matter. Voluntary associations are one thing, but federally mandated groupings of professionals is another. The last time I checked, that qualified as conscripted service, as a minimum; with confiscation and/or devaluation of assets and professional 'slavery" as a potential claim.

When Canada went through the metamorphosis to national care, they did it at the provincial level. That made great legal sense, as that solved the incorporated-entity issue and provincial professional license issue at the correct jurisdictional level - one at a time. Eventually, after all provinces established their separate systems, they were able to link the provincial systems with regards to funding and elements of standardization.

Let us not kid ourselves. There are massive State's Rights issues involved, and the Federal Government does not have the authority to terminate a state-granted corporation or revoke a state-issued professional license. So, to autocratically (federal) change business models and impact state corporation grants and state-issued professional licenses, those are those "nasty details" which the HR 3200 proponents are trying to shove under the rug. 10th Amendment, 13th Amendment and 42 USC arguments will abound, and HR 3200 may not stand up to Constitutional and civil rights scrutiny - all in the protection of medical professionals, with the government (a.k.a. taxpayer) getting the bill for recompense for business damages and legal fees. Just because a bill gets passed by Congress and signed by the President does not mean it is Constitutionally sound and that the Supreme Court can't toss it if the statute is challenged.

HR 3200 may end up being a lawyer's dream. The cases which this bill will probably spawn - just the ones from medical professionals against the government - could make the Tobacco and Asbestos cases seem like peanuts. With all the potential money to be made advocating for medical professionals, I may even have to come out of retirement for this (no, I wouldn't, am having too much fun in TV! Am not going back to DC for any reason!)

This will be funnier than "Boston Legal" reruns!

[Guest]

You state the potential problems so succinctly, Steve. What worries me is that if the 435 somehow missed the thought that they way they wrote the C4C law would result in a lot of money filtering off to foreign lands, is there a chance they missed the potential of this problem?

http://i275.photobucket.com/albums/jj316/Villages_Kahuna/GoodBlueDog.jpg

[Guest]

You state the potential problems so succinctly, Steve. What worries me is that if the 435 somehow missed the thought that they way they wrote the C4C law would result in a lot of money filtering off to foreign lands, is there a chance they missed the potential of this problem?

http://i275.photobucket.com/albums/jj316/Villages_Kahuna/GoodBlueDog.jpg
I made a decent living based on the fact that laws were confused, conflicting and downright unconstitutional.

Wait until the later discussions we all will have on "comprehensive immigration reform." If the McCain-Kennedy bill had passed, that would barred any federal prosecution of anyone - citizen or non-citizen - for identity theft and many other felonies due to "suspect class" issues, and would have made no dent on employer violations even with a couple thousand more ICE agents hired specifically for employer review (because no increase in the size of the court which handles those cases was included, and that would have stretched court dockets out several years, resulting in dropped cases)

Legislators don't care if the resolutions/bills are legal. All that matters is that they generate headlines and publicity to carry them through the next election. This President taught Constitutional Law, so he knows HR 3200 is a mess. It's crazy....

Again, the "law of unintended consequences" strikes every time something is rushed through the legislative system.

[Guest]

When the talk is about paying for quality instead of quantity they are referring to outcomes. Do Dr. Y's patients with Type 2 Diabetis maintain HgbA1C levels of 6.5 or below? Do Dr. Y's Type 2 Diabetics get a HGBA1C ordered every 3 months? The various forms of how outcomes will be used for payment reform is yet to be decided. It is currently in an embryonic stage in the Medicare program called PQRI and was not very sucessfull for clinics.

One of the things being wrestled with is how to look at outcomes when the patient does not follow recommended treatment.

Because of the high costs of running a private clinic and the ever dwindling reimbursement for services most Primary Care Physicians have already joined some type of employer.

The more concerning issue is that there are fewer and fewer med students who select this field.