"Monetary problems" eh? How silly to think that doctors will have to compete on price... just like every other service industry.

I don't think it is the doctors who will have a problem - afterall, there's a shortage of doctors (Growing evidence of a national physician shortage prompted the Association of American Medical Colleges to call last month for a 30% increase in medical school enrollment within the next decade.) The problem will be the clinics that close because they can't recruit docs who graduate with $300K debt for their educations and elect to go into high paying specialties in big cities and suburbs. Maybe WalMart is the answer - but they are going to need helicopter pads. They won't just be seeing "well" patients. Where are they going to send the sick ones when the local clinics and hospitals close?

I love how we worry about free market competition reducing the level of service.

Free nights and weekends, 30 minute pizza delivery and free loaner cars are all products of free markets.

Government forcing a standard of care while lowering price is what will truly lower the level of service.

IN CASE YOU'RE NOT AWARE, AND APPARENTLY YOU'RE NOT, THE INSURANCE COMPANIES ARE TOTALLY CONTROLLING THE FEES PAID TO DOCTORS AND HOSPITALS. FOR THE LAST 8 YEARS THE INSURANCE COMPANIES HAVE CUT FEES PAID TO DOCS AND HOSPITALS BY 65%, WHICH HAS REACHED A CUT SO SEVERE THAT MANY DOCS HAVE CLOSED THEIR PRACTICES OR HAD TO GROUP TOGETHER IN ORDER TO CUT THEIR OVERHEAD AND COSTS. DOCS ONLY HAD A 50% MARK-UP TO BEGIN WITH (WELL WITHIN THE NORMAL PROFIT MARGIN) YET THEIR FEES HAVE DECREASED WELL BELOW THIS. AND MIKEY IS RIGHT, ADMISSIONS TO MED SCHOOLS IS DECREASED DRASTICALLY, WHO WANTS TO SPEND THE TIME AND MONEY TO BECOME A DOCTOR WHEN YOU CAN EARN ALOT MORE MONEY DOING SOMETHING ELSE.  I HAD A MAJOR  3 HOUR SURG 4 YRS AGO AND MY DOCTOR GOT PD 1100.00 (YES THAT'S CORRECT ELEVEN HUNDRED DOLLARS TO SPEND HER ENTIRE MORNING DOING MY SURGERY) WHEN HER STAFF WAS AT HER OFFICE GETTING PD AND NOT BEING ABLE TO GENERATE ANY MONEY FOR HER DURING HER ABSENCE.  WHEN YOU ADD THE COST OF PAYING HER STAFF, OFFICE EXPENSES, RENT, ETC SHE LOST MONEY ON MY SURGERY.  OH BY THE WAY, THE FUULY BOARD CERTIFIED SURGEON WHO ASSISTED HER GOT PAID 364.00 .  IT'S PATHETIC.  NO OTHER BUSINESS HAS HAD THEIR FEES REDUCED YEARR AFTER YEAR LIKE THIS.  OTHER BUSINESS JUST INCREASE THEIR CHARGES WHEN THEIR OVERHEAD, ETC GOES UP, DOCTORS FEES ARE REDUCED ACROSS THE BOARD BY INSURANCE COMPANIES EVERY YEAR BY AT LEAST 10%, WHICH COSTS THEM THOUSANDS OF DOLLARS IN REVENUES, YET THEIR COSTS CONTINUE TO SORE WITH SUPPLIES, STAFF, RENT, UTILITES, MAL PRACTICE.  THESE WAL MART, CVS ETC, MINI CLINICS ARE STAFFED BY NURSE PRACTIONIERS, PHYSICIAN ASSISTANTS WHO ARE UNDEREDUCATED AND OVERLY EMPOWERED FOR WHAT THEY ARE BEING ALLOWED TO DO.  THESE CLINICS ARE ALSO VERY, VERY LIMITED IN THE SCOPE OF BEING ABLE TO FULLY ASSESS MEDICAL CONDITIONS.  WE COMPLAIN ABOUT HEALTH CARE COSTS, MOST OF THE PATIENTS IN THE PRACTICE I WORK FOR COMPAIN ABOUT PAYING THEIR 20.00 OR 30.00 COPAYS, YET THIS IS REALLY A MINIMAL FEE FOR BEING ABLE TO SEE A PHYSICIAN AND FULL EVLAUATION.  WHY DON'T PEOPLE COMPLAIN ABOUT PAYING 100.00 FOR A DINNER OR COMPLAIN ABOUT THE 150% PROFT BUILDERS MAKE ON THE HOUSE THEY BUY?  PEOPLE HAVE LOST ALL RESPECT FOR PHYSICIANS AS THEY HAVE BEEN TAINTED WITH MIS-INFORMATION THAT DOCS HAVE CAUSED THE HIGH PRICES OF MEDICAL CARE WHICH IS AS FAR FROM THE TRUTH AS IT CAN BE.  HAVE YOU BEEN TO THE DENTIST LATELY?  TRY PAYING 2000.00 FOR A ROOT CANAL AND CAP AND COMPARE THAT TO THE ELEVEN HUNDRED DOLLARS MY DOCTOR GOT PAID FOR A VERY COMPLEX SURGERY SHE DID ON ME!  THE CEO S OF THESE INSURANCE COMPANIES MAKE MILLIONS IN ANNUAL SALARIES, WHICH IS LUDICROUS, WHERE WOULD THEY BE WITHOUT THE DOCTORS TO SEE THEIR SUBSCRIBERS?  THIS HAS GOTTEN SO FAR OUT OF CONTROL.  DOCTORS WORK VERY LONG, TENSION FILLED HOURS, SPENDING HOURS EVERY DAY ALSO DOING THEIR DICTATION ON PATIENTS CARE. WE NEED TO APPRECIATE THE FACT THAT WE HAVE THE BEST HEALTH  CARE AVAILABLE AND STOP COMPLAINING ABOUT 20.00 COPAYS.  ALSO, WITH THESE YEARLY, SUBSTAINTIAL CUTS ON DOCS FEES BY INSURANCE COMPANIES DON'T YOU QUESTION WHY THE INSURANCE COMPANIES HAVE TO CONTINUE TO RAISE YOUR YRLY PREMIUMS?  LOOK AT THE YRLY FINANCIAL REPORTS OF THESE INSURANCE COMPANIES, THEY MAKE MILLIONS IN PROFITS,WHILE DIPPING DEEPER INTO YOUR POCKETS AND THE POCKETS OF THE DOCTORS.  ALSO MOST OF THE PRIVATE INSURANCE COMPANIES ACTUALLY PAY THE DOCTORS LESS THAN THE STATE MEDICAID DEPARTMENT DOES FOR THE SAME PROCEDURES, AND THAT'S THE TRUTH, I POST ALL THE MONEY AT THE CLINIC I WORK FOR AND PRIVATE INSURANCE COMPANIES FEE REIMBURSEMENTS TO THE DOCTORS IS ALOT LESS THAN WHAT THE PRIVATE INSURANCE COMPANIES PAY. I WILL STOP FOR NOW, BUT COULD GO ON FOREVER THIS IS TWISTED.

