Is this not something that competition and free markets could help? For instance, you can not open another hospital in this county without getting a certificate of need from the folks in Tallahassee. A lot of people in nowal are unhappy with hospital care in the area, and there is a place that has expressed interest and has financing to open up another health care hospital like facility. Yet without this certificate of need, they are prevented. Of course, the argument is that this is protecting the current hospital, but why is it that they enjoy this sort of monopolistic protection?
I wonder what "hospital like facility" means. Could it be a hospital without an ER? If that's the case, then the "protection" you refer to is in place to keep the playing field level. An ER is the most expensive, money-hemorrhaging endeavor in healthcare -- it must be staffed 24/7 by doctors and nurses, have a full range of expensive diagnostic equipment and medicine, and many of the people that utilize the ER are indigent. As we all know, prices on other services are raised in order to underwrite the cost of the ER that a hospital (not a surgical hospital or other outpatient or limited inpatient bed facility) is legally required to have and staff in a certain way.
The "hospital like" facility can underbid contracts with insurance companies drastically because they are operating without the burden of the ER (or ICUs). This leads insurers to contract with the secondary facility, and then offer the primary hospital a take it or leave it contract. The secondary facility is able to deliver good quality care and service at these rates, while the hospital quality suffers...more and more paying patients with choice go to the secondary facility, and then the community as a whole loses because there is no where to go for emergencies, for the major cardiac events and strokes and severe illnesses that require intensive care. While I generally agree the market is the best regulator, sometimes the "protection" isn't so soviet. The days of the corporate statesman are over, and Tallahassee does have to make sure we have access to high level care. Trust me, when Sacred Heart got it's certificate of need they had to agree to a number of beds, an ER, and JCAHO accreditation that requires all sorts of inefficiencies and redundancies that their financial people would have preferred to leave off. How fair would it be for the secondary facilities to be able to open up without the same burdens? Why would anyone ever make an initial investment to build a hospital in a medically underserved area if Florida began doing such things?
Competition and free markets are great. The real problem is that all the solutions being batted around by politicians regarding healthcare are too simple to tackle such a complex industry. Few people proposing solutions even understand the ways money flows through the system (or the ways it's diverted). Previous solutions have made things worse, and conservatives have actually put in place Soviet-era cost controls because they did not understand the implications of enacting a relative value scale for Medicare reimbursement.
You asked a few questions to open thread --
So if you are a Doctor, do you think the government should be able to tell you what to charge and whom to see as a patient?
That is precisely the system we have in place today. Doctors can charge whatever they want, but they are only paid Medicare's RVS or some regional Medicare based percentage. All doctors are paid the same, whether they are the best doctor or the worst, whether their office is pristine or filthy, whether they have a courteous staff or have to hold for 20 minutes just to get an appointment. Doctors can "fire" a patient if they do so in writing for good cause and give them a period of time to find a new provider. This opens the physician up to all kinds of lawsuits, so they have to be very careful and only do it as a last resort.
If you are healthy, should the government be able to force you to buy health insurance?
No, but the front-runners in both parties advocate this approach, and it doesn't seem to be hurting them in the polls. I still believe the best approach is the one advocated by George W. Bush -- the move to consumer driven basic healthcare vis a vis healthcare spending accounts and high-deductible/catastrophic insurance coverage. Unfortunately, the Bush administration never did anything to make this happen. They were too afraid to go up against the insurance and pharmaceutical lobbies that profit by our current system where market forces play no role in utilization decisions.
Is it fair that you pay a set premium on health insurance when you live a healthy lifestyle, yet your neighbor, who does not, pays the same amount?
Is it fair? What is this, sixth grade? Is it fair that people are allowed to have guns in this country so people get shot and ER's have to pay for all sorts of expensive equipment used to treat relatively rare gun shot wounds and therefore the costs of being prepared for GSWs is picked up by me and my health insurance even though I'd never have a gun? It's not fair, but the right to bear arms is a liberty I'd never dream of taking away from a fellow American that chooses to exercise that right.
The role of government is to protect life, liberty, and the pursuit of happiness. Nothing in there about universal healthcare, but if that is something the people want the government needs to get all in or all out. Either let the system be totally free market with a Medicaid safety net (and doctors shouldn't be forced to accept Medicaid, so that the real costs of it will be reflected in numbers reported by the government), or let the two systems of Canada and England develop here. This current hybrid system we have is too labyrinthine, and leaves so much room for the few who understand the system to manipulate the many who don't into enacting more policies and regulations that enable them to limit competition and extract even more money from the healthcare system that has nothing to do do with health.
