Sorry I didn’t get back to this sooner.

Thera wrote in part:

If you want to get M.D.’s on board, here’s how. First focus on what doctors find frustrating about practice today – most doctors are extremley unhappy with the present practice conditions. Right now physicians are feeling very hemmed in due to insurers taking away their independence. They feel forced to join networks. They feel burdened by insurers taking away their decision-making in a variety of ways. There is also little continuity in terms of being able to see patients longterm if insurances change, year by year. And they are also hugely burdened by student loans. So, I would put together a package to lure doctors into supporting universal care.

First, I would make a commitment that if all citizens are to have healthcare, then all doctors will receive incentives like partial forgiveness of student loans, a minimum standard of living (to lure doctors into primary care, where the money is less than specialization), and new doctors will be trained via partial government subsidy of tuition. In addition you need to address the high cost of malpractice insurance and ways to prevent medical errors, including primary care docs having more time with each patient.

I think if you find ways to help doctors see that you are concerned about what frustrates them with practice, you will go a long way to luring them to support a program which helps everyone in the system, not just patients.

Thera also added:

If they say, we don’t like socialized medicine, I’d say, well I don’t like insurance company controlled medicine.

I could not agree with the points you made more, and I know that to be true of scores of physicians if not hundreds or an even greater magnitude. These are all very crucial, valid points–and there are a lot in addition.

I fully understand the time committment.

All your points are extremely valid. This is a vast topic. I know what’s in physician’s heads, believe me. Most physicians, particularly those who had training up to a few years ago, never dreamed they would have to wrestle with insurance companies, that they would be restricted in what they can often Rx by managed care. They were trained to go for the best cutting edge medications/proceedures that had the most efficacy, and the least side effects or morbidity.

Most physicians are focused on the vast complexities and energy it takes to keep a practice going; to keep up with the rapidly changing literature and developments–and it’s not always as focused in one specialty as you’ve descrived–particularly for primary care physicins whether they are Family Practice (FPs) or internists.

There is also the issue that many primary care physicians can spend a lot of time and do a lot of work on a patient who comes in with three significant diseases whereas some surgical subspeicalists can do proceedures that take considerably less time but earn exponentially more money.

In a number of places in this country, primary care physicians are scarce or lacking, and there is real concern about recruitment of future physicians due to changing trends.

Believe me, many physicians have the brain power and skills to go into a lot of other professions and make a helluva lot more money with a helluva lot less work and time. I kid you not. I’ve seen it done when people are at the peak of their careers in their mid forties due to some of the hasslesa and the grind. Of course there are profound rewards, but there is an equation where there is a point of diminished returns for everyone.

Malpractice premiums weren’t the huge burden they are for some subspecialties now. Often insurance contracts are written where the doc is forced to settle when he has made no mistake. OBGYNs have a very high chance they will be sued 3 years out of residency, and a high proportion of the suits are for maloutcome, not malpractice, and it’s not a cliche–it’s absolutely a fact.

Your point about followup is extremely important for most physicians. I don’t see how it can be otherwise. Every physician feels rewarded by being able to follow a patient’s outcome of an episodic problem or long term care benefits. They are equally highly frustrated when they can’t find out what happened to their patients or participate in ongoing care, and this is happening increasingly in the HMO/PPO setting.

Physicians also have lost control of much of what they can do for their patientsbecause of intervening third parties like insurers or HMOs, over the last twenty years despite the rapid increase in medications and modalities.

There are all kinds of situations where patients are falling through the coverage cracks, another source of great frustration for MDs.

I ran accross this earlier in NYT, and a lot of patients and physicians can relate to this:

Cancer Returns and the Bills Pile Up

I know a lot of physicians with a wide variety of interests, but I believe many of them to be politically narrow minded and a high percentage “conservatives” and many not likely to find the resonance I do with the bright and agile minds on Fire Dog Lake, EW, Tbogg, and many so-called liberal blogs out of sheer blind prejudice that has been hard wired into their psyches and made them entrenched.

And call this a bias of mine, but I firmly believe that most Republicans or so-called conservatives are not very well read or as open to ideas as you will find the bloggers and the commentors on this set of blogs, the blogs linked and often mentioned here, or someone as bright and analytical as Glenn Greenwald. Very few of them would have the interest in some of the nuances in constitutional law you are going to here from EW, Christy, LHP, or Jane and some of the other bloggers here.

