How SHOULD Health Care Work?

[vern_humphrey]

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

Not any more – it’s a non-profit chartered public corporation.

it’s not. the financial agency managing the MSA is a middle man.

No more than a bank – and it isn’t a middle man in the medical field – it doesn’t make any rules about what I can do with my MSA.

also, you’ve said yourself that MSAs wouldn’t be sufficient for catastrophic situations, and we would need private insurance for that.

Yep – but that would reduce the insurance impact on costs by over 90%

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!”

MSAs won’t prevent a comet from hitting the earth, reverse global warming, or raise the average mileage of the auto fleet.

But they will go a looooong way to controlling costs in the medical industry.

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).

I haven’t seen a thousand doctors in my whole life.

Nor does every doctor see the same patient for the same complaint – so the same paperwork has to be done in every doctor’s office anyway – for each patient, for each visit.

Now if we keep our present insurance-ridden system, or go to a government-paid system, then I can see some advantage. Insurance claims can be transmitted electronically. But we already do that.

 

[emily47017]

vern, it sounds to me like you’re brand new to the concept of single-payer insurance. perhaps you would find the answers to your questions at the physicians for a national health program website: pnhp.org/facts/singlepayer_faq.php

 

[vern_humphrey]

vern, it sounds to me like you’re brand new to the concept of single-payer insurance. perhaps you would find the answers to your questions at the physicians for a national health program website: pnhp.org/facts/singlepayer_faq.php

Quite the contrary. I am well aware of the theory – and the pitfalls – of single-payer insurance.

 

[manualman]

I really like the Canadian joke. It actually illustrates emily’s point. Why NOT do like I originally proposed and have a BASIC universal health care system modeled on Canada’s for preventative and routine care, tab picked up by the taxpayer.

BUT, don’t take it to the extreme they have. Retain a modified version of our current private health care system (modified to use MSAs and proportionate copays) for the hospital stuff? Yup, the rich still get the very best care, but they also finance the ADVANCE of medical science. In 30 years, perhaps Clinton’s procedure will be routine and the rich folks will have funded the discovery of an even BETTER form of treatment only available to them-for a while.

P.S. Don’t kid yourself. If Hillary had gotten her way, well-connected guys like Bill would STILL find ways to butt in line in front of us peasants!

 

[vern_humphrey]

I really like the Canadian joke. It actually illustrates emily’s point. Why NOT do like I originally proposed and have a BASIC universal health care system modeled on Canada’s for preventative and routine care, tab picked up by the taxpayer.

How would we do this?

BUT, don’t take it to the extreme they have. Retain a modified version of our current private health care system (modified to use MSAs and proportionate copays) for the hospital stuff? Yup, the rich still get the very best care, but they also finance the ADVANCE of medical science. In 30 years, perhaps Clinton’s procedure will be routine and the rich folks will have funded the discovery of an even BETTER form of treatment only available to them-for a while.

I’m still unclear of that the government will pay for, and who will benefit.

P.S. Don’t kid yourself. If Hillary had gotten her way, well-connected guys like Bill would STILL find ways to butt in line in front of us peasants!

That is my point, exactly. As I said, if Bill were an ordinary citizen, he’d die on the waiting list.

When you starve with a tiger, the tiger starves last.

 

[chicago]

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

I mean that they should work largely uninsured. One of the most significant reasons for rising healthcare costs are rising insurance costs and lawsuit settlements. People aren’t really suing doctors, typically, they are suing insurers. If there is no pot of insurance company gold for lawyers to go after then there is little reason to sue and health care costs can drop.

But as we are only human, mistakes happen - and our get-rich-quick society jumps in and tries to capitalize on them.

Then we are basically in agreement.

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.

If a physician “makes a mistake” then he should bear the responsibility personally and professionally, not schlep it off to an insurer. Conversely, the insurers are the ones with significant money, much more so than the physicians. If there is relatively little to “get rich” on from suing an uninsured physician alone, then lawsuits will likely plummet. A generally good physician who (under such a system) still makes a legitimate mistake and honestly bears the burden (rather than escaping due to liability coverage or paying off every time someone sues with little more than a half baked case just because the insurer finds it expedient to do so) will likely be a better physician in the future, and his colleagues would do well to help him overcome any burdens of a lawsuit in order to continue practicing. If, of course, he loses a lawsuit and truly deserves to be hung out to dry, then his lack of insurance sheltering will be all the better to make him feel the brunt of responsibility and loss of practice.

