High cost for health care in America

[dochawk]

Alternatively, could moving towards a free market

Yes.

My own plan, going back to the 90s, is that we
a) require a price database for any provider that wants to be paid for standard procedures. Charge what you will, but for insurance purposes, we pay based on at most 1 (or 1.5, or whatever) standard deviations above the mean. Full disclosure of full price with advanced patient consent would be required to collect anything above that amount from the patient.
b) standardized base policy (or as many as three) among all insurers. Riders could add or subtract from this plan, but must use it as the base.
c) (the kicker) A fundamental change in how we deal with pre-existing conditions. We insure against acquiring one, with the entire actuarial present cost of future expenses being taken as the “event.” If you mess up a knee with present value of $250k in future expenses, and you transfer from Blue Cross to Aetna, Blue Cross writes a $250k check. If you decide to skirt the system and get such an injury, you write the check as your buy-in when you get insurance.

This system, among other things, lets the government put out bids for medicaid (or whatever): “we need bids for 5,000 class A policies with no riders”

The “corner cases” are going to be an issue no matter what we do: those born with congenital problems, those that become quadriplegic in accidents, and so forth. We can out them into a separate government program without making having them drive standard practice.

side note: ( I haven’t verified it, and won’t stand by it, but it seems likely given the comments above on excessive consumption of subsidized services). I heard a report which seemed to be largely back of the envelope level, but it multiplied the fraction of the population with pre-existing conditions, multiplied by the costs of those high risk pool policies, and found that it would have been far less expensive to buy every one of them a policy than to make the changes that we did . . .

 

[aper1]

Please don’t be a sensitive. Ignorant isn’t name-calling. By definition, it’s stating that someone is lacking knowledge on a particular topic, which is precisely what I was trying to convey. Also, I request you don’t involve anyone else when I was directly speaking to only you. That’s, um, quite unbecoming of a man. (Is that wordage suitable?)

It’s ok; we are all ignorant about certain topics. To say so is not disparaging, but acknowledging our place in relation to the only One who is truly all-knowing.

 

[Theo520]

Private care in the U.K. is done by the same doctors that work in the nhs system, your standard of care or your quality of doctor is no different. What you do get is nice private rooms, hotel style toiletries in your bathroom, a more comfortable bed, your own tv/entertainment options, nicer menu options (+ wine) at mealtimes. Obviously if you have the money to pay for those perks and want them, you’d opt for private insurance. It should be noted that if an emergency takes place, in 90% of cases, you will be transferred straight to an NHS hospital for intensive care. Your private option will only cover you for nicer facilities and a shorter wait time, your odds of surviving that surgery or treatment are absolutely no different.

A shorter wait time and being able to select your doctor can have a huge impact.

 

[_Ruby]

A shorter wait time and being able to select your doctor can have a huge impact.

You can already manage that on the NHS. The U.K. NHS system runs under a ‘choose and book’ system where you can choose your treatment providers at the time of referral. All providers must release their wait times on a weekly basis so patients can choose from a whole host of options.

If there is a particular doctor or team you wish to be treated by, you either choose that hospital/provider when your GP does your referral. If, for whatever reason, they are not under choose and book, you can have your GP contact them directly for a referral.

With wait times, all providers must publish those weekly on the choose and book system so patients can pick the fastest option if that is what they want. All the wait time stats etc are online and patients are given plenty of time to go home, think about the provider options they may want and then go onto the online choose and book system to pick.

 

[InThePew]

For starters, nobody enters NZ without a visa.

cough cough* NZ Visa Waiver Program cough cough

Americans seems to have this aversion to government run anything (be it telephones, railroads, or healthcare)which I’ve never really understood - I’m guessing it goes back to the revolution…

No system anywhere is perfect, Britain’s NHS in particular comes in for criticism but, for me at least, the litmus test is how well you’re dealt with in an emergency (as well as what it costs). When my brother was living in the UK he found out one day that he had a detached retina (as you do); within a week he was having surgery as a specialist eye hospital. Other than a few days off work, the whole experience (from doctor’s visit to surgery) cost him nothing.

