Re: who's gonna pay for health care?

[Guest guest]

" But as it is now, people want a pill for their every ill, and labs tests up

the wazzoo, because they think they don't pay for it. Having to pay

directly for that million-dollar workup of fatigue before you've tried

eating well, exercising and getting some sleep would probably encourage some

to pause, and hopefully defer. "

My thoughts exactly! People don't care in the current system because things

like health care, auto collision repair, etc are paid for by someone else

(insurance) & it does not seem to effect their own pocket book.

[Guest guest]

ok, so we have three jobs-- one is to educate people as to what we actually do, and how valuable it is. the second is once they understand how valuable it is, to help them make sure that what we do is paid for. a third is to train patients to be responsible for themselves. if we don't, our value, as doctors and what we do, once people are paying out of pocket, is nil. more and more people will turn to catastrophic care only, and they won't pay for routine and preventive care. i believe the only way this will happen is through single payor risk pooling. there is a significant caveat-- this will cause massive unemployment in the health insurance industry. LL Brock DO wrote: "But as it is now, people want a pill for their every ill, and labs tests upthe wazzoo, because they think they don't pay for it. Having to paydirectly for that million-dollar workup of fatigue before you've triedeating well, exercising and getting some sleep would probably encourage someto pause, and hopefully defer."My thoughts exactly! People don't care in the current system because thingslike health care, auto collision repair, etc are paid for by someone else(insurance) & it does not seem to effect their own pocket book.

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

The obvious answer is COLLECTIVELY we all will. How we get there and

what the final formula is, well...

I am a simple person looking for simple solutions. Single payer

catasrophic insurance sounds great to me and then everyone pays their

own way up the the catastophic limit. The impoverished receive some

help/stipend or something. There must be some personal responsibility

built in I think. Empowering people is key. Education is key. My

other idea is when/if the government gets even further dysfunctional we

will all go back to intimate relationships with our docs where folks

pay what they can, barter, trade and we all accept less money for

services from some, more from others - an internal risk pool

essentially.

We need to get away from this insulated, individualistic idea where

people are disconnected and put their own needs ahead of the group and

essentially do not care how systems work or do not work as long as they

are not directly impacted.

solutions:

EDUCATE EVERYONE! empower people to create the world/health care

system we want. Ideas:

1) Teach people to express themselves giving positive or negative

feedback from a place

of compassion. When people come to me and complain about service

elsewhere and they

most certainly do " THANK GOD I found you, you'll never believe what

happened to me

at that other clinic... " I tell them to WRITE a letter to the other

doctor or nurse and give

them feedback from a place of compassion as they are in a way victims

of this dysfunctional

system. Explain that they are nice but seemed rushed and have they

though about going

solo/low volume or practicing in another way.Patients are glad to do

so.

It benefits them to get the issue/frustration processed. It benefits

the doc who may think

" why the hell do I put up with the shitty job anyway. " " I'm outta

here! " Hey, it does

plant the seed!

2) HEALTH CARE ACTIVISM TEAM - I have a little army of patients who

are actively going to

help transform our system (I mentioned it in another email so I won't

repeat)

HUMAN CONNECTION - I feel the more we really know each other (docs,

patients, everyone)

the more we respect each other and look for tenable solutions.

Disconnection is disempowering

and the current system is a million disconnected dots, complicated

formulas - it is ineffective,

dangerous and certainly undermines the sacred doc/pt relationship. I

feel if we really connect

and serve our community and patients it all will work out locally. We

can barter or trade

with patients who can offer no money. There are communities such as

Ithaca NY who

have created their own type of heath insurance network. It is called

the " Ithaca Health Alliance "

www.ithacahealth.org

I really think the answers should be simple. Anything that gets more

complicated, harder to understand, and more disconnected is doomed to

fail. That is how these crooks thrive. They hide behind these

complicated systems

that are totally unnecessary!

What does everyone think?

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

> ok, so we have three jobs-- 

> one is to educate people as to what we actually do, and how valuable

> it is.

> the second is once they understand how valuable it is, to help them

> make sure that what we do is paid for. 

> a third is to train patients to be responsible for themselves. 

> if we don't, our value, as doctors and what we do, once people are

> paying out of pocket, is nil.  more and more people will turn

> to catastrophic care only, and they won't pay for routine and

> preventive care. 

> i believe the only way this will happen is through single payor risk

> pooling.  there is a significant caveat--  this will cause massive

> unemployment in the health insurance industry.

