How SHOULD Health Care Work?

[JW10631]

it seems to me the first thing to do is eliminate the health insurance industry altogether – there’s nothing wrong with hospitals or drug companies making a (reasonable) profit on the work they do, but the idea of a middle man skimming off the top without contributing to anybody’s health or healing is pure insanity.

eliminating the health insurance industry means implementing one of two existing solutions: a government run system (a la britain), or a single-payer insurance system (where there are copays, premiums and whatnot, but it’s all funneled through one not-for-profit organization).

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
• promoting a cultural shift within the health care community away from new/shiny and toward tried/true, AKA evidence-based practice
• 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.
  it’s not always the case that people don’t value things they get for free. i’m sure there are some who would go “yahoo!” and turn visiting the doctor into some form of entertainment. but not everyone. i’m on medicaid, which means all the health care i recieve is paid for by the state and federal government, and also by the doctors i see, who don’t get as big a reimbursement from medicaid as they do from for-profit insurance companies. i’m keenly aware of this, and i do what i can to keep my expenses low.

i’m stumped by what to do about the drug companies. i suspect that the scientists who are designing and researching the new drugs do it as much for love as for money; i’m not so sure about the execs or the share-holders. banning drug ads is a great idea, and we ought not to feel obligated to offer them tort “reform” in return. if they’re making a profit off us, they need to be held accountable for rushing drugs to the market or suppressing information about health risks. that’s what punitive damages are for.

Drop the single-payer nonsense. Single-payer is a catch phrase for government controlled health care. government owned monopoly.

I have worked in health care - hospitals and health insurance - since 1979.

The growth in health care costs is due to utilization. 90% plus of a health insurer’s expenditure is to pay claims. All it takes to prove this is to read a financial statement. Insurance companies are swamped with Federal and state regulation. Don’t think so? Do my job, then tell me what it’s like.

The end user of health care services is the one who pays for this regulation as well as the rising cost of health care services. Insurance companies don’t set the cost of services. That comes from hospitals, pharmeceutical companies, physicians, medical equipment providers, other health care professionals.

What is typical is that many people take the bait from the media and blame the insurance company for all that is wrong. I’m not excusing them. I worked for an insurer that was investigated by the US Congress in 1993. Our CEO flew all over the world on the Concorde and a VP stocked his wine cellar with the company expense account.

We don’t have a single payer auto insurance system.
We don’t have a single payer home insurance system.
We don’t have a single payer life insurance system.
What is needed is the ability of groups and individuals to shop for the health insurance they want and for consumers of health care to take better care of themselves.

Do you want to pay higher auto insurance rates so a teenager can pay a cheaper rate? The same process applies.

 

[vern_humphrey]

What is needed is the ability of groups and individuals to shop for the health insurance they want and for consumers of health care to take better care of themselves.

Amen – we need choices, so we can be in control of our own fate, and not leave it to Big Brother.

 

[cynic]

Choices for those with the right income. You are as free as you can afford.

 

[vern_humphrey]

Choices for those with the right income. You are as free as you can afford.

No, choices for everyone. Let each of us make our **own **choices and not have them dictated to us from On High.

 

[cynic]

In countries where a public health system is the norm, choice is still not dictated from government. Anyone can take out insurance and use private healthcare services and reap the benefits of a (ussually) better quality of care and shorter waiting lists. You know this. ‘Choice’ is not the issue. Even the quality of service is ultimately irrelevent. It’s a smokescreen to hide an ideological position, one opposed to taxation and wealth redistribution in the form the tax payer funded health care option. Why not just be honest and tell us you fundamentally disagree with this, as a lot of americans obviously do.

 

[whatevergirl]

We have a lot of smart folks around here, certainly smarter than those who are likely to ACTUALLY make law on health care in the near future. Let’s hear some ideas about how to make health care work properly.

Some ground rules:

1. Have some sense of reality. There has never been a society that could afford to give everyone everything they want.
2. Try to structurally include catholic values. I’m sure jesus wouldn’t approve of “Pay your way or die and get it over with.”
3. Discuss ideas without reference to political party or controversial public figures. This is a hard enough issue without bringing in political prejudice.

Here are a few of my thoughts and concerns.

