Fix America's Health Care

[AthenaC]

A similar thread was started (that I posted on). I believe the person who started the thread is asking for the threads to be merged / directing us over here. Anyway, here was what I said regarding what I would do if I were in charge and the ACA were completely scrapped (i.e. we were back at square one):

I work as a financial auditor, and I specialize in hospitals, although recently I have worked on some state Department of Health jobs. I also majored in economics in college, although to be fair that was some time ago.

Also, keep in mind that I am not convinced there is any sort of healthcare “emergency” in the U.S. Maybe it’s because I’ve mainly worked on Catholic hospitals that have managed to be profitable, despite the horrendous Medicaid reimbursement rates in some states. and despite being rather (in my opinion) generous with charity care. I fully acknowledge I don’t know exactly how it is all over the country, but from what I’ve seen, everyone who needs care and *asks for *care gets care. The providers are managing. Somewhat.

Here’s what I would do:

1. Force insurers to compete across state lines.

Then stop. Give the market a few years to normalize after that change.

1. Allow a person with an insurance policy to add / delete people off their policy at will. This will probably mean that a person pays an additional premium for each additional dependent they have, similar to how a person pays additional auto insurance for each driver and car they add to their policy. However, this will allow parents to keep their children (or grandchildren) on their policy indefinitely if they do desire. Elderly parents can be added to their childrens’ policies when the time comes. I can add a down-on-her-luck friend of mine to my policy while she stays with me for a bit. Things of that nature.

Then stop. Give the market a few years to normalize after that change.

1. Pre-existing condition reform.
2. Re-examine what we consider “necessary” medical care, especially among the elderly and unhealthy on public assistance, in order to keep costs down.

For specifics on #3 and #4, I would first want to see how exactly #1 and #2 would play out before hashing out specifics on #3 and #4.

 

[Elizabeth502]

Thank you, Athena. You may be interested in what this poster said (has some things in common with you) on another thread, when challenged to create a fix:

I am not wise enough to be able to craft an entire program, however if I were doing it, I would have a bipartisan panel with health care professionals on it to help solve the problem. The current plan was written by lawmakers, actually there surrogates, who have no training in the field of medicine. Firstly, I would have a program that would help those who truly cannot afford insurance for themselves. This is a small number as compared to the entire population of the country. Then I would put people in charge of their own health care by allowing buying insurance across state lines thus being able to bargain with the insurance companies. There could be county or city groups formed that could bargain for the group as a whole. This way people could get the kind of insurance that best suits his/her family. Tort reform needs to be addressed. Making the suer pay costs if it fails would be a start. The “jury” should have people on it that understand medicine and not sympathetic people who think deep pockets should pay for everything. We have a bad case of sueitis in this country and not every part of medicine assures a black and white outcome.

This is just a start. I am sure improvements could be made if our “esteemed” Congress wanted to do so. Right now there is no way this country can pay for what has been promised and in the long run, those who suffer most are the patients.

 

[Elizabeth502]

While my love-hate relationship with medical insurance companies has increasingly drifted toward hate in the last 10 years (with their unaffordable premiums for much of the middle class, with their game-playing as far as coverage goes, with their exclusion of pre-existing conditions and their precipitous dropping of subscribers), there’s something to be recognized here that affects a large segment of the U.S., and the economy itself: the sheer size of the medical wing of the insurance industry. It employs millions of people. It is currently integrated into health care delivery (for better or worse), and to discourage its existence on a really massive & sudden scale (by introducing alternatives) is a little dangerous & irresponsible, I believe.

I think any version of a PPACA should be – have been – experimented with on a state level first (and not all 50 at once). I think federal support/involvement should have gone to smaller states first, with some kind of measured waiting periods for implementation in phases. First of all, it would give time for the medical industry to meet more significant patient demand. (Check out the article on kqed.org news about how CA will likely not be able to serve its new demand in short order) Second, it would give a breather for insurance companies to make some adjustments without imploding completely.

I also think that the gov’t does have a role to play in incentivizing doctors. For example — just as it has done with forgiveness of portions of loans for teacher education – it could do that forgiving for physicians who begin or shift their practice to primary care in high-need locations, and in particular to the more efficient community clinics which do (not “will”) reduce costs. That helps to alleviate pressure on doctors to work in only in lucrative fields so that they can repay their high med school debt.

I agree with a couple of posters (was it Mary and Athena) regarding eliminating juries to decide medical malpractice cases. This is something I suggested to “insiders” (lawyers) about 15 years ago. It’s absurd to have non-specialists handing out major financial verdicts in matters involving professional and technical review. Often these cases are decided out of emotion, not on facts. Such a move would help to lower malpractice insurance rates, which would also benefit physicians & patients in terms of the fees charged for services. Again, these changes should be started small, in states, individually, and not the entire country.

 

[charicel]

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[epan]

I believe that the biggest problem with US healthcare is the insurance companies. As has been advocated by another poster, I would like to see barriers to competition, and monopolies over geographic areas eliminated. That might be the first important step for private healthcare which could work.

However, the bottom line is that every “advanced” nation, except the US, provides healthcare for all of its people at a lower cost than occurs in the US whiles excluding MILLIONS of people. The cost difference us just about the price of private insurance.

The question to answer is: "what should the goal of our healthcare system be? If the answer is, “to enrich insurance companies,” then we are ontrack. If the answer is, “to provide good healthcare to everyone,” then we need to go with a public policy that works.

The advantage we have us that there are many systems in the world. We can emulate what is known to work, and discard what does nt.

 

[Joe_5859]

For any who may be reading and not notice, this thread is a year old and was just resurrected with a spam post (which will likely soon be deleted).

Just throwing that out there in case any new readers are expecting us to pick up the conversation again.