>  

> LL

>

> Brock DO wrote:

>> " But as it is now, people want a pill for their every ill, and labs

>> tests up

>> the wazzoo, because they think they don't pay for it.  Having to pay

>> directly for that million-dollar workup of fatigue before you've tried

>> eating well, exercising and getting some sleep would probably

>> encourage some

>>

>> to pause, and hopefully defer. "

>>

>> My thoughts exactly!  People don't care in the current system because

>> things

>> like health care, auto collision repair, etc are paid for by someone

>> else

>> (insurance) & it does not seem to effect their own pocket book. 

>>

>>

>>

>>

>

> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

>

>

[Guest guest]

The obvious answer is COLLECTIVELY we all will. How we get there and

what the final formula is, well...

I am a simple person looking for simple solutions. Single payer

catasrophic insurance sounds great to me and then everyone pays their

own way up the the catastophic limit. The impoverished receive some

help/stipend or something. There must be some personal responsibility

built in I think. Empowering people is key. Education is key. My

other idea is when/if the government gets even further dysfunctional we

will all go back to intimate relationships with our docs where folks

pay what they can, barter, trade and we all accept less money for

services from some, more from others - an internal risk pool

essentially.

We need to get away from this insulated, individualistic idea where

people are disconnected and put their own needs ahead of the group and

essentially do not care how systems work or do not work as long as they

are not directly impacted.

solutions:

EDUCATE EVERYONE! empower people to create the world/health care

system we want. Ideas:

1) Teach people to express themselves giving positive or negative

feedback from a place

of compassion. When people come to me and complain about service

elsewhere and they

most certainly do " THANK GOD I found you, you'll never believe what

happened to me

at that other clinic... " I tell them to WRITE a letter to the other

doctor or nurse and give

them feedback from a place of compassion as they are in a way victims

of this dysfunctional

system. Explain that they are nice but seemed rushed and have they

though about going

solo/low volume or practicing in another way.Patients are glad to do

so.

It benefits them to get the issue/frustration processed. It benefits

the doc who may think

" why the hell do I put up with the shitty job anyway. " " I'm outta

here! " Hey, it does

plant the seed!

2) HEALTH CARE ACTIVISM TEAM - I have a little army of patients who

are actively going to

help transform our system (I mentioned it in another email so I won't

repeat)

HUMAN CONNECTION - I feel the more we really know each other (docs,

patients, everyone)

the more we respect each other and look for tenable solutions.

Disconnection is disempowering

and the current system is a million disconnected dots, complicated

formulas - it is ineffective,

dangerous and certainly undermines the sacred doc/pt relationship. I

feel if we really connect

and serve our community and patients it all will work out locally. We

can barter or trade

with patients who can offer no money. There are communities such as

Ithaca NY who

have created their own type of heath insurance network. It is called

the " Ithaca Health Alliance "

www.ithacahealth.org

I really think the answers should be simple. Anything that gets more

complicated, harder to understand, and more disconnected is doomed to

fail. That is how these crooks thrive. They hide behind these

complicated systems

that are totally unnecessary!

What does everyone think?

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

> ok, so we have three jobs-- 

> one is to educate people as to what we actually do, and how valuable

> it is.

> the second is once they understand how valuable it is, to help them

> make sure that what we do is paid for. 

> a third is to train patients to be responsible for themselves. 

> if we don't, our value, as doctors and what we do, once people are

> paying out of pocket, is nil.  more and more people will turn

> to catastrophic care only, and they won't pay for routine and

> preventive care. 

> i believe the only way this will happen is through single payor risk

> pooling.  there is a significant caveat--  this will cause massive

> unemployment in the health insurance industry.

>  

> LL

>

> Brock DO wrote:

>> " But as it is now, people want a pill for their every ill, and labs

>> tests up

>> the wazzoo, because they think they don't pay for it.  Having to pay

>> directly for that million-dollar workup of fatigue before you've tried

>> eating well, exercising and getting some sleep would probably

>> encourage some

>>

>> to pause, and hopefully defer. "

>>

>> My thoughts exactly!  People don't care in the current system because

>> things

>> like health care, auto collision repair, etc are paid for by someone

>> else

>> (insurance) & it does not seem to effect their own pocket book. 

