>>>As consumers, we have a duty to be on the lookout for MD's who shill for big pharma, prescribe needless tests, etc. but ultimately there is no substitute for an ethical, competent MD.
>When we look at spiralling costs then, we have to look first at MD's.
>
>A wise man once said "beware the poor doctor." So it's easy enough: return to the way it was in the good old days. Pay physicians so well that a) they have too much to lose to want to cheat, and b) there's not much of an incentive to cheat if you're already top of the food chain without cheating. Add the serious kudos that physicians used to enjoy and there's every incentive to be a responsible, ethical practitioner who has every reason to like her patients as well- even to do house calls and take on charity cases as the need arises. FWIW I once lived in a house where the previous physician owner had a room at the front and an external light so people could and did drop in day or night for care. That's what happens when money is not your object.
>
>The problem in today's society is that parasitic types (e.g. currency traders) are lionized while heavily compensated healthcare managers earn bonuses if they can clamp down on nurse and physician incomes. Physicians in particular often have very large student loans and usually were smarter and did better at school than those who became parasites or who now want to clamp down on physician incomes to bolster their own. This is a breeding ground for resentment and/or indifference to rorting the system.


Agreed about all the parasites.
Insurance itself, especially for smaller dollar figures is the direct cause of all this rorting.
The patient is so divorced from the price of service that he cannot shop if he wanted to.

I had a kidney stone on 2 occasions.
The first time I was fully insured, the second I was not and had to pay out of pocket.

The fully insured version included a $700 MRI scan, a pointless emergency room visit ($3000) and two outpatient procedures - probably close to $10,000 all costs considered.

The self-pay version included a negotiated $225 (cash price) MRI scan, a $70 visit with a nurse practitioner, and $13 worth of pain meds.

The self-pay version was actually resolved without any procedures - I followed the advice of a friend, an Indian-American doctor.
I drank water and more water and even more water until the stone passed.

If I had called my doctor friend first, I could have saved $308 and avoided a day stoned on painkillers.
I doubt the many liters of water I drank made any impact on my water bill.

Why was the first version so much more expensive?
Insurance covered the cost - I had no motivation to shop, nor actually any power to do so.

The cost of medical care in the US includes a lot more than delivering medical care.
It must also support the additional (non-care) doctor office staff that exist only to bill insurance companies and the whole insurance bureaucracy and government bureaucracy and the lawyers who exist to suck money out of the system.

Actual medical care is probably one of the smaller components of our cost of medical care.