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(Deleted comment)
Jan. 13th, 2010 03:28 pm (UTC)
Yeah, his comment about MA was a cheap shot. However, they DID see a huge jump in wait times when the new insurance laws went into effect -- mostly because already too-few PCPs were now far, far overburdened.

His rates aren't shockingly cheap, but it's pretty obvious he cares about his quality of life, which I'm coming to think is a really good thing. That's the reason people become specialists, not PCPs. It's not about making the affordable part of health care more affordable. It's about making it a humane process.

I go to a doctor that's in a lot of ways like him. She spends an hour per patient per visit most of the time. That's the real revolution. It's the telling insurance companies to fuck off, giving me the refill on my prescription without charging for an office visit just to get the necessary pittance out of an insurance company.

The bit about MRIs? It makes me start thinking that getting one might not end my financial independence for a decade. The normal rate is several thousand dollars. The 2005 Medicare rate for one is just a hair over $500. It's an organized version of walking into a medical center with cash in hand and saying "If anyone wants to give me an MRI and skip the paperwork and billing, I've got money I can hand you today." . . . Doctors gobble that shit up. Nothing like actually getting paid.

He's right about medical software, too. It sucks. Universally. ("Doctor! I've made a machine that can do the work of a hundred men!" "Why have I not heard of it before now?" "Well, it takes a thousand men to operate it.") Doing the bare minimum, and outsourcing the rest to a firm that can put procedural safeguards on electronic records, and do it as their primary focus. This is already beginning to exist.

Sure, he'll get filled up too. But he's making enough of a living that perhaps more than a few doctors next year will become PCPs. Perhaps he'll grow his practice at rates like Qliance (Reuters story) and have a dozen physicians and a few nurses about, all able to spend enough time with patients to actually give decent service.

My optometrist works this way. My primary care doctor works this way. They're seeing ten patients a day, if even, they're relaxed, communicating, and I get a whole hour when I visit. I pay cash, and I think that's sane, considering that the insurance model for preventative care is pretty much the epitome of wrong. Better to just suck it up and realize that investing in one's health directly makes sense, and perhaps implement Qliance-style fee-sharing, by getting the fee low enough, the overhead low enough, so that people are actually paying more than they need for service and having it STILL be super-affordable, so that the few who are sick more often can just get what they need without going bankrupt.

Sure, he'll pay a lawyer. Most professionals do. Perhaps he'll get someone to help his administration -- or more likely, team up with a different sort of professional like a nurse or PA, for things like labs. But likely one person to serve a handful of doctors, or who can run their own independent service while aiding his. An online service set up right, who charges him a flat fee monthly for data storage? Done right, they'd have much of the legal liability, and at a scale that would give them real incentive to do it right. Put security and privacy in the hands of people with a vested interest in doing it and incentive to get it right -- rather than an adjunct to another business. The economies of scale have been shown to work out there time and time again -- you don't hear about data breaches at credit card companies, but you do from analyst's offices at banks, from large merchants, and from all the people who have incentive to keep the data at hand rather than safe. Security also works best when the party who has the ability to mitigate the risk is responsible for it
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