>>

>>

>>

>>

>

> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

>

>

[Guest guest]

Pamela: Again I think you are very articulate and express the problem and solution well. Creating the network or the insurance product that allows this to happen is another story. When I purchased my catastrophic health insurance, no broker offered a similar plan. Each broker was asked to come up with a competative offer for catastrophic coverage. They all claimed ignorance. Only one broker out of 10 proveided a similar plan. When insurance companies start to offer health insurance, they right very provitable policies and ignor the effective solutions. We may have to write our own policy for primary care insurance to take the business of providing basic healthcare away from those who would lump it into a policy costing $14000/year with $5000 deductible. I know I can provide quality care for what Larry call a dollar-a-day bargain! Now we only need to know how to write the policy and have the strength

to offer it to patients.] pamela wible wrote: The obvious answer is COLLECTIVELY we all will. How we get there and what the final formula is, well...I am a simple person looking for simple solutions. Single payer catasrophic insurance sounds great to me and then everyone pays their own way up the the catastophic limit. The impoverished receive some help/stipend or something. There must be some personal responsibility built in I think. Empowering people is key. Education is key. My other idea is when/if the government gets even further dysfunctional we will all go back to intimate relationships with our docs where folks pay what they can, barter, trade and we all accept less money for services from some, more from others - an internal risk pool

essentially.We need to get away from this insulated, individualistic idea where people are disconnected and put their own needs ahead of the group and essentially do not care how systems work or do not work as long as they are not directly impacted.solutions:EDUCATE EVERYONE! empower people to create the world/health care system we want. Ideas:1) Teach people to express themselves giving positive or negative feedback from a placeof compassion. When people come to me and complain about service elsewhere and theymost certainly do "THANK GOD I found you, you'll never believe what happened to meat that other clinic..." I tell them to WRITE a letter to the other doctor or nurse and givethem feedback from a place of compassion as they are in a way victims of this dysfunctionalsystem. Explain that they are nice but seemed rushed and have they though about goingsolo/low volume or practicing in

another way.Patients are glad to do so.It benefits them to get the issue/frustration processed. It benefits the doc who may think"why the hell do I put up with the shitty job anyway." "I'm outta here!" Hey, it doesplant the seed!2) HEALTH CARE ACTIVISM TEAM - I have a little army of patients who are actively going tohelp transform our system (I mentioned it in another email so I won't repeat)HUMAN CONNECTION - I feel the more we really know each other (docs, patients, everyone)the more we respect each other and look for tenable solutions. Disconnection is disempoweringand the current system is a million disconnected dots, complicated formulas - it is ineffective,dangerous and certainly undermines the sacred doc/pt relationship. I feel if we really connectand serve our community and patients it all will work out locally. We can barter or tradewith patients who can offer no money. There are

communities such as Ithaca NY whohave created their own type of heath insurance network. It is called the "Ithaca Health Alliance"www.ithacahealth.orgI really think the answers should be simple. Anything that gets more complicated, harder to understand, and more disconnected is doomed to fail. That is how these crooks thrive. They hide behind these complicated systemsthat are totally unnecessary!What does everyone think?PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220Eugene, OR 97405roxywible@...On Nov 30, 2005, at 10:20 AM, lawrence lyon wrote:> ok, so we have three jobs-- > one is to educate people as to what we actually do, and how valuable > it is.> the second is once they understand how valuable it is, to help them > make sure that what we do is paid for. > a

third is to train patients to be responsible for themselves. > if we don't, our value, as doctors and what we do, once people are > paying out of pocket, is nil.  more and more people will turn > to catastrophic care only, and they won't pay for routine and > preventive care. > i believe the only way this will happen is through single payor risk > pooling. there is a significant caveat-- this will cause massive > unemployment in the health insurance industry.>  > LL>> Brock DO wrote:>> "But as it is now, people want a pill for their every ill, and labs >> tests up>> the wazzoo, because they think they don't pay for it. Having to pay>> directly for that million-dollar workup of fatigue before you've tried>> eating well, exercising and getting some sleep would probably

>> encourage some>>>> to pause, and hopefully defer.">>>> My thoughts exactly! People don't care in the current system because >> things>> like health care, auto collision repair, etc are paid for by someone >> else>> (insurance) & it does not seem to effect their own pocket book. >>>> >>>>>> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.>>

[Guest guest]

Pamela: Again I think you are very articulate and express the problem and solution well. Creating the network or the insurance product that allows this to happen is another story. When I purchased my catastrophic health insurance, no broker offered a similar plan. Each broker was asked to come up with a competative offer for catastrophic coverage. They all claimed ignorance. Only one broker out of 10 proveided a similar plan. When insurance companies start to offer health insurance, they right very provitable policies and ignor the effective solutions. We may have to write our own policy for primary care insurance to take the business of providing basic healthcare away from those who would lump it into a policy costing $14000/year with $5000 deductible. I know I can provide quality care for what Larry call a dollar-a-day bargain! Now we only need to know how to write the policy and have the strength

