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

To: i-node who wrote (6749)	5/6/2009 10:25:48 AM
From: Lane3	1 Recommendation Read Replies (1) \| Respond to of 42652

because the states want to be rid of the drain on funds. I can understand why state officials don't want the problem, but for the taxpayers, it's six of one, half dozen of the other. Unless the states don't lower taxes accordingly. Or the feds take on the cost without raising taxes, that is, running a deficit. It's a power thing and the taxpayer loses either way.

To: i-node who wrote (6749)	5/6/2009 10:44:53 AM
From: skinowski	Read Replies (1) \| Respond to of 42652

Damn. I'm starting to sound like him. LOL! There is something very (emotionally) appealing about the idea of universal access. The problem is that politicians - inevitably - will have a feeding frenzy if they get their hands on the funds. Just look what they did with the "bailouts". Each will try to bring home so much bacon that they'll kill the pig that lays the golden eggs. Flying down to Shreveport this Saturday. Will visit friends in El Dorado, and hang out for a few days at lake Claiborne in north La. Can't wait. South is addictive... :)

To: i-node who wrote (6749)	5/6/2009 11:37:35 AM
From: skinowski	Read Replies (3) \| Respond to of 42652

With regard to the Great Primary Care Debate.... I am beginning to envision more and more clearly that the solution may be a situation when each Internist works with and supervises 2-3-4 nurse practitioners or PA's. My thinking is very simple. Nowadays, an Internist or Family Doc - between Medicare, HMO's etc. - when all is said and done receives probably about $60-70 per "cognitive" encounter. In order to be able to spend a needed amount of time with each patient - and pay expenses and still make living - this amount would need to be well over $100. This will not happen, since health care costs are perceived to be - and probably are - already higher than what people generally can afford. That said, much of what a Primary Care Doc does is very simple. The treatment for many conditions, once properly diagnosed, is quite well worked out. There are more and more "evidence-based" treatment guidelines and protocols, and when used appropriately, for the most part they make sense. An intelligent, intuitive and experienced nurse would be able to do quite well probably some 70-90% of what the MD does in a primary care setting - and there is no shortage of smart nurses out there. They'd probably be better at communicating with patients and families than a good many doctors. I think it can be done. I think if I ever decide to go back into practice, I'd try to create a setup when 2-3 docs would work with - and supervise - a few times as many "mid-level" personnel.