From: starr@genie.slhs.udel.edu (Tim Starr)
Subject: Re: health care industry woes
Organization: UDel, School of Life & Health Sciences
Distribution: usa
Date: Thu, 19 Nov 1992 10:47:30 GMT

In article <1ebbl2INNlu1@agate.berkeley.edu> sherw@ocf.berkeley.edu (Gregory Sherwin) writes:
}
}Has anyone else noticed these things?:
}
}Doctors were first against Medicare and Medicaid when it was first introduced
}years ago, but since then their salaries have skyrocketed.  Physicians weren't
}one of thye top income earners until government paid for care for
}that many more patients, and hence many doctors learned that you could process
}patients like an assembly line earning an amount of money for each as set
}and provided by the government (this does not speak for everyone - but a
}trend since Medicare and Medicaid).

Many costs associated with medical practice have gone up far ahead of price
inflation since then, especially administrative costs and malpractice
insurance premiums.  These contribute to the high salaries of MDs.  My
understanding is that administrative costs were fairly linear until the
passage of medicare and medicaid, then it became much more exponential;
malpractice law has changed so that liability that used to be limitable
through contract isn't anymore, resulting in more litigation, which drives
up the cost of the insurance premiums.

}The health insurance industry sets our costs without any real consideration
}for supply and demand economics.

True.  There's a conspicuous absence of consumer forces.  Insurance companies
used to be for accidents only (their specialty is risk-management), but
they're used now for much more than that.  The reform that Milton Friedman's
proposed, probably among others, is to set up medical IRAs which would be
tax-deductible.  Then cash would be available for consumers' medical needs.
Currently in the USA, medical insurance is only tax-deductible if obtained
through employment.

}In an independent study comparing a Canadian hospital with an American one -
}where there was approximate equivalence in skilled staff, specialization,
}equipment, etc.  For handling just insurance FORMS, the Canadian hospital
}had an office with 4 full-time staff members.  In the U.S. hospital - of
}equivalent size as the Canadian one - they had dedicated an entire BUILDING
}with 300 full-time employees to just paper pushing for the various
}insurance companies.

One possible contributing factor to this would be the fact that the government
has "sovereign immunity" from liability, which cuts down the amount of
malpractice suits it has to face when it coercively monopolizes medicine.

}Health care reform, I believe, must begin not with government, but within
}the industry itself.

Here's where I strongly disagree with you.  I'm a libertarian, and if you
know anything about us, it's that we have a plethora of arguments against
government intervention into private industry.

The AMA should no longer be self-regulating...we are
}all paying the price.  Incentives must be provided towards investment of
}resources in cost-effectiveness, with financial disincentives for the
}development of 4-of-a-kind or costly, hardly used technologies or
}procedures.  It is important to test the horizons of medicine, but it is
}also ignorant to think that some form of medical-resources rationing is
}unconstitutional and not necessary.

The best thing to do to the AMA would be to repeal medical licensure laws,
opening up this cartel to competition.

When medicine is conducted on the free market, unlike now in the USA, there
are incentives for cost-effectiveness, as profits depend upon it.

Rationing unconstitutional?  That depends on what you mean by rationing.
Everything is rationed, it just depends how.  The Pepsi that I drink is
rationed by price: I can't afford to drink unlimited quantities.  Health
care in England and Canada, where they have national health insurance, is
rationed by line: people have to hurry up and wait in line to get any.

This is why there's an "underground railroad" for Canadians in need of
immediate treatment to get it in the States.

If you mean government rationing of resources that don't belong to it, then
it is unconstitutional, as a violation of the 10th, 9th, and 5th amendments
at least.

}There - now we have some rantings and ravings in this newsgroup to talk about..

Thank you for providing the rantings.

Tim Starr - Renaissance Now! - Think Universally, Act Selfishly
starr@genie.slhs.udel.edu

"True greatness consists in the use of a powerful understanding to enlighten
oneself and others." - Voltaire
Newsgroups: talk.politics.medicine