to offer it to patients.] pamela wible wrote: The obvious answer is COLLECTIVELY we all will. How we get there and what the final formula is, well...I am a simple person looking for simple solutions. Single payer catasrophic insurance sounds great to me and then everyone pays their own way up the the catastophic limit. The impoverished receive some help/stipend or something. There must be some personal responsibility built in I think. Empowering people is key. Education is key. My other idea is when/if the government gets even further dysfunctional we will all go back to intimate relationships with our docs where folks pay what they can, barter, trade and we all accept less money for services from some, more from others - an internal risk pool

essentially.We need to get away from this insulated, individualistic idea where people are disconnected and put their own needs ahead of the group and essentially do not care how systems work or do not work as long as they are not directly impacted.solutions:EDUCATE EVERYONE! empower people to create the world/health care system we want. Ideas:1) Teach people to express themselves giving positive or negative feedback from a placeof compassion. When people come to me and complain about service elsewhere and theymost certainly do "THANK GOD I found you, you'll never believe what happened to meat that other clinic..." I tell them to WRITE a letter to the other doctor or nurse and givethem feedback from a place of compassion as they are in a way victims of this dysfunctionalsystem. Explain that they are nice but seemed rushed and have they though about goingsolo/low volume or practicing in

another way.Patients are glad to do so.It benefits them to get the issue/frustration processed. It benefits the doc who may think"why the hell do I put up with the shitty job anyway." "I'm outta here!" Hey, it doesplant the seed!2) HEALTH CARE ACTIVISM TEAM - I have a little army of patients who are actively going tohelp transform our system (I mentioned it in another email so I won't repeat)HUMAN CONNECTION - I feel the more we really know each other (docs, patients, everyone)the more we respect each other and look for tenable solutions. Disconnection is disempoweringand the current system is a million disconnected dots, complicated formulas - it is ineffective,dangerous and certainly undermines the sacred doc/pt relationship. I feel if we really connectand serve our community and patients it all will work out locally. We can barter or tradewith patients who can offer no money. There are

communities such as Ithaca NY whohave created their own type of heath insurance network. It is called the "Ithaca Health Alliance"www.ithacahealth.orgI really think the answers should be simple. Anything that gets more complicated, harder to understand, and more disconnected is doomed to fail. That is how these crooks thrive. They hide behind these complicated systemsthat are totally unnecessary!What does everyone think?PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220Eugene, OR 97405roxywible@...On Nov 30, 2005, at 10:20 AM, lawrence lyon wrote:> ok, so we have three jobs-- > one is to educate people as to what we actually do, and how valuable > it is.> the second is once they understand how valuable it is, to help them > make sure that what we do is paid for. > a

third is to train patients to be responsible for themselves. > if we don't, our value, as doctors and what we do, once people are > paying out of pocket, is nil.  more and more people will turn > to catastrophic care only, and they won't pay for routine and > preventive care. > i believe the only way this will happen is through single payor risk > pooling. there is a significant caveat-- this will cause massive > unemployment in the health insurance industry.>  > LL>> Brock DO wrote:>> "But as it is now, people want a pill for their every ill, and labs >> tests up>> the wazzoo, because they think they don't pay for it. Having to pay>> directly for that million-dollar workup of fatigue before you've tried>> eating well, exercising and getting some sleep would probably

>> encourage some>>>> to pause, and hopefully defer.">>>> My thoughts exactly! People don't care in the current system because >> things>> like health care, auto collision repair, etc are paid for by someone >> else>> (insurance) & it does not seem to effect their own pocket book. >>>> >>>>>> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.>>

[Guest guest]

if you're suggesting capitation, i am against it. capitation is just another form of gambling. that's why managed care insurance loves it. remember, the house always wins. if you're suggesting that doctors become health insurance providers, i am against that, too. we're doctors, not insurance brokers. we need a universal plan which removes the profit motive from health care, which emphasizes prevention and healthy habits, and then when we see a patient, get paid for the work which we do. i am against any system where one gets paid for not doing anything. that breeds disincentives, and is the slippery slope to denial of care. the only american health care system which comes anywhere near to a universal system, and not close at that, is state workers compensation. LL Egly wrote: Pamela: Again I think you are very articulate and express the problem and solution well. Creating the network or the insurance product that allows this to happen is another story. When I purchased my catastrophic health insurance, no broker offered a similar plan. Each broker was asked to come up with a competative offer for catastrophic coverage. They all claimed ignorance. Only one broker out of 10 proveided a similar plan. When insurance companies start to offer health insurance, they right very provitable policies and ignor the effective solutions. We may have to write our own policy for primary care insurance to take the business of providing basic healthcare away from those who would lump it into a policy costing $14000/year with $5000 deductible. I know I can provide quality care for what Larry

