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[quote=Anonymous]I think it is smart to cover pre-existing conditions, and I understand the need for getting everyone to be insured in order to not create a moral hazard - ie for people to not buy insurance until they are already sick.

I think that it is very smart to make preventive services free.  The problem is that any one insurer is not incented to provide preventive care, because the patient is probably on another health plan by the time they are 50-60 and the benefits show up.  But we know that if everyone does it, we all save money in the long run.  So good for that.

I am disappointed that the government did not do more to address the underlying cost of care.  We pay too much for procedures (way too much - I mean should an appendectomy be 2-4x the cost here?).  And we order too many of them.  But the government cannot just set prices like in Israel or Britain or other countries with national health care.

However they could use market clout.  I wish we could create a national health plan that anyone could buy into.  For all the complaining about medicare/medicaid reimbursement, doctors by and large still take them.  And if the general public had a health plan that negotiated aggressively on rates, we could cut costs because the private insurers would be strongly incented to do the same.  Right now we have to beg them not to spend premiums on overhead and marketing.

One thing we could do, and I would catch hell for this if I said it in front of the doctors in our family, but we should cut the power / privilege of doctors.  They are too expensive and they are highly motivated to add cost to care.

But medicine is only rarely a thing that requires the best and brightest, and none of it requires a doctor to be the child of wealthy parents.  Other countries pay for medical school.  And they churn out lots of doctors who treat their job like a job - regular hours, salary, etc.  They aren't setting up MRI clinics to refer their own patients.  They care about their patients but they don't order test after test and they don't recommend every procedure they can.  A good neurologist can detect serious neurological conditions by a physical exam - which pays very little.  But throw the patient in an MRI and the dollars start flowing.  As a result, someone stuck me at 18 in an MRI for headaches caused by seasonal allergies, which I told them because I am always sneezing and stuffy.  OK not a big deal because an MRI is not radiation like a CT scan but come on!  MRi's were insanely expensive back then too.

All professions throughout history have moved from the highly technical and restricted, to the more ordinary.  Blacksmiths, cobblers, accountants.  It is the way things go.  It has happened in other countries already, and their life spans are better than ours.  It needs to happen in medicine, too.
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