Switzerland and France have systems worth looking at.

http://www.howstuffworks.com/10-heal...ems.htm#page=5
10 Health Care Systems Around the World


…"Unlike in the U.S., insurance in Switzerland isn't tied to one's employment. Rather, all citizens choose from a selection of private plans; those who can't afford to buy one may receive subsidies from the government. Everyone's premium for one of these private plans is the same. Another crucial difference from the U.S. is that private insurance companies in Switzerland aren't allowed to make a profit on basic health care, basic health care being a rather comprehensive set of services."…

Interesting article :

The Strategy That Will Fix Health Care

http://hbr.org/2013/10/the-strategy-...lth-care/ar/11
…"Providers that cling to today’s broken system will become dinosaurs. Reputations that are based on perception, not actual outcomes, will fade. Maintaining current cost structures and prices in the face of greater transparency and falling reimbursement levels will be untenable. Those organizations—large and small, community and academic—that can master the value agenda will be rewarded with financial viability and the only kind of reputation that should matter in health care—excellence in outcomes and pride in the value they deliver."...

Originally Posted by radind

Sanders can call it whatever he pleases, but there is little current GOP support for the ACA.

That's what is so ironic, they oppose what their team basically created.

From the article that was just posted. I guess if your wealthy, the following probably doesn't matter.

But they warn that premiums don’t tell the whole story.

The low rates are possible in part because insurance companies created special plans that include fewer in-network doctors and hospitals than many current plans.

This may not be a problem for healthy people who currently lack insurance. But those with illnesses may discover that their specialists are not covered by an exchange insurance plan. Low-income people accustomed to a certain community clinic may find that going there is no longer an option. And everyone may encounter long waits to see a doctor.


In addition, many of the lowest-cost plans may carry high deductibles, despite a cap imposed by the law that limits out-of-pocket costs to $6,350 per person per year.


“Despite the fact that the premiums are lower than expected, enrollees on exchanges are likely to face very high out-of-pocket costs before they hit their cap, and they are at risk of being in very narrow network plans that may or may not include all the providers they need access to,” said Caroline Pearson, vice president of health reform at the consulting firm Avalere Health, which did its own report on rates this month.


Some healthy people may also experience sticker shock on premiums. A recent analysis by the Manhattan Institute, a conservative think tank, found that some people who buy low-cost private plans today could see their rates jump by 24 percent.

That's really not very good news, is it? Unless, of course, you can guarantee that you will never get sick, have a debilitating auto-immune illness, need an operation, have a genetic diseaase or be in an accident.

Originally Posted by Deb C

From the article that was just posted. I guess if your wealthy, the following probably doesn't matter.

That's really not very good news, is it? Unless, of course, you can guarantee that you will never get sick, have a debilitating auto-immune illness, need an operation, have a genetic diseaase or be in an accident.

If your point is, the options stink is some places, you win. Florida will be particulaly bad. In its first year or two, Medicare stunk up the place too. Why is this surprising? It won't get fixed immediately either, so you can complain for a while.

Originally Posted by Marx & Lennon

If your point is, the options stink is some places, you win. Florida will be particulaly bad. In its first year or two, Medicare stunk up the place too. Why is this surprising? It won't get fixed immediately either, so you can complain for a while.

I think her point is more about if you have really expensive specialist needs, your costs are going to still be very high.. You may max out the OOP but your premiums are going to still be very high (although likely less under the ACA's broadening of the pool than they would have been).

The other complaint being less access to those very expensive specialists in order to keep the overall rates for everyone in the pool low. Good if your an average person in the plan, bad if you are unfortunately someone who needs the expensive specialists.

I think I've come to understand why she has certain positions on this issue - it is more of a personal issue for her whereas most of us are looking at it from a societal perspective.

The difficult part here would be trying to explain why single payer would likely not be the panacea she is hoping for in her particular case. Single payer will come with considerable cost controls that will do exactly the same thing of excluding expensive specialists; one might want to look at how Medicaid, rather than Medicare, handles the situation to get a better sense of what the sought-after single payer of the future will have to offer. The problem is that railing against that will be a lot more diffuse under that future single payer than the current offer of evil corporations or the guy in the WH. It's not a pleasant situation to be in - now or what may someday come in the future.

Originally Posted by Deb C

That's what is so ironic, they oppose what their team basically created.

I don't think most of the GOP ever viewed Romney as part of their team. In any case, I would prefer to see some dialogue on now and the future. What should the USA do for health care reform?