call a dollar-a-day bargain! Now we only need to know how to write the policy and have the strength to offer it to patients.] pamela wible wrote: The obvious answer is COLLECTIVELY we all will. How we get there and what the final formula is, well...I am a simple person looking for simple solutions. Single payer catasrophic insurance sounds great to me and then everyone pays their own way up the the catastophic limit. The impoverished receive some help/stipend or something. There must be some personal responsibility built in I think. Empowering people is key. Education is key. My other idea is when/if the government gets even further dysfunctional we will all go back to intimate relationships with our docs where folks pay what they can, barter, trade

and we all accept less money for services from some, more from others - an internal risk pool essentially.We need to get away from this insulated, individualistic idea where people are disconnected and put their own needs ahead of the group and essentially do not care how systems work or do not work as long as they are not directly impacted.solutions:EDUCATE EVERYONE! empower people to create the world/health care system we want. Ideas:1) Teach people to express themselves giving positive or negative feedback from a placeof compassion. When people come to me and complain about service elsewhere and theymost certainly do "THANK GOD I found you, you'll never believe what happened to meat that other clinic..." I tell them to WRITE a letter to the other doctor or nurse and givethem feedback from a place of compassion as they are in a way victims of this dysfunctionalsystem. Explain that they are

nice but seemed rushed and have they though about goingsolo/low volume or practicing in another way.Patients are glad to do so.It benefits them to get the issue/frustration processed. It benefits the doc who may think"why the hell do I put up with the shitty job anyway." "I'm outta here!" Hey, it doesplant the seed!2) HEALTH CARE ACTIVISM TEAM - I have a little army of patients who are actively going tohelp transform our system (I mentioned it in another email so I won't repeat)HUMAN CONNECTION - I feel the more we really know each other (docs, patients, everyone)the more we respect each other and look for tenable solutions. Disconnection is disempoweringand the current system is a million disconnected dots, complicated formulas - it is ineffective,dangerous and certainly undermines the sacred doc/pt relationship. I feel if we really connectand serve our community and patients it all will

work out locally. We can barter or tradewith patients who can offer no money. There are communities such as Ithaca NY whohave created their own type of heath insurance network. It is called the "Ithaca Health Alliance"www.ithacahealth.orgI really think the answers should be simple. Anything that gets more complicated, harder to understand, and more disconnected is doomed to fail. That is how these crooks thrive. They hide behind these complicated systemsthat are totally unnecessary!What does everyone think?PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220Eugene, OR 97405roxywible@...On Nov 30, 2005, at 10:20 AM, lawrence lyon wrote:> ok, so we have three jobs-- > one is to educate people as to what we actually do, and how valuable > it is.> the second is once they understand how

valuable it is, to help them > make sure that what we do is paid for. > a third is to train patients to be responsible for themselves. > if we don't, our value, as doctors and what we do, once people are > paying out of pocket, is nil.  more and more people will turn > to catastrophic care only, and they won't pay for routine and > preventive care. > i believe the only way this will happen is through single payor risk > pooling. there is a significant caveat-- this will cause massive > unemployment in the health insurance industry.>  > LL>> Brock DO wrote:>> "But as it is now, people want a pill for their every ill, and labs >> tests up>> the wazzoo, because they think they don't pay for it. Having to pay>> directly for that million-dollar workup of fatigue

before you've tried>> eating well, exercising and getting some sleep would probably >> encourage some>>>> to pause, and hopefully defer.">>>> My thoughts exactly! People don't care in the current system because >> things>> like health care, auto collision repair, etc are paid for by someone >> else>> (insurance) & it does not seem to effect their own pocket book. >>>> >>>>>> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.>>

[Guest guest]

Larry: What I am suggesting is that over the last year I have seen 660 patients, not visits, but patients. I have performed all the primary care for these patients. Now take revenue and divide by patients and that number is $200 or close to that. I have spent hours and hours on billing and collection, but am impressed that I spend much less time purchasing gasoline with a credit card than I do collecting a $7 co-payment from a patient. You will note two themes, payment and efficiency. I am not restricted to the solution I have proposed, but the insurance company already collects the money month after month after month efficiently. What I want is to be paid efficiently. If that means I need to sell affordable health care coverage for $1/day that would be $365/year not $200. If the patient paid $365 retainer then $30/month automatic debit, I could concentrate on

providing the best primary care possible. In fact if I could sell this to patients, say 1000 patients, I know I could hire a clinical nurse coordinator to implement chronic care measures and continue to improve the health care of my patients. I do not see this as capitation, but liberation. Is it what patients want? Certainly less than a cell phone. I think companies, individuals, and perhaps medicare patients could chose the health care providers that provide the best care and make these payments to them directly. I am sure direct payments for primary care like this would make my job of providing care the focus of my time. Larry, others, I am interested in your thoughts. lawrence lyon wrote: if you're suggesting capitation, i am against it. capitation is just another form of gambling. that's why managed care insurance loves it. remember, the house always wins. if you're suggesting that doctors become health insurance providers, i am against that, too. we're doctors, not insurance brokers. we need a universal plan which removes the profit motive from health care, which emphasizes prevention and healthy habits, and then when we see a patient, get paid for the work which we do. i am against any system where one gets paid for not doing anything. that breeds disincentives, and is the slippery slope to denial of care. the only American health care system which comes anywhere near to a universal system, and not close at that, is state workers compensation. LL

Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Wow, now this is getting " heavy " folks. Messages about integrating our

lives and work into a complete joyous oneness (perhaps the ONLY important

question in life if you think about it) and discussions on how to solve

the health care financing problems in America.

I've got so many ideas about this issue that it quickly becomes obvious

there is no single " right " answer. But I'll share a few thoughts.

1) Check the website ...

http://www.washingtonmonthly.com/features/2005/0512.newprogressivism.html

related to a discussion of why America is not taking to the ownership

society presented by Bush. I especially liked " Bush's Ownership Society:

Why No One's Buying " by Glastris that touches on our apparent human

nature to say we desire " freedom " and " choice " but in the end often want

some " protection " and reasonable limits in choices. The website was

linked to the Center for American Progress. (NOTE - I don't wish to

trigger a larger discussion of political thinking... it's just that the

recent discussion reminded me of these articles and I thought they may be

of interest to others on the list)

2) The current healthcare financing has a ton of problems. Single payor

plans have many weak points. And getting insurance to cover catastrophe

sounds nice, for me, but boy it scares me if we think we can get the whole

health care system into that. Let's not assume that old ways were

" better " . Fifty years ago there was not a focus on prevention or early

detection, so that financing has to be accounted for. And also fifty

years ago a great many of our country's elderly and poor literally got no

health care and lived in profound poverty. Also, I'm willing to bet

doctors' salaries were relatively not better compared to the larger

society than they are today (this is my guess, I don't have evidence to

support it). Rather, part of the value of being a physician was the larger

societal respect and how everyone inter-related in the old days... that

aspect of our field may have been lost a great deal. Why? That's a whole

other discussion that I ain't touching today.

3) I really like 's ideas and would love to get $365 per patient per

year. I beieve I could do great medical care with that. And that is the

essence of what makes our health care system great, no matter what the

payment methods are. Whether we are capitated or fee for service, if a

doc is consciencious and motivated to find ways to provide great care, he

or she will. The difficulty is not getting painted into a corner or

overwhelmed by the " needs " of other players in healthcare and the larger

society. I think that is ultimately what the low-overhead micropractice

offers -- flexibility to manipulate our small world no matter what other

parts of healthcare or society need.

4) I've got thoughts about capitation (I love the concept and have seen a

ton of good come from programs within capitated systems) but feel the real

weakness is that the general public doesn't understand how healthcare is

funded or that most of the profits from the year-to-year premium increases

goes to people not directly related to their care (drug companies, medical

technology companies, etc). And, on the other hand, I love the concept of

simply getting paid for what I do in fee-for-service. But in the end,

either system's success at providing good care depends on our willingness

to serve the patients and work hard for their well being. " Lazy " docs can

make a killing in either a capitated or fee-for-service system, get home

early and not have provided what I feel is adequate care for the patients.

Unfortunately research shows patients are not good at judging who is

really a good physician (again, that's a whole other discussion).

5) Personally, I think there is a big problem with the financing of

primary care/prevention with emergency care/catastrophe. It seems crazy

to me that the high tech stuff in hospitals and the advances in medicines,

each of which are used on a relatively small percentage of the population

each year, would affect how much insurance companies would pay the family

doc who monitors the health of patients and hopefully lessens the need to

use the hospitals in the first place! Ultimately I think dividing the

insurance between primary care and emergency/catastrophe may be needed and

integrated with a government backed system of some kind -- basically a

hybrid of single payor and straight fee-for-service that could balance the

needs of society, the patients and the docs. How could we get there?

Beats me as I don't think anyone in our government or the health care

profit-making industry is speaking honestly about the problems or has the

power to shift general mindset of the population.

I'm presenting these thoughts not as possible answers (because I don't

think I have any really) but more as exercises to think about. But in the

end I'm not really sure what " organizing " can do -- seems every idea

offered already has organized groups supporting it. Personally, I think I

will keep the discussion going, give bits of info and perspective to

patients and others as opportunities arise. And perhaps in a few years,

when I have a steady bunch of patients, explore insurance options and

present a model of care so I would get the $365/ year for primary care and

the patient would have catastrophe insurance beyond that. But first I

need to be sure they understand the issues at hand related to health care

financing and that they can, with a little financing planning, have both

protection from the risk of financial hardship and get good primary care.

