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Medical Licensing vs. Basic Health Care
Kevin Carson makes some points about medicine that can't be made too often:
The professional licensing cartels outlaw one of the most potent weapons against monopoly: product substitution. Right-wing libertarians are fond of using "food insurance" to illustrate the effect of third-party payment: if there were such a thing as grocery insurance, with low deductibles and a flat premium, people would be buying a lot more filet mignon and a lot less hamburger. The problem is that we've got a medical licensing system that criminalizes the sale of hamburger and mandates the sale of filet mignon. While healthcare consumers fall into many tiers of income, the state mandates only one tier of service regardless of ability to pay.
Much of what an MD does doesn't actually require an MD's level of training. Unfortunately, no matter how simple or straightforward the specific procedure you need done, you have to pay for an MD's level of training. The medical, dental and other lobbies make sure that legislation is in place prohibiting advance practice nurses or dental hygienists from performing even the most basic services without the "supervision" of an MD or DD.
In an open-source healthcare system, someone might go to vocational school for accreditation as the equivalent of a Chinese "barefoot doctor." He could set fractures and deal with other basic traumas, and diagnose the more obvious infectious diseases. He might listen to your cough, do a sputum culture and maybe a chest x-ray, and give you a round of zithro for your pneumonia. But you can't purchase such services by themselves without paying the full cost of a college and med school education plus residency.
I'm not sure what would be "open source" about such a service, but I agree that it ought to exist. I also appreciate Carson's call for something like the old lodge practice system that existed before the AMA destroyed it, in which a fraternal society would pool its resources to hire a doctor who handles its members' medical care. Put those ideas together, and you'll have neighborhood clinics
staffed mainly with nurse-practitioners or the sort of "barefoot doctors" mentioned above. They could treat most traumas and ordinary infectious diseases themselves, with several neighborhood clinics together having an MD on retainer (under the old "lodge practice" which the medical associations stamped out in the early 20th century) for more serious referrals. They could rely entirely on generic drugs, at least when they were virtually as good as the patented "me too" stuff; possibly with the option to buy more expensive, non-covered stuff with your own money....No doubt many upper middle class people might prefer a healthcare plan with more frills, catastrophic care, etc. But for the 40 million or so who are presently uninsured, it'd be a pretty damned good deal.
Waquoit|4.2.09 @ 12:07PM|#
Physical Therapists are next. New requirements will require PT's to have a Ph.D. Another rip-off.
|4.2.09 @ 12:09PM|#
There was a story on PBS about what may be a modern version of
the "Lodge Practice".
A lefty labor lawyer is now devoting her time to something called
the "Freelancers Union". It is supposedly free to join (no dues I
think) and obviously cannot strike against employers.
It main purpose is to negotiate health care insurance for its
members.
|4.2.09 @ 12:11PM|#
My brother is a Physician's assistant* in Utah. He has a whole
slew of people who see him just as if he was a regular general
practice physician. If I lived there, I would see him myself.
*similar to Nurse Practitioner, I think.
Naga Sadow|4.2.09 @ 12:21PM|#
Ah. I believe that they actually made the argument in the past that the reason for inefficiencies is . . . to many doctors. Also, in Alaska they are attempting to ban dental hygienists from doing most kinds of dental work. Cartel is the correct noun to use alright.
|4.2.09 @ 12:25PM|#
Aren't those mini-clinics in Wal-Mart-type stores, that are staffed by nurses and PhysAssts already doing this to some extent?
libtdem|4.2.09 @ 12:28PM|#
PAs and NPs have similar practice areas, but not entirely
overlapping.
While I agree with much of the article, I disagree with the
discussion of NP(and other advanced practice nurses/PAs roles).
While technically supervised, this does not really affect patients
much. The role of supervision varies greatly between different
practitioner pairs.
For example, a psychiatric (let's speak quietly so Sullum can't
hear us) NP might meet with their psychiatrist supervisor once
every two weeks and not talk about anything except for the one
patient they were a bit unsure of. They might even only call
occasionally as something comes up, and otherwise just meet to
upkeep their relationship.
