Let'sPick And Choose

I agree with what most people have been saying.  

1) We need to follow the idea of picking what works and what doesn't work, and try to adapt those ideas to our system.

2) We need to get everyone insured.

3) We can't let insurance companies choose who they are going to insure.

Some of the other ideas are a little more controversial.  I personally agree with the idea that insurance companies need to be not-for profit.  The German model seems to support that this is an option,  though I'm not sure I understand how it can be called non-profit if the more clients you have the higher salaries you distribute, unless there is some sort of government subsidy.  

The issue that seemed to continue to come up is that when the hospitals and doctors are paid less (for fixed prices) they aren't able to cover their expenses.  In our system, physicians are paid more ostensibly because they have very high loans, and are starting repayment relatively late in life (as compared to say a stock broker who starts earning right out of business school).  Not even mentioning malpractice insurance and overhead costs.  I don't see how fixing prices at 10$ a nite for a hospital bed can even approach paying for bedding and nurses and IVs and food and supplies, when 10$ won't even get you a decent bed in a hostel.  The answer seems to be to try to keep prices low, but maybe not as low as Japan and Taiwan are trying to be. 

Another issue that I feel should be addressed is drugs/innovation.  What hasn't been said, and may or may not be true, is that the cost control mechanisms are negotiated by the companies, which is to say that low drug prices are being subsidized by the people who are paying more; eg, the US.  Are the MRI machines that are so cheap for Japan, cheap there because we are paying Toshiba a boatload here?  Or is it like car production, where in the UK, the cars already get 50-60 mpg, but in the US we're struggling to get 40mpg with hybrids only because we have always tolerated the low efficiency?  I used to defend the drug companies, because only 3 of every 10 drugs tested makes it to market, and only 1 of every 10 ever makes a profit.  Then I looked at some of the budget sheets, 30% of the operating budget goes to R&D, while 35% goes to marketing!  I think ultimately I agree with the Swiss interview, the companies will find a way around it.  God forbid I don't get my drug pen.

I am not sure about fixed prices, I think it'll get a lot of opposition from physicians, drug companies and insurance companies.  There would have to be some sort of mechanism in place to prevent physicians from just taking care of the easy patients.  For instance, will surgeons who get  paid a fixed amount for taking out an appendix need an incentive to take out the ones in people with heart disease and diabetes and prior surgeries, when its going to be a much more difficult, time consuming and risky surgery, whats to stop them from saying, no I won't operate on you, when I can operate on 3 healthy patients in the same time.  Of course this is a problem we have  now, and why the county hospital is full of medicaid patients that are too "complicated" for their own doctors.  

In summary:

We need to stop tolerating our inefficient system.  We need a universal, part-social insurance plan, and we need to cut costs.  Schooling and malpractice are not separate issues and need to be addressed.  All doctors should be on salary, with bonuses for keeping patients healthy and with some check on quality/quantity of care.