I find the parsing of some of these constitutional and legally strategic questions pretty interesting, and that they are posed by people with talent, and experience, and a healthy smattering of lawyers who are good writers.

the word capitalism will win every time. It would take conditions similar to the Great Depression to change that

We don’t have to consider capitalism a blight. We just have to work on our system to improve it bit by bit.

A little more competition here and a little more R&D investment there and a little more infrastructure over there and a few tax policy changes and the next thing ya know the things holding back growth are put aside and things sail along more smoothly.

If the object of getting insurance were to cut the insurance companies out completely, which I hear many advocating, how would this effect capital formation. The insurance companies are known to be large pools of money that isn’t just left sitting around. It is invested in your mortgage and mine, in Reits that finance that big new skyrise in your city, or the apartment complex next door. I’m pretty sure they also supply money for other products that need capital formation, and large pools of money to invest.

That’s an excellent point. It’s also relevant when discussing the wealth imbalance issue (do we need rich individuals to create capital formation for business investment?) and when considering any banking reforms.

I think the biggest danger to pay attention to is the huge risks of changing our system too quickly. This is a powerful argument against an immediate switch to a government-only UHC. I think there are other arguments against it too, but yours is very powerful.

I think it might be more productive to emphasize pragmatism, the degree to which mixed economies work to solve differing problems, than to preach a doctrinaire economic system.

To me ‘pragmatism’ is often a way of avoiding conscious effort to get a certain result and just relying on what seems right or good, in hopes it will result in good outcomes.

I’d prefer to start with goals and then look at ways to get to those goals. You can be pragmatic at that point as it offers more flexibility.

Take for example the economic argument of competition or choice for the purpose of price control: in the current health care system there is choice among insurance providers, but not so much with health care delivery. So, a UHC like Edwards or Clinton would offer actually improves the economics by incorporating MORE choice and competition for dollars.

If you take competition/choice as a goal from the start, then you can see how their plans are more likely to get it done.

I think if you find ways to help doctors see that you are concerned about what frustrates them with practice, you will go a long way to luring them to support a program which helps everyone in the system, not just patients.

I agree completely. The problem with that kind of detailed in depth reform is it could take years and years of incremental change to get there. The more Progressive approach is to change the box our health care is delivered in and ensure that macro economic system works better. Then, you can work gradually on practical things like those you suggested.

Sure, the medical practice isn’t perfect, but it’s partly that way because of the insurance system. Fix that and quite a bit of the micro problems might disappear.

The country is ready for universal health care and if the Dems could just say, “we’re going there, even if we have to take on the insurance industry and the whole Republican party, we’re ready for that fight” — I think that’s a campaign they can win.

Sure, that would help us win. It helped Bill Clinton too. But, ya see, we don’t just want to win the election, we want to really get UHC. It’s a difference between “change you can believe in” and real change.

I suspect that Hillary and Edwards both understand where this goes, but both have chosen not to confront the insurance industry directly for now. Dunno whether that’s smart politics or poor leadership.

There are some major corporations which consider their health care plans to be big plusses in hiring & holding good employees and don’t want UHC taking away that advantage. Other corporations are sinking under the growing costs of health care. So, Edwards & Clinton compromise and let corps keep it if they want, but then offer government-run care for those who want that. Choice!

Whether it will work well in practice is unknown. But, we have to try because the current way is killing us. Many cities are laying off police officers because they can’t afford to pay their health care. That leads directly to very real deaths and unsolved crimes.

Seniors need health care and they need it now; in my case, I was in good health for most of my life, so I rarely gave it a thought. As I hit fifty, I started feeling run down, but I rationalized everything…It’s just age that’s catching up with me. It’s natural for me to need a nap on weekends at my age. It’s normal for riding my horse on weekends to make me extraordinarily tired. This went on and on without my noticing any symptoms that might lead me to believe that my arteries were getting very blocked. I was having a hard time breathing, and blamed it on cigarettes, which of course were related, but it was also the copd that was developing when I didn’t realize it. So losing a job at 56, and the associated loss of insurance, took a big toll. Just when I needed insurance worse, I didn’t have it and couldn’t afford it, and had pre-existing conditions that I was unaware of. I’m pretty sure I’m not the only one.

I think this was a little what the SCHIP program was supposed to do…although I didn’t see much preventative care involved in that, actually. But the schools need to be involved, with perhaps a real pediatrician (not just nurses) involved at schools. There should be dental, vision, auditory, nutritional and other mobile labs visiting schools and assisting these preventative programs. We also need to make sure kids are eating well and have access to nutritive foods. And exercise. Kids nowadays don’t get physical activity and we are rapidly producing a nation of obese, diabetic teenagers.