[B-Chan]

If I were an M.D., I'd simply require all my patients to pay their bills in cash. This would allow me to fire the entire administrative staff of my practice (no more insurance processing, accounts payable, or accounts receiveable to waste resources on) and slash prices across the board. I'd also publish a menu of services with prices, offer house calls (for colds, allergies, flu, etc.) and limit office visits to those that required office facilities. One more thing: I'd allow my patients to subscribe to my services on a monthly basis, with a regular checkup every six months and two hours of office time per quarter in exchange for a flat fee (discounted for families). This would encourage my patients to care for their own health rather than running to the doc every time somebody looks at them funny -- and in time they'd hopefuly come to see me as a Marcus-Welby-type family doctor rather than as a mere source of pills -- or as a target with deep pockets.

As for prescriptions: I'd publish a list of bus companies that serve Mexican cities, and a list of "approved" pharmacias in each city for them to use. Drug prices in the US are outrageous. Just a thought.

[cynicom]

The idea you propose is already in place in several large cities. Yearly membership ranges from $15,000 to $25,000 and up. While this a sound capitalistic business pracitce, it will also serve to bring on socialized medicine for the rest of us.

[Mamzelle]

What you suggest is fine as far as it goes, but you are not taking into account the souring costs of hospitalization. Office visits and treatments are the least expensive of this cost pyramid.

It is a very despressing thing to watch, this exploding hospitalization cost. There are many difficult dynamics at work.

For instance, I do a bit of investing in biotech. I am privy to some discussions of new medical technology--and my ears always perk up at the "Wow, how cool!" things that come down the pike. They are investment opportunities.

A really wow-cool thing that we will have shortly are new shunts used in cardiovascular surgery. They will come imbedded with a medicine which will prevent/slow the formation of tissue that heretofore has shortened the useful life of the shunt. The question--which company will produce the best shunt?

Notice that the question is not, and will never be as long as the legal situation is as it is--"What is the best shunt for the money?"

A few years back there was a big competition for a heart-attack medication, administered in the ER. One cost $3K, another cost $300. The pharm company that produced the more expensive version pulled out all the stops to establish that it was *slightly* better (and even that wasn't really established). The hospitals wanted the cheaper version--but they knew better than to go for it when the other company had created a "paper trail" of marginal superiority. They couldn't risk being dragged into court with an accusation of being a dangerous cheapskate.

Multiply this by thousands of similar circumstances in medical practice, and it just seems so hopeless to try to contain costs...

[jiggyboy]

Here in Silicon Valley, at least, some of the walk-in "corporate" medical places give you a 10 or 20% discount if you pay cash. I had crummy health insurance at a company and decided that I'd do better just paying for low-level stuff like sinus infections myself.