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

To: skinowski who wrote (24629)	9/1/2012 1:29:05 PM
From: Lane3	Read Replies (1) \| Respond to of 42652

When you "determine how many units are in the service" you are effectively determining the price of the service in dollars. That's true. But you'd doing it via an intermediate that is designed to be more objective that directly assigning dollars. I recall thinking that many surgeries were compensated higher than what a primary care doc could gross in a week. It seems to me that you are saying the same thing as those folks who argue that teachers are underpaid. You think that primary care is worth more than it earns. Teachers need advanced degrees but police officers face mortal danger. How much do you want to weight those and other factors in determining what the job is worth? Your mileage may vary. Seems to me that if you want to evaluate and compare two RVU's you'd have to look at what factors were included to see if they were the right ones and if they were counted and weighted appropriately. As a lay person, I would think that many surgeries would be worth more than what a primary care doc could gross in a week. Cardiac catheterizations would probably not be one of them because they are a repetition -built skill, but many surgeries. Diagnosing and freezing a wart or reading a blood report and prescribing a statin would have to be done thousands of times before they would equal the heft of many single complex and unique surgeries, seems to me. I don't know a thing about the details of RDU's but I do have experience with the concept of weighting jobs. I'm approaching the RDU discussion in the abstract. I submit that both the original pricing - and the later changes - were pulled out of the hat by committees. They may have originally been based on the usual and customary charges or at least adjusted for them when originally implemented to ease the transition. I say that because that's what one would do if designing and implementing such a system. When you're trying to get buy-in on a new system, you can't jolt people too much in the beginning with stark differences. If two things under usual and customary were worth the same and the RDU model came up with something totally different, adjustments would have to be made or the losers in the transition would have been screaming. Why should government price fixing work better in healthcare than it would in any other industry? I'm not suggesting that it would. As I'm sure you know, I don't advocate government price fixing. Only saying that if you are stuck with government price fixing, which we are, it would be better for it to be based on some model that objectively assigns value to the underlying work components. It looks to me that a two tier system may be the best answer. Maybe the only answer, really. It would solve the problem you raise. But it would introduce others. We have a tendency to try to fix a problem by blithely developing a system that optimizes the thing we're dealing with and ignoring the potential for unintended consequences. The folks who designed Obamacare did that. They were focused on universal coverage and paid no heed to consequences elsewhere in the system.