Expansionary fiscal policy with contractionary monetary policy (aka, Reagan) creates debt.

Expansionary monetary policy tends to create inflation, which wipes out existing debt but generally increases future interest rates.

I also see this as a viable part of the solution for our lack of primary care physicans and geriatritians (sp?), and for bringing badly-needed medical care to places in the country (like Indian reservations, city slums, and poor rural areas) that are already part of the rationing that is the great “free market”.

Should expansionary monetary policy say attempt to create more private debt on the lower and middle class?

Should expansionary fiscal policy say attempt to create more gov’t debt?

Can too much debt lead to falling private-sector demand?

Is there already too much debt???

There are probably dozens of other ways this system could be gamed, but it does seem to have an essentially good core idea: pay more for the test when it generates value. With enough structure it might actually work!

“rate 1) Marginal cost of providing the scan (no profit). This is paid when the scan is conducted but nothing is found.

“rate 2) A highly profitable rate. This is paid when the scan is conducted and something is found. However, to receive compensation, the doctor must submit radiological records electronically for verification (and 1/10th of scans are audited, with penalties being applied for lying, including possible revocation of license to practice).

“Benefits: No incentive to over-treat, and high incentive to treat patients who are likely to need treatment.”

Interesting idea. :)

My grandfather was a doctor, and he actually did treat one patient on a contingency basis. For a while he lived near a lawless, rural area, and one afternoon he was driving his buckboard home when out of the trees came three armed men on horseback, a man and two of his sons. A third son had been wounded in a gun fight, and my grandfather was told, just like in the movies, “If he lives, so do you.” Fortunately, he did. :)

But perhaps there are kernels of this idea that could be used. For instance, Medicare could compensate scanning at two rates:

rate 1) Marginal cost of providing the scan (no profit). This is paid when the scan is conducted but nothing is found.

rate 2) A highly profitable rate. This is paid when the scan is conducted and something is found. However, to receive compensation, the doctor must submit radiological records electronically for verification (and 1/10th of scans are audited, with penalties being applied for lying, including possible revocation of license to practice).

Benefits: No incentive to over-treat, and high incentive to treat patients who are likely to need treatment.

How about contingency fees for health care? E. g., bills to be paid off over 5 years, if the patient is alive. ;)

Hear, hear! :)

“Right now we cannot afford our legal system or our current health care system. We cannot afford a government solution either, unless you’re willing to ration medical services and legal services.”

Well, under our current system both are rationed, anyway. Legal services are even more rationed than medical services, it seems.

This is a great point as it underlines the fact that many of us go about our lives assured of this right or the other, never once considering that money and its exponential relationship to time can be exhausting if not prohibitive in the legal arena. Small businesses and technology concerns come up against this fact when infringement enters the picture. Often, time and its related billable hours conspire to rob little companies with the law on their side, not of their day in court, as most can afford a day; the problem is, days quickly turn to years and the corporations know this.

I suspect the Founding Father’s never once considered how placated the population would be, merely believing their precious rights assured. Sadly this is not so. This country loves the term humane and civilized and in so many of our endeavors we are far from the mark. Of note is that so many of us, who can count ourselves among the “haves” today, forget that Tomorrow excels at changing fortunes. Especially the fortunes of those of us subject to time. Unless all of us are protected, none of us are.

Healthcare, legal rights, and education of an entire nation are being affected for all. Its astonishing that we have all these discussions about nationalizing corporations, but only when business is expected to give something back. Corporate America, is for Socialism in everything except profits. When they pollute water tables, soil and the entire environment, are not the side effects felt by all and so socialized. People who have nothing to do with those companies are touched by them when they drink the water and breath the air. Even now, elementary students, who’ve never been in the job market, are affected by the poor decisions of Wall Street. When their teacher’s are laid off, there’s serious familial medical complications or family involvement in the courts; they are experiencing the socialized side effects of corporations. We need to be honest with ourselves and admit that corporations socialize everything but profit. They don’t have separate water and resources they pull from that don’t deplete our own. No, what they use belongs to us all. When things go well for them, very few of us are directly enriched. Let things go bad however and very many of us experience very real and very destructive consequences. Whether cancer, near everything simply being priced out of reach, or a glut of the previously employed, almost homeless, used to be upper middle class beating the streets looking for work with everyone else corporate america laid off, for its transgressions as it continues to reward itself for poor performance, believe me, they socialize all of the bad.

This is a scary thing, because the courts are the place where all things are settled or at least a place of last resort. Other than murder or some other gross personal wrong, where the states all too willingly, sometimes overzealously assail individuals for the purpose of protecting the public, states aren’t always nearly as effective at going after large entities and corporations that can really do the ‘true’ public a lot of harm at scale. So, if you can’t afford a good lawyer, I hope knowing in your heart that you are in fact right, will be enough, because it will be all you have.

http://blogs.wsj.com/economics/2009/01/05/state-sales-tax-cuts-get-another-look/

Actually, there isn’t any perfect free market solution to health care or legal services, just as there isn’t a perfect government solution. We have varying degrees of imperfection.

Right now we cannot afford our legal system or our current health care system. We cannot afford a government solution either, unless you’re willing to ration medical services and legal services.

Until we learn to live within our means, whether you adopt a public model or a private model, the point is moot — we’re screwed.