John,As an employer with a self funded insurance plan I would beg to differ with you. We know you are a doctor and thus you believe that the problems of healthcare could be resolved easily by letting healthcare professionals do what they do best.A good doctor is not a good businessman and or a good manager.You may perform your services for free but that does not mean what is true for you is true for all...I remember meeting with a group of doctors in our town and and then another town where we had a facility and laying out a new idea with them. I wanted to develop a "gatekeeper" program. An employee would pick a primary care physician and this physician would then be responsible for monitoring and directing the patients care. I then put my money where my mouth was by saying that we would pay twice the usual and customary rate for a visit that the employee had with their primary care physician and I expected the primary care physician to spend twice the amount of time with the patient. I then also wanted the patient referred to a specialist when the protocol required it...rather than four five office visits to the primary physician before a referral was issued. I also expected our employees to be able to see their primary care physician within 24 business hours of an appointment being made.(To limit emergency room visits for non emergency care).At the time I had employees going to a specialist, who may have treated them in the past for something in their speciality, to now be treated for something well outside their specialty...and thus I was paying a heart specialist to treat a sinus infection.Guess what, it worked, but it took years. The employees adapted real quick...the medical community was much slower. Within three years we cut our healthcare costs dramatically, just by a little economic conditioning. We got employees to develop a relationship with a primary care physician, we got employees to go to their doctor earlier rather than later, and we got the doctors to "slow" down.While our costs for primary care physicians dramatically increased our costs for life threatning diseases dropped dramatically.We also sponsored health fairs and monthly seminars and screenings...all of which were paid for by the employer...Oh, and this employer is an apparel manufacturer where most of the employees lack college educations and for the most part never had access to regular healthcare, and the last price increase this manufacturer has been able to pass on to its customers occured in 1996; and this is due to a true free market.I do not agree that employer provided insurance is the issue, it can be, but is not always the case. Just as I do not believe that healthcare providers can solve all of their own problems, they can, but not in every case.TAO
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