In a global economy, in which America is competing, we should be looking at our competition: How does Japan deal with health care, how does France deal with health care, etc. Somehow, despite an aging (and therefore sicker) population, Japanese auto companies continue to beat the pants off American auto companies–and their electronics giants like Sony and Panasonic continue to do well too.

The big payoff is in streamlining the operations of the medical *providers*. Many of their forms are still paper (not yet online). They don’t even have standardized procedures for management of those forms; it’s often ad hoc.

I went to a hospital a couple of years ago, and they actually misplaced my medical records! Panic ensued. Doctors, nurses, receptionists, were all running around the hospital floor trying to find my medical records. After looking for nearly two hours, they found them. (That was time they should have been spending treating patients, not running around.) And my medical records consisted of a bunch of papers stuffed into a folder. Nothing was online, nothing.

On other occasions, I had to hand-carry medical records, X-rays, CT scan films, from one hospital or one doctor to another. IOW, we patients act as unpaid couriers for the hospital’s information management. And we can screw up too.

What would really save money would be a secure “MedNet,” containing all the medical records, X-rays, CT scans, everything, for all hospitals and all doctors in the nation. If you get injured while skiing or driving, the doctor logs onto MedNet and gets all your medical history–instantly.

Obama is making a serious mistake if he thinks that the main driver of health care costs is private insurance companies. It’s not. America’s health care *costs*–what we spend on medical providers–really are rising, regardless of who pays the bill. And they will continue to rise until the providers shape up.

……A doctor who judges the effectiveness of the UK NHS by the state of the restrooms at Heathrow as I recall.

……Actually the French get most things right……it’s only widespread Francophobia that makes us blind to the fact.

I agree with you that the French model is a good one to copy but then you go on to say

“but the academics who designed the Clinton Plan (I know them all), and are advising Obama, know nothing about private practice. They will wreck the system if left alone.”

As of now the entire medical delivery system is going to remain essentially unchanged ie. principally in private hands. All that’s being addressed at present is how it is paid for. Inevitably in the longer term thy are going to improve efficiencies but “designing a plan.” No plan is being designed or if it is perhaps you could describe this plan since you seem to know so much about it.

That said, I’m in agreement with you on the value of the French system. It looks like they’re getting something right that we should take a serious look at.

I get confused – are you a doctor or an aerospace engineer?

I haven’t read the entire thread but ran across this statement and it discredits your other point, which was good. LBJ tried to deal with the cost of care in the 1960s by flooding the market with doctors. My class in 1966 was 64, USC now graduates 180 or more every year. Many more schools opened plus DO schools have been opening. We now have hundreds of thousands of nurse practitioners and physician assistants who do what primary care docs did 30 years ago. The all-powerful AMA has been am myth since about 1955. Certainly since 1965. That is not the answer and the pool of good applicants who don’t get in is not that big.

What I would suggest is following the French model which has a national fee schedule which is optional but which the health plans (multiple) use for payment. They pay 80% roughly (I have the schedule of co-pays on my blog) and private insurance pays the balance. Good doctors charge higher fees and patients who choose those doctors pay the higher fees. There are private hospitals that charge higher rates and patients who choose those hospitals pay them.

Take a look at the satisfaction levels and compare France with the NHS and Canada. We could evolve our system toward the French model but the academics who designed the Clinton Plan (I know them all), and are advising Obama, know nothing about private practice. They will wreck the system if left alone.

…..Sinz how can I handle this….but single payer is out for political and practical reasons. Given the legalized bribery that is the US political system the insurance companies have enough clout to block it. And to be fair there’s the practical reason that we have a whole bureaucratic infrastructure built around the present inefficiencies. This couldn’t go cold turkey and stop because it employs hundreds of thousands. The public option squeezes it because the insurance companies are going to have to become more efficient if they are to compete with the public option. That’s why Obama/Orzag need it as part of their grand plan. To give you one example the insurance companies have fought for years having a standardized claim form. Thus doctors offices have these women behind the glass handling typically 10-20 different claims forms from different insurance companies, medicare etc.

“My mother switched countries over healthcare.”

……The British NHS didn’t come into existence until 1947 or 1948 ie. About 60 years ago so I’m not sure that situation 80 years ago is relevant.

……I’ve been treated in the British system both publically when I was as student there and semi privately when I was older and richer. Both experiences were excellent. I also have a British brother in law who had a 9 month hospitalization for Guillame Barre syndrome followed by 18 months of intensive after care. Didn’t cost him a cent, effectively cured or as cured as you get with that condition.

I completely agree. I think this is a situation where politics is forcing people to advance partial situations, which have the potential of at least in the short run making things worse.

Let’s consider what we’re dealing with here, on some of the legit concerns.

a) supply of doctors. This has clearly been limited by the AMA over the recent past the same way DeBeers and their partners limit the supply of diamonds onto the market. I have no question that America produces plenty of smart motivated people who would go into the medical profession but can’t because the bar is set intentionally high to limit the number of doctors.

The way to break this is simply to build more medical schools on taxpayer dollars.

Another problem is that doctors come out of med school deeply in debt. They need to be paid a lot of money right off the bat to pay off that debt. And in our economy, we expect to be paid more over time – and more than a lot of money is a whole lot of money.

It is impractical for a nationalized system to pay a whole lot of money to doctors. However, if you pick up the tab for their med school, you remove the need for them to be paid a lot of money right off the bat.

I seriously doubt that you’d have a watered down applicant pool were the government to offer free med school, followed by an 8-year committment to do residency in and then work in assigned federal healthcare facilities at a salary starting at $80K/year and escalating over time to $160K/year (current dollars). And the cost control savings would pay off the med school investment.

b) facilities. One of the other arguments being made is that all these newly covered people will swamp existing facilities. Legit point. Let’s build new ones – in places that the current marketplace underserves. Staff them with a combo of experienced and new doctors. Yeah – there’s a cost, but it’s a cost that I think we all would agree needs to be born, if there really is not sufficient capacity to serve the needs of the population.

Unfortunately, the marketplace does not have an incentive to significantly reduce waiting times, until it negatively affects profits. There are things the market does a great job of, and things that it does poorly at – sometimes because doing poorly produces greater profits than doing well.