Here’s the plan: 1. Limit care to the elderly by destroying Medicare and forcing seniors into Govt plan. The Govt plan will be weighted toward ages 15 to 50.

2. Reduce the number of specialists and replace them with primary care doctors, whose fees are lower.

3. Limit and reduce the size and services of hospitals and replace them with community health centers.

4. Ration health care by age and prognosis through Comparative Effectiveness Research and a British-style health board.

The signs are already there. If you don’t like this plan, make your representatives in Congress accountable.

Can’t “decline in those choosing primary care of over 50% over the past decade” be attributed to an even more drastic decline in medical students seeking to open up primary care practices.

“The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP).” – according to USA Today.

I’d say the decline in primary care options is the reason the numbers show less people are choosing primary care. You are very right to point out the glaring need for “subsidies to primary care education.”

Physicians, especially anesthesiologists are already cut to the bone on reimbursement from medicare and medicaid. Anesthesia reimbursement is less than 35% of commercial insurance reimbursement while other specialties get 80%.

Limiting our choices for therapy, diagnostic tests, invasive monitoring LIMITS our ability to provide safe anesthesia care for sick elderly patients. During the past 3 decades anesthesia care in the united states has become the safest in the world. I routinely care for patients in their 80’s and 90’s for abdominal aortic repairs, carotid repairs, vascular endografts and vascular radiology cases. Most of these patients require extensive diagnostic tests perioperatively to determine their best anesthetic care…..They require echocardiograms, stress tests, cardiac catheterization and many receive intraoperative cardiac physiologic monitoring (Swan Ganz catheters and arterial lines) to allow me to optimize them using pharmacologic and fluid management.

Having government intereference “ding” me for using more monitoring and more perioperative diagnostic tests will have a detrimental effect on my patients’ outcomes….by preventing me from using an armenentarium of diagnostic information.

Limiting care and rationing care will be the equivalent of taking giant steps back in time.
Government panels to determine best practice (being done by non medical non specialist panelists) will be devastating to our healthcare to both patients and providers.

Talk of the threat of medical malpractice claims and awards as a major reason for the high cost of medical care is nothing more than another way to derail any real health care reform. I can’t understand why no one is focusing on the psychological effects that medical insurance company practices have on the way doctors practice medicine. I have several examples of doctors “downgrading” medical findings and ignoring positive lab test results due to feared repercussions of insurance companies delaying their payments or because the reimbursement from the insurance company wouldn’t fully compensate them for the time they would need to spend to analyze my condition. I became disabled as a result. The experiences are interspersed in my portrayals at http://doctorblue.wordpress.com.

I never filed a warranted medical malpractice claim because I didn’t have any money left after spending it fruitlessly on doctors and tests to get well. Even the few attorneys who take cases on contingency rightfully require the injured party to pay thousands upfront for expert witnesses, court costs, administrative fees, etc. I find it ironic that once a party is made disabled, jobless and broke at the hands of doctors he paid, the justice system prevents him from filing a claim. We should be looking for ways injured parties could bring class action suits against medical insurers for failure to oversee that their providers provided the medical care promised in SEC filings and patient contracts.

Excellent points, as usual. However, the way medical compensations work right now, the overuse of procedures is encouraged regardless of the evidence for them improving quality of life or increasing the life span. People get very expensive heart catheterizations right and left even though studies suggest that conservative treatments are no less effective. Anesthesiologists are paid more for sitting in the corner of the ER reading the Wall Street Journal than surgeons do who operate for 8 hours straight in the same ER, which is absolutely ridiculous. Specialists who are artificially overpaid under the current system should be paid less, and primary care should be paid more. That is the only solution which will bring more physicians into the primary care. Right now insurance pays you very little to think, but a lot more to stick something into the patient. The primary care doctors are overworked and severely underpaid.

Everyone has an opinion about health care reform based on their access to the system. 85% of people say they are satisfied with their healthplan – but 85% of the people don’t use much health care in a given year!
The current health care system is badly broken and the 1000’s of pages of proposals ( few of which have even read!)being introduced will not do anything but create a bigger more expensive mess. Imagine adding another 1000 pages of regulations to the IRS- its the same unmanageable quagmire.
Idea! Design a clean solution – prove it works in one state and then duplicate it 50 times.

I am the sole remaining practicing Internist of 23 years from a group of 7. Four of my partners gravitated to hospitalist services and the remaining two are making a decent living as administrators. Therein lies the problem. Direct 24/7 retainership medical care is the least reimbursed and therefore, I am duty bound to tell prospective medical students to avoid my field and to inform my patients that when I retire, there will be no physicians to take my place. The propsed reform to place me in a ” medical home” and to subjugate me to provide data points at my expense for hungry IT data harvesters is doomed to fail. Somehow, both the politico and medical associations have missed the point that it does in fact boil down to the doctor patient relationship when it comes to the enactment and practice of healthcare. So it does give me some satisfaction to see the medical bureaucracy fall on their faces when they realize the worker bees are gone. Remember, the “doctor” side reimbursement was increasing over 10% per annum and “slowed” to 6.5% last year. That is why our cuts occurred…question is…who got the raise? Well, many of us physicians were too dumb to realize how facilities tied to hospitals, ancillary services, imaging, high end infusion drugs (pharma) became “doctor fees”. I wish more docs cared to change this or at least understood how terribly exploited our patients and direct caregivers have been these many years.