To be fair, there are plans floating around Washington for MSAs if not for some of your more radical suggestions. Bush has supported them. McCain has them as part of his health proposals.

The first problem is that there's no way the public would put up with dissolving the FDA. The political left would hit the roof and they have too much power now, so it's never going to happen.

As for regulating doctors, that already is mostly private. The AMA and the various medical boards and boards of specialization are essentially private groups. And realistically doctors are the one part of the system that basically isn't broken. They work hard, do a good job and their pay is pretty reasonable overall.

The main problem remains the health insurance companies and you don't really address that problem. Regulatory requirements have certainly played a large role in encouraging them to engage in their rather excessive practices, but what evidence is there to suggest that deregulating them would make things any better?

Dave

Interesting thoughts. I can tell you from personal experience that the MSAs have not worked for me. Sure it lowers the cost of the total premium, but your providers are not going to lower their fees just to accommodate your plan. Our MSA was totally wiped out with one visit, and that was for my daughter. My husband and I never even got to use it.

Dave hits the nail on the head with the comments on the insurance industry. Even if you have insurance, that's no guarantee that they will cover you. They're rather adept at denying claims. After all of these years, I'm starting to think that paying premiums was throwing my money into the wind. I could have saved all of it in aggressive accounts and used the savings for any medical catastrophe.

New providers could offer alternative healing programs.

You mean like quacks? "Alternatives" to science? "Alternative medicine"--no thanks, I'll take scientific medicine.

A multi-tier system could develop in which common maladies would be treated by less expensive, minimally trained providers. For serious cases, specialists would receive referrals from the lower tier.

Who decides what is common and what is serious? Is there a committee? Common symptoms can be indicative of serious conditions. It is difficult at times for a trained experienced doctor to make a diagnosis. So, how do these untrained people recognize this without a complete understanding of a patient's medical history?

In Zambia, I have been treated by doctors who would not be eligible for licensure in the U.S. because their medical training, received in Zambia, does not meet U.S. standards.

Thanks but, I think I'll keep the standards we have here.

Now, under the above described system, many folks would ask, how can we be sure medical professionals would be qualified to treat patients? Certainly, medical schools would still provide top quality training for practitioners otherwise their enrollments would decline causing economic stress to the larger university.

Last I heard, diploma mills didn't have this problem. Oh, but then that's why we have licensing!

Again, many would ask, how would we know if our drugs were safe or not? The answer is the same as the one for ending licensure. Private testing organizations like the Underwriters Laboratories would spring up to test drugs for safety and effectiveness.

And what about drugs that weren't submitted for testing but simply marketed directly? What about unscrupulous manufacturers who don't care if their drug works? My guess is a lot of those would "spring up" in direct proportion to legitimate manufacturers. That's okay though, if you die you can just sue them.

...pharmaceutical companies would have incentives to produce drugs and medical equipment that were safe lest they would face civil or criminal lawsuits.

Have you actually looked at the sheer number of quack cures and remedies there are, along with some fake generic drug companies? This would essentially give these people a "license" to step-up their fraudulent activities.

This condition makes price comparison shopping unnecessary. If some other institution is footing more than 70 percent of a bill, the consumer has little incentive to shop for the best deal.

Ummm, right! That is what I look for in a physician. Not the best doctor, but the best DEAL in doctors! Guess the diploma mill people will be able to offer the best deals. But wait, I thought you said that doctors would have to be good so they wouldn't lose patients? How does this jive with doctors who are better "deals" than other doctors?

Oh, by the way, I guarantee you that those who would pose as doctors would be able to fleece enough people to do well enough to not worry about losing patients.

Medicine would become like selling cars. Allow me to pull up a prime example from my quackwatch days:

"Not a real Dr." Hulda Clark, claims intestinal parasites are the cause of cancer along with most things that ail you. She has her own "invented" "testing equipment" to diagnose these intestinal flukes. She then treats them with, you guessed it, her own "invented" curing equipment called a "zapper". Clark has been chased around for years while scamming U.S. citizens who are victims of their own credulity. Clark has since moved to Mexico where she operates her "cancer clinics". Not only does she draw cancer victims to Mexico where they spend their last days away from their families in a rat trap compound. But, she plays on the sensitivities of parents looking for cures for their children. People have been known to pay her everything they have until they are down to say their home. She has no qualms about fleecing them out of this either, by convincing them that with only a few more treatments their child may be cured. Appealing to them to reconsider, for if they remove their child from treatment, and the child dies, well...I think you get the idea.

