I read it last night and thought EVERYBODY should read it...

This "trend" towards patients as "revenue centers" has been evolving out in plain sight over the last 20 or so years... it seemed to really gain legitimacy as a concept back when the "medical billing" business was introduced to "prevent Medicare fraud" ...

Doctors who got in on the ground floor of the medical billing industry (usually by the underwriting existing "mom and pop" paperwork handlers they were already using) became role models of physician entrepreneurship... outsourcing to one's own subsidiary.

The blatant descriptions of physicians demanding "salaries" (as a kickback by any other name) in return for using a certain hospital or imaging center is chilling. As is the increasingly extravagantly "thorough" battery of tests that will be "strongly ecouraged" on every insured ER patient... etc.

Funny thing, doing the right tests and the right time improves quality of care. Doing a blizzard of tests which are largely normal (or not) can easily obscure what's going on or distract attention away from "the patient" and the actual complaint.... and lead, of course, to yet more testing to explore the significance of an unexpected abnormal result == hearing hooves and hunting for zebras ...

How do we find a way to get the healthcare companies, indeed, the entire industry to ignore Wall Street's continuous demand for maximum quarterly profit and maximized shareholder value which, OF NECESSITY and by clear practice, REQUIRE that the healthcare industry ignore patient outcomes and best practices in order to maximize revenue (so clearly illustrated in the policies and practices of the pharmaceutical industry).

Unless we can cut Wall Street out of the equation (say, with a government healthcare plan?) we will continue to travel exactly the same road on which we have already come much too far. The fact is, Wall Street will be DELIRIOUSLY HAPPY when the poor and middle class have no medical care at all because those at the top of the income scale are where the profit really lies.

If the poor and middle class die early, it will help ensure no tax increases to prop up medicare and social security, too, won't it?

This, of course is what our darling Governor, Tim Pawlenty, meant here in Minnesota when he said that "increases in the health and human services budget were unsustainable" that people better be prepared to just die rather than expect reasonable medical care, especially if they're old or have been laid off.

The New Yorker piece was fantastic. The author was thorough in examining medical practices across the nation. But the article devotes not a single word on how other industrialized nations do it. We aren't alone in this problem. They have it too, and for the most part seem to have solved it. For example, he states:

We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it.

But somehow single-payer systems in Europe, notably in Spain, France, the Scandinavian countries, and others, spend half of what we do, with better outcomes. Could it be that in their case the public "insurer" (the government) has repeatedly shown that they can do it? That they can impose a quality-first approach?

We cannot advance our understanding of this problem by holding to worn out cliches like "the government is not the answer", and by ignoring those who have succeeded. By all means lets take Grand Junction and Mayo to heart. But lets also examine what is going on in Sweden, France, etc. They provide some large scale working examples.

Yes socialized care as practiced by Canada and Europe is cheaper and provide better outcomes BUT it's still expensive and countries like France, UK and Germany are facing large budget DEFICITS trying to maintain their social services like health care. The whole point is that NO ONES system is sustainable and sustainability is a major issue that needs to be addressed or we are going to face an economic collapse in the future.

"The challenge facing us: Finding a way to institutionalize norms that encourage the free flow of ideas and collaboration[.]"

Those anchors started out in government funded university laboratories where nearly everyone understood the concept of enlightened self-interest (I help a neighboring lab get their grant and that brings in more people and equipment to help me get my grant). The key here is Government Funded, as in Single Payer! Cutting the vultures out of the health industry and turning it into the health care field is long overdue.

First: who said socialized medicine was some sort of magic bullet? There is no magic bullet of any kind. You want a service, you have to pay for it.

Second: It's so typical of detractors of socialized medicine to come out and say "it costs too much" without ever denying that it costs half of what our system costs. So let's examine your logic: We shouldn't consider European socialized medicine because it costs half as much as our system costs. Brilliant! And how do we rank in the World Health Survey? For all our spending we rank just above Cuba. (see http://www.photius.com/rankings/healthranks.html)

Third: European nations, particularly Germany, are going through a tight period of budget deficits not because socialized medicine and other social services cost too much, but because they (like so many others) participated in our current financial mess:

This sharp increase in deficit spending stems mainly from the stimulus package announced on Tuesday by Chancellor Angela Merkel. At 50 billion euros (66 billion dollars), it is the largest since 1945. [...] Other elements include a 100-billion-euro loan guarantee programme to help stricken companies hobbled by the credit crunch and a one-off, 100-euro extra child benefit payment.

(see http://www.eubusiness.com/news-eu/1231921022.85/)

So don't blame socialized medicine for the excesses of the financial class. As usual there will be those who wish to balance budgets on the backs of the poor when the fault lies elsewhere. In our own country we are already being told that we can't afford Social Security and Medicare. But we can, apparently, affort to spend $ trillions on bailouts for the self-same thieves on Wall Street who are telling us this. And speaking of excesses, we could afford a dandy socialized medical system if we would stop wildly over-spending on "defense." (10 times what our nearest competitor--China--does. And that doesn't include our wars of choice.)