Great commentary. Many of us have been discussing exactly what you said, but you are right about the video clip. It was extremely weak and made me fear that there was not a plan to take on the special interests. I gave them the benefit of the doubt by saying, "Perhaps they are waiting to see what else the people have to say." I think that the posts reveal that it is clear that the public is on to what has been going on and are not going to stand for a "band-aid" as you put it. I proposed on an earlier post that Tom Daschle post another video that shows that our voices are being heard and that a clear plan is being formulated.

The simple plan would be to do away with the private insurance industry, audit the pharmaceutical and industry companies, and put caps on their profits, and let doctors be doctors again. Stop trying to control the way we practice. If patients can shop for their doctors, then competition should take care of any potential greed or quality problems that may arise. Patients are the best referral system a physician can have. Happy patients tell their friends, and unhappy patients tell anyone who will listen. There is no need for so much regulation on what tests or procedures doctors order. What happened to doctors was not really regulation, it was just a way to create an illusion that something was being done to contain healthcare costs. The result was less service for more money, and the corporate world made out like bandits.

I like your network TV/internet open forum discussion idea. I was sad that I overslept and missed the conference call that was offered the day before this blog was started. I had a lot to say. There are a lot of people on this blog with great ideas and various backgrounds who should be contacted as consultants to formulate a plan. I am sad to hear that as a volunteer you felt overlooked. I hope it was a mistake. You really hit the nail on the head as far as the problems that need to be fixed.

You are so right about pride and dignity. They are terms that are becoming foreign in this country in all areas. It's sad. I find it amazing how hard it is to get my own son to truly understand the importance of possessing these qualities even when we talk about it on a daily basis. Imagine those who never hear it?

You are incorrect about who makes the decision to do surgical procedures. The surgeon who does the procedure is the consultant who decides whether surgery is necessary and makes all of the arrangements for the surgery to be done. There is no middle man decision maker there. The surgeon is responsible for both the specialty consultation as well as the specialty surgery.

There are a lot of doctors who would volunteer if the risks of malpractice suits were minimal and if they solved the paperwork problem of our current system. With insurers running the show, there is no real way for the AVERAGE physician to have the time or the money to be able to afford to volunteer regularly. My fellowship director created a program called "Operation Walk" which provided free joint replacements to people with no resources. They have helped people all over the world in third world countries and even in our own version of a third world country, the underserved population of Los Angeles. Industry donated the implants, and former patients from the Arthritis Institute's practice donated their walkers and knee immobilizers that they were no longer using for the benefit of patients who qualified for the program. Dr. Dorr has gotten many of his contemporaries across the country to take other trips with their teams. Dr. Dorr one a Humanitarian Award from the American Academy of Orthopaedic Surgeons for his work. I believe there are doctors in other specialties who do similar work out of the kindness of their hearts as well. It is amazing though, that they can get like 40 joint replacements done in just a few days in a third world country, and in some places in this country, it would be impossible because of the red tape.

I think the person posting meant international competition.

You should be commended for being so loyal to your employees, but unfortunately, you are still being ripped off by insurance companies. With a government system that works fairly, you could still offer benefits to your employees through the government program, but they would be more affordable to you. Obama's original plan was that if people liked their insurance, they could keep it. As a physician who sees insured patients not getting what they paid for, I 'd like to see this clever new administration surprise us with something the government can provide that actually works well. I think the more involved the American people are in the process, the better chance we have.

You are right about the outrageous amounts of money charged for things that just simply should not cost that much. Robert commented that b setting prices nationally you risk not having services available in the less desirable parts of the country. This may be true, but I do not think that has anything to do with cracking down on the greed in the healthcare industry. Physicians have little control in the health care arena, and that is why to lower costs legislation has been aimed at controlling how much doctors make and how many services they can offer. This is the real threat to not being able to attract physicians. It won't even be just a problem in less desirable locations, it will be a problem nationally. Setting prices nationally probably won't work, but national and local averages of costs should be made available to health consumers so that they can have a base of what is fair market price for certain services. If you eliminate the greed and give back power to the people who actually deliver the healthcare, then a competitive market should control costs. If those providing health care services begin to get greedy, then they should be subject to regulation as well. I think that it is appropriate to pay higher salaries to doctors who provide care in less desirable parts of the country.