"That is what I look for in a physician. Not the best doctor,..."

As if you know now. The AMA makes sure you can't find out the qualifications of their members except in the most rudimentary fashion.

And over nearly three years of being my acutely, chronically ill wife's medical manager and advocate, I have had to fire far more doctors than I've retained. Unfortunately, not before they have a chance to wreak their havoc on my poor wife, because I can't find out much about them before they're working on her.

Incompetence among the physicians in this country is fairly widespread.

I agree with you Clav. As I have had the same experience with my husband's CHF diagnosis. I mentioned once I ended up arguing with his cardiologist and demanding a simple cheap blood test to rule out CHF. When the blood test confirmed what I expected, I found a "real doctor", who admitted my husband through the emergency room directly from the consultation visit, thus saving his life.

That is a fact, you don't "know" and you had better be educated yourself, lest you end up a statistic of medical incompetence. It could only get worse in a system with no licensing at all.

I have a modest and rather simplistic suggestion. Make friends with a really good physician, of any specialty; it does not matter what speciality. I do not mean to suggest that you become a fawning leach, or that you befriend someone whom you don't genuinely like and with whom you share few common interests and insights. That just wouldn't work.

When I was diagnosed with cancer by a very competent physician in Venezuela more than a decade ago, he suggested that since I had medical insurance in the U.S., I go there because better staging and treatment were available. My wife and I immediately contacted our former next door neighbor in the U.S. He is a psychiatrist and not an oncologist; doesn't matter. He was either well acquainted with appropriate oncologists and surgeons, or knew colleagues who were and he asked them and, I assume, filtered their responses. His resulting recommendations were excellent because he cared, and despite a statistical 23% chance of five year survival I am still here with no recurrence. Our friend and former neighbor was and remains at the top of our list of best friends; that doesn't ordinarily happen with next door neighbors, but this time it did, fortuitously.

A physician, attorney or for that matter an auto mechanic, who is not a personal friend, is not likely to give really useful referrals; he may try, but has no personal interest. A good friend who is also competent is quite likely to do so.

I have no idea how or whether this relates to free, universal health care. If the impact is adverse, I am opposed to it.

Dan

I think you just got lucky, Dan.

Most of them won't break the great white line.

Clav,

Our GP was relying on the original cardiologist for feedback (he kept urgently sending my husband back to him) as well as the new pulmonologist who thought my husband should be in the hospital but deferred to the cardiologist as an expert.

Meantime, I am gathering all the tests done by these people and scouring the internet for the meanings of the results and in a day, I collect enough evidence to suit me that my husband is suffering from uncompensated congestive heart failure and has been for over 3 months.

This is despite the good intentions of our GP, who I still wouldn't trade and who genuinely cares and the pulmonologist who originally clued me in enough for me to launch my search but didn't act herself (for it was not her domain it was the cardiologist's).

So, I say you need to understand basic medicine. If you don't you might be lucky and you might not be.

There was also my husband's new neurologist (my husband began experiencing these sort of symptoms after he exited the hospital the first time) who told me that the cardiologist I had fired a few weeks earlier was "a great doctor".

He referred me to a neurologist whom I later fired after he failed to have any interest in my husband in the hospital. He saw my husband twice in 12 days in the hospital and also made horrible calls as to my husbands needs and condition. I essentially forced him to use an extended eeg test which showed the reason for my husbands myoclonic seizures. The new neurologist prescribed the medication I had suggested (asked about) 14 days earlier on my husband's admittance.

By the way, my aunt was suffering from an undiagnosed condition for years (at least 4). She even had psychiatrists tell her it was psychological (all in her head). Until the day one smart physician diagnosed her with early onset Parkinson's Disease (the same thing Michael J. Fox has). She was so desperate for an explanation I had to save her from joining the cult of Scientology.

I am afraid it is hit or miss! My own choice is to research the best hospital around for a particular condition and then to find out who there is the best in her/his field. (I try to get in with a head nurse to ask who s/he thinks cares the most about patients).

I am sort of appalled by all this owing to the fact that the only hard science class I ever took was Botany (Research Methods, which is soft scientific method aside.)

Or I should have said, scientific method for the soft sciences.

Cindy,

I've been at this for three years now; you are on the right track.