POST SCRIPT FROM WEESIE, WHO PAYS 96.00 FOR A BRIEF VISIT TO A DOCS OFFICE? MOST OV COPAYS COST THE PT 20.00 TO 30.00 IF THEY HAVE INSURANCE. ALSO, AT OUR CLINIC, WE SEE A FAIR NO OF PATIENTS WHO HAVE NO INSURANCE AND WE EITHER SEE THEM FOR NOTHING OR WE GIVE THEM A VERY REASONALBE REDUCTION FOR THEIR CARE. IS WAL MART GOING TO GIVE FREE CARE OR REDUCE THEIR 65.00 FEE TO HALF OR LESS?  IN OUR COMMUNITY WE HAVE A FREE CLINIC WHERE DOCS VOLUNTEER THEIR TIME EVERY WK TO SEE UNINSURED PEOPLE AT NO COST, WE ALSO SEE THESE PTS AS WELL.  YOU ARE ALL OVERLOOKING THE COMPASSION AND DEDICATION OF DOCS TO HELP PEOPLE EVEN AT NO COST.  WE GOT PAID TWO-THIRDS LESS TODAY FOR THE CARE WE GIVE THAN WE DID 15 YRS AGO, AND THAT'S NO EXAGGERATION OR LIE, I WISH IT WAS.  MY DOCTOR IS 58 YRS OLD AND IS SO FRUSTRATED AT THE ABILITY TO COVER HIS OPERATING COSTS HE JUST WANTS TO GIVE UP.  WOULD YOU LIKE TO HAVE YOUR SALARY CUT LIKE THIS, I DON'T THINK SO.

I'VE BEEN WAITING OVER 40 MINUTES FOR MY BLOG TO POST, WHEN YOU SAY YOUR COMMENT WILL APPEAR SHORTLY, WHAT IS YOUR DEFINITION OF SHORTLY?

JUST IN CASE ANYONE HAS READ BY LAST TWO POSTINGS ABOVE, THE INSURANCE COMPANIES LOVE THE FACT THAT THEIR SUBSCRIBERS GO TO THE SELF-PAY MINI CLINICS INSTEAD OF SEEING THEIR OWN DOCTORS BECAUSE THE INSURANCE COMPANY DOESN'T HAVE TO PAY FOR THE SUBSCRIBER'S CARE WHILE STILL COLLECTING THEIR OUTRAGEOUS PREMIUMS.  IT WILL END UP SAVING THE INSURANCE COMPANIES ALOT OF MONEY MAKING THEM EVEN RICHER.

IN ANSWER TO WEESIE WHO PREVIOUSLY POSTED.

ALTHOUGH I SHARE YOUR RESPECT FOR THE AMERICAN HEALTH CARE SYSTEM, I DISAGREE AND TAKE OFFENSE TO YOUR COMMENT ABOUT THE "UNDER-EDUCATON "

OF NURSE PRACTITIONERS. I HAVE SPENT OVER 25 YEARS IN NURSING. I HAVE 8 YEARS OF COLLEGE AT THE GRADUATE LEVEL. I HAVE TAKEN CARE OF PATIENTS FOR THE LAST 1O YEARS IN A MID LEVEL PRACTITIONER ROLE. A GOOD HEALTH PROVIDER, WHETHER PHYSICIAN, PA OR NP, ALWAYS KNOWS THEIR LIMITATIONS. THERE IS NO SEARCH FOR POWER...JUST GOOD HEALTH CARE. PLEASE REMEMBER THAT THE NEXT TIME A PA OR NP IS THERE FOR YOU IN THE ER, IN A PCP OFFICE , OR MAYBE AT THE SCENE OF AN ACCIDENT.

policymatters.net

"Using information technology these clinics might be a good option of expanding healthcare to the villages and distant areas. With healthcare being on the top of the list for the new administration; mini-health clinics, telemedicine and self-care models might be good options to consider for health care reform."