From: nyeda@cnsvax.uwec.edu (David Nye)
Newsgroups: talk.politics.medicine
Subject: Re: The future of medicine
Date: 11 Jan 93 23:53:21 -0600
Organization: University of Wisconsin Eau Claire

[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.
 
>However, providing suboptimal care is not so obvious.  At the extreme
>if every member of the population was completely healthy and lived in
>an environment where the stayed that way there would be no need for
>physicians.  Ultimately this should be the goal of a national(global)
>health care policy.  The problem with such a goal is that should we
>actually make progress in achieving it we would reduce the power and
>pretige of physician not increase it since there would be less demand
>for medical care.  This goes counter to the interests of the AMA.
 
That's absurd.  I know of none of my colleagues who want to keep their
patients sick.  It would be stupid to try to do so.  Patients will find
out that Dr. X never seems to be able to help people and will stop going
to him.  Furthermore, we get a great deal of satisfaction out of helping
people.  Few physicians have holes in their appointment schedules.  If
they did, they would move on to somewhere they could have a full
practice.  There is no need to recycle old patients when there are
plenty of new ones to see.
 
Preventative health care is generally not something the physician can do
for you aside from periodic checkups.  Most patients already know how to
keep themselves healthier but don't take the necessary steps.  If you
don't smoke, drink in moderation, exercise, eat sensibly and maintain
your ideal weight, wear your seatbelt, never drive after drinking, etc.,
you are likely to be stay healthier and live longer.  Most patients find
preventative medicine too much bother.
 
>Although the AMA doesn't not make a policy of injurying individuals
>they do so indirectly by selectively supressing information that would
>be helpful to the general population in pursuing more effective and
>less costly treatments.
 
Examples, please.
 
>Personaly the only way that I can see to curbing health care costs to
>change the financial incentives that physicains receive.   When and if
>we as a society provide a financial incentive for physician to have
>healthy patients we will see a decline in health care costs.
 
You will likely get your wish under the Clinton administration.  It's
called the HMO.  I like HMOs and feel they are a good way to hold costs
down, but many patients don't, particularly when they are denied tests
they think they should have or a visit to someone outside the plan the
primary physician feels is unnecessary.
 
>MRI utilization in the USA is about one seventh our capacity.
 
Not here where I practice.  We have two MRIs in a town of 60K with a
referral area of 250K.  They are full to capacity, running evenings and
weekends.  I can't believe that the average MRI sits idle 6/7ths of the
time.

David Nye
nyeda@cnsvax.uwec.edu
Newsgroups: talk.politics.medicine,alt.politics.homosexuality