In turn, when a lawyer can legitimately argue before jury that to award a huge settlement will “ruin the man”, they may take it seriously (even considering that they’d be best off for their own health concerns not to put every doctor out of business willy nilly) rather than just tossing some monetary judgement the plaintiff’s way knowing full well all along that it’s basically free money which the insurer has plenty of.

 

[vern_humphrey]

I mean that they should work largely uninsured. One of the most significant reasons for rising healthcare costs are rising insurance costs and lawsuit settlements.

Wow!

If the doctor is not insured, he risks personal bankruptcy – and under those conditions we’d soon run out of doctors!

People aren’t really suing doctors, typically, they are suing insurers. If there is no pot of insurance company gold for lawyers to go after then there is little reason to sue and health care costs can drop.

Would you willingly drop your homeowner’s insurance?

If a physician “makes a mistake” then he should bear the responsibility personally and professionally, not schlep it off to an insurer.

The majority of suits against doctors are proveably “junk” lawsuits.

In turn, when a lawyer can legitimately argue before jury that to award a huge settlement will “ruin the man”, they may take it seriously (even considering that they’d be best off for their own health concerns not to put every doctor out of business willy nilly) rather than just tossing some monetary judgement the plaintiff’s way knowing full well all along that it’s basically free money which the insurer has plenty of.

And if you grin confidently at a grizzley bear, he may be intimidated – but don’t bet the farm on it!!

 

[chicago]

Wow!

If the doctor is not insured, he risks personal bankruptcy – and under those conditions we’d soon run out of doctors!

I disagree. Society need physicians and we would very figure out that we can’t just bankrupt everybody. Rather, what this would do is call more people to responsibility: personally, professionally, and societal. And THAT is ultimately the only thing which will solve the problem.

I’ve been advocating this idea for about 15 years or so now. Everyone always thought I was crazy. (Well, ok they think I’m crazy even absent this idea, but anyway…) In recent years I learned about a Chicago physician, who never heard of me nor I of him, that had enough courage to take it up himself. The insurers hate him (as it challenges their way of making money), but he has a lot of silent support from other physicians and it has grown as a movement. He used to have a website which outlined these principles, but it is no longer up and running. Do a search on “Dr. Mark Macumber”, however, and find some of the articles and interviews available online where he discusses the matter.

Would you willingly drop your homeowner’s insurance?

That’s a different thing entirely. No one is going to sue me because of what my house did or failed to do to them. And if my house gets destroyed because of some “mistake” I make, then my insurer probably isn’t going to cover it, either.

The majority of suits against doctors are proveably “junk” lawsuits.

Exactly. Which is causing the rise in healthcare as the insurers are typically settling them rather than fighting to win. Now, would a doctor whose livlihood is on the line be more prone to pay off or defend his repuation, livlihood, and personal finances? Stop providing easy targets and easy paydays for personal injury ambulance chasers and costs will de-escalate.

 

[chicago]

He used to have a website which outlined these principles, but it is no longer up and running. Do a search on “Dr. Mark Macumber”, however, and find some of the articles and interviews available online where he discusses the matter.

This isn’t exhaustive (it doesn’t include many of the print articles on him, for instance), but it could prove a good first place to start:

medschool.northwestern.edu/depts/family_med/faculty_profiles/Macumber_Mark.html

 

[vern_humphrey]

I disagree. Society need physicians and we would very figure out that we can’t just bankrupt everybody. Rather, what this would do is call more people to responsibility: personally, professionally, and societal. And THAT is ultimately the only thing which will solve the problem.

It would be a lot easier to accept that argument if society had figured that we can’t bankrupt everyone and controlled the lawyers – but we haven’t managed to do that.

That’s a different thing entirely. No one is going to sue me because of what my house did or failed to do to them. And if my house gets destroyed because of some “mistake” I make, then my insurer probably isn’t going to cover it, either.

You give them any hint they can get your house or other possessions via a lawsuit, and stand back.

Exactly. Which is causing the rise in healthcare as the insurers are typically settling them rather than fighting to win. Now, would a doctor whose livlihood is on the line be more prone to pay off or defend his repuation, livlihood, and personal finances?

And if he won the case, he’d still be bankrupt. Lawsuits cost money, you know.

Stop providing easy targets and easy paydays for personal injury ambulance chasers and costs will de-escalate.

I propose we attack the perpetrators, not the victims.

 

[chicago]

It would be a lot easier to accept that argument if society had figured that we can’t bankrupt everyone and controlled the lawyers – but we haven’t managed to do that.