My wife's conditions (she has multiple things wrong with her) involve (some of them) severe, VERY severe pain, and she reacts very poorly to opioids. She has coded several times because of this, becoming extremely hypotensive, with her respiratory rate dropping to below 3. Most of the codes have just been "rapid Response" level, but she did actually flatline once.

I have become quite familiar with, and very well versed in both the physiology and the clinical aspects of all her ailments. There have been physicians attending her whom I was sure knew less about her specific problems than I do, even if they did know more about medicine in general. Those have been among the ones I've fired.

She's been extremely sick since August 2005, and has spent 21 of the last 27 months in hospitals. Of those 21 months, more than 2 have been in ICUs. Her current stay started in mid February, and there's no end in sight yet.

I have learned more than I ever cared to know about sarcomas, neurology, paraplegia, spasticity, spinal cord injury and a whole host of other conditions not suitable for discussion in this venue; not to mention the vicissitudes and hangups, the egomania of modern American medical practice and its practitioners.

Neurological conditions seem so confusing. A person could have all the symptoms of something, yet not have that thing. At, least a heart problem is clear cut once you find out what's wrong.

I wish you the best with your wife Clav.

Thanks, Cindy, and I wish you and your husband the best as well.

"The new neurologist prescribed the medication I had suggested (asked about) 14 days earlier on my husband's admittance."

Which had you asked for? Dilantin or Keppra?

The neurologist started my wife on Dilantin after her first seizure, though the the EEG they gave her right away didn't indicate any lasting problems. He then decided he wanted to do a "24 hr." (his term) EEG, just to definitively rule out everything, but she's not been well enough since to conduct it. Then, she had a second one, and he switched her to Keppra, which she's still getting.

Keppra, yeah, that is what I asked about. The first neurologist told me he wasn't having seizures and acted like I was an idiot for suggesting he might be. In the hospital, the 2nd neurologist did not suspect seizures and did no further tests until I was able to force him. Nothing showed up on the standard eeg. I had read that seizures may only show up on the eeg if the person is having one during the test. But I was told that if he had any seizures, something would have shown up. That did not turn out to be the case.

My husband also acted like he had aphasia (which is caused by brain damage). After 12 days, the 2nd neurologist said he could give my husband "speech therapy". That was the extent of his treatment plan. I asked him to give my husband the extended eeg, which he did because, he had been so blatantly neglectful, he could hardly say no. Then I fired him and got a 3rd neurologist who assessed the eeg, diagnosed myoclonic seizures, and gave my husband the Keppra.

The aphasia? Who knows. It eventually disappeared after my husband got a pacemaker. (His new and excellent cardiologist saw him (or sent a colleague) every single day in my husband's 2nd hospital stay of 21 days) Both the seizures and the aphasia-like symptoms may have been a combination of depression and lack of oxygen to the brain. One neurologist (the one who helped my husband) says yes to this, a 4th one outside the hospital says no.

During the extended eeg (which they keep on as long as they need to) they use a video camera as well. This is sometimes called a 24 hour eeg, but isn't necessarily limited to that.

Neurology is almost an art, it pays to get many opinions and especially to have a group of them in one practice that actively confers on cases. Whatever you do, don't think that you couldn't possibly come up with answers if they can't. Many of them don't seem to agree with each other. Your's seems to be on the right track with the 24 hr eeg. Follow your own instincts, no one cares more about your wife than you do.

The problem with the original article is that it is based on dreams, misconceptions, omissions and logic errors.

The author dreams that certain things will happen if he has his way:

"Consumer groups would develop rating systems for medical providers to inform the public."

The article is filled with such dreams.

Yet no evidence is offered. It's just a dream. One could as well dream that propaganda groups would develop lovely lies to convince people of exactly what is against their interest. Rather like the current automobile advertising business which promotes an archaic overweight vehicle as being safer. Or a food advertising system that tells people to eat obesity and diabetes inducing foods that will kill them.

The author promotes the misconception that high costs are the result of regulation without offering any reason to believe that. there are many reasons costs are high, not the least of which is that the corp execs are cream-skimming the revenue enthusiastically supported by the shareholders of their monopolies. One could assert with better evidence that high costs are the result of monopoly domination of markets.

The baleful effects of regulation are because the regulators are dominated by providers and insurance companies, not by recipients.

And then there are simple logic errors, such as: "...thereby decreasing competition and raising costs." Yet prosperous well-run corporations everywhere buy up their competition, thereby decreasing competition, and fire their redundant overhead thus decreasing costs. Are they all mad?

