3 basic things to regulate would go a long way to extend care while working on a system to include everyone.

1. Insurance companies: regulate so that they can not deny coverage for anyone or charge ridiculous premiums. Make policies available nationwide. As an individual buyer, if I get dropped for some crazy reason, there are really no other insurers locally...this would also increase the competition between companies, maybe even level that part of the playing field.

2. Incentives for primary care physicians. Very few current graduating docs are choosing family practice. Loans >>> reimbursement. I know i am preaching to the choir here.

3. Tort reform. This is essential. I personally do not like caps, but i think lawyers benefit too much from these cases, so by decreasing the amount that they get may decrease frivilous stuff. Also, a "jury of peers" should be redefined for medical malpractice lawsuits. Laymen should not decide whether a patient gets rewarded. I rotated under a doc that consults for depositions on a regular basis and he said that the outcome is not generally linked to facts, but whether the jury feels sorry for and likes the plaintiff. and if the doc does not charm the jury, they are OUT OF LUCK. There should either be this or a separate kind of fund to support those who were really injured from a medical procedure.

Good points, Alkatz. I have made the point in this thread already that if Tort reform and increased reimbursements for primary care providers were part of the reform being debated in Congress, this would be a much more popular topic among physicians. I think the Democrats ought to include tort reform in their debates. This would be a small compromise for them to make. Actually, this might go a long way toward decreasing health care spending if physicians were practicing less "defensively". Not sure what the data about health care spending in the states that have enacted tort reform show, would be interesting to see.

Well, we will see tonight what Obama has to say, and I hear Baucus and his crew are coming close to a resolution. Just hate to see the nation turned into Massachusetts (my home state) which be the most likely outcome...costs are astronomical, all the extra money is going into the pockets of the insurers, and there is a horrible shortage of primary care providers. The state has had to close public health clinics to cover the increase in costs for the program...

kpzr, from everything I have heard, the Massachusetts experiment is not working out very well (their healthcare costs are the highest in the nation yet access is still a problem). I hear that they are planning to cut physician pay next. It is sad but totally predictable that they will not call it a failure and will keep digging themselves in deeper. At least Hawaii realized that they had made a mistake and ended their program! I really worry that the whole country will end up like Massachusetts.

I do too, but this is where we are headed. At least with a public plan option, people have more choices. And, the ENTIRE market share does not go to the private insurers!

The truth is that the United States already covers over 47% of all medical bills through Medicare, Medicaid, the Veterans Administration, the Department of Defense and the Bureau of Indian Affairs. At four percent overhead!

Well, we will see what happens next. I am concerned, though, that it will not be real reform. Let's hope the private (and public, too!) insurers are heavily regulated at least.

Here is an article that discusses the issue of 4% (or 3% or 6%) overhead, saying that it is due to higher medical costs (think: old, sick Medicare patients), not lower administrative costs:

http://www.realclearpolitics.com/articles/2009/06/27/the_adminstrative_cost_bene fit_myth_97193.html

I especially like these figures, which show that Medicare's administrative cost per beneficiary is higher than private insurance's:

http://timerealclearpolitics.files.wordpress.com/2009/06/admincosts1.gif

Way to spin facts! Of course if people are sicker, the absolute administrative cost should be higher. For the healthy, privately insured citizen who goes to the doctor, say, a couple of times a year, there should be no administrative cost beyond cost of enrollment, processing premiums, and processing a couple of reimbursements! Compare that to the elderly person with multiple claims to process monthly. Of course the ABSOLUTE administrative costs will be higher. How could it be any other way?

The fact that administrative costs per person for private insurance in 2005, for example, is ONLY $50 LESS (= 10% less administrative costs) despite total health care costs that are $6,000 LESS (= roughly 65% less total health care costs) (i.e. presumably 65% less claims to process, to simplify) goes to show that Medicare is indeed more efficient.

Exactly BE - talk about fuzzy math! The per patient admin costs may be lower (very slightly) with private plans but that's because of the diluting effect of their low risk, low sick patient population. Once patients reach 65 or become disabled or develop ESRD or other Medicare qualifying illnesses, they get dumped into that that system. So private plans are paying almost the same on average in adminstrative costs per patient on patients that use less care. How efficient is that?

One other issue that is glaringly absent in this article and others who talk about the "efficiency" of the prvate insurance market is the profiteering these companies engage in. Medicare does not have to make a profit for its executives or it's shareholders (it has no shareholders) -an inherent conflict of interest and an arrangement that I feel, as I have stated previously and will again now, is immoral. Where are these costs accounted for?

We can do better than this. I heard a lot that I liked last night with the President's address. I was very thrilled to hear he has authorized Sebelius to start demonstration projects regarding tort reform. I was very glad to hear him call for a ban on pre-existing illness exclusions and that he wants to make it illegal for companies to drop patients. I think opening up markets to erase state barries to competition as well as creating health insurance exchanges and, yes, a public option are all good ways to ensure that these regulations do not result in higher premiums. Insurers won't be able to simply pass these higher costs on to patients if they face stiffer competition for customers.

The plan has a lot to offer to both sides of the debate, both sides of the political spectrum,and I sincerely hope something good comes out of it.

I do believe that insurance companies need to be held accountable for the awful things that they do. Insurance executives ought to be going to prison for practices such as dropping patients after they develop cancer or delaying authorization for treatments in which time is of the essence. I don't agree with a lot of what is proposed in the current plans, but I do agree with cracking down on the insurance industry.

And the move toward tort reform is fantastic!

I just want to add that the estimates for "administrative costs" don't even begin to cover the costs of the workers who do nothing but billing, chart review, claims, HIPAA, case management, financial counseling, coding, compliance, JCAHO readiness, blah blah blah. They are hired by the hospitals and clinics, but really their jobs are solely created so we can collect our due pay from CMS and insurance companies. ("Mmmm....Excuse me, Dr. Smith, you see, you have to document 'hypokalemia' in the chart if you replace the potassium or we don't get paid for it." And so on....)

If those jobs counted as "administrative costs", you can tack on a few million if not billion, I'm sure.

(IMHO, there are WAAAAY too many midlevel managers/administrators in health care...but that's a different thread .)

Yes - very good point asunshine!