Steve Perry wrote:
> *Why* have costs spiralled upward so dramatically in the past 20
Here is a consideration that hasn't been brought up. HMOs were initiated in part to the postion that consumers needed to be controlled from going to more doctors than they "needed" - hence the gatekeeper physician concept in HMOs. What I found when I enrolled in one HMO that took Medicare beneficiaries was that the physician was totally incompetent to handle my needs. He even told me that outright but did not refer me to a specialist who was any more competent.
But fee for service was not much better on the competency front. I know so many many and let me repeat many people who have to go to ten maybe twenty doctors to find one who could accurately diagnose and treat them. Maybe physicians were better trained in the old days. Maybe if physicians were more competent people would not need to wear themselves out trying to find a good one -- and hence less cost to the system.
But these days the right to chose a doctor is imperative - HMOs are doing much damage to their patients in this department. When we speak of controlling medical costs those people with the most experience with using the medical profession must be engaged in the discussion.