Obviously, you are talking to people with insurance and money to spend on health care.

There is no “market” for people without money. SChip, Medicare, Medicaid, and VA are government run programs that provide essential medical care for people without income or capacity to contribute economically (i.e. children, elderly, injured, disabled, unemployed, etc…).

These are the citizens that don’t qualify for private insurance or access to hospitals, doctors and lifesaving treatment.

It is embarrassing to argue in favor of a system that, literally, excludes sick grandmas and orphans. As if it is the only way. yuck.

Economists worry about numbers and $. Legislators are concerned with Public Policy.

I wonder if you can predict the financial impact of pandemic swine flu on the American Economy and society?

…Its really good for the Pharmaceuticals…

I’m not sure what you mean by “the quality of care” shot way up. If you mean you are getting more preventative care, that is good for you, but don’t fall victim to the fallacy of composition — what might be good for any single individual is not necessarily good for the group as a whole.

the classic example is the person who stands up at the ball game to get a better view. That’s good for him. But if everyone stands up, no one is really better off than they were before. Preventative care works much the same way.

Preventative care certainly makes us healthier, but it also means we are providing preventive care to some individuals who are going to get sick and require expensive care anyway, and we are providing preventative care to people who would not have required expensive care irrespective of receiving preventative care. Individually and perhaps as a group, we are healthier, but we don’t save money.

In the case of your plan, the health insurance company is setting the parameters of your doctor’s care by providing a capitated payment structure. Essentially, this passes the financial risk from the insurance company to the doctor, who is ill-equipped to do the actuarial work necessary to set prices. As you correctly note, if it gets down to the end of the year and he’s running out of money, he may cut back on “quality.” He may put off treatment for you until the next year — pain pills instead of surgery, for example. This is what happens all the time in Canada.

On a larger scale, capitated payment systems tend to push doctors to practice in clinics like, I’m guessing you go — where the patients are all fairly well-to-do middle class people who will generally do what the doctor tells them, come in for their check-ups and are pretty healthy. If a doc is going to be capitated, that’s the kind of place where he wants to work — not where people are poor, have bad health habits and aren’t likely to follow-up with recommendations.

that’s just a brief look at capitated medical payment — Phase 3 payment for those familiar with the Transformation Task Force health care proposal. I’m glad its working out for you, but capitated payment is in aggregate a really bad idea.

I do plan to do a shorter version of this paragragh by paragraph fisk of Dr. Oliver.

I have only one problem with your analysis, and that is probably a matter of semantics. By your definition “prepaid managed care” is allowance that someone outside the doctor-patient relationship determines what care is provided. Under the plan that my employer calls “prepaid care” the health care organization is given a certain amount of money for the year to care for me. If they don’t do preventive care, I get really sick and that cuts into their profit. If I get sick and they don’t treat me as effectively and quickly as possible, that comes out of their profit, too. When I switched to this plan, costs were cut in half and the quality of care shot way up. This confirms what you’ve said, what I’ve said, and what the Mayo clinic economists have said, that if the problem with the US health care system is cost, then we could cut costs in half by having the government “butt out” and turn it into a true free-market system.