OK, I'm off the soap box for now.

Tim

> Larry:

>

> What I am suggesting is that over the last year I have seen 660

> patients, not visits, but patients. I have performed all the primary

> care for these patients. Now take revenue and divide by patients and

> that number is $200 or close to that. I have spent hours and hours on

> billing and collection, but am impressed that I spend much less time

> purchasing gasoline with a credit card than I do collecting a $7

> co-payment from a patient.

>

> You will note two themes, payment and efficiency. I am not restricted

> to the solution I have proposed, but the insurance company already

> collects the money month after month after month efficiently. What I

> want is to be paid efficiently. If that means I need to sell

> affordable health care coverage for $1/day that would be $365/year not

> $200. If the patient paid $365 retainer then $30/month automatic

> debit, I could concentrate on providing the best primary care

> possible. In fact if I could sell this to patients, say 1000

> patients, I know I could hire a clinical nurse coordinator to

> implement chronic care measures and continue to improve the health

> care of my patients. I do not see this as capitation, but liberation.

> Is it what patients want? Certainly less than a cell phone. I think

> companies, individuals, and perhaps medicare patients could chose the

> health care providers that provide the best care and make these

> payments to them directly.

>

> I am sure direct payments for primary care like this would make my job

> of providing care the focus of my time.

>

> Larry, others, I am interested in your thoughts.

>

>

>

> lawrence lyon wrote:

> if you're suggesting capitation, i am against it.

> capitation is just another form of gambling. that's why managed care

> insurance loves it. remember, the house always wins. if you're

> suggesting that doctors become health insurance providers, i am

> against that, too. we're doctors, not insurance brokers. we need a

> universal plan which removes the profit motive from health care, which

> emphasizes prevention and healthy habits, and then when we see a

> patient, get paid for the work which we do. i am against any system

> where one gets paid for not doing anything. that breeds

> disincentives, and is the slippery slope to denial of care. the only

> American health care system which comes anywhere near to a universal

> system, and not close at that, is state workers compensation.

>

> LL

>

>

>

>

>

>

>

> ---------------------------------

> Yahoo! Music Unlimited - Access over 1 million songs. Try it free.

[Guest guest]

Here is the new president of the AAFP and

his ideas for those who are interested:

http://www.aafp.org/x40539.xml

Re:

Re: who's gonna pay for health care?

Wow, now this is getting " heavy " folks.

Messages about integrating our

lives and work into a complete joyous oneness

(perhaps the ONLY important

question in life if you think about it) and

discussions on how to solve

the health care financing problems in America.

I've got so many ideas about this issue that it

quickly becomes obvious

there is no single " right " answer.

But I'll share a few thoughts.

1) Check the website ...

http://www.washingtonmonthly.com/features/2005/0512.newprogressivism.html

related to a discussion of why America is not

taking to the ownership

society presented by Bush. I especially

liked " Bush's Ownership Society:

Why No One's Buying " by Glastris that

touches on our apparent human

nature to say we desire " freedom " and

" choice " but in the end often want

some " protection " and reasonable limits

in choices. The website was

linked to the Center for American Progress.

(NOTE - I don't wish to

trigger a larger discussion of political

thinking... it's just that the

recent discussion reminded me of these articles

and I thought they may be

of interest to others on the list)

2) The current healthcare financing has a ton of

problems. Single payor

plans have many weak points. And getting insurance

to cover catastrophe

sounds nice, for me, but boy it scares me if we

think we can get the whole

health care system into that. Let's not

assume that old ways were

" better " . Fifty years ago there

was not a focus on prevention or early

detection, so that financing has to be accounted

for. And also fifty

years ago a great many of our country's elderly

and poor literally got no

health care and lived in profound poverty. Also,

I'm willing to bet

doctors' salaries were relatively not better

compared to the larger

society than they are today (this is my guess, I

don't have evidence to

support it). Rather, part of the value of being a

physician was the larger

societal respect and how everyone inter-related in

the old days... that

aspect of our field may have been lost a great

deal. Why? That's a whole

other discussion that I ain't touching today.

3) I really like 's ideas and would love to

get $365 per patient per

year. I beieve I could do great medical care

with that. And that is the

essence of what makes our health care system

great, no matter what the

payment methods are. Whether we are

capitated or fee for service, if a

doc is consciencious and motivated to find ways to

provide great care, he

or she will. The difficulty is not getting

painted into a corner or

overwhelmed by the " needs " of other

players in healthcare and the larger

society. I think that is ultimately what the

low-overhead micropractice

offers -- flexibility to manipulate our small

world no matter what other

parts of healthcare or society need.