I’;m not saying that the US should crate a carbon copy of Britain’s NHS (the difference is population is only one factor to consider) but I would say that Americans need to recognise that the government of any country has a primary role is assuring the health and well being of its citizens through affordable and accessible health care as much as it does through defence expenditure.

 

[Theo520]

cough cough* NZ Visa Waiver Program cough cough

lol, you misunderstand what transpires.

They don’t require an advance visa from rich countries or cruise ships, put you must obtain an NZeTA before you come, which is effectively the same thing as multi visit visa.

I’m pretty sure everyone gets their passport checked and stamped (with a visa stay length) when they arrive.

Everyone who comes is checked an approved, plus they pay their fees

 

[KMC]

Most of the savings comes from going from thousands of health insurance schemes to one.

This may be true, but if you figure that states require insurance companies to spend approx 85%-90% of revenues on medical treatments, using the remaining 10-15% to cover expenses (salaries, admin, profit) do you really think the government can do the same work for less cost? typical ebitas of large healthcare providers are less 5% or less. Would your proposal have the government administer all healthcare, or just hire a single private company?

 

[Zzyzx_Road]

87 posts and no one talks about the degree to which corporate cronyism has taken over the health care and insurance industry in the US.

The ACA was written with the industry lobbyists at the table, but no one was there to represent the unsubsidized consumers.

So we get things like near complete opacity in prices, out of network surprise billings, thousands of opaque billing codes, hospital chains that drive private physician groups out of business, huge price disparities in drugs, MRI’s, medical devices, etc., between the US and other countries. And so on. None of which are consumer friendly.

Let’s tackle opacity in prices, for instance. This would include so-called “out of network” surprise bills. Long ago, the same sort of opaque pricing, surprise billing, bill padding, etc., took place in the auto repair industry. The Robinson Patman Act was used to bring the industry into compliance with consumer friendly pricing policies. Let’s do the same for the health industry. Let’s force all their prices into the open, let’s force all sellers and providers to post prices publicly in their offices and on their websites for the most common services provided, let’s force all providers to give accurate estimates of procedures to prospective patients, let’s force all providers to make their volume discounts public and available to any group that qualifies for them, let’s not allow any provider to charge uninsured patients more than the Medicare allowed price. And so on.

There is nothing legally that keeps the DOJ and the state AG’s from enforcing the Sherman Anti-trust Act and the Robinson Patman Act against the health industry. But they won’t do it. Why is that? It’s because the corporate cronies have a death grip on both sides of Congress as well as all of the state legislatures.

As I said in another thread, in what world does anyone think that these corporate cronies won’t be at the table when the MFA is being negotiated by a future Congress? In a small country like NZ, it’s possible for the citizenry to have a much closer interaction with their federal leaders than we do. So the NZ leadership has to be more responsive to abusive practices than they are here in the US.

 

[InThePew]

They don’t require an advance visa from rich countries or cruise ships, put you must obtain an NZeTA before you come, which is effectively the same thing as multi visit visa.

Similar but not quite the same - more of a method of pre-screening since passport holders from countries on the approved lists never needed visas in the first place (much like the US program). Note though that the “wealth” of the country isn’t the only yardstick; visa requirements are linked to a number of factors both political and economic (with reciprocity also playing a part). interestingly, Argentina, Uruguay and Vatican City make it onto the NZ list but not the US one.

Of course, being a remote island nation, New Zealand doesn’t have to worry too much about illegal immigration (at least not on a mass scale). That said, (most) foreign nationals aren’t entitled to free healthcare. Like the US, anyone who shows up at the ER will be treated but those not eligible for publicly funded services (so basically, non NZ residents, with a few exceptions) can expect to receive a bill afterwards.

The interesting part comes when dealing with personal injury (i.e. accident) cases. In such cases, treatment is free since New Zealand has a universal accident insurance scheme (ACC) that covers treatment costs for accidental injuries. The scheme covers anyone in New Zealand for acute accident-related hospital treatment, and a other services.

 

[Peeps]

I’ve worked in a hospital lab for almost 37 years now.

I see signs that things are unraveling in the health care industry.

A few years ago, our hospital was bought out by a huge university system that is swallowing up many independent hospitals and health care systems in its path.

