Don't jump to the conclusion that most doctors are against the public option, and not just altruistically for patient benefit. Government programs like Medicare are relatively simple, straightforward and pay reliably. They don't have pre-authorizations, and aren't continually changing drug formularies and generally set up hoops and hurdles to provide care, like most private insurers. Keeping up with the credentialing and billing requirements for dozens (or even 100's) of health plans is a nightmare, requiring hiring office staff and the doctor's time. Simplifying the business aspect of medical practice has great appeal for many physicians, especially primary care physicians, and many women and new physicians. The older extablished and more procedure-oriented physicians (disproportionately represented in the AMA) will be more resistant, but they are not a majority. Surveys have shown almost 60% of physicians support single-payer.

Medicare by far has way more rules and regulations and paperwork than you think. They makes these rules as ways to deny payment. ie. when i give an anesthetic my in room time start time,end time of proceedure must exactly match on all of many pieces of paperwork or Medicare will not pay me. Just one example. Also Medicare pays about 2/3rds of what private insurers do for the same anesthetic. I dont't know anyone who is in favor of single payer so you 60% number seems fishy to me. You will not like it. I hope i dont have to say sorry i told you so.

Your response from Ckone is on target. Private practitioners get paid pitifully little for the services they provide. The only way they can make a decent living with Medicare patients is in volume. Is that the way you want your medical services to be based? The paper work is ridiculous.

The European model taxes the sap out of their people and depends on the US for their defense. If they had to provide for their own defense, provide stability around the world for the peaceful democratic countries their tax rates would be 70-90% You socialist leaning people conveniently forget that part of the overall picture.

Our system needs some modifications, mostly with the coverage and insurance picture. The health care is better than any, or at the very least, the same.

A major difference is the overall lifestyle of the various populations, the amount, quality and makeup of the food consumed the lack of exercise over the general population and the obesity epidemic, even among young children (which is a condemnation of the parenting they get). Fat begets fat. You see if every day, every place. Fat, out of shape parents produce or create fat, out of shape children; who carry it on into the future generations. Europeans probably smoke more than we do – at least over the last decade or two. But that wasn’t always the story. Our older generations still smoke a lot more than the younger ones and they’re dying off due to smoking related diseases.

What do you propose for the doctors with higher skills, a stronger work ethic and a willingness to take on more patients? Are you, like a good little socialist, going to suggest they get paid the same as the scofflaws that do the bare minimum to get by? Without incentives, everything goes to hell. It’s amazing how so many people don’t understand or don’t want to believe that.

It’s a GREAT think that this health bill package isn’t going to be fast tracked. That means less crap slipping in under the rug and more taxpayer input. Obama has moved too fast and has created a bow wake that is stalling him out. People are waking up and his absence of substance, absence of specific plans and absence of realistic numbers are catching up with him. Turns out, smoke and mirrors will get you only so far and then you have to deliver some common sense solutions.

Do you agree that we cannot afford the current system? that, if health care costs keep escalating as they have been, we will be paying like 70% (I confess I don't know the real estimated percentage) of our GDP on health care? If so, then what are we supposed to do?

Or, do you think things are fine?

DirtyBird, you probably know as well as I do that a doctors' reimbursements are not associated with their level of skill, but only with what kind and how many procedures they do. Only in competetive markets may skills make a difference (usually, social skills such as courtesy to referring provider and patients are more important). The salaried docs at Mayo etc. do excellent work (and are not underpaid since likely, their fixed salaries start at 150-200K), although I have to admit that their model is not easy to generalize - docs go to Mayo as being part of an world reknowned institution and may forfait some pay for that.

"If they had to provide for their own defense, provide stability around the world for the peaceful democratic countries their tax rates would be 70-90% You socialist leaning people conveniently forget that part of the overall picture." I am happy that you are so satisfied with the peace American troups have brought to the world since WWII. Go, team America!

And BTW, many people, and I would assume very many if notmost highly educated professionals know other incentives/motivation than money. My little libertarian, it is hard to read your statement "Without incentives, everything goes to hell" any different way than: "I will not do any extra effort if I don't get extra money, and I don't think anyone would do different".

I'm talking about an entire system, not just some individuals. Overall socialism and communism have amply demonstrated that private property and enlightened self-interest are the best motivators. Putting people on salary for providing a set minimum effort without incentives for more productivity is self-defeating.

Would you rather work or spend time with your family, sail boat, fishing, etc.; if the money was the same? Given the incentive I'd produce until I have what I want and need. If I get nothing for myself or my family why am I going to put in extra hours? There are a few folks of will - granted. But they are in the small minority. Don't kid yourself. It's been proven throughout history.

f the Cleveland Clinic and Mayo are so hot, why haven't they been reproduced all over the country? Because besides being physicians, they aren't fools and the want to be rewarded for what they do, not what the collective does.

Dirty Bird,

I do believe a lot of professionals in this country work for a salary. Some places let you get overtime. Some only pay it if you have more than 40 hours in billable time. Billable time is dependend upon the contract for the project. etc etc etc. In my field, essentially I worked a lot for free, because of varying circumstances. Some places give you bonuses based on performance. But what is that performance based on, how is it measured. Did you make something, did you bring in a big contract, or do you brownnose your boss and he is too dumb to know it. Or do you get extra money for just beign a good old crony? Pride in my work, and wanting to work is why I try to do a good job (deadlines and managers are also good motivators).

Incentivising something like health is immoral. Unless you do it right. Fee for service is not the right way. Period.