Originally Posted by Marx & Lennon

If your point is, the options stink is some places, you win. Florida will be particulaly bad. In its first year or two, Medicare stunk up the place too. Why is this surprising? It won't get fixed immediately either, so you can complain for a while.

I don't view my position as complaining, as much as it is pointing to the major problems of ACA. To think that these junk policies that are being sold, high out of pocket expenses, millions still without coverage, will get better, may just be a pipe dream. Medicare probably had it's problems in the beginning but it also wasn't in the hands of the greedy insurance industry. I see that as a major difference.

In a few months I will be on Medicare. So while I voice my concerns about all of the above fissures in ACA, I will continue my quest for health care equality, even when it doesn't affect me personally. I speak out about many issues because that's what I feel called to do.

Originally Posted by radind

I don't think most of the GOP ever viewed Romney as part of their team. In any case, I would prefer to see some dialogue on now and the future. What should the USA do for health care reform?

It would seem that the first order of business in the USA working for health care reform, would be to educate the people about the benefits of an improved Medicare for all system. But to do that, we would need to break through the myths of universal health care. Unfortunately, we have been sold a bill of goods when it comes to misinformation about health care for all. We have been told that there will be long waits and blah, blah, blah. It would be beneficial to educate about much lower administrative costs, everyone included, simple system of merely handing the clerk a card, instead of the mile high paper work.

There is a reason that we haven't joined the evolution of other nations with their health care as a right for all citizens. IMHO, it's because of how much power the insurance industry has in Washington.

So education on the benefits of universal care and debunking myths, would be my first steps. What are your ideas?

Originally Posted by Deb C

It would seem that the first order of business in the USA working for health care reform, would be to educate the people about the benefits of an improved Medicare for all system. But to do that, we would need to break through the myths of universal health care. Unfortunately, we have been sold a bill of goods when it comes to misinformation about health care for all. We have been told that there will be long waits and blah, blah, blah. It would be beneficial to educate about much lower administrative costs, everyone included, simple system of merely handing the clerk a card, instead of the mile high paper work.

There is a reason that we haven't joined the evolution of other nations with their health care as a right for all citizens. IMHO, it's because of how much power the insurance industry has in Washington.

So education on the benefits of universal care and debunking myths, would be my first steps. What are your ideas?

I agree with your points. The GOP has fought health care reform for as long as I can remember. That is one reason I am an independent. With a few exceptions, I see the Democratic party as pushing plan without regard to buy in by the American people. I think we need to start with a few counter examples of where the health care system is working reasonably well( my choices are France and Switzerland).
We need to foster dialogue in place of the rock throwing in Congress.
It seems that this will take a strong grass-roots push to convince Congress to do better.

All I want is an affordable prescription plan, national healthcare? Yeah right forget it! Our congress is currently having a giant temper tantrum over Obamacare, which is a giant blowjob to the insurance companies. The United Corporations of America have voted, we lost.

Originally Posted by radind

I think we need to start with a few counter examples of where the health care system is working reasonably well( my choices are France and Switzerland).

We need to foster dialogue in place of the rock throwing in Congress.
It seems that this will take a strong grass-roots push to convince Congress to do better.

Yes, pointing to successful programs would have a lot of clout. Maybe once the majority of Americans understand that universal health care would be best for all involved, there might just be that grass-roots push that you say is needed.

Originally Posted by Deb C

It would seem that the first order of business in the USA working for health care reform, would be to educate the people about the benefits of an improved Medicare for all system. But to do that, we would need to break through the myths of universal health care. Unfortunately, we have been sold a bill of goods when it comes to misinformation about health care for all. We have been told that there will be long waits and blah, blah, blah. It would be beneficial to educate about much lower administrative costs, everyone included, simple system of merely handing the clerk a card, instead of the mile high paper work.

There is a reason that we haven't joined the evolution of other nations with their health care as a right for all citizens. IMHO, it's because of how much power the insurance industry has in Washington.

So education on the benefits of universal care and debunking myths, would be my first steps. What are your ideas?

Medicare, as we know it, cannot remain under single payer. You can only have one single payer with severe cost limitations (Medicaid) and another with relatively little limits (Medicare) when there is the perception that the latter is paid for by "da working people" and not by "da lazy people.". That perception will go away under an all-inclusive single payer.

The only way to preclude that is by having the single payer offer several options of coverage where the individual has to pay for increasing coverage to get out from under the cost limitations - your $1000 will not go away, it will just go to the govt instead of a private insurer.

