Jump to content
Chris--I am not sure what you mean by 'sustainable'. We know that Medicare is underfunded. I do not know why so many like Medicare, but I have to guess that it is because it costs a good deal less than commercial insurance. But we already know that Medicare reimbursements do not cover the full cost of a docs business, so something must give there, less service? As before, I do know from personal conversations with more than a few docs that they are no longer taking new Medicare patients. I really would appreciate someone providing numbers. Nancy--what is the risk you are willing to take? I understood that you will be paying less under CC, so I think I know your incentives. But, again, what will keep the docs in practice here? I understand Norwegian docs might not leave Norway, but that is not the same as a doc moving practice to another state. BTW, any business, not satisfied with a system or a process of the magnitude we are talking about would never make a wholesale change, but would test in a disciplined manner perturbations while assuring that 'customer service' would not be damaged !
One need only look where differential tax or other cost regimes exist, to see the huge potential for problems that Colorado Care presents. Look for example at the tax structure on booze and tobacco products in Canada vs the US and see who is buying what in the border towns before they cross back north. Ditto vis a vis US states in the east and say DC. Or further south in the tobacco states. Why are duty free shops successful?
Meanwhile, I see nothing which says that docs can exist on Medicare payments, nor do I see anything describing the rate at which docs are leaving Medicare, here or in other states. I know that they are, so we are in a period of medical disequiibrium, and it isn't obvious where the balance lies.
Such a healthcare system may or may not be working in Saskatchewan, but I have great doubts folks will be moving there from say Vancouver or Toronto, while I have no problem thinking that the folks from CA and elsewhere thinking about moving here will be further incentivized to do so. CO is much more appealing than Sas.
And, I am very unsure exactly what risk Nancy is taking and would like her to explain for the rest of us.
Nancy--I know this is pedantic, but Colorado doesn't spend $30B annually--$30B is spent by individuals, making thousands of decisions every day. Saying Colorado spends makes it sound very statist, very government controlled. I haven't gotten a response to my question above so I have to believe in general, docs are leaving Medicare, so I wonder what the fall back position is if the savings are not there? Who is gong to do what, to whom, how quickly? $5B is roughly $500 million a month, so what if after three months the savings are not being realized? To make this kind of a discontinuous step, I believe the individuals making those thousands of decisions every day would expect, would need to have essentially 100% assurance that nothing will fall thru the cracks. Can you give that kind of assurance with respect to continued service and realized savings?
Dan Shores--What precisely is the problem, in one declarative sentence, please?
Do any of the contributors here have a very recent fix on the number of doctors no longer accepting Medicare patients? I believe I know the direction that has been heading but would appreciate independent verification.
James--You and I are fully aligned. Time needs to be spent arriving at an agreed upon problem definition before even listing ANY potential solutions. We (even here in SS) waste more time because we start with a 'solution', and inevitably have to retreat, turn around, stop, spend money, etc.. I continue to wonder why, especially in SS why time cannot be spent arriving at an agreed up problem.
James--In re the CDC, my WAG (and really a G) is the perception is that the CDC is much less than a completely unbiased entity.
Dan--What is the problem you are proposing be solved?
Sorry, David, you made the assertion--even though you've substituted crony capitalism for free market, it is still up to you to make the connection with factual information, please.
Pls explain, David.
Murphy--To the best of my knowledge we have never met, so first I would like to congratulate you for having the fortitude and taking the time to write to the paper. I know that at your age, I never would have considered doing so. However it goes, it will be a learning experience I am sure.
While several commenters have already taken the blog in the directions they wish to go, including ad hominem attacks, I would like to address your opening; i.e. that the concept the United States was built on was adapt or die. No it wasn't. Rather the basic premise of our Founders was that a free and independent people were capable of governing themselves. Today not a novel concept, but back in the time of monarchs quite a step. Indeed it led to wars with Britain! The Founders further premised that we had certain unaleanable Rights, endowed by our Creator and that among these are life, liberty and the pursuit of happiness. It is important I believe to bear these in mind as the basic principles. It would be ludicrous to say that the Founders did not expect change however given they were setting out to create perhaps the most significant change in history up until then!
It is clear to me that the Founders, flowing from the concept that all men are equal and free to govern themselves expected change! Indeed the Constitution has provisions built into it for such. As generations passed and new ones came, change was inevitable. The Constitution proscribes how we are to manage change, and by a three-way split in our government, that change shall not be easy. This makes many uncomfortable, for they would like to see their preferred changes happen forthwith. The tension among the three, when it is working properly is what keeps us moving in the right direction.
What follows is that each of us, you, me and the others commenting here must be prepared to change too! None of us has a lock on all knowledge especially where human behavior is concerned. We all operate with mental models of how the world works. So, I encourage you to continue learning your entire life. Read as much as you can, learn several foreign languages, travel widely, meet other peoples, continue to adapt your mental model over your lifetime. Best of luck to you.
Last login: Monday, July 11, 2016
Contents of this site are © Copyright 2016 Steamboat Pilot & Today. All rights reserved.
Tablet version |