From: rrb@corona.CSS.GOV (Robert Blandford)
Newsgroups: talk.politics.medicine
Subject: Re: The future of medicine
Summary: An approach to give patients and doctors motivation to give
	 good care at low prices.
Date: 12 Jan 93 21:42:15 GMT

In article <1993Jan12.193801.8870@netcom.com>, tjm@netcom.com (Thomas J. Merritt) writes:
> In article <1993Jan11.235321.3075@cnsvax.uwec.edu> nyeda@cnsvax.uwec.edu (David Nye) writes:
> >[reply to tjm@netcom.com]
> > 
> >>It is easy to see that curbing health care costs in not in the
> >>interests of physicians.
> > 
> >In the short term, perhaps.  In the long term, some of us realize that
> >the system is going to collapse without radical modifications, and that
> >we have an interest in helping modify the system so that it will survive
> >and we can continue to be part of it.  Physicians would like to maintain
> >their salaries (probably not possible) while trimming waste in the rest
> >of the health care system -- overutilization of tests from which they do
> >not profit and money leaving the system to lawyers, clerical workers and
> >the insurance industry.  The physicians' fees actually constitute a
> >rather small percentage of the health care dollar.
> 
> You can point the finger at attorneys and clerical workers but the ones
> that are taking the big chunks out of the pie are physicians, insurance
> companies, and pharmacutical companies.  (I known malpractic costs are
> high, but it has less to do with lawyers than the business practices of
> insurance companies that are designed to maximize profits.)  Physicians
> do get a big chunk of the health care pie, this doesn't mean that all
> physicians share equally.  You can certainly cite many dedicated physicians
> that take only a modest salary.  However, it takes many of these folks
> to make up for just one physician making a half million.

To support this note that Consumer Reports states that while median US wages
have remained flat since 1970, doctor's wages have increased by a factor
of three and specialists by a factor of 10.  Thus it seems more than 
reasonable that savings of at least a factor of 2 are possible.  Here is
a summary of an approach that I have posted previously


---------------------------------------------------------


                 An Approach to National Health Care

               A Fixed, Lifetime Personal Entitlement

                        (Seven Point Summary)



(1) Each person receives a fixed, non-transferable $50,000-100,000 lifetime
 entitlement at birth. Persons alive receive a pro-rated amount propor-
 tional to typical future lifetime expenses.

 Also each person receives a "use or lose" entitlement of $250-500 each
 year.


(2) The patient chooses any licensed provider. Almost all procedures are
 available: dental, eyeglasses, long-term care, but perhaps not cosmetic
 surgery or long-term psychotherapy. Providers may charge any amount.

 The provider bills the Federal government (single payer) who pays,
 deducts from the patient's account, does not control costs but checks
 for fraud, and sends reports of payments and remaining balance to
 patient.

 Fraud is minimized compared to other approaches because of the self-
 interest of the patient. The patient can pay provider directly if desired.


(3) Catastrophic $10,000 deductible insurance may be purchased yearly
 with the fixed entitlement but not with the "use or lose" entitlement.
 All other health insurance is not tax deductible or is taxed.


(4) Comprehensive health insurance for accidents, acts of God, and assaults
 is provided by the government.


(5) When a person's entitlement is exhausted a program like medicare, but
 with benefits very substantially less than those of medicare, begins.

 Current medicare recipients have the choice of remaining in medicare.


(6) After age 75, 1/3 of any entitlement remaining after death is credited to
 the deceased's estate.


(7) This approach has the advantage over managed competition that per-
 sons can choose any provider and more procedures; and that consu-
 mers are not indifferent to cost once their insurance premiums are
 payed. This second feature is also an advantage over the Canadian
 single-payer plan.









Newsgroups: talk.politics.medicine