Largely because there are no real repercussions to poor practice and a message gets sent along with a knowing understanding that “nobody” seems to be personally getting held responsible, anyway - and since no one seemingly gets “hurt” by tapping into the insurance company pots of gold why not just let 'em have it!

So, get the insurance companies out of the mess and things might well change.

You give them any hint they can get your house or other possessions via a lawsuit, and stand back.

Which is what insurance settlements do

Further, if one doesn’t really want to deal with the inherant risks, it would be better for them to stay out of the fray in the first place.

And if he won the case, he’d still be bankrupt. Lawsuits cost money, you know.

The more defendants won lawsuits, the less malpractice attorneys would file, especially on conginency contracts. I’d wholeheartedly support physician collectives which would serve to defend just cases rather than settling. When there are too many settlements, no one is really taking responsibility or learning from mistakes.

Of course, everyone is entitled to a court appointed defense free of charge. (Not that it would be very good. But if more physicians demanded it, the quality might necessarily improve.)

I propose we attack the perpetrators, not the victims.

If the perpetrator is a poor physician, allow him to suffer the consequences. If it is a lawyer looking for an easy pay off, let him suck up all the real fees and costs of doing business by fighting rather than settling.

 

[vern_humphrey]

Largely because there are no real repercussions to poor practice and a message gets sent along with a knowing understanding that “nobody” seems to be personally getting held responsible, anyway - and since no one seemingly gets “hurt” by tapping into the insurance company pots of gold why not just let 'em have it!

So, get the insurance companies out of the mess and things might well change.

“Lawsuit” does not equal “poor practice.”

You don’t save the lambs by getting rid of the sheep dog – the problem is predatory lawyers, not malpractice insurance.

Further, if one doesn’t really want to deal with the inherant risks, it would be better for them to stay out of the fray in the first place.

That’s exactly what I said in the first place – this scheme would drive doctors out of practice and deter new men from entering practice.

We don’t need a doctor shortage in this country!

The more defendants won lawsuits, the less malpractice attorneys would file, especially on conginency contracts. I’d wholeheartedly support physician collectives which would serve to defend just cases rather than settling. When there are too many settlements, no one is really taking responsibility or learning from mistakes.

The legal system is not designed to make people take responsibiliy or learn from mistakes – it’s designed to make predatory lawyers rich.

Strip away the only protection physicians have without reining in the lawyers, and you destroy the medical profession – to the detriment of all of us.

Now, if you reined in the lawyers, got them under control, made **them **take responsibility and learn from their “mistakes” – then doctors wouldn’t need malpractice insurance. And if they chose to carry it, the loss rate would be so low that the insurance premiums would be payed in pocket change.

Of course, everyone is entitled to a court appointed defense free of charge. (Not that it would be very good. But if more physicians demanded it, the quality might necessarily improve.)

There is no right to a free defense lawyer in a civil suit – only in criminal cases.

If the perpetrator is a poor physician, allow him to suffer the consequences. If it is a lawyer looking for an easy pay off, let him suck up all the real fees and costs of doing business by fighting rather than settling.

You realize what you propose is like running two trains at top speed down the same track, and expecting good things to happen when they meet?

 

[chicago]

Now, if you reined in the lawyers, got them under control, made **them **take responsibility and learn from their “mistakes” – then doctors wouldn’t need malpractice insurance. And if they chose to carry it, the loss rate would be so low that the insurance premiums would be payed in pocket change.

Alright, then. How do you recommend accomplishing THAT? I’m suggesting making an economic situation where there is disincentive for them to attempt such. What’s your plan?

]There is no right to a free defense lawyer in a civil suit – only in criminal cases.

I believe that some states do offer this right, at least for people who can not afford to pay for their own attorneys.

Again, a collective of physicians could retain an attorney to respond to any allegations at shared cost.

…this scheme would drive doctors out of practice and deter new men from entering practice.

I want only noble men and women of great sacrifice and commitment to enter this noble profession. Like those called to the priesthood (which is sadly suffering) they are out there, but need only be properly nurtured towards responding to this sacrificial call.

You realize what you propose is like running two trains at top speed down the same track, and expecting good things to happen when they meet?

The present gravy train NEEDS to be derailed! No doubt, that will be a messy process (as any real change typically is.) Simply managing present track capacity is not a sufficient solution.

In conclusion, yes, I’m more interested in changing paradigms for the greater good than continuing the status quo.

