How SHOULD Health Care Work?

[vern_humphrey]

Vern, your plan seems not to respect Occam’s Razor.

IN what way? My plan is basically, pay for your own care up to the catestrophic level, and then use insurance. Neither pay your own way nor insurance are new ideas, so I have “created” nothing.

Similarly, my plan involves basic economics – choose to buy, or choose to save – and I didn’t invent that, either.

Our plan, while blithely simple, does not work in practice for all people.

A wise man once said, when you starve with a tiger, the tiger starves last. When you rely on the government for medical care, those with most political clout get the best care.

The only thing I can say to folks is: be ever vigilant, educate yourselves on your own health, and fight like hek for quality health care. The squeeky wheel gets oiled.

“Quality health care” and “the government makes all the decisions” don’t go together very well.

 

[DrPiano]

What I don’t trust is the bureaucrats who run the system. I wouldn’t want to be trying to deliver medical care back in the bush and get shot at with bullets paid for by the black-market sale of the medicines we are giving to the poor.

And keep them from being ripped off and used to fund private armies.

You walk point – I’ve already got two Purple Hearts.

Sorry - medical restrictions keep me from joining the military. Thank you for your service, though. I highly applaud and appreciate anyone who serves our country as a member of the armed forces.

 

[vern_humphrey]

What do you mean exactly by “we” pay emergency treatment?

By we, I mean all of us. Instead of jacking up the bill of the guy in the next bed, we pay for indigent medical care by sending the bill to the state.

And what qualifies, in your opinion, as emergency treatment?

The same thing you mean by emergency treatment – the exact same treatment the indigent receive when they present at the emergency room.

I see requiring some basic level of insurance as analogous to requiring a basic level of car insurance.

Bad analogy. We require liability insurance – which pays the other guy if we cause an accident.

We do not require collision insurance, which pays to fix our car.

Anyone who operates a car in this country must have a minimum level of insurance. Some have more, that is fine. But to drive, you must have the minimum. It’s not really for the person driving the car - its for society. Its to minimize cost to society and the people around you.

Only liability insurance, not collision insurance.

In a medical setting, this would mean if you drop the doctor’s prize vase while sitting in the waiting room, the insurance pays. But it doesn’t pay for your treatment.

For this I think a minimum should be required. Perhaps its simply the catastrophic insurance? I don’t know. Personally, I just think there should be a minimum - I’m not trying to set that minimum here.

Massachusetts is doing exactly that – and while it doesn’t improve access to medical care, it is a bonanza for the insurance industry.

 

[Ani_Ibi]

DrPiano:

What do you mean exactly by “we” pay emergency treatment? And what qualifies, in your opinion, as emergency treatment?

Don’t get me wrong here. I do not mean to say that emergency treatment should be de-escalated. But I think health care would be vastly less costly if more emphasis was placed on prevention, healthy lifestyle, and healthy environment.

Hek the environment that we live in in the big cities has become a cesspool.

 

[DrPiano]

Get the insurance business away from the doctors and hospitals. This will keep the easy pay day that the lawyers want diminished in the equation. You can still sue if there is real damage done. But if there is no “pot of gold” to go after (or bailout settlement potential), then why bother. Doctors, physician associations, and medical centers will actually fight, under this system, for their own livlihood and if they lose, they risk going broke. Society as a whole might recognize what we have to lose but filing lawsuits willy nilly and people who practice poorly might actually go out of business - as they ought. Physician associations can still choose to “cover” an associate if they feel they he got a raw deal, but they would be in no way obliged to if they think he got what he had coming to him. Keep the practice of medicine a humble one and not just a get rich quick scheme on anyone’s part this way. And keep costs down as patients would only need to be paying for actual services and not making the insurance companies and lawyers, or even the doctors (hey, if they don’t own much of anything, there isn’t much reason to sue them) rich.

I’m confused at what you’re implying here. Please clarify what you mean by “Get the insurance business away from doctors and hospitals.”

