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View Diary: Why is nobody talking about the OTHER Obamacare subsidy? (178 comments)

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  •  More docs/RNs = more competition (3+ / 0-)
    Recommended by:
    marina, Notreadytobenice, KingTag

    A lot of the problems with health costs are because of a lack of competition.

    If doctors had to compete with each other for business, wouldn't costs be lower?

    Trivia: there are 2 industries that are exempt from the anti-trust laws: major league baseball and health insurance companies.

    Cheers.

    Against stupidity the gods themselves contend in vain. Friedrich Schiller

    by databob on Fri Nov 22, 2013 at 05:45:29 PM PST

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    •  I'm not sure law of supply and demand.... (1+ / 0-)
      Recommended by:
      Odysseus

      holds in medical professions. The legal profession has abundant # of J.D.'s and still paying $200-300+/hour at least here in Boston.

      For the Professions, consider Managed Competition as having the best benefits vs. costs for our country.

      I'd like to see managed competition considered for other trades as wells. Major League Baseball players and Major League CEO's come to mind.

    •  It doesn't work like that. In places with (2+ / 0-)
      Recommended by:
      Cardinal Fang, kurt

      an abundance of doctors and especially hospital beds expenditures are higher. Examples: Boston area and that town  in TX that Atul Gawande wrote about (the New Yorker, June 2009).

      What is needed is more primary care providers and fewer specialists. Except psychiatrists — more, many more of those are needed.

      Competition in personal services doesn't reduce prices. Do you really look for the cheapest doctor — or the cheapest barber/hairdresser?

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Nov 23, 2013 at 06:04:23 AM PST

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      •  Actually, we don't need more psychiatrists (0+ / 0-)

        a large part of today's apparent epidemic of mental illness is due to people living in constant economic and social insecurity...if people who wanted them could find living wage jobs that were reasonably secure, there'd be a whole lot less depression. A lot of what looks like mental illness (I'm not saying all, obviously there are plenty of genuine schizophrenics  and bipolars out there) is just a normal reaction to living in very screwed up society.

        What we really need are gerontologists. Caring for elderly patients calls for special training, and when doctors without that training make mistakes, it not only injures elderly patients, it sends Medicare costs through the roof.

        "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

        by Alice in Florida on Sat Nov 23, 2013 at 04:37:45 PM PST

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        •  We need both. But Psychiatrists are (0+ / 0-)

          in very short supply. And when someone with a serious disabling mental illness has to wait 6 to 12 weeks between appointments or can't get a hospital bed when the need is very high — as for Gus Creeds — there is a serious lack.

          You denigrate mental illness with your "it's a reaction to a crazy society" dogma. People with serious depression don't get better if you give them a job. Often they can't DO a job. We are not seeing an epidemic of mental illness. Low grade depression in people in ghastly situations is normal and not illness.

          And adequate diagnosticians are of utmost importance as well as close supervision at the start of treatment. we don't have that.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Mon Nov 25, 2013 at 12:47:33 AM PST

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          •  I agree there is a shortage (0+ / 0-)

            of hospitals and psychiatrists, I just thought you were suggesting that there was an epidemic of mental illness--based on the way antidepressants and antipsychotics are being doled out (including antipsychotics being used as an all-purpose remedy), that's what a lot of people seem to think. The overall nastiness of today's society,  the bullying, the insecurity, can push a lot of "normal" people over the edge.

            The real tragedy of psychiatry is how it is practised these days, which may be in part a function of shortage, which is that they spend little time with patients and mostly concentrate on writing prescriptions. It may be onn of the things that pushes doctors away from choosing that as a speciality...that and maybe it's not a great way to make money. Or maybe not many doc's want to be around the mentally ill, just as they don't want to be around old people. Or, given the shortage of general practitioners, they don't like treating people....

            "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

            by Alice in Florida on Mon Nov 25, 2013 at 08:37:30 PM PST

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      •  I know a number of people (1+ / 0-)
        Recommended by:
        Notreadytobenice

        who look for a cheap hairdresser, if not necessarily the cheapest. I am among them, living in a city where it's not at all unusual for a woman (we pay more, you know!) to spend upwards of $100 for a haircut. My hairdresser is a nice, competent lady working in a very dowdy, unfashionable salon, and she charges $35.

        I don't think the comparison is really apt, though. A bad haircut can't kill you (though it might kill your social life for a few weeks). I don't choose my doctors that way, and they are all over the place on price.

        "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

        by sidnora on Sun Nov 24, 2013 at 04:19:25 AM PST

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        •  Do you call around for the cheapest? (0+ / 0-)

          Or do you ask about quality measures? do you even know what to ask?

          Do you ask how often they perform some type of surgery? do you ask about infection rates and other quality indicators before you go in the hospital?

          Do you even research whether the propped treatment has any value at all?

          Nice that you are happy with a mid cost hairdresser but that doesn't mean you shopped based on cost.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Mon Nov 25, 2013 at 01:02:20 AM PST

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