Under that temporary situation, you will have two ends pressing on the middle. People on the high end will not like having to pay more to the govt for their less limiting insurance and people on the low end will not like getting limited insurance because they can't afford to pay the government more. The only way to solve that is bring what everyone pays to a minimum AND simultaneously make more stringent the limits on what is covered.

Single payer will become a floor for everyone, there will be no distinction between Medicare and Medicaid. Those who can afford to will buy supplemental insurance to pay for those things the govt's single payer will not pay for. Eventually, you will pay the $50 that everyone pays for your single payer coverage from the govt and then you will pay the $950 to a private insurer to get the less limited supplemental coverage. This reality is obscured in some countries with single payer by "waiting periods" - you need a life-saving transplant but have to wait 3 or 5 years to move up the list - the actuaries know the odds of you still being there. People in such countries pay a private insurer so they can "jump the line" while they're still here.

From a personal level. you should get on Medicare and hope that single payer does not come along too quickly and make you pay a lot more while reducing what is covered. Voting against your own economic self-interest can be honorable. The timing can make that really easy or really tough - on a personal level.

On a broader note, it seems the lack of understanding regarding what truly comes with single payer (which I support) is once again setting up expectations on the Far Left that will once again lead to great disappointment and cries of "evil I's tell you, evil bad-bad!" once again. Kind of sad.

Originally Posted by Deb C

It would seem that the first order of business in the USA working for health care reform, would be to educate the people about the benefits of an improved Medicare for all system. But to do that, we would need to break through the myths of universal health care. Unfortunately, we have been sold a bill of goods when it comes to misinformation about health care for all. We have been told that there will be long waits and blah, blah, blah. It would be beneficial to educate about much lower administrative costs, everyone included, simple system of merely handing the clerk a card, instead of the mile high paper work.

There is a reason that we haven't joined the evolution of other nations with their health care as a right for all citizens. IMHO, it's because of how much power the insurance industry has in Washington.

So education on the benefits of universal care and debunking myths, would be my first steps. What are your ideas?

It would also help if everyone just forgot how to do the math.

Very interesting article in the Washington Post about 8 uninsured people in the DC area and how Obamacare would or would not affect them.

The first profile is the reason why I'm holding my nose and voting for Terry McAuliffe for VA Governor and even canvassing for him.

Originally Posted by playwrite

I think her point is more about if you have really expensive specialist needs, your costs are going to still be very high.. You may max out the OOP but your premiums are going to still be very high (although likely less under the ACA's broadening of the pool than they would have been).

The other complaint being less access to those very expensive specialists in order to keep the overall rates for everyone in the pool low. Good if your an average person in the plan, bad if you are unfortunately someone who needs the expensive specialists.

I think I've come to understand why she has certain positions on this issue - it is more of a personal issue for her whereas most of us are looking at it from a societal perspective.

The difficult part here would be trying to explain why single payer would likely not be the panacea she is hoping for in her particular case. Single payer will come with considerable cost controls that will do exactly the same thing of excluding expensive specialists; one might want to look at how Medicaid, rather than Medicare, handles the situation to get a better sense of what the sought-after single payer of the future will have to offer. The problem is that railing against that will be a lot more diffuse under that future single payer than the current offer of evil corporations or the guy in the WH. It's not a pleasant situation to be in - now or what may someday come in the future.

Actually, a single-payer plan will either support certain procedures and drugs or it won't. Anyone with a stake in the game will be pulling to have their things included, but may have to give away the windfall profits they've grown to expect. It wil be a long slog getting from here to there, even if we had single payer today. The one upside: there are no lifetieme maximums allowed, starting in 2014. Insurers will start being a lot more agressive on pricing if a treatment can never end while the patient lives.

Originally Posted by The Wonkette

Very interesting article in the Washington Post about 8 uninsured people in the DC area and how Obamacare would or would not affect them.

The first profile is the reason why I'm holding my nose and voting for Terry McAuliffe for VA Governor and even canvassing for him.

Thanks for the link, Wonkette.

Originally Posted by playwrite

Medicare, as we know it, cannot remain under single payer. You can only have one single payer with severe cost limitations (Medicaid) and another with relatively little limits (Medicare) when there is the perception that the latter is paid for by "da working people" and not by "da lazy people.". That perception will go away under an all-inclusive single payer.

The only way to preclude that is by having the single payer offer several options of coverage where the individual has to pay for increasing coverage to get out from under the cost limitations - your $1000 will not go away, it will just go to the govt instead of a private insurer.