 

[vern_humphrey]

Alright, then. How do you recommend accomplishing THAT? I’m suggesting making an economic situation where there is disincentive for them to attempt such. What’s your plan?

If you read through this thread, you’d see it:

1. The United States is the only industrialized nation where there is no requirement for a valid case in order to sue. All other nations have something like a judicial hearing before a lawyer is allowed to file a suit – and that cuts out a lot of junk lawsuits.
2. Apply the English Rule – the loser pays the winner’s costs. In the case of a contingency fee arrangement, the lawyer pays his share.
3. Enact caps – damages should be limited to actual loss, and pain and suffering should be held to a low level. Punitive damages should only be assessed through a criminal trial.
4. Require all scientific evidence to be peer-reviewed, and hold all statistical evidence to the same standard. (A classic example is the Dalkon Shield case – the Center for Disease Control admits that the data shows the Dalkon Shield was no more likely to cause toxic shock syndrome than any other such device.)
5. Eliminate class action lawsuits – where the defendant pays billions, the lawyers get most of it, and the actual plaintiffs get a coupon for $10 off their next oil change.

I believe that some states do offer this right, at least for people who can not afford to pay for their own attorneys.

Do you have a cite for that?

Again, a collective of physicians could retain an attorney to respond to any allegations at shared cost.

And they could call it an “insurance company.”

The present gravy train NEEDS to be derailed! No doubt, that will be a messy process (as any real change typically is.) Simply managing present track capacity is not a sufficient solution.

Then talk to the people driving the train, the lawyers.

 

[jman507]

How should health care work?

Well, if we are wondering whats wrong with the health care system? I say I am, well that’s always a good place to start before looking at other systematic issues. I should be taking a critical look at what I could be doing better, especially the easy things to do. I really need to start eating some more fruits and vegitables, and just having a more variety in my diet. I also need to make sure my blood pressure is kept under control. I guess too I should be working on making sure I warm up and work on flexibility along with my runs, don’t want to have an unecessary injury. Some dollars of prevention is worth the deductable of medical care; I guess for that matter plus the money from any time off of work.

Granted there are systematic problems, we do need to take care of ourselves. That is one thing I like about the MSAs, when you control the money the tendancy is your going to be smarter about what you do, than when your insulated from costs by a third party payer. It reminds me of when seat belt laws were past, I believe the number of high speed crashes increased. You’ve got to be careful when making policy.

 

[emily47017]

That is one thing I like about the MSAs, when you control the money the tendancy is your going to be smarter about what you do, than when your insulated from costs by a third party payer.

i’m not sure this is always the case. if MSAs are instituted, i certainly hope people will use their money for preventive care… but i have a feeling that a lot of people, especially those living at the edge of poverty, will be more inclined to either keep the money salted away or do whatever they can to save it and roll it over into the IRA. that would seem prudent in the short run, but in terms of long-term financial efficiency (as well as quality of life), it’s better to get as much preventive care as you can in order to stave off the really expensive stuff down the line.

and anyway, my medications alone are costing $7,200 a year… what MSA is going to be sufficient for that level of expense?

my theory is that if people are insulated from the cost, they’ll be more likely to use the more efficient forms of care available to them. that would save money for everyone in the long run.

single-payer insurance isn’t just a step toward social justice, it’s a prudent investment for the nation as a whole. we’d spread the risk across the entire population, we’d promote the most efficient forms of health care, and we’d form an enormous pool for negotiating prices with doctors and hospitals (drug companies too!). we can do all of this for approximately the same amount of money we (we = the state and federal government = your tax dollars) are already spending on subsidies (huge) and the gov’t health care programs we already have (medicare, medicaid, VA, public employees, etc).

as for individuals, think of all the bankruptcies that’ll be averted, premiums and copays saved, work hours that would otherwise be lost due to conditions caught too late.

 

[vern_humphrey]

i’m not sure this is always the case. if MSAs are instituted, i certainly hope people will use their money for preventive care… but i have a feeling that a lot of people, especially those living at the edge of poverty, will be more inclined to either keep the money salted away or do whatever they can to save it and roll it over into the IRA.

If people are not smart enough to run their own affairs, assuredly they are not smart enough to elect politicians to run them.

The deeper you look into our problems, the more you find that the proposition that someone else should make your decisions **for you **is the crux of them all.

 

[chicago]

If you read through this thread, you’d see it:

1. The United States is the only industrialized nation where there is no requirement for a valid case in order to sue. All other nations have something like a judicial hearing before a lawyer is allowed to file a suit – and that cuts out a lot of junk lawsuits.

