Is the U.S. Healthcare System Broken?

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We're talking here about aligning incentives between doctors and patients. So, I believe in paying a primary care position an internist, a family practitioner, a pediatrician an OBTYN more than we pay brain surgeon relative to what we pay brain surgeons today. Primary care is tremendously underfunded, and that's why a primary care doctor has to speed up the visits between three and seven minutes for what should be a 30 minute visit at least once a year to really asses the 360 view of a patient.

Primary care doctors don't have time to do that and because they're not paid as much there are fewer coming into the system. We're going to have a crisis beyond the one that we are having right now in terms of a primary care shortage as we see more insured people coming on to the insured roads to the next couple of years towards 2014, where are those people going to get primary care? In our recent paper I wrote called primary care everywhere I argue for the role of pharmacist at Walgreen at Target at Walmart to play a bigger role as part of the medical home for a patient.

I argue for school based clinics to get more funding and federally qualified health centers and care through the air, through wireless so that people can talk to physicians wherever they may be at home. But part of the problem with the American health care, parting his own question is that we have licensing policies that are 19 century that have nothing to do with how healthcare could be practiced now.

And the key one there is life insrance across the practice for doctors. So, if you want to have doctors participating with patients across borders say I live in Philly[sp?] but there's a great doctor in New Jersey or Connecticut or even in Hawaii, who may know about a condition that I have, that doctor will only accept an out-of-pocket payment from me because no health insurance is going to pay for that.

Once we start aligning in a rational way, payment for care at the right place at the right time. The most cost effective place, and that means the most cost and effective place at the same time. I think we can start aligning incentives between doctors and patients, and getting people the kind of care that they really want with the kind of doctors that they really want.