Is Fee for Service Going to Bankrupt Healthcare?

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Well, I mean I think that in the current Free for Service system and the way it has existed has created a lot of purpose incentives. And if a physician for example is making his or her living by doing a particular test or procedure, there's a completely natural inclination for them to do it more.

And a lot of instances there's data to support the idea that if you use this particular test you're going to accomplish good things. Proper reforms probably do include uncoupling that kind of incentive, and a system like the Kaizer System or certain other closed healthcare systems are much better at doing that than the fee for service systems and probably better solutions.

But, you can look at systems with centralized healthcare administration in other countries, and find that they work either more or less well, depending on the circumstances. In United Kingdom for example, fully one third of the population carries private health insurance even though there's national health insurance for everybody.

So, it's obvious that for a large percentage of the population what's being provided to them is not fully meeting their needs or their desires, and it is worth it to them to spend the money to go outside of the system. I think we are probably going to evolve to a dual system like that here.

And maybe appropriate, because I think whether you call health care a right, or a privilege it's in the best interest of society I think for everybody to get some basic level of health care. First of all, I don't think any one of us wants to live in a society where we make the choice to value monetary gain over human suffering.

We want to insentient people in private industry and so forth, and you know I'm in the private sphere, and I think I deserve to be paid well for what I do. But, I don't think anyone of us want to be in a country where that's the only priority. We want to be taking care of our fellow citizens.

But at the same time, I think if you say there have to be limits on what people can be provided. First of all, that's only the reality, and secondly it's probably appropriate. Bariatric[sp?] surgery for diabetes management would be a brilliant example of that in my opinion. If you do a gastric bypass procedure on somebody with bad diabetes, they may actually be cured almost immediately.

It's an interesting medical point anyway, why does this happen? But that person may benefit enormously. I think there are a lot of questions about the long term outcomes and people with gastric bypass surgery. But in the near term that person is benefiting enormously, but is that an appropriate expenditure of funds to mange a disease where lifestyle change should at least in fairy be able to work.

And you certainly wither you're a national health care system is fee for service whereas, administered by the federal government, if you start saying that we're going to provide Bariatric[sp?] Surgery to everybody whose overweight with diabetes, you'll pretty quickly bankrupt the system.