From: sherw@ocf.berkeley.edu (Gregory Sherwin)
Newsgroups: talk.politics.medicine
Subject: health care industry woes
Date: 17 Nov 1992 17:54:42 GMT
Organization: U.C. Berkeley Open Computing Facility
Distribution: usa
NNTP-Posting-Host: earthquake.berkeley.edu


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).

The health insurance industry sets our costs without any real consideration
for supply and demand economics.  Doctor X comes up with a new procedure --
how much to charge for it?  Doctors work with the insurance industry to
set some relatively arbitrary value to it - ie. what the insurance company
will pay for it - and therefore doctors and hospitals charge that amount.
This is called a cartel in many circles of the world.  Specializations
with ridiculous incomes like radiology seem to be more out of self-
fabrication than a true sense of economics, and hence general family
physicaians - the REAL care providers - are economically weeded out.  Medical
school bills are huge, and if you can pay them off faster becoming a
radiologist, it's only rational that many do so vs. becoming a general
practitioner.

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.

Also - rather than investing in improving technology to make it more cost
effective, rewards with the government grant system and within the health
care industry itself are focused on the latest and greatest technology.
Which is fine, but when you create only 5 MRI's that are cutting-edge
technology that will be outdated in 6-months for entirely new ones, your
front -end development costs (passed on to consumers) is ridiculously
high.  This is why you have $300 ashtrays and $400 screw-drivers in the
military.  Too many pats on the back, nifty papers, and awards rather than
an investment in making a technology or procedure more universal and
cost-effective.

Health care reform, I believe, must begin not with government, but within
the industry itself.  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.  If our government practiced rationing
a little better, we wouldn't be in so much debt.  There isn't an endless supply
of resources and finances, and cruel as it may sound to some - sacrifices
for some have to be made for the many to enable a resource-limited closed-system
to survive.

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

greg