While I don't think it's necessary, and I love the idea of having
more independent care, especially for NPs and PAs, I think the
current supervision role is, in some cases, very similar to what
that would be like. If you pay out of pocket, it's less than a
doctors visit. If you have insurance, I imagine it's the same (my
office visits are if I see a NP (an NP?) or a doctor. It's up a
bit, because the doctor is paid a portion, I believe, but not very
much at all.
|4.2.09 @ 12:28PM|#
I've been saying this for a few years now as one of many ways that together can lower overall medical costs and the cost and availability of private insurance. Thanks for posting it.
libertarian democrat|4.2.09 @ 12:30PM|#
More autonomy for NPs and PAs would be great though. This cannot be argued for enough.
|4.2.09 @ 12:40PM|#
But for the 40 million or so who are presently uninsured,
it'd be a pretty damned good deal.
No kidding. You *never* hear about bringing costs down; it's all
about "insuring the uninsured."
The AMA is a criminal enterprise.
|4.2.09 @ 12:45PM|#
in other words: "Fuck the poor"
This is a non-solution to a non-problem. People with diabetes or
cancer DO NOT have a choice of a lower-cost treatment. End of
story.
|4.2.09 @ 12:50PM|#
This is a non-solution to a non-problem.
Are you a member of the UAW, by any chance?
Xeones|4.2.09 @ 12:53PM|#
People with diabetes or cancer DO NOT have a choice of a
lower-cost treatment. End of story.
Yes, and because everybody who needs medical attention for any
reason has diabetes or cancer, your non-argument is actually not
idiotic!
Naga Sadow|4.2.09 @ 12:53PM|#
Ray,
Donate your all your pay checks to worthy charities then. And take
your damn hands out of my wallet buddy! Grrrrrrrrr!
EscapedWestOfTheBigMuddy|4.2.09 @ 12:54PM|#
People with diabetes [...] DO NOT have a choice of a lower-cost treatment.
Eh?
Most of the things that diabetics need simply don't require a
physician. A lot of them are better delivered by peer
counciling or single purpose education (diet, exercise, pump
operation, etc).
Most MDs---even some---endocrinoligists have a very primitive
understanding of how to tune a blood sugar control
regime.
|4.2.09 @ 12:56PM|#
In an open-source healthcare system, someone might go to
vocational school for accreditation as the equivalent of a Chinese
"barefoot doctor."
This is stupid, nothing more than a patch on the problem. GET RID
OF THE AMA's MONOPOLY ON LICENSING!
This is a non-solution to a non-problem. People with
diabetes or cancer DO NOT have a choice of a lower-cost treatment.
End of story.
Yes they do - it is called "Free Market Medicine", and it has been
the norm in many countries taken by the Ugly Americans as
"backward". Mexico has a reasonably free market health care system
where doctors can be as cheap as $4.00 per visit for simple things,
you can get Paramedic service for as little as $12.00 per MONTH (I
am not kidding). People buy insurance for CATASTROPHIC events and
not as a payment system, and the licensing system is totally
different than in the USA, with little to zero artificial caps on
how many people can graduate as doctors, as long as the students
make the grades.
Many doctors work from rental offices with ONE, maybe TWO
receptionists, with NO army of medical payment processors needed
because you simply pay ONE fee with cash or check. I could see a
specialist for as little as $30.00 (!!!), and I do not mean COPAY,
I mean FULL FEE.
YOU as Americans do NOT have a free market health care, you have a
heavily regulated and monopolized system.
My Mother in Law suffers from Diabetes - she visits her
endocrinologist every 2 months, pays $50.00 per visit, and buys
about $200.00 worth of medicines each month - THAT'S IT (she also
suffers high blood pressure, that' why the $200.00.) That's in
Monterrey, Mexico. DOCTORS ACTUALLY COMPETE FOR YOUR BUSINESS.
Instead, there are SO FEW DOCTORS in the US that they cannot be
unemployed, EVER, thanks to the AMA union and the Insurance
Cartel.
