Response to HD Carroll:
I never said insurers want to do this. Certainly Blue Cross is against it. But the purpose of this blog is not to make insurers happy. I think Parente’s methodology is sound and it is consistent with other studies — including my own with Gerry Musgrave.

Response to Don McCanne:
Let’s say you have diabetes, and your insurance premiums are higher as a result. Do you want to make them higher still by tacking on mandates for in vitro, acupuncture and marriage counseling?

Response to Jim Morrison and Bobby Aga:
Yes, national insurers are in every state and have networks in every state. Under the interstate purchase, what will be different is the choice of 50 regulatory regimes.

Your posting today reminded me of a question that I have wanted to ask you for some time but that I never think of when I am near a computer.

The idea of “allowing people to buy insurance across state lines” sounds reasonable on its face, of course, but doesn’t it fly in the face of the 10th Amendment to the Constitution? If one argues that it doesn’t because of the commerce clause, wouldn’t that require one to argue that existing state insurance regulations are unconstitutional?

“The number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.[18]

In 2006, when the nation had 100,431 family physicians, a workforce report by the American Academy of Family Physicians indicated the United States would need 139,531 family physicians by 2020 to meet the need for primary medical care. To reach that figure 4,439 family physicians must complete their residencies each year, but currently the nation is attracting only half the number of future family physicians that we will need.[19]

The waning interest in family medicine is likely due to several factors, including the lesser prestige associated with the specialty, the lesser pay, and the increasingly frustrating practice environment in the U.S. Salaries for family physicians in the United States are respectable but lower than average for physicians, with the average being $129,295 [20] and ranging from $110,000 to $204,000[21], but when faced with debt from medical school, most medical students are opting for the higher paying specialties”.

Access: Our practices are small (usually ~4-600 patients). We can only see so many patients and do a good job. 24/7 access/txt/email/no waiting) eg: We discharged today an 85 yo diabetes, coronary heart disease, a pacemaker and constive heart failure that I started on an insulin drip last week. He was on a cruise ship in the middle of the Indian Ocean and I worked with the Norwegian surgeon cruise ship Doc to safely bring him back to Fort Worth. I charge him $167/month. That’s healthcare for a reasonable price.
I bet Senator Hill would love to give health stamps that the Medicaid patients can cash in at a direct practice and use Medicaid for what it’s really for..Catastrophies. Then we work for the patient, and not the government. We save Medicaid, Medicare and Don’t you think a family with an Iraq War veteran with numerous medical and surgical problems would love to pay a doctor directly to guide them through the maze of Walter Reed?

Resource Allocation: Wake up…Virtually no med students are going into primary care. My son-in-law is a 4th year med student at Southwestern in Dallas.
He thinks there are only 4 or five classmates going into primary care. Baylor in Houston just closed their family practice program.

Lastly, we take all comers regardless. Why deal with “change in health status” when what we love to do is patient care. And… many of my patients are alcoholics, drug abusers…etc and don’t have any insurance…and most take care of some patients for free but b/c we can…