Also - please understand that doctors and nurses and other health professionals DO fight for their livelihood. Many (I would even venture to say MOST) of them do the very best they can for all of their patients. But as we are only human, mistakes happen - and our get-rich-quick society jumps in and tries to capitalize on them. Now, mind you, I’m not talking about truly criminal things (like the attending physician who left the resident in charge of the OR while he went to the bank in the middle of surgery). I’m talking about people who do the very best they can but bad things happen anyway.

 

[DrPiano]

Don’t get me wrong here. I do not mean to say that emergency treatment should be de-escalated. But I think health care would be vastly less costly if more emphasis was placed on prevention, healthy lifestyle, and healthy environment.

Hek the environment that we live in in the big cities has become a cesspool.

Ani Ibi,

I fully agree with you - we need to educate our society to value prevention. I agree that this would result in a much lower health care cost (than our current method of mostly helping people only when they’re really really sick).

 

[DrPiano]

By we, I mean all of us. Instead of jacking up the bill of the guy in the next bed, we pay for indigent medical care by sending the bill to the state.

The same thing you mean by emergency treatment – the exact same treatment the indigent receive when they present at the emergency room.

Bad analogy. We require liability insurance – which pays the other guy if we cause an accident.

We do not require collision insurance, which pays to fix our car.

Only liability insurance, not collision insurance.

In a medical setting, this would mean if you drop the doctor’s prize vase while sitting in the waiting room, the insurance pays. But it doesn’t pay for your treatment.

Massachusetts is doing exactly that – and while it doesn’t improve access to medical care, it is a bonanza for the insurance industry.

Actually, in my state we require no-fault insurance. I might be wrong, but I believe what happens is your insurance pays for the damage to your car, his insurance pays for the damage to his car, regardless of who caused it. Again, I could be wrong, but I believe that is how it works here.

 

[vern_humphrey]

Actually, in my state we require no-fault insurance. I might be wrong, but I believe what happens is your insurance pays for the damage to your car, his insurance pays for the damage to his car, regardless of who caused it. Again, I could be wrong, but I believe that is how it works here.

Believe me, there is no state with “no-fault” insurance – you still must have liability coverage, because the other guy can still sue. And as a physician, you have (Dragnet theme plays here) Deep Pockets.

 

[DrPiano]

Believe me, there is no state with “no-fault” insurance – you still must have liability coverage, because the other guy can still sue. And as a physician, you have (Dragnet theme plays here) Deep Pockets.

Sorry - I looked it up after replying. Actually in my state, it is called no-fault, but here is the description:

If you have an auto accident, nofault insurance pays for your medical and wage and the damage you do to other people’s
property. It does not matter who caused accident.
Your basic nofault insurance does NOT for repairs to your car. For an explanation insurance coverages providing protection your car, see the next page of this sheet…

on being sued it says:

The nofault law protects insured persons from being sued as a result of an auto accident except in certain special situations.
In general, you can only be sued:
(a) if you cause an accident in Michigan in which someone is killed, seriously injured, or permanently disfigured;
(b) if you are involved in an accident in Michigan with a nonresident who is an occupant of a motor vehicle not registered
in Michigan;
(c) if you are involved in an accident in another state; or (d)for up to $500 if you are 50% or more at fault in an accident which causes damages to another person’s car which are not covered by insurance.

The problem I have with sending the entire bill for all Emergency Services to the state is
a) the state (or federal government for that matter) does NOT pay medical bills well or sufficiently, at least at the present time. I have a hard time seeing this change any time soon.
b) many people already use Emergency Departments as primary care offices. What is the incentive really, at all, to get even catastrophic coverage? If my life is endangered I can use the ED at no cost anyway. If I have an asthmatic attack, I can just go to the ED. If I get a fever or the flu, I’ll just go to the ED. Why have a PCP at all? Its already abused, particularly in urban areas (for multiple reasons - some don’t have health insurance, some can’t get to a PCP, some can’t get to the drug store, etc.). Why put more incentive in the system to abuse it?

Believe me, I understand your point of view - I really do. I just respectfully disagree. I see people not having ANY insurance as a liability to our society. You disagree - and you are well within your rights to do so. I doubt we will ever see entirely eye to eye and thats ok. Its lots of people working together, bringing all ideas and priorities to the table that is going to help us figure this problem out.