Dave|4.2.09 @ 12:57PM|#
Ray,
if we reduce the demand for services from MDs by sending half their
patients to PAs or NPs, then the MDs will reduce their fees,
lowering the cost of services to the poor. Further, by shifting
from high-cost to low-cost providers, insurers will realize cost
savings, which would be passed along if we allow them to compete,
improving access.
In other words, yes, a competitive market will improve things all
around.
Xeones|4.2.09 @ 12:58PM|#
Naga, i will try to use words that are more small and less hard. What Ray up there was saying is that a thing might not work in one case (the article, which he did not read/understand, addresses this), and therefore cannot work at all, and besides, LA LA LA THERE IS NOTHING TO SEE HERE YOU LIBTARDS MORE CENTRALIZED CARE PLEASE.
|4.2.09 @ 1:00PM|#
But for the 40 million or so who are presently
uninsured, it'd be a pretty damned good deal.
It won't be for the AMA, who will lobby the State to crack down on
such "Open Source" services, just like they did with many so-called
"alternative therapy" doctors in past years (regardless of the
effectiveness of those doctors or quacks, the point is that the AMA
does not have a right to restrict people's choices just because
they *think* they know what's better than the rest of us.)
T|4.2.09 @ 1:03PM|#
What? The AMA and all professional licensing exists to enrich
the guild members at the expense of the public? Rent seeking? What?
No, no, no. It's purely to ensure the safety and efficacy of care
provided to you, the consumer.
Excuse me, I have to go study for my Principles & Practice exam
for my PE license.
libtdem|4.2.09 @ 1:04PM|#
I'm going out on a limb here to say that almost all of the time
(especially in recent history) that the AMA has disagreed with
alternative practitioners, they've been right.
Doesn't make alot of what they do any less wrong, politically or
morally, but really...
JP|4.2.09 @ 1:06PM|#
As a practicing attorney, I can tell you with complete assurance that the U.S. would turn into a Third-World country if we did away with licensing requirements for doctors and lawyers. This is where libertarians go too far with their unrealistic schemes for a free-choice utopia. [/satire]
Reinmoose|4.2.09 @ 1:08PM|#
Ray Butler -
Right! Because you rather them die of pneumonia or suffer from
complications from a simple infection!
libtdem|4.2.09 @ 1:09PM|#
What? The AMA and all professional legally
mandated licensing exists to enrich the guild members at
the expense of the public?
Fixed. I think free market licensing would be a very smart thing to
have. In fact, similar in style to the current system, but not
mandated, licensing would probably be a net benefit.
And separately, under our current not likely to change system: just
to clarify a misunderstanding that appears to exist, most doctors
and professional organizations want to increase the rate at which
physicians are graduated now. There is a strong push, as a
profession, to increase the amount of doctors, but starting and
expanding medical schools isn't so easy, for a variety of reasons.
It's not guild profits so much as bureaucratic inertia that is
currently slowing down an increase in supply.
Tacos mmm...|4.2.09 @ 1:12PM|#
This is stupid, nothing more than a patch on the problem. GET RID OF THE AMA's MONOPOLY ON LICENSING!
I've pointed out in EVERY THREAD where this comes up that
MALPRACTICE INSURERS function as medical gatekeepers as much as, if
not moreso, than medical boards. And it's not because insurers are
a corrupt cartel; it's because they have to pay the lawsuits. If
you eliminated medical boards, you would still have provider
restrictions that probably wouldn't differ too much from what we
see today. They would just be established by insurance companies
instead of medical boards. You might see more basic surgeries, like
herniorraphies, done by PAs, but I don't expect much in the way of
cost savings.
T|4.2.09 @ 1:22PM|#
Also, I find it funny that the health care system practiced
extensively by the US military is considered inadequate for
civilians. The number of times I saw an actual MD during 6 years in
the Army was minimal. For almost everything, an enlisted medic
checks you and sends you to a PA, who gives you a prescription or a
profile and sends you on your way. I saw MDs when I had surgery,
eye exams, and physicals.
And my command ordered psych evals, but let's not go there.
|4.2.09 @ 1:27PM|#
As a practicing attorney, I can tell you with complete
assurance that the U.S. would turn into a Third-World
country if we did away with licensing requirements for doctors
and lawyers.