The author simply omits what he finds inconvenient. reducing costs doesn't help the moneyless, or even the middleclass.

The current health system operates with the same motto as Highwaymen of old: "Your money or your life".

"The current health system operates with the same motto as Highwaymen of old: "Your money or your life"."

And, often enough to be alarming, it's "Your money and your life."

I'm all in favor of reducing Government regulation of everything to the bare minimum. However, there are reasons for not doing this in some cases. Clav and Cindy D provide, perhaps unintentionally, one very good reason: they are highly intelligent and have been extraordinarily diligent advocates, seeking the best possible care for their spouses; they have studied the diagnoses presented by physicians, sought alternative diagnoses, and actually spent a lot of time learning the questions to ask and how to evaluate the answers. They are to be commended for this. Although I have no empirical evidence for the proposition, I am unfortunately confident that there are very few like them, and that most people lack the ability and the resources to do as they have done.

I realize that this seems to parrot the traditional "liberal" mantra, "people are stupid and don't know what's best for them so the Government, full of wisdom and compassion, should tell them what to do." There has to be a better way.

In a previous article, I suggested a few aspects of the health care system here in Panama which should be considered by the powers that be in the U.S. Prescription medicines are far less expensive here, and so is medical care. In general, I think that for those of us who have local medical insurance -- very reasonably priced here at about $100.00 per month for both of us, and we are both over 60 -- care is better than in the U.S. Typically, a specialist -- neurosurgeon, cardiologist, etc., charges about $30.00 for a consultation which takes as long as is needed, frequently an hour or more. There seems to be no pressure to hurry. With our medical insurance coverage, these consultations cost about $10.00. Typically, a physician's business card shows his office number, his cell phone number, and his home phone number. That is, I understand, quite uncommon in the U.S.

The "poor" people who do not have such insurance usually have coverage via the social security system for themselves and for their immediate families during as well as after their working years. For those lacking such coverage, a doctor's visit costs $3.00. The care may not be excellent, but it is better than nothing. Perfection is often the worst enemy of the merely good.

These observations don't speak to the problems of people who lack Clav's and Cindy D's medical sophistication. Perhaps a new medical specialty of independent ombudsman-advocate could be created to provide something akin to what Clav and Cindy D have provided for their respective spouses. It would unlikely be as good or as compassionate, but again it would be better than nothing. Retired general practitioners should be able to do that, although they would likely not be greeted warmly by their colleagues.

I merely throw this idea out for discussion. There are obvious problems with it, and perhaps less obvious solutions to those problems.

Dan

Deregulation in the past has been both good and bad. Considering the history of this country, deregulating medical does not seem wise. I for one do not want to see our court system any further clogged wtih malpractice suits.

I agree with Dave Nalle about medical insurance companies. They are not the only culprits, but a look at their financial statements may be edifying.

My husband was subjected to 15 surgeries over 17 years by the same doctor we eventually found out was because we had good insurance, if we had not had any insurance, then they would have amputatated which would have given him 15 years of no surgeries, and he would have been able to live a little.

Really? Are our courts clogged with malpractice suits? Do you have some numbers?

Why would our courts be clogged by malpractice suits? Are doctors irresponsible or incompetent?

jam: "I for one do not want to see our court system any further clogged wtih malpractice suits. "

"Are doctors irresponsible or incompetent?"

Emphatically, yes and yes.

Lots of them; more than the AMA will ever admit to.

Some of them have been my wife's (though not for long).

I have to agree with Clav. I have a super duper cardiology team for my husband now. It is like having a team of James Bonds descend and take care of everything. (heart catheterization specialist, heart failure specialist, pacemaker specialist--My husband'S pacemaker sends info about his heart over the phone lines nightly. It actually has a built in wireless computer.)

However, the only reason I don't sue his former cardiologist (who treated his heart attack in 2006 and fricking should have told me more and done more than he did) is because I likely wouldn't win. Why? Because my husband's life wasn't shortened by his failure to do diddly-squat? No, because regardless of what anyone does, you have to prove harm beyond what you should have to. I love when people say lawsuits in malpractice are generally frivolous. Because that is entirely bullshit. If you have a case you will be lucky to get what would be deserved.

The AMA assiduously refuses to de-certify doctors who have been proven to be incompetent or malicious or careless. Most malpractice suits are created by a small number of bad doctors, yet the AMA refuses to act.