4) I've got thoughts about capitation (I love the

concept and have seen a

ton of good come from programs within capitated

systems) but feel the real

weakness is that the general public doesn't

understand how healthcare is

funded or that most of the profits from the

year-to-year premium increases

goes to people not directly related to their care

(drug companies, medical

technology companies, etc). And, on the

other hand, I love the concept of

simply getting paid for what I do in

fee-for-service. But in the end,

either system's success at providing good care

depends on our willingness

to serve the patients and work hard for their well

being. " Lazy " docs can

make a killing in either a capitated or

fee-for-service system, get home

early and not have provided what I feel is

adequate care for the patients.

Unfortunately research shows patients are not good

at judging who is

really a good physician (again, that's a whole

other discussion).

5) Personally, I think there is a big problem with

the financing of

primary care/prevention with emergency

care/catastrophe. It seems crazy

to me that the high tech stuff in hospitals and

the advances in medicines,

each of which are used on a relatively small

percentage of the population

each year, would affect how much insurance

companies would pay the family

doc who monitors the health of patients and

hopefully lessens the need to

use the hospitals in the first place! Ultimately

I think dividing the

insurance between primary care and

emergency/catastrophe may be needed and

integrated with a government backed system of some

kind -- basically a

hybrid of single payor and straight

fee-for-service that could balance the

needs of society, the patients and the docs.

How could we get there?

Beats me as I don't think anyone in our government

or the health care

profit-making industry is speaking honestly about

the problems or has the

power to shift general mindset of the population.

I'm presenting these thoughts not as possible

answers (because I don't

think I have any really) but more as exercises to

think about. But in the

end I'm not really sure what

" organizing " can do -- seems every idea

offered already has organized groups supporting

it. Personally, I think I

will keep the discussion going, give bits of info

and perspective to

patients and others as opportunities arise.

And perhaps in a few years,

when I have a steady bunch of patients, explore

insurance options and

present a model of care so I would get the $365/

year for primary care and

the patient would have catastrophe insurance

beyond that. But first I

need to be sure they understand the issues at hand

related to health care

financing and that they can, with a little

financing planning, have both

protection from the risk of financial hardship and

get good primary care.

OK, I'm off the soap box for now.

Tim

> Larry:

>

> What I am suggesting is that over

the last year I have seen 660

> patients, not visits, but patients. I

have performed all the primary

> care for these patients. Now take

revenue and divide by patients and

> that number is $200 or close to that. I

have spent hours and hours on

> billing and collection, but am impressed that

I spend much less time

> purchasing gasoline with a credit card than I

do collecting a $7

> co-payment from a patient.

>

> You will note two themes, payment

and efficiency. I am not restricted

> to the solution I have proposed, but the

insurance company already

> collects the money month after month after

month efficiently. What I

> want is to be paid efficiently. If that

means I need to sell

> affordable health care coverage for $1/day

that would be $365/year not

> $200. If the patient paid $365 retainer

then $30/month automatic

> debit, I could concentrate on providing the

best primary care

> possible. In fact if I could sell this

to patients, say 1000

> patients, I know I could hire a clinical

nurse coordinator to

> implement chronic care measures and continue

to improve the health

> care of my patients. I do not see this

as capitation, but liberation.

> Is it what patients want?

Certainly less than a cell phone. I think

> companies, individuals, and perhaps medicare

patients could chose the

> health care providers that provide the best

care and make these

> payments to them directly.

>

> I am sure direct payments for

primary care like this would make my job

> of providing care the focus of my time.

>

> Larry, others, I am interested in

your thoughts.

>

>

>

> lawrence lyon

wrote:

> if you're suggesting

capitation, i am against it.

> capitation is just another form

of gambling. that's why managed care

> insurance loves it. remember, the house

always wins. if you're

> suggesting that doctors become health

insurance providers, i am

> against that, too. we're doctors, not

insurance brokers. we need a

> universal plan which removes the profit

motive from health care, which

> emphasizes prevention and healthy habits, and

then when we see a

> patient, get paid for the work which we do. i

am against any system

> where one gets paid for not doing

anything. that breeds

> disincentives, and is the slippery slope to

denial of care. the only

> American health care system which comes

anywhere near to a universal

> system, and not close at that, is state

workers compensation.

>

> LL

>

>

>

>

>

>

>

> ---------------------------------

> Yahoo! Music Unlimited - Access over 1

million songs. Try it free.