The obvious question: Why would that be? What's so special about
licensing?
To me, this reads like a very clumsy non sequitur. Can you tell me
if doing away licensing of beauticians would turn the US into a
Third World country as well? Or is it just the licensed lawyers and
doctors that hold the US by its tether?
libertarian democrat|4.2.09 @ 1:31PM|#
FTG, I am going to go out on a limb a second time in this thread and say that, in a free market, there probably would be alot more demand for private licensing of doctors than beauticians.
Tacos mmm...|4.2.09 @ 1:32PM|#
Also, I find it funny that the health care system practiced extensively by the US military is considered inadequate for civilians. The number of times I saw an actual MD during 6 years in the Army was minimal. For almost everything, an enlisted medic checks you and sends you to a PA, who gives you a prescription or a profile and sends you on your way. I saw MDs when I had surgery, eye exams, and physicals.
The military medical population is different from the civilian one.
The military, for example, provides most of its medical care to the
young and basically healthy, whereas the reverse is true in the
civilian world. Also, healthcare providers in the military do not
have to worry about malpractice... see my comment above.
|4.2.09 @ 1:32PM|#
It's not guild profits so much as bureaucratic inertia
that is currently slowing down an increase in
supply.
Not really - the US can perfectly import all doctors the market
needs. The problem is that the State makes any foreign doctor
almost go through medical school all over again just to get the
license to practice, no matter how advanced the schools are in his
country (and I can say without hesitation that many Mexican medical
schools are top notch, especially the one at the University of
Mexico and the one at the Technological Institute in
Monterrey.)
JP|4.2.09 @ 1:32PM|#
FTG -- Please read my comment again, paying special attention to the tag at the end. ;-)
|4.2.09 @ 1:33PM|#
Here's what you do. I'm telling you straight out.
You open an 'alternative medicine' clinic, staffed by people with
the lower tier medical training. Then, in addition to basic suptum
cultures and chest X-Rays, you give them some energy healing or
some shit like that.
You tell the government that the primary purpose of the clinic is
alternatic medicine, but in practice, what you are doing is
second-tier health care.
They try to shut you down, and you just whip out your acupuncture
credentials and start screaming.
|4.2.09 @ 1:38PM|#
Lib Dem,
FTG, I am going to go out on a limb a second time in this
thread and say that, in a free market, there probably would be a
lot more demand for private licensing of doctors than
beauticians.
That MAY be so, but one cannot simply assert that, without
licensing, the US would become a 3rd world country.
The issue with licensing is not that it exists, but that it is
monopolized by the State on behest of a private organization,
namely, the AMA. That is unethical.
libertarian democrat|4.2.09 @ 1:40PM|#
Not really - the US can perfectly import all doctors the
market needs. The problem is that the State makes any foreign
doctor almost go through medical school all over again just to get
the license to practice, no matter how advanced the schools are in
his country (and I can say without hesitation that many Mexican
medical schools are top notch, especially the one at the University
of Mexico and the one at the Technological Institute in
Monterrey.)
I have no idea how good medical education is in Mexico. That said,
I was addressing our current system without reduction of our
current regulations in the US. Some doctors have to repeat medical
school, others just have to take the USMLE exams, it depends hugely
on the country. I imagine from your comments that Mexico is in the
first category, which means they don't trust the education (or some
other reason). The fact that other doctors can enter the country
and practice without re-attending medical school means that the
lack of doctors isn't about profit but again about perceived
quality (or whatever). There are also differences in immigration
laws that make it less nice for foreign doctors.
It's not a strong argument against my point, which is that most of
the professional physician organizations want to expand the supply
of (qualified by their standards) doctors.
T|4.2.09 @ 1:41PM|#
The military medical population is different from the
civilian one. The military, for example, provides most of its
medical care to the young and basically healthy, whereas the
reverse is true in the civilian world. Also, healthcare providers
in the military do not have to worry about malpractice... see my
comment above.