 

[vern_humphrey]

Sorry - I looked it up after replying. Actually in my state, it is called no-fault, but here is the description:

What did you expect – state legislatures are full of lawyers, and anything that affects a lawyer’s pocketbook is going to be watered down and perverted.

I’ll have to tell you about Father O’Malley. He had a parishoner who was a truck driver. This fellow like to kill lawyers. He’d see one walking down the side of the road, twitch the wheel, and THUMP! and he’d drive on.

One Sunday he was going to Mass and saw Father O’Malley walking along the side of the road. He pulled over.

“Can I give you a lift, Father?”

“Oh, t’ank yez, me son. Me auld motor-car broke down a mile or so back and I’ve got to get to church to say Mass.”

So off they went. Topping a hill, there was a lawyer walking along the shoulder of the road, and the fellow instinctively twiched the wheel, then remembered he had a priest in the cab with him. He tried to pull back onto the pavement, but THUMP!

He looked back in the rearview mirror and saw the lawyer lying dead beside the road. “Father!” he said, “You’ve got to forgive me! I didn’t mean to kill that lawyer! I tried to miss him!”

And Father O’Malley, being the kind, understanding priest that he is, put his hand on the fellow’s shoulder and said, “I know yez did, me son. But I got the son-of-a-&^%$ with the door.”

The problem I have with sending the entire bill for all Emergency Services to the state is
a) the state (or federal government for that matter) does NOT pay medical bills well or sufficiently, at least at the present time. I have a hard time seeing this change any time soon.

But how is forcing the sick to pay more somehow more just?

b) many people already use Emergency Departments as primary care offices. What is the incentive really, at all, to get even catastrophic coverage?

That reminds me of a commercial where the actor said, “I wouldn’t buy a product that wouldn’t shrink hemmrhoidal tissue.” I always imagined him going on to say, “I was going to buy an Oldsmobile, but it won’t shrink hemmrhoidal tissue.”

Not all problems can be solved perfectly, and not all solutions will solve all problems – but we haven’t made things worse in this area, and with MSAs we have made things better in many other areas.

already

abused, particularly in urban areas (for multiple reasons - some don’t have health insurance, some can’t get to a PCP, some can’t get to the drug store, etc.). Why put more incentive in the system to abuse it?
We’re not putting more incentive to abuse the system – we’re merely insuring that the sick who can pay don’t bear the full burden of this problem.

It’s an issue of both personal choice and practiciality.

As I said, there is a limit to emergency room care – if someone comes in with a sore finger, you don’t put them up in a hospital room and feed them for the rest of their lives. There is a limit.

As for practicality – a nation with 12 million undocumented immigrants will always have millions of people outside the system, so forcing others to have MSAs will do nothing to solve that problem.

 

[Ani_Ibi]

… if someone comes in with a sore finger, you don’t put them up in a hospital room and feed them for the rest of their lives. There is a limit…

We had this problem up here in Canada for a bit. Folks with head colds were checking into emergency rooms and clogging up the system while folks with heart attacks were being forgotten in the corridors.

Now we have a phone-in service to a nurse practitioner who will then refer the caller to the emerg or simply tell the caller what to do at home until he or she can see the family doctor in the morning.

 

[emily47017]

vern, your idea to bill the state for ER services is one place to start… but that’s the very least efficient use of your tax dollars. get everyone to a PCP early and we all save money in the end.

universal coverage doesn’t mean people won’t be able to make decisions about their own health care. it means that the immediate expense won’t be such a looming factor in their decisionmaking. when you’re living hand-to-mouth, it’s hard to take the long view financially, even if you know perfectly well that preventive care is cheaper than emergency care.

 

[vern_humphrey]

vern, your idea to bill the state for ER services is one place to start… but that’s the very least efficient use of your tax dollars. get everyone to a PCP early and we all save money in the end.

Yep. Your mission, should you choose to accept it, is to round up all 12 million undocumented aliens for their checkups.

As always, should you or any member of your team be captured, the Secretariat will deny all knowledge.

