Those are good ideas! Tort reform is an absolute necessity as the fear driven model of medical practice is not working for doctors or patients.

Two questions:
1. If we took all the payments that we are are currently making for health insurance (individuals, business and government), how much would that amount to?
2. Is it possible that we already are paying enough money to cover everyone if we stopped wasting so much on unnecessary care (i.e that driven by fear of suits)?

Obviously, we all need to discuss this very thoroughly if there are to be any productive changes in the current system.

1. If you pay an internist $X/hr, what is to prevent her from seeing 1 patient per hour? If you then require Y pts/hr, that’s how many she will see. Is this an improvement?
2. You don’t see a need for a multiple of greater than 2 between the lowest and highest paid specialties (presumable this is net of practice costs). If a senior student has the choice of earning $200/hr after a 3 year primary care residency, or $250 after a decade of post-grad training to become a pediatric cardiac surgeon, there will be a lot of dead babies.
3. I agree completely with balance billing, tort reform proposal, and the need to scrap RBRVS.
4. The answer to the unfunded mandates forced on the profession is not to get govt to pay us. The answer is to remove the mandate. Bring your own damn translator, or accept the fact that we will do our best under the circumstances.

Government “oversight” has gotten us into this predicament. The answer is to get the govt out of the medical business, not further into it. I’m old enough to remember life before Medicare and Medicaid. The streets of America were not not filled with the corpses of people who needed medical care but could not get it. Docs worked in charity clinics and waived fees for poor folks and people got the care they needed. It wasn’t perfect, but better than the system we have to live in today.

Actually the pediatric cardiac surgeon has much lower overhead since much of his time is spent at the hospital and OR where another entity(the hospital) pays rent, staff costs, etc. So $400/hr is significantly more than double $200/hr actually in his pocket.

JB is exactly right. The problem isn’t that we have the wrong physician payment system. The problem is that we shouldn’t have a physician payment system. Let individual doctors and individual patients find the price and the payment scheme that works best for them.

Does anyone remember the free exchange of goods and services through mutually voluntary transaction? They used to call it capitalism. It’s much maligned but all other systems are worse.