Under that temporary situation, you will have two ends pressing on the middle. People on the high end will not like having to pay more to the govt for their less limiting insurance and people on the low end will not like getting limited insurance because they can't afford to pay the government more. The only way to solve that is bring what everyone pays to a minimum AND simultaneously make more stringent the limits on what is covered.

Single payer will become a floor for everyone, there will be no distinction between Medicare and Medicaid. Those who can afford to will buy supplemental insurance to pay for those things the govt's single payer will not pay for. Eventually, you will pay the $50 that everyone pays for your single payer coverage from the govt and then you will pay the $950 to a private insurer to get the less limited supplemental coverage. This reality is obscured in some countries with single payer by "waiting periods" - you need a life-saving transplant but have to wait 3 or 5 years to move up the list - the actuaries know the odds of you still being there. People in such countries pay a private insurer so they can "jump the line" while they're still here.

From a personal level. you should get on Medicare and hope that single payer does not come along too quickly and make you pay a lot more while reducing what is covered. Voting against your own economic self-interest can be honorable. The timing can make that really easy or really tough - on a personal level.

On a broader note, it seems the lack of understanding regarding what truly comes with single payer (which I support) is once again setting up expectations on the Far Left that will once again lead to great disappointment and cries of "evil I's tell you, evil bad-bad!" once again. Kind of sad.

A lot of the waste in Medicare is directly related to customer-satisfaction issues. Medicare patients have been unwiling to use HMOs or other health gateway solutions, they insist on seeing the doctors they want to see, and are unwilling to wait. All of these cost extra. Medicaid patients have no clout, so they take the imposed plans and don't complain. There are also greater limitiations on what will be treated under Medicaid than Medicare, and Medicaid providers are actually compensated at below cost in many cases.

When we get to the full single-payer healthcare plan, it will be more generous than Medicaid, because we'll demand it. At the same time, providers will learn how to practice more efficiently, so costs will drop. Eventually, we will resemble Europe or possibly Japan in this area, but not soon. We have too much to fix ... especially among practioners. Our way of providing medical care is monumentally inefficient, and too many "providers" get rich doing not all that much.

Originally Posted by Marx & Lennon

A lot of the waste in Medicare is directly related to customer-satisfaction issues. Medicare patients have been unwiling to use HMOs or other health gateway solutions, they insist on seeing the doctors they want to see, and are unwilling to wait. All of these cost extra. Medicaid patients have no clout, so they take the imposed plans and don't complain. There are also greater limitiations on what will be treated under Medicaid than Medicare, and Medicaid providers are actually compensated at below cost in many cases.

When we get to the full single-payer healthcare plan, it will be more generous than Medicaid, because we'll demand it. At the same time, providers will learn how to practice more efficiently, so costs will drop. Eventually, we will resemble Europe or possibly Japan in this area, but not soon. We have too much to fix ... especially among practioners. Our way of providing medical care is monumentally inefficient, and too many "providers" get rich doing not all that much.

Just curious, to which providers are you referring.

(Updated through July 2013 by Dr. Ida Hellander)

How Much Would a Single Payer System Cost?
Editors’ Note: With the recent resurgence of interest in controlling health care costs, we thought a review of some of the state and national fiscal studies performed on single payer over the years might be useful.

July 2013: Economist Gerald Friedman, Ph.D., University of Massachusetts, Amherst

“Under the single-payer system created by HR 676 [the Expanded and Improved Medicare for All Act, introduced by Rep. John Conyers Jr., D-Mich.], the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else.


“Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014.


“Health care financing in the U.S. is regressive, weighing heaviest on the poor, the working class, and the sick. With the progressive financing plan outlined for HR 676, 95% of all U.S. households would save money.


“HR 676 would also establish a system for future cost control using proven-effective methods such as negotiated fees, global budgets, and capital planning. Over time, reduced health cost inflation over the next decade (“bending the cost curve”) would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.”
Excerpted from “Funding HR 676: The Expanded and Improved Medicare for All Act, How we can afford a national single-payer health plan,” July 30, 2013.

Originally Posted by Marx & Lennon

A lot of the waste in Medicare is directly related to customer-satisfaction issues. Medicare patients have been unwiling to use HMOs or other health gateway solutions, they insist on seeing the doctors they want to see, and are unwilling to wait. All of these cost extra. Medicaid patients have no clout, so they take the imposed plans and don't complain. There are also greater limitiations on what will be treated under Medicaid than Medicare, and Medicaid providers are actually compensated at below cost in many cases.

