OT: health care was: (UTOPIA) Tax Alert : Stop 150% tax pledge increase

Nicholas Leippe nick at leippe.com
Mon Apr 21 10:52:11 MDT 2008


On Friday 18 April 2008, Carl Youngblood wrote:
> There's another wrinkle to all this, however (actually there are
> probably many more wrinkles).  There are many procedures that can only
> be performed in hospitals, which also have policies of their own.  So
> even if your doctor wants to offer his/her services at private rates,
> it may not be possible in the hospital.

I've thought about that issue. My best idea to solve that problem would be for 
hospitals to exit the medical process--become mere facilities providers, and 
allow doctors to lease the use of facilities/office space/procedure 
rooms--rather than employ the doctors directly.

This could potentially solve many issues. Hospitals, would not be liable for 
any malpractice--that would be directly on the doctor's own head--where it 
should be. Same as for the nurses, which would be staffed by the doctors 
themselves, not the hospital, or at the very least hired to the doctors on a 
per-job basis--thus their actions and liability is via the doctor and not via  
the hospital. Thus there would be no giant organization to hide behind for 
any medical professionals, and there would be incentive for doctors to 
employee good nurses, and nurses, who are in the potentially best position 
for visibility, could choose to work for the best doctors--thus the cream 
more obviously rises and you know how good a doctor is by the company they 
are able to keep as well. Maybe they could do "satisfaction awards" like in 
other industries--anyone can give food ratings, but do we have nurses rating 
doctors and doctors rating nurses? That would be cool to see a plaque on the 
wall "doctor rated best to work for" by the nurses association, etc.

Also, this could provide obvious, direct competition. Two competing doctors 
could have adjacent offices rented out in a hospital, rates clearly posted, 
and all who entered could see their options.

Additionally, if a doctor does a procedure that requires in-patient care, 
since the doctor is not employed by the hospital, the option to rent a room 
there, somewhere else, or have a nurse under his employ come to your home for 
recovery, is a much more open decision. There is no 'hospital' required to 
release you--you are always free to employ the care services as you and your 
doctor see fit--not at a hospital's mercy (and billing mercy) until they say 
you can go.

This again brings competition into the mix--if they want you there, they're 
gonna have to charge less than $30 bucks for an aspirin to convince you, 
otherwise paying for the doctor's nurse to visit you at home begins to look 
like a much more cost effective choice. Additionally, if they want doctors to 
stay and rent their facilities, they need to make it cost effective as well. 
If the hospital in the next city over charges less to rent their O.R., 
doctors could freely choose to use those facilities instead--again, 
competition.





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