Even the NY Times has an article showing the folly of the proposed ( and present ) healthcare system

http://tinyurl.com/lh3m4u
A Doctor by Choice, a Businessman by Necessity
By SANDEEP JAUHAR, M.D....I recently started moonlighting at a private medical practice in Queens....how different this job is from my regular one, at an academic medical center on Long Island. For it forces me to think about how much money my practice is generating.
A patient comes in with chest pains. It is hard not to order a heart-stress test when the nuclear camera is in the next room. Palpitations? Get a Holter monitor — and throw in an echocardiogram for good measure. It is not easy to ignore reimbursement when prescribing tests, especially in a practice where nearly half the revenue goes to paying overhead.
Few people believed the recent pledge by leaders of the hospital, insurance and drug and device industries to cut billions of dollars in wasteful spending. We’ve heard it before. Without fundamental changes in health financing, this promise, like the ones before it, will be impossible to fulfill. What one person calls waste, another calls income.
...a friend who dropped out of medical school 20 years ago to pursue investment banking...often wonders whether he should have stuck with medicine...“It is a good time to be a doctor,” he said yet again, as I recall. “I’d love a job where I didn’t have to constantly think about money.”...the reality is that most doctors today, whether in academic or private practice, constantly have to think about money. Last January, Dr. Pamela Hartzband and Dr. Jerome Groopman, physicians at Beth Israel Deaconess Medical Center in Boston, wrote in The New England Journal of Medicine that “price tags are being applied to every aspect of a doctor’s day, creating an acute awareness of costs and reimbursement.” And they added, “Today’s medical students are being inducted into a culture in which their profession is seen increasingly in financial terms.”...obvious consequences for the public: ballooning costs, fraying of the traditional doctor-patient relationship. What is not so obvious is the harmful effects on doctors themselves....trained to think like caregivers, not businesspeople. The constant intrusion of the marketplace is creating serious and deepening anxiety in the profession.
Not long ago, a cardiology fellow who had been interviewing for jobs came to my office, clearly disillusioned. “I was naïve,” he said. “I never thought of medicine as a business. I thought we were in it to take care of patients. But I guess it is.”
...there has always been a profit motive in medicine. Doctors who own their own imaging machines order more imaging tests; to take an example from my moonlighting work, a doctor who owns a scanner is seven times as likely as other doctors to refer a patient for a scan. ****This is not completely true. A doctor can perform a scan IN HIS OWN OFFICE but cannot refer his patient to an outside imaging center which he owns.**** In regions where there are more doctors, there is more per capita use of doctors’ services and testing. Supply often dictates demand....so many hospitals and doctors, especially in large metropolitan areas, are in financial trouble. More and more doctors are trying to sell their practices, or are negotiating with hospitals for jobs, equipment or financial aid.
At hospitals, uncompensated care is increasing as patients suffering from the economic downturn lose health insurance. Admissions and elective procedures — big moneymakers — are declining. Hospitals are cutting administrative costs, staff and services. “More and more you’ll see people in medicine get M.B.A.’s,” a doctor told me at a seminar, in a prediction borne out in my experience. “We are in a total crisis, and I don’t know the answer.”...As a loyal member of my guild, I want to see doctors exert more control over our financial house....Most doctors went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income. There is a palpable sense of grieving. We strove for so long, made so many sacrifices, and for what? In the end, for many, the job has become only that — a job.Until I went into practice, I never had an interest in the business side of medicine. I sometimes yearn to be a resident or fellow again, discussing the intricacies of a case rather than worrying about the bottom line. “You need to learn a little of the private-practice mind-set,” a doctor friend recently advised me. “You can’t survive with your head in the clouds.” But something fundamental is lost when doctors start thinking of medicine as a business. In their essay, Dr. Hartzband and Dr. Groopman talk about the erosion of collegiality, cooperation and teamwork when a marketplace environment takes hold in the hospital. “The balance has tipped toward market exchanges at the expense of medicine’s communal or social dimension,” they write.... It is a battle for the soul of medicine.****At one time, the practice of medicine in the U.S. baffled economists because it seemed to obey the law of "the justified price." According to this, each doctor was entitled to a certain standard of living and if the number of doctors doubled while serving the same population, they each had to double their prices. Of course, in this environment, once the desired "justified" standard of living was achieved, their practice could be conducted with charity and without regard for income maximization. Before WWII, I don't recall any mention of "health insurance", even in an urban area like New York City. Things were affordable because both the family doctors and even the specialists they referred to developed relationships with their patients and charges were "accommodated." Things have gotten more technical and complicated but the advent of employer-sponsored health insurance, occasioned more by wage controls during WWII than any other consideration, obsoleted this pleasant system. Rural dwellers recall even more nostalgia about their doctors (all of whom, by the way, routinely made house calls.) The author of this article pines for his days as a fellow. That's what's inapposite about the administration's looking to the Mayo Clinic as a paradigm. Even attending physicians at such places as Mayo and the Cleveland Clinic function more as fellows with base salaries, little to no paperwork, medical malpractice assumed by the institution and, above all in the two case cited, the prestige of serving time at Mayo or CC, more than made up for any deficiency in income compared to what could be exacted in separate, private practice elsewhere. I'm sure Obama would cite the costs of a Catholic education ( with unpaid nuns and priests)as a goal except that the teachers have a union that makes large contributions to the Democrats. Are doctors totally helpless and vulnerable? (A consequence bad for the nation since early retirements and fewer newcomers will depopulate healthcare at the same time as the needs are increased.) Probably not. More diagnostic tests and referrals out to minimize the risks of malpractice lawsuits. Doctors will spend less time with patients and do less. (An example: for years, I had my earwax removed by my doctor's nurse or medical assistant, presumably at no cost beyond the standard office visit. Most recently, I was referred to an otolaryngologist for the same function at a list price charge of a couple of hundred dollars. The only difference was that the specialist used a pick to remove the wax while the nurse used to use water and a syringe. Why should the GP continue to spend time doing something that took some office time and didn't bring any remuneration?
The best thing to do is to hark back to the free market as much as possible and restore the patient-doctor relationship to whatever extent possible. The best results have been achieved in eye surgery where increased quality AND PRODUCTIVITY has reduced cataract operations, for example, from $1000s to $100s and, of course, cosmetic surgery, refractive surgery, dental surgery and veterinary medicine where the "benefits" of insurance are largely unavailable. Of course, breaking the silly link with employment and reforming the tort law system should be the first two things to address. ****