Actually, it does – as was pointed out in the case of Bill Clinton’s heart surgery, if his wife’s health care plan had passed (and if he had been an ordinary American), he would have been put on a waiting list and died before receiving surgery.

And how do you propose to change that? Have the poor who can’t pay anything forced to have checkups? Who will pay for it? Congress has steadly resisted preventive checkups in most cases in virtually all government-run health plans.

 

[DrPiano]

Yep. Your mission, should you choose to accept it, is to round up all 12 million undocumented aliens for their checkups.

As always, should you or any member of your team be captured, the Secretariat will deny all knowledge.

Actually, it does – as was pointed out in the case of Bill Clinton’s heart surgery, if his wife’s health care plan had passed (and if he had been an ordinary American), he would have been put on a waiting list and died before receiving surgery.

And how do you propose to change that? Have the poor who can’t pay anything forced to have checkups? Who will pay for it? Congress has steadly resisted preventive checkups in most cases in virtually all government-run health plans.

Actually - universal coverage (everyone has health care) is NOT equivalent to a single-payer system (government or otherwise). If my memory serves me correctly (I was fairly young at the time) Hilary Clinton’s idea was a single-payer system. Others here are suggesting universal coverage in a multipayer, market-driven system.

Sick people footing the bill for their expenses actually does seem just and right to me. They are the ones using the services. When I get sick and use the emergency department (or any medical services for that matter), I pay for them.

FYI - I’m in favor of tightening security at our borders and deporting illegal immigrants. I’m all in favor of legal immigration - obey our laws (including on how to enter our country), respect us, and do your best to integrate into our society if you want to live here.

Don’t make an incentive to use emergency services. If the government pays for everyone to use the ED then what would be the incentive for ANYONE to use a primary care physician. Paying for the ED is one way to use tax dollars - but is it the wisest way? Does it give us the best return on investment? I respectfully submit that it does not. Helping people get health plans that cover ED visits might be better… And I agree with emily47017 - the wisest return on our investment would be to figure out a way to encourage people to get plans that pay for preventive care - and that pay for keeping chronic illnesses under control. Am I advocating forcing people to have these plans? NO. But I would suggest that perhaps a middle ground - such having at least a minimum insurance that would pay for things like ED visits- might be a wiser investment of US Tax Dollars.

 

[vern_humphrey]

Actually - universal coverage (everyone has health care) is NOT equivalent to a single-payer system (government or otherwise). If my memory serves me correctly (I was fairly young at the time) Hilary Clinton’s idea was a single-payer system. Others here are suggesting universal coverage in a multipayer, market-driven system.

All such systems founder on the same rock – “Why shouldn’t I go to the doctor for my hangnail? I pay the premiums, don’t I?”

That drives costs up. The counter to that is regulation – which generates paperwork, which drives costs up. It also sets prices – as one doctor said to me, “If I know the insurance company will pay $100 for a particular treatment, why would I ever charge $95?”

MSAs work by motivating people to bargain for health care and to avoid over-consumption.

Sick people footing the bill for their expenses actually does seem just and right to me. They are the ones using the services. When I get sick and use the emergency department (or any medical services for that matter), I pay for them.

I agree – I don’t expect the hospital to pay for my car, laundry, rent and so on!! I pay that myself.

FYI - I’m in favor of tightening security at our borders and deporting illegal immigrants. I’m all in favor of legal immigration - obey our laws (including on how to enter our country), respect us, and do your best to integrate into our society if you want to live here.

And I agree – except for one thing:

How many 40-passenger busses would it take to deport 12 millino people. Allowing 60 feet per bus, and 100 feet between busses, how long would the column be? At 55 mph, how long would it take for that column to pass an intersection?

Don’t make an incentive to use emergency services. If the government pays for everyone to use the ED then what would be the incentive for ANYONE to use a primary care physician. Paying for the ED is one way to use tax dollars - but is it the wisest way? Does it give us the best return on investment? I respectfully submit that it does not. Helping people get health plans that cover ED visits might be better… And I agree with emily47017 - the wisest return on our investment would be to figure out a way to encourage people to get plans that pay for preventive care - and that pay for keeping chronic illnesses under control. Am I advocating forcing people to have these plans? NO. But I would suggest that perhaps a middle ground - such having at least a minimum insurance that would pay for things like ED visits- might be a wiser investment of US Tax Dollars.

