I found the state of medicine in UT to be poor and moved to another state. The negatives: high litigation rates, poor reimbursement, IHC pistal whipped apathetic collegues who were affraid to challenge IHC and fight to improve things. Most docs willing to accept a poor practice environment because they will not live any where else. I found the morale among UT doctors to be low; they were very fatalistic and chronically depressed. My specialty is in high demand in UT, patients wait over 3 months to see MDs for this area of medicine. An under appreciated fact: 30% of doctors that move to UT leave within 3 years. You can thank IHC for that fact. They have purchased protection from state government and enjoy a true monopoly!

Cost-containment requires intervention on multiple fronts.

The prohibitive cost of medical care has diverse origins, among them: high overhead charged by insurance companies; administrative costs from for-profit hospitals; obscene prices charged to Americans for tests and pharmaceuticals, and; unrealistic expectations by all of us for immediate care and expensive, marginally effective procedures.

The costs burdening us paying, insured customers are escalated when we must also pay for the 46 million uninsured and indigent patients who come to our emergency departments for their only health care.

Lawyers could reduce malpractice premiums, but defensive medicine, IMHO, is less a problem than touted: it *is* prudent to order an expensive "serum porcelain" test in an initial diagnostic evaluation even if there's only a 1-in-50 chance that a patient might have a treatable condition that couldn't be diagnosed otherwise.

IHC is not the problem. University Hospitals, also favored by their not-for-profit status, is not the problem. I don't even blame poor reimbursement for Providers since the practice of Medicine is intrinsically rewarding.

At the core is the lack of transparency for the consumer: purchasing health care is very different from buying an automobile.

Reform must be systemic. A patch-job won't do.

The way things are going right now, I'll give the healthcare system about five years before it utterly collapses. Malpractice has little to do with it and is generally overblown as a problem. Only 1% of the cost of healthcare is due to the cost of malpractice insurance for doctors and hospitals.

Instead, we have an insurance system that is costly, inefficient, and contains all the wrong incentives.

We, the American people, demand a very high standard of care from doctors and nurses. This standard is so high that these groups expect to be paid huge amounts of money when they obtain the skill level they need to work in the health car
e system.

In the meantime, our population grows ever older and more in need of healthcare services. Yet, the position of our country in the world is not improving. America's economy is struggling.

We are on a collison course and the current system simply has to be reformed. I'd suggest a single payer national health insurance system with cost containment strategies built into it.