When we get to the full single-payer healthcare plan, it will be more generous than Medicaid, because we'll demand it. At the same time, providers will learn how to practice more efficiently, so costs will drop. Eventually, we will resemble Europe or possibly Japan in this area, but not soon. We have too much to fix ... especially among practioners. Our way of providing medical care is monumentally inefficient, and too many "providers" get rich doing not all that much.

The efficiency argument is in regard to the paperwork. With the many insurers' systems having to interact with the many different providers' systems. A single payer not only has one set of forms but forces one set of forms onto the providers. It results in enormous savings.

That, however, has absolutely nothing to do with the costs of the providers beyond the paperwork. It's simple supply and demand. And that is only partly and temporarily a result of the number of people coming into the system (there will be the 'bulge" for any new system; like Obamacare is just starting to experience) . The real pressure on prices will be the relatively unlimited expenditure potential of the federal government and no constraint on it other than what can be mustered by political force.

One either comes to the understanding that there will be limits imposed on what single payer will cover and then it being a matter of how much the constraints, or one lives in magic pony land of free lunches for all.

Once one exits magic pony land, then one will come to grips that the very inflation of health care prices will impose the limitations. Yes, we will have very powerful groups (AARP, AMA) both lined up against doing much about the price inflation, but that doesn't mean the price inflation goes away. As long as the govt pays, there will not be much opposition... for a while. But, as the impact of the federal govt raising taxes and cutting non-single payer expenditures gets severe and obvious, there will be demand for cost limitations - and the divide will become very generational to a much greater extent that it is today.

Originally Posted by Deb C

(Updated through July 2013 by Dr. Ida Hellander)

How Much Would a Single Payer System Cost?
Editors’ Note: With the recent resurgence of interest in controlling health care costs, we thought a review of some of the state and national fiscal studies performed on single payer over the years might be useful.

July 2013: Economist Gerald Friedman, Ph.D., University of Massachusetts, Amherst

“Under the single-payer system created by HR 676 [the Expanded and Improved Medicare for All Act, introduced by Rep. John Conyers Jr., D-Mich.], the U.S. could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). In 2014, the savings would be enough to cover all 44 million uninsured and upgrade benefits for everyone else.


“Specifically, the savings from a single-payer plan would be more than enough to fund $343 billion in improvements to the health system such as expanded coverage, improved benefits, enhanced reimbursement of providers serving indigent patients, and the elimination of co-payments and deductibles in 2014.


“Health care financing in the U.S. is regressive, weighing heaviest on the poor, the working class, and the sick. With the progressive financing plan outlined for HR 676, 95% of all U.S. households would save money.

Paperwork savings would be substantial, with most of it being absorbed by federal govt that can spend without actually having to pay for it (it's called "national debt"). I'm okay with that. A lesser amount, but still substantial, would be saved, as I noted above, by making the paperwork a lot less complicated by forcing the whole system into one-siz-fits-all. I'm okay with that as well. These are reasons I support single payer.

However, if anyone believes that there is 1/2 a trillion dollars in potential paperwork savings out there for the plucking, I have this bridge in NYC that I'm sure you would be interested in buying. This is the kind of horseshit that gets the Far Left's magic pony expectations going, followed by the "grand disappointment" and soon nothing left but the "evil I's tells ya, bad-bad" screeching on Internet forums.

And most importantly, after all the paperwork savings have been made, that isn't going to stop the price inflation going to extreme as the federal spending kicks-in with the only non-political constraint being the price inflation. It is as near to an operational tautology as one can get.

Originally Posted by Deb C

... would also establish a system for future cost control using proven-effective methods such as negotiated fees,

B I N G O! B I N G O! B I N G O!
And Bingo was his name-o

Now that you got the basic outline, then its to what degree those fees are gonna be. Do ya think there might also be some 'we don't reimburse for dat" per chance?

Here is a very pro-single payer description of the Canadian system -

http://bcn.boulder.co.us/health/healthwatch/canada.html

....
The Canadian system is a publicly funded insurance program where costs are controlled and both hospitals and doctors are private. Any Canadian can go to any doctor or hospital in the country. Each province has its own system and its own unique way of funding it. In spite of this decentralized approach, there are agreements among all provinces that provide for treatment of any Canadian citizen regardless of where the need occurs. The great success of their system causes almost all Canadian politicians, even conservatives, to defend it vociferously. It is called single payer because there is only one "payer"; there is no alternative program, such as private health insurance, to which Canadians can turn for basic health care. Since the wealthy as well as the middle income people have no alternative, they make sure it is funded adequately. This together with cost controls insures that everyone including the poor, who use the same system, receives the same high quality care.....

