<<private physicians are profit oriented as well, so they tend to want to keep THEIR OWN costs down.>> This statement is on target but out of context. With few exceptions, specialists have suffered reimbursement shortfalls due to reduced gate-keeper referrals, deep discounts required for HMO affiliation, and reimbursement delays with cost of opportunity loss. Consequently, the specialty physician's bottom line is being eroded while his operating costs keep pace with the "booming economy."
<<under a Bush administration, we would see the same actions taken against price gouging or denial of service actions by HMOs>> Well that sounds reasonable, but is it a realistic expectation when insurance companies control the food chain? Believe me, the insurance is no more honorable than the trial lawyers. Which bring us to the next point...
<<tort reform has driven many doctors into the "safety net" of the HMO system.>> You have lost me on this one. "HMO safety net," boy that's a belly laugh. For example, we just tossed an American Specialty Health Networks plan into the trash. Unbelievably, their contract among other things required the physician agree to pay for diagnostic procedures or consultations that he recommended if the HMO adjustor denies the claim. In some jurisdictions, if a doctor recommends a diagnostic procedure, the HMO denies it, the patient can't or wont pay for it, and the patient is avoidably injured because the test was not performed - guess who is held liable? - the doctor. Does that sound like a safety net to you?
<<Were tort reform enacted, then maybe individual physician networks could re-establish the previous level of personal care that seems to have been lost in the current "assembly line" HMO system. I would be curious to know if you concur.>> I agree that tort reform should be enacted not only for the sake of healthcare but for general well being of society.
Let me conclude by saying that In the future I see interlinked non-emergency, diagnostic screening and referral centers. Entry into the healthcare delivery system, for routine medical problems, will be via this conduit. The patient will be diagnosed and referred to qualified specialists and treating physicians. Such medical centers, will be staffed by physicians who have completed competitive-residence programs, not C- and D-grade medical-school graduates. Such residence curriculums will emphasize computerized diagnostic and referral decision models.
Gore's healthcare proposals are on target. At least that's the way I see it from here. |
