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Healthcare reform is a perennial topic because it touches everyone. We talk about the various ways that healthcare is delivered and paid for. We also look at the cost drivers.

  • Causes of high medical costs
    • Some is the mystery cost disease that medicine and education have
    • Limited numbers of doctors
    • Medications
    • Hospital service fees
    • Fee-for-service
    • Price opacity
  • Payment methods
    • Single payer (second/third party payer systems)
    • First-party payer
    • First-party payer with catastrophic care insurance
    • First-party payer with catastrophic care insurance and a required HSA
    • Second-party payer with first-party contribution (Kaiser)
    • Third-party payer
  • Dealing with the doctor shortages
    • The doctor training system
      • College (biology)
      • Medical school
      • USMLE
      • Residency
      • Continuing education
    • There are limited residency spots
    • Even doctors who are otherwise qualified may not be able to complete training
    • Licensing a doctor is like licensing a driver
    • Demand gets higher, AMA does not have an interest in increasing supply
    • Other types of health care providers
    • DO - Doctor of Osteopathy (not that different)
    • PA - Physician’s Assistant (pretty different, no residency, 1-2 less years)
    • NP - Nurse Practitioner (much less training, licensing question pool is short and public)
    • PA’s and NP’s are trying to get the right to form their own practices
    • We should recognize the continuum of training
    • Some places are starting to have Assistant Physician or House Physician roles. Trained doctors (all of medical schooL) without residency
    • Solutions:
      • Increase residency spots, funding is an issue - self fund?
      • More Assistant/House Physician laws
      • Create a system that recognizes the differences in training rather than treating it as only one of two levels. Allow capabilities in accordance with the training and experience.
      • Licensing through testing at least partially tests test-taking skills rather than medical skills. Could we take a more comprehensive look?017-HealthCareReform-Part1017-HealthCareReform-Part1017-HealthCareReform-Part1


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