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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Mary Cluney who wrote (6181)	2/17/2009 11:21:04 PM
From: i-node	2 Recommendations Respond to of 42652

But I think a lot of it can be fixed by reforming healthcare in terms of getting rid of inefficiencies, duplications (redundancies), and errors. This is where the solution mill grinds to a halt. Obama has claimed that EMR will solve these problems. And while I've made my living for a long time by developing and selling software to make medical practices "more efficient" and "reduce errors", the reality is that there just isn't that much to be had. While there is no doubt that EMR within a medical facility improves efficiency within that facility, the proposition of creating a centralized database that provides the kinds of efficiencies they're talking about is a very long way away -- and there are some pretty big problems that have to be solved before we're there. If they move to implement EMR quickly, I think we'll see a shortage of physicians for the coming few years that create a health care crisis like nothing we've seen -- 10-15% of physicians who are retirement minded will just go ahead and do it. Forgetting all that for the moment, suppose you could save 50% of Medicare costs through efficiency measures (a figure I'm sure most people would agree is obviously not achievable). What would be the effect of such a savings? You would have an immediate health care crisis. Physicians would stop seeing Medicare patients because the revenue from Medicare would not cover the cost of rendering the services; the load on emergency facilities would be increased. Drug companies, if squeezed by Medicare, will refocus efforts on high-margin drugs only, and R&D for new medications will drop, causing the pace of development of new medications world wide to drop immediately. Hospitals will be impacted similarly, although their stronger negotiating positions with non-governmental payers would relieve them somewhat. My point is that any savings in Medicare has to made up for somewhere. Providers already take a huge hit by serving Medicare patients, essentially, making up the difference on private insurance like BCBS, AETNA, CIGNA, etc., which pay better than Medicare. A provider who sees only Medicare patients cannot even make a decent living at this point. Longer term, would-be physicians will devote their efforts to other fields of study which can assure them of a good living. While some want to be physicians for other reasons, most, ultimately, are interested in the money. Our health care system today operates within a very delicate balance, and when you start making changes to it, those changes have a chaotic effect on other parts of the system that can really end up being magnified many times over. I am reminded of the collapse of the Tacoma Narrows bridge, in which the tiny oscillations gradually grew to the point that a total collapse was inevitable. I would hate to see that happen with our health care system.