The problem is looking for a solution where it isn’t – like the drunk looking for his car keys under the lamp post because that’s where the light is.

How will you care for the indigent? What do you propose for the illegal who comes into the emergency room with a fractured leg?

The current answer is, “The other patients must pay for it.” Is there a better answer?

 

[emily47017]

And how do you propose to change that? Have the poor who can’t pay anything forced to have checkups?

you missed my point. most people want to make responsible decisions about their health care. if checkups, routine tests, management of chronic illnesses and early detection of progressive illnesses are all available free or at low cost, that’s going to save us all boatloads of money in unnecessary ER visits.

as it is, if i have $15 to spare this month, i’m more likely to spend it on milk, peanut butter and a couple pounds of vegetables than on the copay for a doctor’s appointment to check out that shortness of breath i’ve been having… maybe i’m just allergic to something and it’ll go away on its own. or maybe it’ll turn out to be congestive heart failure. the best investment for taxpayers is to help me do both: buy food and get that symptom checked out before it sends me to the ER.

 

[vern_humphrey]

you missed my point. most people want to make responsible decisions about their health care. if checkups, routine tests, management of chronic illnesses and early detection of progressive illnesses are all available free or at low cost, that’s going to save us all boatloads of money in unnecessary ER visits.

Oh, I don’t miss the point at all.

I ask, “Who’s going to pay for it?” And how?

as it is, if i have $15 to spare this month, i’m more likely to spend it on milk, peanut butter and a couple pounds of vegetables than on the copay for a doctor’s appointment to check out that shortness of breath i’ve been having… maybe i’m just allergic to something and it’ll go away on its own. or maybe it’ll turn out to be congestive heart failure. the best investment for taxpayers is to help me do both: buy food and get that symptom checked out before it sends me to the ER.

And how will you change that?

 

[emily47017]

see my first post on this thread.

 

[vern_humphrey]

see my first post on this thread.

Okay:
eliminating the health insurance industry means implementing one of two existing solutions: a government run system (a la britain),
We talked about this – if Hillary’s plan had been implemented, and Bill had been an ordinary citizen, he’d have died on the waiting list for heart surgery.

Government run systems neither hold down costs, nor do they provide better care.

or a single-payer insurance system (where there are copays, premiums and whatnot, but it’s all funneled through one not-for-profit organization).

Kind of like the Post Office.

Let’s see the hands of everyone who wants to turn his healthcare over to the Post Office.

the outrageous cost of health care in the US can be mitigated by:
cutting out the middle man!

digitizing medical records and making them available to providers anywhere in the country
That would be a violation of HIPPA (the Health Insurance Portability and Privacy Act) as written. And I really don’t see any great cost savings there – help me out. Where do the savings come in?

promoting a cultural shift within the health care community away from new/shiny and toward tried/true, AKA evidence-based practice

Or as they say in Canada, “Our government provides us with the best medical technology available in the 1970s.”

providing the best preventive care possible (this has to go way beyond the yearly physical – smoking cessation, weight loss, vaccination, proper management of chronic conditions, early detection of acute conditions, etc.), which means, i’m sorry to say, providing it for free.

Nothing is free. Someone must pay. Who do you see paying for this?

 

[emily47017]

Kind of like the Post Office.

no, the post office is government run and more analagous to my first option.

That’s essentially what MSAs do.

it’s not. the financial agency managing the MSA is a middle man. also, you’ve said yourself that MSAs wouldn’t be sufficient for catastrophic situations, and we would need private insurance for that.

MSAs don’t alleviate the problem of avoiding preventive care; if you’re rolling leftovers into an IRA, you’d even be able to rationalize by saying “i’m saving for retirement!”

Where do the savings come in?

in eliminating wasted time (in getting information to deal with whatever ailment is presenting) and man-hours (in processing the same paperwork a thousand times in a thousand different doctor’s offices).