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View Diary: "Consumer Driven Health Care" and other fantasies- (12 comments)

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  •  Skyrocketing costs (none)
    A very complex issue, the supply of physicians, which I believe needs to be thought about outside of the present box. /

    While I agree that this is a complex issue, when you have an administration talking market, market, market at the same time that healthcare costs are skyrocketing at a rate much faster than almost anything else, then I think this supply side connection has to be made clear to the public.  If induced demand is the main cause of the increasing cost problem, then deal with that somehow.  My ideas on this are to use strong and widely disemminated standards of care for diagnosis and treatments!!  

    If access and costs due to limited provider availablility are the main problem, then since it is a problem, a market solution would be to increase the supply and competition to provide the services, again assuming one figure out how to handle induced demand, as you say.

    The situation of midlevel providers is another interesting subject, and one that I want to tell a couple of little stories about.  There was a time when physicians did not want to allow such alternative providers, and it was only after they were assured that these mid-level providers would not hurt their monopoly too much that they gave in, although I think that there is still some hard feeling from oldtimers on this issue. Can you imagine the access problems that would exist now if these mid-level providers were not allowed at all.  Also, makes you wonder what other types of lesser trained providers could help if allowed and why aren't they!

    In dentistry, something I know a lot about, the fox controlling the henhouse is very, very alive and well in all states, as it has been for 50 years.  Number of providers trained, numbers let into a state to practice, what they can do, prohibition on foreign grads, /minimization of new types of providers,and lack of evidenced based medicine to encourage efficiency and effectiveness, has led to a great access crisis for many poorer folks.  As the retirement of many badyboomer dentists takes place over the next 15 years, this country is set to loose up to 10-15% or so of its total provider force if nothing in the current process changes.  Then, even the middle class will be hard pressed to get care (so keep your current dentist folks if he/she is young!).  BTW, this organized strategy has worked quite well for the current dentists (renewing my faith in supply and demand), as recently the average dental GP's net income surpassed the average net income of medical GPs.  How do folks here find the cost of dental services, cheap?  What dentists do mainly is not rocket science, BTW!  Legislatures are beginning to take some notice of what is going on, but unfortunately, there just are not enough proponents of change yet. That may/will change when the middle class gets more affected.

    Political censorship is the root of all evil! It is the antithesis to a functional democracy!!

    by truthbetold on Fri Jan 28, 2005 at 10:21:30 AM PST

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