The government should provide coverage that is essentially credit that can be used for healthcare services of the patient's choice. The amount of credit given should be based on the need for coverage. In other words a young healthy patient should not have to contribute as much to the system as an older person with more medical needs. All contributions should be affordable based on the patient's ability to pay of course. This pooling of contributions is what would be used for health coverage credits, which in turn can be used to pay for health related services of the patient's choice. That way you bring competition back into the mix. Patients should be able to shop for doctors and doctors should have the freedom to treat the way they choose without some insurance company telling them what services are appropriate. It will take some work to figure out a balance between what is a reasonable amount of credit to be available based on ones contribution and needs, but I think this would create an opportunity for more money (i.e. credit) to be available to pay for services than an individual could save on their own for healthcare.

Obviously that money pooled would need to be liquid enough such there there would never be a freeze on payments for services, but should be able to be invested in a way that it grows by collecting interest over time. That way the system does not create a deficit and in theory could slowly grow. I think that before this could be implemented, there needs to be legislation to better regulate health service-related capitalism (i.e. the amount of profit that is reasonable). I mean even pro athletes have caps. Why not CEOs and corporation stockholders in pharmaceutical and industry companies?

If the system were not such a pain in the neck, then you would have less doctors leaving the field and more doctors (and nurses and other healthcare providers)) entering the field. Also, if you fix the system so that healthcare workers do not spend 80% of their time doing paperwork to please the insurance companies just so they can get paid their peanuts, then you will have plenty of doctors (and nurses and other healthcare providers) to care for everyone. It is not acceptable to NOT support a system that provides healthcare for everyone simply because you think there are not enough doctors. That's like saying, "Sorry. Anyone who is not rich does not deserve to be cared for when they need it." Average people can no longer afford healthcare, and that is unacceptable. This is due to the greed of private insurers, pharmaceutical and industry companies, and even some hospital administrations.

I think there are certain things that a patient can enter into a health record. Perhaps there would be something that designates whether it is patient-entered or physician-entered information. If the patient enters it, it would be the same as if you are taking a history. If a physician enters it, then it would essentially be an exam finding, an interpretation or assessment of clinical information, a diagnosis, or a treatment plan. Patients should obviously not be able to alter information entered by physicians, nurses, or other healthcare providers. However, I have had more than a couple of patients say that what entered in their health record by a doctor or nurse, or therapist, etc. was incorrect. There should be a way for the patient to document and dispute the information in their records. It does not change what is already in the chart, but it makes a note of a potential error. Patients would need to be encouraged to periodically go over their information with their doctors in order to make sure their records are as accurate as possible.

Having patients fill out questionnaires to give a history definitely saves time for the physician in the exam room if the patient has already entered most of the history. I have a FileMaker Pro system that I use, but have not gotten to where it is user-friendly enough to have patients use it. I am looking into using things that are familiar to people like using a stylus rather than typing and using check boxes and drop-down menus.

I do very detailed documentation for various reasons. Billing is one of them, however, with a good electronic records system, it is not really necessary to ask the patient to provide their entire health history if it is already in the system. Our clinic's system provided this information, but it did not have the capability to generate clinic notes in any way. All the notes were dictated. I personally can't stand dictating, especially since the people doing the transcription to frequently transcribe the wrong thing. I came up with my own system to avoid using the rotten one purchased by the clinic. The hospital's system was much better.

That's another thing... most places I have had any interaction with have separate systems for the clinic and the hospital. Sometimes they are compatible and sometimes they are not. It seems silly to not have access to hospital records when you are in the clinic and vice versa or that you have to go from one program to another trying to extract information that you need to make a comprehensive assessment.