This huge conglomerate of hospitals are all expected to do things the way the “mother ship” does things.

And we are starting to say no.

I work in microbiology. Although we still do most of our work with gram stains, agar cultures, and IMVIC tests (variations of), we have a lot of instrumentation available to us now that gives us diagnoses in less than an hour. It’s wonderful technology!

But the instruments vary greatly in their ease of use, accuracy, etc.

Our “Mother Ship” wants all their hospitals to use the same piece of junk that they use. And MY supervisor is standing up against them saying, NO! After seeing many instrument demos, we want to acquire the instrument that actually WORKS and is manufactured and serviced in a Chicago suburb only an hour away from us by people who actually LIVE in that suburb!

Also, the Mother Ship wants everyone to use a very convuluted computer system (medical system) that was obviously designed by toddlers who think they’re playing video games.

We’ve tried to adapt to their system. It’s so bad that people have quit over it. I have considered it. I had a nurse on the phone, and when I told her that she would have to speak with her Team Lead about her computer questions because we in the lab don’t use the same modules that the floors use, the nurse started crying and said, “I AM the Team Lead!”

That was a dark day.

Anyway, the people in our hospital are beginning to speak up. Again, my supervisor told them that they had BETTER provide excellent training, not the college kid that danced around the front of the room and ignored everyone over age 30. She mentioned me (not by name) and said that she does NOT want to lose someone with 36 years of experience and knowledge because of a lousy computer system taught by someone who has no clue what lab people actually do.

These are just a few examples, but I think that objections to the “massive-ization” of health care systems are starting to get out without the objector getting fired which is what used to happen when someone didn’t “get on board the team ship.” At this point in U.S. history, there simply aren’t any replacements for “team members” who quit in disgust. And that means no health care.

 

[Buks]

I hope your voice is heard by many.
And I hope to find more such perspective here from people who are on the front line of health care (and who have not become ultra wealthy).

 

[Pattylt]

We went through this, too. Our “Mother Ship” is in another state and guess what! They have their lab services contracted out to a for profit organization. Mother Ship wanted all equipment to match because they could save money with volume purchases…the chemistry analyzers were the last ones we would have chosen! We would have to hire two more day techs and a dedicated night chem tech to run the stupid thing…there went their volume price savings!

We put our foot down. Our volumes aren’t the same as Mother Ship. Our patient demographics aren’t the same and our staff numbers aren’t near the same. We had a lab manager with the patience of a saint and a stubborn streak to match. We got OUR chemistry analyzer. Now, they have them too…which makes me wonder if there was money under the table somewhere from the other analyzer company.

Eventually, however, it seems to be a losing battle. We are a regional medical center lab still owned by the hospital. That’s changing in another year or so. We lost our whole microbiology department to a sister hospital 40 miles away. They needed the business so all the techs had to relearn doing and reading gram stains for stat orders. It was a massive undertaking as most techs hadn’t read a gram stain in 30-40 years…that cost wasn’t figured in! We also have to have transport every 2 hours day and night for time critical micro specimens. A nightmare all around…and we lost our lovely micro techs! We rarely see them now. Being asked to commute 40 miles was tough on several of them.

I retired just in time. The lab lost 4 more techs to retirement last year and will lose 4 more this year…and not near enough applicants to replace their bodies much less their skill level. I see nothing but crisis after crisis in laboratory medicine…the department that produces 75% of diagnosis!

I hope you survive until you want and can retire…truly, I do!

 

[Vouthon]

Where I’m from in Europe, practically every country has some version of universal single-payer healthcare funded by public taxation which makes the service free at the point of use.

All of these countries are advanced free-market economies. Some, such as the Nordic countries of Scandinavia in the EU which have the largest welfare states, collective bargaining, 30% of their population in the state sector and a heavily unionised populace, also have much lower rates of corporation tax than the United States and are very attractive to foreign inward investment / international business.

They have, in other words, balanced social care and egalitarianism with individual free enterprise and competition far better than America has.