Oh, indisputably. These points are all true. But if you propose not
requiring a licensed physician's supervision to have somebody slap
6 stitches in a cut, somebody comes out of the woodwork screaming
how people are gonna die. I've had enlisted medics dig crap out of
my leg and suture it back up under the supervision of a PA. Propose
that out here in the real world and see what happens.
libtdem|4.2.09 @ 1:42PM|#
FTG, I agree with you. The original statement was a joke, and I was just responding to your criticism of it, because I don't think it was a completely valid analogy even had the original comment been serious.
|4.2.09 @ 1:43PM|#
FTG -- Please read my comment again, paying special
attention to the tag at the end. ;-)
Sorry, JP - got carried away three ;-D
Tacos mmm...|4.2.09 @ 1:46PM|#
There are a lot of misconceptions here.
The number of doctors in the US is NOT limited by the number of US
medical schools. It is limted by the number of post-graduate
training programs, with the difference in US med school graduates
and training slots made up for my foreign medical graduates (FMGs).
Increasing the number of US medical school grduates will simply
displace more FMGs without increasing the number of practicing
physicians.
The number of post-graduate training slots is essentially
controlled by federal subsidy through medical. It cannot be
increased indefinitely, however, because training programs have to
meet certain accreditation standards (google "acgme"). You can't,
for an obvious example, run a neurosurgery training program at a
hospital with no neurosurgeons. You need hospitals that have enough
of the procedure or patient that you're training on, and enough
trainers. This will naturally limit the potential number of
training slots if the type of case or patient is less common - one
reason, for example, that there are fewer neurosurgeons than
general surgeons.
If you are a graduate of medical school (not necessarily US) AND
have graduated from a post-graduate training program (with as
little as one year of training), then getting a medical license is
essentially a formality. The state board will not limit the
number of pracitioners. They will simply confirm your
credentials, do a background check, may make you take a test on
medical law in the state, etc. If you don't get a license, it's
probably because your credentials are bad, or you have significant
ethical or legal problems in your past.
What determines the number of physicians in an area is the local
market.
Tacos mmm...|4.2.09 @ 1:51PM|#
Oh, indisputably. These points are all true. But if you propose not requiring a licensed physician's supervision to have somebody slap 6 stitches in a cut, somebody comes out of the woodwork screaming how people are gonna die.
I don't think it's a safety risk. But an unsupervised PA would have
a higher malpractice rates than a full physician, while having
substantially less gross income. You can pull this off in the
military, where you don't need malpractice insurace, but in the
real world, it's going to limit the number of people seeking the
job.
libertarian democrat|4.2.09 @ 1:52PM|#
Tacos mmm, while your point about residency is a good one, and
one I should have touched on as well, I have some slight
disagreement.
I believe there are generally enough residencies for all American
graduates and quite a few FMGs, but that they might not be in the
right field. I think Family practice and other GP residencies often
have empty potential slots (sometimes filled by people that want
other fields but give up trying).
Of course, more residencies are necessary too, which is a great
point.
Tacos mmm...|4.2.09 @ 1:56PM|#
The issue with licensing is not that it exists, but that it is
monopolized by the State on behest of a private organization,
namely, the AMA. That is unethical.
When I consider the problems facing our medical system today, the
ethics of licensing is probably second-to-last.
Licensing schemes will exist. If they are not drawn up by boards of
doctors or the government, they will be drawn up by actuaries.
Personally, I actually prefer the medical boards on this one, since
they reflect the public obligation of the profession.
Tacos mmm...|4.2.09 @ 1:58PM|#
I believe there are generally enough residencies for all American graduates and quite a few FMGs, but that they might not be in the right field. I think Family practice and other GP residencies often have empty potential slots (sometimes filled by people that want other fields but give up trying).
This is true, but we don't incentivize these fields in terms of the
ratio of work to compensation, and none of the solutions posited in
this thread, which largely seem to be centered around forcing down
providers charges for primary care, are likely to change that.
Kolohe|4.2.09 @ 2:03PM|#
Also, healthcare providers in the military do not have to
worry about malpractice... see my comment above.
