Saum Sutaria, M.D.

One of the things that comes up is what have the industry participants done to actually help with this problem? And the argument will always get made, well, it's grown so quickly they've done nothing. And I don't think that's even remotely true. Sadly, I think you could be in a situation where expenditures would have grown even faster. So think about this.

One of the things that comes up is what have the industry participants done to actually help with this problem? And the argument will always get made, well, it's grown so quickly they've done nothing. And I don't think that's even remotely true. Sadly, I think you could be in a situation where expenditures would have grown even faster. So think about this.

From a hospitalization perspective, the number of bed days per thousand, so how many hospital days per thousand population have fallen by a half since 1980? The number of physicians per thousand people has more than doubled. The industry has added significant physician capacity in order to help with access. Do we have shortages still in certain areas? Of course we do.

From a hospitalization perspective, the number of bed days per thousand, so how many hospital days per thousand population have fallen by a half since 1980? The number of physicians per thousand people has more than doubled. The industry has added significant physician capacity in order to help with access. Do we have shortages still in certain areas? Of course we do.

But the number of physicians has doubled from about one and a half per thousand to 2.8 per thousand. So the industry has expanded its capacity. The insurance companies through their managed care programs have demonstrated the ability to manage cost.

But the number of physicians has doubled from about one and a half per thousand to 2.8 per thousand. So the industry has expanded its capacity. The insurance companies through their managed care programs have demonstrated the ability to manage cost.

If the consumer were accepting of some of that management, that's a different issue to get into, which is how to do managed care in a way where it doesn't reduce and frustrate consumers or physicians with respect to choice and professional freedom. But make no mistake about it, tight managed care has controlled costs for a short period of time until there's been a bit of a revolt in terms of that.

If the consumer were accepting of some of that management, that's a different issue to get into, which is how to do managed care in a way where it doesn't reduce and frustrate consumers or physicians with respect to choice and professional freedom. But make no mistake about it, tight managed care has controlled costs for a short period of time until there's been a bit of a revolt in terms of that.

And product choice within insurance companies has created choice. So if you go back, you had Medicare for a very long time. Sometime around the late 90s, 2000, Medicare Advantage really took off. Why did Medicare Advantage get created? Medicare Advantage was a way to create product and benefit choice for seniors that wasn't just traditional Medicare.

And product choice within insurance companies has created choice. So if you go back, you had Medicare for a very long time. Sometime around the late 90s, 2000, Medicare Advantage really took off. Why did Medicare Advantage get created? Medicare Advantage was a way to create product and benefit choice for seniors that wasn't just traditional Medicare.

Right. And the government gave an incentive. I mean, I think that payments to private insurers as an incentive to get into the Medicare space were almost 115% of regular Medicare expenditures because they were trying to incentivize bringing people into the system, privatizing part of the system, providing better benefits, giving them choice.

Right. And the government gave an incentive. I mean, I think that payments to private insurers as an incentive to get into the Medicare space were almost 115% of regular Medicare expenditures because they were trying to incentivize bringing people into the system, privatizing part of the system, providing better benefits, giving them choice.

And ultimately have that managed care hopefully reduce cost. And the jury's out on that in terms of whether it's really reduced cost or shifted cost or whatever. But it is a highly functional private system built on government dollars called Medicare Advantage. And increasingly managed Medicaid is doing the same thing.

And ultimately have that managed care hopefully reduce cost. And the jury's out on that in terms of whether it's really reduced cost or shifted cost or whatever. But it is a highly functional private system built on government dollars called Medicare Advantage. And increasingly managed Medicaid is doing the same thing.

So the industry participants have done a lot in many ways over the last, in particular, 30 years in this space to try to curb costs without necessarily reducing this fundamental driver that defines our healthcare system, which is the desire for immediate access and choice. And that defines our system, is that desire for immediate access and choice.

So the industry participants have done a lot in many ways over the last, in particular, 30 years in this space to try to curb costs without necessarily reducing this fundamental driver that defines our healthcare system, which is the desire for immediate access and choice. And that defines our system, is that desire for immediate access and choice.

Yeah, and the number of hospitals has declined.

Yeah, and the number of hospitals has declined.

Yeah, the U.S. has the highest physician salaries relative to other countries. But I would tell you that physician compensation on a real basis since the 1990s has been flat or declining. That is a stunning fact. It grew rapidly from the 1950s roughly until the early 90s. But since then, physician compensation... has been flat or in many cases declining.

Yeah, the U.S. has the highest physician salaries relative to other countries. But I would tell you that physician compensation on a real basis since the 1990s has been flat or declining. That is a stunning fact. It grew rapidly from the 1950s roughly until the early 90s. But since then, physician compensation... has been flat or in many cases declining.