PLAYER57832 wrote:Most particularly, you have pretty much ignored or underplayed the impact of the previous condition exclusions and lifetime limit provisions. Those alone are responsible for placing thousands, if not millions on the government funded roles instead of private insurance.
The only way I will believe that this is effective is if health care costs go down. There is, as of yet, no incentive associated with a decrease in health care costs.
I see, so more people getting care is just of no consequence to you?
PLAYER57832 wrote:It is just one of many reasons why straight market economics just doesn't work in medicine. (not saying that market elements have to be ignored, but they are not the sole solution).
Dollars are not the primary driver of medical care (or, at least, they are not supposed to be). The primary driver of medical care is to receive treatment such that you do not need to receive additional medical care. This is precisely why market economics should work in medicine. If I go to Doctor Smith and she doesn't solve my problem, I'm not going to go to Doctor Smith anymore. I'll go to Doctor Jones. Ultimatley, Doctors Smith and Jones are interested in treating and solving my problem, whether because they take their roles as doctors seriously or whether they would like to increase the size of their business.
No, for several reasons.
First, most people just don't have the option to just "choose another doctor", particularly in critical care, which is where the biggest cost issues are. You may not trust the local "hillbilly" doctor, but if your daughter breaks her leg or has an appendicitis attack or even is in a serious accident (heaven forbid of course) you rarely will be able to just choose whatever doctor you want.
The place where you theoretically can “make the choice” is in basic and preventative care. There, however, there are a few interesting twists.
Take one issue.. use of antibiotics. I hope you are aware that antibiotics are vastly over-used and that, as a result, we will be soon facing a world where there are no longer easy treatments for many diseases. (this IS the real situation, by-the-way…excepting only some magical new discovery akin to the transition from sulpha drugs to antibiotics earlier). So, why is this happening? Two fully market-driven reasons. First, antibiotics give animal producers a slight edge. These antibiotics permeate our world and expose more microbes to antibiotics, killing off many and leaving the more resistant ones behind. That this is happening is no longer even questionable, (unless you are expecting money from the meat industry and willing to thus ignore research) \.
Second, direct use.. doctors prescribe antibiotics to people who don’t need them because, as you say, if that doctor doesn’t give off the antibiotic, then some other doctor will… and the patient will likely not return. Many of these doctors know they are doing something incorrect, but feel they have no choice because they want to make a living. They will try to educate, but some people just won’t listen. [A third issue is not market-driven, per se.. its that people just don’t follow the doctor’s instructions to finish all their medication. As a result, instead of killing off “all” of the bacteria in the body, they leave a lot around.. those left naturally are those better able to resist the drug.. they reproduce and voila, we have more resistant bacterial strains flourishing. All three are significant, but you could even take out this last one and the impact would still be significant.]
A related example was given to you earlier.. that of orthopedics, where the more doctors you have in an area, the more surgeries/procedures and the lower the probability of success. I will refer you back to that discussion rather than reiterating it here, but the basic reason is that well meaning doctors find themselves very slightly making judgement calls more to do something than to not do something when other doctors are around. Partly its like above (not always conscious), that if this doctor doesn’t treat the patient, another doctor might. People are funny in that they too often think a doctor that “does something” is somehow “more willing to listen”, etc than one who just saying “go home and take 2 aspirin”. The other factor is that these doctors talk amongst themselves and wind up convincing each other that doing more work is truly necessary. Again, its not overt and intentional, but the impact is quite real… and dangerous.
I can give you example after example, but the bottom line is that medical care is not a traditional market-driven system. Add in that you have to actually know whether the results the doctor are giving you are or are not better…..and you have a real mess. I mean, there is a HUGE difference between a doctor who studies for years, has years of experience and someone making a few quick (or lengthy) internet searches to find the “better” answer. The internet is good at allowing people to find “answers” that are just plain dead wrong. On this level, this goes well beyond freedom of choice, because people tend to be very vulnerable and willing to listen to anyone who offers hope in many medical situations. It is, in fact, where the “optimism bias” comes seriously into play. The more serious the medical issue, the more vulnerable people can be… but the same thing happens for “lighter” issues as well.
The plain truth is that most people just are not equipped to nay say their doctor and to make truly informed decisions. They can decide they like or dislike the manner of the doctor, but when it comes to outcomes, it mostly involves trust… whether the outcome is good OR bad. Even knowing which happened can be a matter of trust (seriously… think about it. Can you “just tell” if your cancer was really cured… or if other problems were caused by the treatment, etc.?
In any event, the ACA will not solve this problem (if it is a problem) either. Keeping a patient on the books for financial reasons (which, honestly, I don't think doctors do for a variety of reasons) is not going to change if the patient now has better health insurance that will pay for more.
Lifetime limits? That IS ALREADY law. I am now able to get care, despite a lapse in insurance, because of the law. Before, my only real option was the PA fair pay plan, but only if I were lucky enough to be one of those enrolled… and that program is apparently on the chopping block.
The REAL solution is to have reasonable, science based limits on healthcare, NOT to leave it up to individual choice. People just don’t have enough information to do that. Insurance companies already do this to boost their profits, but any talk of doing that intentionally, in the open, in a government system subject to challenge gets shot down by conservatives shouting things like “death panels”.. Oh yeah, and your church is very much a part of that problem!
PS Or, to be more brief… The problem is that the first doctor might very well have been the better doctor, medically. It could be that your “problem” was not really a problem, that the risks of any potential solution actually outweigh any benefit (this is often the case with back/orthopedic issues, by-the-way) or that the doctor did have a real solution, but just not one you wanted to hear (maybe you need to lose weight instead of having knee surgery
You could argue that this is part of the system, customer care and all that. and yes, there is a push to train those factors more. Except, well, doctors are human. Doctors tend to get trained in medicine. Attorneys are the ones trained to argue convincingly.