This is not entirely true but for the point you were making
(because the govt mostly self insures) it is.
Kevin Carson|4.2.09 @ 2:12PM|#
Thanks, Jesse. I used the term "open-source" partly as a tie-in
to my venue (the P2P Foundation blog), but I think it's
appropriate; "open-source" medical care is free from barriers to
the free transfer of skill and knowledge, in the same way that free
software is free from analogous barriers like copyright and
patents.
Ray: Your response is typical of the liberal response on many
issues. Your kind assume, in just about every imaginable field,
that the existing scale of production, the production technology
used, and the technical means currently predominating, are the
inevitable results of some technological imperative. Galbraith's
view of the "technostructure" is a good example. But in fact the
opposite is true. In just about every case, the scale of operation
and the technical means adopted reflect a choice between
alternatives, and the choice reflected the institutional needs of
those in control of the system rather than any objectively superior
"efficiency."
Hazel Meade: If you really believe the FDA and medical licensing
boards are LESS likely to clamp down on a practice because it uses
the term "alternative medicine," you're sadly mistaken.
I think Ray's and Hazel are operating from almost mirror-imaged
assumptions. Ray, blinded by the goo-goo assumption that all
government intervention must be intended primarily for the public
welfare (apparently never heard of "Bootleggers and Baptists"),
that he dismisses the whole universe of cooperative clinics, Ithaca
Health, Andrew Weil, etc., as monstrous conspiracies to "fuck the
poor." And Hazel is so adamantly convinced that government is
instinctively on the side of all the "goddamned tree-hugging hippie
crap" that she hates, that she thinks the term "alternative
medicine" will actually protect a cooperative clinic like a hex
sign over a barn.
Government regulators absolutely LIVE to spy on "alternative
health" clinics and catch them doing anything that some licensed
professionals have a legal monopoly on. Just the same as they LOVE
shutting down hippie-dippy food-buying clubs operated out of
someone's home, whenever they can entrap them into crossing the
line and "stealing" business from licensed grocers (hard as it is
to believe, putting "organic" over the door doesn't ward them off,
Hazel).
|4.2.09 @ 2:23PM|#
The state has no business licensing any occupation, particularly health care. State medical, dental, nursing and other licensing bodies do a tremendous amount of damage to health care, innovation, consumer education and liberty.
Kevin Carson|4.2.09 @ 2:24PM|#
P.S. Shirley Svorny's article on licensing for CATO includes
quite a bit of evidence that the licensing bodies almost never
revoke licenses after the fact, even in some of the most egregious
cases of malpractice. So a license is more like a "seal of
approval" from a trade association--a source of false
confidence.
As Tacos mmm... said, malpractice suits in the civil court system
(which we'd have even without licensing) have far more of a
real-world effect.
|4.2.09 @ 2:29PM|#
Kevin, you're taking me far too seriously.
But doesn't it strike you as pretty absurd that an alternative
medicine clinic can offer any kind of service, as long as there's
no proof that it actually works? But if it's backed by science, the
government steps in and shuts them down?
Tacos mmm...|4.2.09 @ 2:42PM|#
As Tacos mmm... said, malpractice suits in the civil court system (which we'd have even without licensing) have far more of a real-world effect.
Malpractice insurers ARE the true governning bodies. The derth of,
say, OB/GYNs in south Mississippi is not due to medical boards,
it's due to malpractice costs. Medical boards are quite useful, in
theory, with dealing with a small group of seriel offenders -
individuals who commit gross negligence, get sued, and then simply
go bankrupt or vanish and set up shop at another locale. Without
medical boards, sorry as they can sometimes be, there would be no
real check on this kind of practice, while well-delivered care
would be unlikely to increase.
|4.2.09 @ 2:44PM|#
The number of doctors in the US is NOT limited by the number
of US medical schools. It is limted by the number of post-graduate
training programs
Certainly true for specialists, but I believe a med school graduate
without an internship, fellowship, or board certification can get a
license and practice as a general practitioner.
They won't be able to get on most hospital medical staffs,
true.