Anyone thinking that single payer is going to come along and take care of every health problem for little or no costs is smoking something. And smoking is bad for your health, by the way.

Originally Posted by Deb C

Just curious, to which providers are you referring.

Virtually all of them. The independent office model is, frankly, stupid and wastefull. It's designed to separate you and your insurance compamy from any loose change it can. One thing it's not designed to do is make you well.

If you want to see a prime example of an effective and efficient model, try the Cleveland Clinic, or any one of a hundred or so similar operations throughout the country. The clinic model will probably be the most common one in the future, since team medicine is both effective and less expensive.

Originally Posted by playwrite

The efficiency argument is in regard to the paperwork. With the many insurers' systems having to interact with the many different providers' systems. A single payer not only has one set of forms but forces one set of forms onto the providers. It results in enormous savings.

That, however, has absolutely nothing to do with the costs of the providers beyond the paperwork. It's simple supply and demand. And that is only partly and temporarily (there will be the 'bulge" for any new system; like Obamacare is just starting to experience) a result of the number of people coming into the system. The real pressure on prices will be the relatively unlimited expenditure potential of the federal government and no constraint on it other than what can be mustered by political force.

One either comes to the understanding that there will be limits imposed on what single payer will cover and then it being a matter of how much the constraints, or one lives in magic pony land of free lunches for all.

Once you exit magic pony land, then you will come to grips that the very inflation of health care prices will impose the limitations. Yes, you will have very powerful groups (AARP, AMA) both lined up against doing much about the price inflation, but that doesn't mean the price inflation goes away. As long as the govt pays, there will not be much opposition... for a while. But, as the impact of the federal govt raising taxes and cutting non-single payer expenditures gets severe and obvious, there will be demand for cost limitations - and the divide will become very generational to a much greater extent that it is today.

All the systems in use elsewhere have had similar growing pains. The Brits always fight about the size of the NHS budget, while the French push for new cost-saving techniques. We'll be more in line with the French, I think. We'll move to electronic and universally compatable records, and change the practice model toward clinics or other group practices. PAs, NPs and other non-MDs will be the frontline troops, doing the most hands-on work. Pay scales will have rise a bit for the generalists and drop for specialists, who will be employees along with the other MDs, DOs and similar providers. Costs will be reduced; it won't be an option.

What has to be avoided is turning these clinics into businesses where the CEO gets rich whipping the highly-educated troops. Keeping the practices as LLPs may be the answer ... or not.

It's new ground and we have a dull plow.

Originally Posted by Marx & Lennon

Virtually all of them. The independent office model is, frankly, stupid and wastefull. It's designed to separate you and your insurance compamy from any loose change it can. One thing it's not designed to do is make you well.

If you want to see a prime example of an effective and efficient model, try the Cleveland Clinic, or any one of a hundred or so similar operations throughout the country. The clinic model will probably be the most common one in the future, since team medicine is both effective and less expensive.

The group model is one that the younger Med students are accepting as a way forward. Most of our local hospitals have now started physician groups that are basically owned by the hospital. It's a plus for the physicians who won't have to be concerned about billing and overhead--- and the hospitals have on campus offices that then bring patients to their facility.

Our son, who is in Med school, says that the main resistance to these new models, are the older doctors who are use to being independent.

One giant plus to doctor groups, is that they can focus on being a doctor and not have to wear so many administrative hats.

Originally Posted by Marx & Lennon

What has to be avoided is turning these clinics into businesses where the CEO gets rich whipping the highly-educated troops.

Like IT?

Businesses can no more live without IT, than people can live without medical care. Also, like IT, someone has to finally show up, and perform service in person. They try to minimize this, and the metrics are what you live and die by, daily. Lies will be told. Troops will be sacrificed for management failure, notably not enough techs per customer. Or, no one will admit that the box needs to go (money), and blame the tech. The Help Desk will be used to hold off as many callers as it can, until somebody dies. Or, a lot of people die. Or someone embarrassingly important dies. Stupidly. Every CIO has a number of checkboxes next to his position on the org chart. Each box represents a Fail. Guess what happens when there is a truly Epic Fail?

That is what the reduction in provider networks is about. Minimize the bricks and mortar, use RN's or lower for the Help Desk (my ex used to do this for Cigna), and pray to cash out the lottery ticket before you go to jail.

New meaning for "the network's down!". Or, "have you tried rebooting your body?"

Happening with, or without, single payer/ACA.