Viable healthcare reform is unlikely with Democrats in power. Being ideologically committed to populism, they will not be able to tell the people what they will have to hear and accept to make any improvement in our healthcare system.
No healthcare reform package can succeed without establishing a firm limit on the publics responsibility to pay for individual healthcare services. Everyone cannot have everything they want regardless of their ability to pay for it, but setting limits is anathema to populism. Along with public-responsibility limits, the reform package must contain federal-level tort reform. As long as doctors are presented with the choice of saving the country money or risking your home and estate, doctors will continue to order everything for everyone. Why not: Someone elsethe rest of usis paying for it. But Democrats are heavily beholden to the plaintiff bar, so tort reform is unlikely too.
We have decimated medical education programs and primary-care physiciansfamily and internal medicine physiciansover the past two decades with managed care and other cost-cutting measures to the point that even if everyone suddenly had insurance coverage, there are not enough physicians to care for them. Massachusetts is in the midst of learning this hard lesson. Finally, all the information technology hype from both sides of the aisle is completely bogus. You dont improve medical practice productivity by turning the most expensive resource in the system into a data entry clerk.
Ronald A. Hellstern, M.D.Medical Practice Productivity ConsultantsDallas
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