The Preaching of Peter, a fragmentary text from early in the second century CE that was referenced by a number of Early Church Fathers as an authentic tradition of the Apostle Peter’s teachings, premises the duties of the rich, with regards to their superfluous wealth, in God’s equal endowment of all mankind:

The Preaching of Peter

" God hath given all things unto all, of his own creatures. Understand then, ye rich, that ye ought to minister, for ye have received more than ye yourselves need. Learn that others lack the things ye have in superfluity. Be ashamed to keep things that belong to others. Imitate the equality of God, and no man will be poor ."

(From St. John of Damascus, Sacred Parallels , A. 12, Rhodes James, 1924, 18-19)

If I may quote the scholar Sarah Drakopoulou Dodd in relation to the social teaching of early church father St. John Chrysostom (died 407 CE):

"Chrysostom conceived the nature of ownership essentially as that of a dynamic function of sharing the world’s wealth to meet he requirements of a life of dignity for all.

According to Chrysostom, human welfare depends upon an abundance of goods, the general peace and a reasonably equitable distribution of wealth. If these three conditions are satisfied, then one can commence the quest for an approximation of a welfare state (vol. 58, Homilies on the Psalms , 341B).

Chrysostom in his Homilies on the Priesthood stressed that love and friendship among men increase when there are no extreme inequalities in the distribution of possessions…

The Fathers, and especially Chrysostom, believed that the role of taxation was mainly the redistribution of income and wealth. He was in favour of progressive taxation, condemning the equal fiscal treatment of rich and poor "

(Ancient and Medieval Economic Ideas and Concepts of Social Justice (2000), p.195)

(continued…)

 

[Vouthon]

His contemporary, St. Augustine of Hippo dreamt of a future in which the landless poor would be maintained by social welfare distributed by the government via progressive taxation:

CHURCH FATHERS: City of God, Book V (St. Augustine)

…the admission of all to the rights of Roman citizens who belonged to the Roman empire, and if that had been made the privilege of all which was formerly the privilege of a few, with this one condition, that the humbler class who had no lands of their own should live at the public expense — an alimentary impost, which would have been paid with a much better grace by them into the hands of good administrators of the republic.

St. John Chrysostom argued that the equal right of all to the use of the wealth of the earth, which includes medicine, was akin to their right to breathe the air:

CHURCH FATHERS: Homily 12 on First Timothy (Chrysostom)

Is this not an evil, that you alone should have the Lord’s property, that you alone should enjoy what is common?

Mark the wise dispensation of God. That He might put mankind to shame, He hath made certain things common, as the sun, air, earth, and water, the heaven, the sea, the light, the stars; whose benefits are dispensed equally to all as brethren.

We are all formed with the same eyes, the same body, the same soul, the same structure in all respects, all things from the earth, all men from one man, and all in the same habitation. Other things … He hath made common, as baths, cities, market-places, walks.

(Schaff, 1886, 13, p.448)

 

[JoeShlabotnik]

So, what you are saying is that Germany, France, Great Britain, Japan, South Korea, and most other free market countries are capable of doing in health care what America cannot do?
Their coverage is better and their costs are less.

 

[Servant31]

Drug prices? It is fact that America bears the burden of drug development cost. Drugs are cheaper elsewhere because we pay the major cost of development. Canada, et al, then benefit from our investment.

This is something I often hear missed. I’m not a fan of “big pharma” per se. However to be realistic we must factor in their costs for development, which involves a rather large amount of risk.

 

[JoeShlabotnik]

Please take a trip to Canada or to Mexico.
You will be shocked when you compare the cost for the same drugs.

 

[Servant31]

I could go on and on about the health care system as it currently is but what often, to me, seems to be missing from the argument is that of human nature/behavior such as this. Preventative care is often an afterthought with required large scale risks on the back end, but we can be risk averse about lifestyle changes on the front end. But also the business mindset of insurance and hospitals/providers can be neglected in both the positive and negative.

 

[KMC]

I’m saying our batting average at saving money on anything is quite dismal.

I’m saying I’ve been hearing for five decades from politicians is how this program, or that program will save money. Why would I believe them now?

Medicare has unfunded liabilities of $46T.

Fool me once…

 

[JoeShlabotnik]

Preventative care is a big key. If our health insurers would consider how much less if costs to keep us healthy than it does to pay for illness or disease after the fact, they would see that preventative care saves money and lives.