Fun fact: The federal government, via Medicare, effectively caps
the number of graduate medical education slots in this country (GME
is a notorious cost sink for hospitals, and Medicare will only take
up the slack for a specified number). Medicare has been trying to
drive down the number of GME slots for years.
|4.2.09 @ 2:50PM|#
Kevin-
Wait a minute-you just got my seal of approval and then you concur
with Tacos' point that the elimination of the state sanctioned
monopolies do not have much real world effect. What gives?
The harassment of wholistic and alternative providers is not some
infinitessimal/neglible phenomenon. The costs of harassing
providers who do not cowtow to the cartels include;
(1) Death by Medicine.
(2) The Continuation and Expansion of Ignorance.
(3) Spectacular Misallocation of Resources.
(4) Loss of Liberty.
Tacos mmm...|4.2.09 @ 2:52PM|#
Certainly true for specialists, but I believe a med school graduate without an internship, fellowship, or board certification can get a license and practice as a general practitioner.
It varies from state to state and board to board (allopathic vs.
osteopathic) with international medical graduates sometimes needing
more, but no state permits less than an internship, and some
require up to three years (Maine, Nevada)
Medicare has been trying to drive down the number of GME slots for years.
Very true. Residencies are subsidized heavily, but it's difficult
to imagine them existing without subsidies.
|4.2.09 @ 2:58PM|#
One of the leading causes of death in this country is iatrogenic
death. Death by medicine, death by medical doctor, death by the
same tired prescriptions of pharmaceutical drugs, surgeries,
vaccines, anti-biotics, death by nurse, death by hospital- death by
allopathic jihaddists.
Tacos, with no monopoly, there would be no third party payment
regimes. Why does it cost $200.00 just to see a medical doctor for
10 minutes? Very little of that cost is attributable to malpractice
insurance premiums. How about FDA approved junk science
pharmaceutical garbage? Do you think that very much of the cost of
these vessels of death is attributable to malpractice premiums?
JB|4.2.09 @ 3:08PM|#
For anyone who wants government or socialized healthcare, I say they should get serious about their proposals. I say let's cap healthcare salaries at $30,000 per person. They can sacrifice for the greater good. That should solve all problems.
Tacos mmm...|4.2.09 @ 4:13PM|#
Tacos, with no monopoly, there would be no third party payment regimes. Why does it cost $200.00 just to see a medical doctor for 10 minutes?
Your quote is a high for ten minutes, but cost-shifting from
medicare/medicaid/private insurance runs up prices on private-pay
patients. A general physician's time should cost about $200 for a
complex visit of about an hour, and $50-100 for a shorter visit,
but this varies significantly by locale.
One of the leading causes of death in this country is iatrogenic death. Death by medicine, death by medical doctor, death by the same tired prescriptions of pharmaceutical drugs, surgeries, vaccines, anti-biotics, death by nurse, death by hospital- death by allopathic jihaddists.
This doesn't merit response except to say that when it comes to
medical nutcasery, the far left and far right are virtually
indistinguishable.
|4.2.09 @ 5:10PM|#
Tacos-
Yes, the $200.00 tab for 10 minutes may be a bit high for Fargo,
but not the greater Boston area.
You have not really addressed the relationship between price and
state mandated cartels by means of licensing schemes. That
relationship plays a far bigger role in the setting of a
physician's fee than does a malpractice insurance premium.
Pray tell, what is medical nutcasery? One would be a nutcase to
claim that iatrogenic death is not one of the leading casues of
death in the US.
Tacos mmm...|4.2.09 @ 5:50PM|#
You have not really addressed the relationship between price and state mandated cartels by means of licensing schemes. That relationship plays a far bigger role in the setting of a physician's fee than does a malpractice insurance premium.
I think you're missing my point. Without a licensing scheme, anyone
practicing medicine would still need malpractice insurance. If Joe
Schmo the mechanical engineer wanted to do surgery, even if it were
legal, he still couldn't get insurance or a hospital (worried about
their liability) to let him use their OR. The field of medical
practioners would still be narrow, but it would be insurance
actuaries determining who could practice, not state medical
boards.
|4.2.09 @ 6:08PM|#
so...what is the lower-cost treatment for the following
illnesses?
diabetes
cancer
lacerations
ulcers
heart disease
Hey LibertyMike - let me know the next time you have a strep
infection. I'll going shopping for a black suit while you get your
aura cleansed and avoid "allopathic medicine". See you at your
funeral.
