All that said, I had an interesting conversation with a physician recently.

He's concerned that further Medicare payment cuts will put some doctors out of business, or they will stop accepting Medicare patients. (I guess the corollary is that physicians are already dependent on government run health care?)

He also cited the usual stuff about tort reform, but made an good point when I countered that malpractice lawsuits are only about 1% of the cost of health care. He said that figure doesn't include all the hidden costs of defensive medicine, which isn't measured and is generally wasteful.

But we both agreed that weeding out bad doctors would help across the board, and he agreed that more oversight is needed v. the generally "self policing" model that now exists in the profession. He favors an independent "arbitration board," which would probably be better than what we have but not as fully regulated as I would prefer.

But what bothered me was when he said that if we somehow figure out how to expand health care to cover everyone there aren't enough doctors to provide services. He also said if you drove down costs enough to pay for it that it would remove incentives and nobody would want to go into the field so we would have fewer doctors.

So basically we have a system that only works when a large percentage of people aren't served so doctors can be paid more by people who can afford it?

Any void of doctors created by increased demand would be filled by foreign physicians, nurse practitioners, and physician assistants. There will always be a shortage of some specialties, like Rheumatology, where a usual wait for appointment now is about 4- 6 months.

Six years ago when my mother was sick she went to a clinic where she saw the nurse practitioner most of the time, who was much nicer and thorough than the doctor. When she did see an MD, it was who ever was working that day.

I can't imagine some physicians, like Internal Medicine, giving up their Medicare patients because that is the bulk of their volume.

We may all see less MRI's and CT scans done and that is not necessarily a bad thing.

Here's proof:

(link...)

I'd suggest that anyone who follows this site try to locate physicians on their plan who belong to PHNP. (Unfortunately, that would probably be a small number here in Republicanland.)

My cardiologist called me at eight o'clock last night to discuss the results of some recent tests. I teased him about working such hours. He modified my medications and then we talked about his new Kindle.