From: mayer@sono.uucp (Ron Mayer)
Newsgroups: rec.motorcycles
Subject: Re: Re; Nat'l Health Plan (Was: Re: Lance Hols
Date: 22 Jan 93 00:38:37 GMT
	<1jhg1nINN28c@seven-up.East.Sun.COM>
Organization: Acuson; Mountain View, California


egreen@East.Sun.COM (Ed Green - Pixel Cruncher) <1jhg1nINN28c@seven-up.East.Sun.COM> writes:
>
>In article 24761@murdoch.acc.Virginia.EDU, cdw2t@dayhoff.med.Virginia.EDU (Clifford David Weston) writes:
>>
>>As long as I can sue an MD, he'll continue to perform "needless" tests for no
>>other reason than to cover his butt.  
>
>One other reason:  to make $$$.

Ever since my hospital experience after my motorcycle getoff, I've
been bothered by this entire concept.  While one of my knees was badly
hurt and needed medical attention, my other one was merely scratched,
but the surgeon still wanted to "cut" on it anyway so he could "check
it out and clean it out better" anyway.  When I asked why, the reasons
he gave me included:

    "Insurance pays for it anyway."

    "If I don't do everything and something goes wrong you could sue me."

    "I want you under a general anesthetic so you won't notice anyway."

When I asked the emergency room tech, who cleaned it out and bandaged
it many hours earlier; she said it didn't look that serious to her and
if it were her, she'd prefer to just leave it in it's bandaging.

This entire discussion only came up *after* I refused to sign a form
stating something like "I agree to whatever procedures the doctor
decides is best for me, and I don't need to know about the risks
involved in these procedures."  Only after I asked him "Can I sue you
if you do more than I want you to?" did he listen to me when I told
him I only wanted him to do my seriously hurt knee and refused the
general anesthetic.


The problem IMHO is that our system states that only a doctor is
qualified to make health care choices.  When I called up my brother
(studying to be a doctor) and complained about the "whatever procedure
the doctor thinks is best" form, he gave me the party line that "well,
the doctor _is_ more qualified than you to know what's best for your
knee."

>Doctor:  "Either will be more than your deductable, so there is no
>difference in cost to you."
>
>Under these circumstances, 10 out of 10 people will choose the more
>expensive diagnostic tool.

In reality, how often does the patient even have a choice.  In my
rather limited experience with hospitals, doctors end up making nearly
*all* the choices; and end up being both the supplier and customer of
the medical expenses.  In many hospitals the doctor is not in any
movated to choose the more affordable procedure, and guides the
patient to whichever procedure he prefers, for whatever reason.

It's pretty likely that the doctor/hospital will actually _gain_
financially by charging a more complex procedure to the insurance
company, in addition to possibly reducing the risk of their patients
and reducing their liability.  If both procedures are equally
effective I'd doubt that the patient would care which is chosen, but
if the doctor sees that he can get more money from the insurance
company with the expensive procedure I'd bet 11 out of your 10 doctors
will probably choose the more expensive diagnostic tool.

In my case, the doctor was arguing _for_ the more expensive care, and
the patient (me) was arguing _against_ the more expensive procedures;
even though neither cost me anything.


>Make consumers personally financialy responsible for their health
>care choices, and the aggragate cost of health care will drop like a
>motorcycle on ice, and it will happen overnight.

Make patients personally financially responsible in our current
system, and you'll still have doctors trying to get as much money as
they can out of the customers; and you'll have a lot of patients
selling their homes and souls for unnecessary medical procedures.

Make doctors financially for the health care they provide (The doctor
is payed only based on what problem he solves, and he has to pay for
the MRI, etc, and whatever expences arrise from the treatment he
provides), and the cost_of_health_care_motorcycle you mentioned will
crash through a hole in the ice you mentioned and sink to the bottom
of the icy lake (obmotorcycle:-)).


IMHO the solution is that the insurance shouldn't pay for whatever one
doctor/patient combination they choose.  Instead, they should consider
the patient's condition, and if they don't like the doctor's
"estimate", they'd send out some their own insurance-adjustor doctor
to make his own estimate.  They then give the patient however much the
estimate says the problem would cost.  If the patient wants the more
expensive doctor, he pays the difference.  If the doctor can't fix it
for about the price of his estimate, he keeps working on for free
until he gets it right.  If a doctor screws up, he pays for the
damages he causes.

Isn't this kinda like auto^H^H^H^H motorcycle insurance works
(obmotorcycle again!:-))?  Why doesn't it apply to health care?

        Ron Mayer sun!sono!mayer DoD#556  92R100GS 78GS400
Newsgroups: rec.motorcycles