Tag Archives: AMA

Medical Doctor Alternatives


I think that one of the reasons our medical care system is so expensive is that the system is not built to match procedure to appropriate expert.

For example, there are very skilled landscapers in this world capable of designing and building stunning works of art in the natural world.  And then there is the need to have your lawn mowed.  Imagine how expensive it would be to obtain a contractor to mow your lawn if you were required to hire that highly skilled, trained and often time licensed landscape designer.

Another example I came across was during a conversation with my mother-in-law.  We were discussing health care and costs and I mentioned that it’s unfortunate that I need to see an MD to have a finger reset, x-rayed and cast when I’m sure it could be done by a PA at most and perhaps a nurse at worst.

[ there may be cases where this is possible – i was using the specific example to make the larger point ]

She objected claiming that if it was her, and had she the insurance that she indeed has, she would insist on not only a doctor but then an orthopedic specialist.

Why the editorial?  I saw this and was confronted that without allowing price to act as a signal, we may not be getting optimal results:

Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday.

These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin.

The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said.

“There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview.

“They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.”

David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said.

But we don’t allow the delivery of medical services be exposed to the market.  And so people are not going to shop their needs on said market.  Additionally, we have special interest groups, read AMA, that lobby to create legislation that make it illegal to see anyone BUT a doctor for such commoditized services.


Pino Is Right – Sebelius Blames Claims Obama Kept Promise

Kathleen Sebelius

Last night at about 6:30 I opined on how long it would take the administration to deflect blame on the policy cancellations from Barack Obama to the insurance companies.

It took about 18 hours:

The White House has struggled to defend President Obama’s 2009 claim as thousands of people receive notifications that their insurance companies are dropping their plans.

“Is he keeping his promise?” Rep. Marsha Blackburn (R-Tenn.) asked Sebelius.

“Yes he is,” the Health and Human Services secretary responded.

She repeated the administration’s argument that, if people are losing their plans, it is because of insurance companies and not the new healthcare law.

“If a person had a policy in place in March 2010, liked that plan, and the insurance company made no changes to disadvantage the consumer, those policies are in place, you keep your plan if you like it, and that goes on,” Sebelius told the House Energy and Commerce Committee.

“People though who had a medically underwritten policy, were paying more than their neighbor because they happen to be female … they will have a new day in a very competitive market,” she added.

Many insurers have stopped offering plans that do not comply with regulations issued by the Health and Human Services Department outlining basic levels of coverage. Consumers who have received such notices are often left with more expensive options.

These people simply lied.  It’s not like the traditional campaign speech promising no school on Fridays and a pretty girl for every boy.  They knew that people, by the millions, would lose their coverage and they kept saying that they wouldn’t.

The next sound bite?

“Yes, you DID lose your plan, however, it will be replaced by one that is better.”

Obamacare – Shihfting Blame

Barack Obama

Insurance companies are cancelling policies by the hundreds of thousands.

I wonder how long it will take before the official line out of the administration regarding such cancellations is that the law didn’t cancel the policies, rather it’s the insurance companies doing it.

The Mandate And The Cost Of Insurance

Let’s set aside the debate on whether or not the mandate represents a penalty or a tax.  In many ways, it doesn’t matter; the bill was made law, the law was challenged and the law remains the law.

A question occurred to me as I was watering failing to save my flowers Saturday:

Given that individuals are offered the choice of purchasing health insurance or paying a penalty, and that penalty is paid to the federal government of the United States, what will this do to health insurance premiums?

The answer is, of course, “Insurance premiums will go up.”

Individuals will make a value based decision on whether or not to purchase insurance or pay the penalty/tax.  The problem comes into play when you consider that the organization making the determination, and receiving the money, of how much that penalty/tax will be is NOT the same organization that is required to insure people who decide not to purchase insurance.

In short, the insurance company has to cover uninsured individuals while the government keeps the penalty/tax.  What this means to the insurance companies is that they have to cover uninsured people for free.  And since coverage of medical costs isn’t really free, they will have to raise the rates of everyone to cover those costs.  As those costs rise, more and more Americans will conduct value propositions and conclude that purchasing insurance isn’t worth it.

And costs will rise.

And costs will rise.

And costs will rise.

Romney On Obamacare: It’s A Tax

There was a big decision last week.  The Supreme Court ruled that the AMA was constitutional under the ability of congress to tax.  Republicans, and I, jumped on this to claim that Obama broke his pledge to raise taxes.

Initially, Romney claimed that the AMA, Obamacare, was not a tax but rather a penalty:

In an appearance on MSNBC’s “Daily Rundown,” Romney strategist Eric Fehrnstrom was asked whether Romney agreed with last week’s Supreme Court ruling.

“The governor believes that what we put in place in Massachusetts was a penalty and he disagrees with the court’s ruling that the mandate was a tax,” Fehrnstrom said.

When pressed by host Chuck Todd about whether Romney supported calling the financial burden placed on Americans who choose not to buy health care “a penalty or a fee or a fine” rather than a tax, Fehrnstrom replied: “That’s correct.”

However, governor Romney has changed his tune, to one that sounds more true:

GOP presidential candidate Mitt Romney attempted to clarify his campaign’s position on the individual mandate, calling the provision a “tax” days after his top adviser said otherwise.

“The Supreme Court has spoken and while I agreed with the dissent, that’s taken over by the fact that the majority of the court said that it’s a tax and therefore it is a tax,” said Romney in an interview aired Wednesday on “CBS This Evening.”

This happens to be what I think.  Obama never meant this to be a tax.  He adamantly denied it was a tax.  It never would have passed had it been a tax.  It clearly was meant to be a mandate under the commerce clause.  However, that is not how the supreme court saw it.  To them, the mandate is a tax, therefore, legally, it’s a tax.