EscapedWestOfTheBigMuddy|4.2.09 @ 6:29PM|#
so...what is the lower-cost treatment for [] diabetes
For all patients:
Lifestyle issues (diet, exercise, sleep habits, stress reduction,
etc.).
Regular blood sugar monitoring
Quarterly Hemoglobin A1C measurements
Year ocular exams
For all type I and some type II patients:
A well designed insulin regime using a minimum of insulin
and a the most suitable delivery mechanism (pump, inhaler,
injections)
For some type II patients:
Drug therapy
All patients need occasional physician consults, but most of these
can be delivered by technicians with much less, but more focused
training than an MD. Moreover, my observation is that peer
councilling is more effective for more people for the lifestyle
issues than most formal support.
As for lacerations: I wouldn't flinch from having a PA or NP do my
stitches. I mean, excepting from the needle, 'ya know. Hell, I
wouldn't worry about having an RN do them if that's what was
available, though I would want to know that there was a physician
they could go to if they got into trouble.
But casting about for a list of problems that do
require highly trained care does not imply that
all complaints require the same level of skill. So
kindly start being enginuous, 'eh?
Kevin Carson|4.2.09 @ 11:07PM|#
Hazel: The thing is, though, I don't think "alternative"
providers can do anything that's not officially approved as a
treatment for disease, and just get away with it because it's
called "alternative." Look at Hoxsey's Red Clover treatment, for
example. The authorities are looking very closely for anyone
selling herbal supplements and making medical claims for them, so
they can jump on them with both feet.
Libertymike: I just agreed with tacos that licensing wasn't
effective in carrying out its ostensible purpose (i.e., eliminating
malfeasors from practicing medicine). The licensing cartels are
quite effective in shutting out unwanted competition up front.
|4.6.09 @ 8:18PM|#
dr dmv:
Why cant I just study on my own and pass all the licensing? If you
are not smart enough to pass, then go to medical school. I am
guessing most will just study on their own and pass. Medical
schools make alot of money selling licenses, why is this?
dr. skynet:
software has been around that can outperform humans (MYCIN, TREAT,
Isabel), problems are industrial not technical, in that how do you
get the data in? However, now we have Google, Walmart, Microsoft
health vaults, so a streamlined industrial standards are emerging.
For diabetes, since some have discussed this, DIAS exists.
Automated bayes net- able to predict hypoglycemia (sensitivity 5/6,
specificity 50%)- suggest reduced insulin dose (thereby prevent
hyper-gly)
http://www.miba.auc.dk/~okh/dias#Clinical
endgame: The cartel is too strong, it will not allow
NP/PAs/alternative credentialing. However, what is stopping a
generalist/specialist war? Radiologists and gastro go at it all the
time over reading colonoscopies, why should a generalist refer a
diabetes patient to a endocrinologist? What could a cardiologist
unable to outperform software do to a generalist who does not refer
the arrythmia patient?
dr. lechter: Technology will cause canabilization within the ranks
of medicine. What effect will that have on clinician salaries or
patient costs can be guessed at? Will the $300K/yr anesthesiologist
be making $70K given the widespread use of clinical diagnostic
decision support software? I was recently told curtly by an
aspiring medical student interested in anesthesiology, "good luck
with that"
good luck with that:
so what am I missing here? if in ten years, seeing a human for
diagnosis is considered poor level of treatment, what will Reason
be critical of? If doctors are making $70K, patient costs are down,
and patient quality is up, what will be the problems of the day?
Will I go to Walmart for heart arrythmia, or cancer treatment, and
get free care after just watching some advertisment...
|4.15.09 @ 2:54PM|#
Doesn't This looks like an awesome place to begin your academic program! The True Blue Campus at St. Georges University.
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