I might find that fair enough. Still, if a lawsuit has NO legs, it won’t get far in court.

1. Apply the English Rule – the loser pays the winner’s costs. In the case of a contingency fee arrangement, the lawyer pays his share.

I’ve already suggested something along this line. I don’t know if a “loser pays” is entirely fair as it can hurt justly hurt clients (it would also promote more settlements to avoid risk of ultimate loss), but I certainly wouldn’t argue with the court appointing fees be paid by the loser in cases of little merit. Certainly, it would behoove well is attorneys had to pay their own way for cases rather than just seeking contingency awards. Get rid of contingency percentages and this might take care of itself as only cases likely to be won which a client can then afford to pay for would be filed. Then don’t pay them off so easily.

1. Enact caps – damages should be limited to actual loss, and pain and suffering should be held to a low level. Punitive damages should only be assessed through a criminal trial.

Interesting idea to offer punitive damanges only through criminal trial. That might be worthwhile. Though we might be sending a lot more doctors to jail, in that case.

I disagree with caps for two reasons. Primarily, I don’t think it solves anything. It only manages the cost of doing business and sets the price of malpractice. As long as people know that, “hey, there’s a quarter of a mil in play”, they’ll still take a shot at it. Secondly, it fails to offer any real jurisprudence to send a message and allow the offender to feel the hurt from the harm inflicted. Punitive measure remain a must, IMO.

1. Require all scientific evidence to be peer-reviewed, and hold all statistical evidence to the same standard. (A classic example is the Dalkon Shield case – the Center for Disease Control admits that the data shows the Dalkon Shield was no more likely to cause toxic shock syndrome than any other such device.)

Still, does this not carry the alternate risk? That of physicians protecting themselves.

1. Eliminate class action lawsuits – where the defendant pays billions, the lawyers get most of it, and the actual plaintiffs get a coupon for $10 off their next oil change.

Fair enough.

Do you have a cite for that?

Not offhand. I’m speaking from memory. Among other things, I recall where courts have appointed private defense for what I believe were civil cases and ordered the public defenders’ office to foot the bill. But it’s been awhile since I’ve had to pay attention to that sort of stuff closely.

And they could call it an “insurance company.”

I suppose. But I like to think of it as more of a cooperative where they would be making collective decisions. Just paying into the cooperative wouldn’t necessarily guarantee you rights if you were wrong. It isn’t meant to be a labor union, afterall. Nor is the idea isn’t merely to protect their insurance pot of gold.

Then talk to the people driving the train, the lawyers.

I think three or four sides are running the train. Lawyers are certainly one. Physicians are another. Insurance companies are a major player. As are the big corporatizing businesses that run health care institutions these days. And all of them (though not evenry individual involved, necessarily) are ultimately out to maximize and protect their own profits more than responding to the real needs of people’s health. Really, I don’t think that there are, generally speaking, “good guys” and “bad guys” in this to take sides over. It’s just an overall mess of mischief that everyone tends to get tied up in… to the detriment of society as a whole and the heath of those in need, who either have to pay through the selling of their blood just to ride on the caboose or get run over by a 100 car fast running transcontinental freight.

Now, on the patient side of things, at least we agree about MSAs.

 

[emily47017]

The deeper you look into our problems, the more you find that the proposition that someone else should make your decisions **for you **is the crux of them all.

again, the single-payer system doesn’t make decisions for anyone. it gives people a wider range of options so they can truly be free to make their own decisions. if someone never went to a doctor until they were knocking on death’s door, that would be their own business. if that same someone wants to go to a doctor, but is having to decide between a pap smear on the one hand or food for a week on the other… their options have just narrowed considerably. single-payer erases that particular dilemma.

 

[vern_humphrey]

again, the single-payer system doesn’t make decisions for anyone. it gives people a wider range of options so they can truly be free to make their own decisions.

Does it allow them to opt out of the single payer system? Does it allow them to keep the money they save? Does it allow them to pay out of pocket for treatements not covered by the single payer?

if someone never went to a doctor until they were knocking on death’s door, that would be their own business. if that same someone wants to go to a doctor, but is having to decide between a pap smear on the one hand or food for a week on the other… their options have just narrowed considerably. single-payer erases that particular dilemma.

But most people don’t have that dilemma – the poor can get the pap smear free.

The problem with programs like this is they are designed for the lowest common denominator – and then they drag us all down to that level.