1. There needs to be a basic safety net level of coverage for everybody. We effectively have that now in hospital ERs, but that really isn’t very fair to the hospitals, is it? Why not 'fess up to the problem and develop policy to handle it? Perhaps expand Medicare to provide universal BASIC care to all Americans who can’t afford a private plan. As a starting place, we can define Basic health care to be anything currently done in a Gen Practice office or available in a hospital prior to say 1955. Yes, this means transplants and open heart surgey are ‘denied’ to the poor. Gotta afford this somehow. As medical science advances and todays cutting edge care become routine and cheap, the definition of BASIC can be revised upwards.
2. Drug research and approval costs a fortune, so the drugs that result costs a fortune. Does anybody know of ANY company or NGO that develops drugs from scratch, but doesn’t market them in the US or charges the same prices in the US as elsewhere? I don’t think so. Much as drug companies are corrupt beasts, I fear that if there is NO profit to be made there will be precious little advancement in the future. Right now, the rest of the world acts as a medical parasite on the US (They get the drugs that were developed for the US profit market). As a start, how about we BAN all advertising of prescription drugs and the use of drug reps? In return, the drug companies get immunity from lawuits in excess of actual economic damages (No, you can’t put a price on a lost life, just lost wages).
3. Same tort reform for doctors and hospitals. CYA policies currently drive millions of dollars in extra tests and possibly uneeded procedures. I’ve seen it happen in my own family.
4. No free lunch. Nobody values anything that doesn’t cost them anything. Every procedure except maybe a yearly physical should have a copay. Copays should increase with the overall cost of the procedure, but not necessarily in a direct proportion. When people know they won’t be footing the bill, they don’t care what it costs. The consumer will ALWAYS be the best front line of defense against price gouging. Offer medical savings plans that can be used to pay the copay and allow major procedure copays to be paid over a period of years.

Sound off.

I’m in the healthcare/benefits industry…and part (very large) of the problem is litigation. Lawsuits and dr’s fees are sky high…and it’s a revolving circle with the insurance, then…more lawsuits…more dr’s paying out…mal practice claims going up…the scales tip…and the patients pay more out in copays, and deductibles. It’s not a problem that is ever going to be easily fixed as long as we have these problems, I’m afraid. But we can hope.

 

[vern_humphrey]

In countries where a public health system is the norm, choice is still not dictated from government. Anyone can take out insurance and use private healthcare services and reap the benefits of a (ussually) better quality of care and shorter waiting lists. You know this. ‘Choice’ is not the issue. Even the quality of service is ultimately irrelevent. It’s a smokescreen to hide an ideological position, one opposed to taxation and wealth redistribution in the form the tax payer funded health care option. Why not just be honest and tell us you fundamentally disagree with this, as a lot of americans obviously do.

No, it’s a smokescreen to hide an ideological positon that we should all be forced to wear the same size shoes, give up all control over our own lives, and create another bloated bureaucracy.

If I can take out private insurance, why should I need this single-payer system? That’s like saying that I have to buy a certain brand of automobile, which doesn’t run. But if I have any moeny left after I pay for it, I can buy another car – if I can afford two cars.

 

[mary_bobo]

I’m in the healthcare/benefits industry…and part (very large) of the problem is litigation. Lawsuits and dr’s fees are sky high…and it’s a revolving circle with the insurance, then…more lawsuits…more dr’s paying out…mal practice claims going up…the scales tip…and the patients pay more out in copays, and deductibles. It’s not a problem that is ever going to be easily fixed as long as we have these problems, I’m afraid. But we can hope.

I agree with you. In the past I have attended court cases with physicians and the hospital’s medical records where someone is suing the doctor, the hospital and nursing staff and on and on. A common problem I have seen with this is that tort attorneys make medicine out to be a black and white science and often times it is not. These same lawyers encourage their clients to believe that something happened and SOMEONE must pay. Often times there really is not blame to be placed. But the deep pockets theory so endorsed by our famous torts lawyers has played havoc with the medical profession and with insurance in general. Those huge payouts that uninformed juries give out are running the whole practice of medicine into the ground.

I may be wrong, but I think in some countries with socialized medicine no contingency law suits can be filed. That would sure be a step in the right direction.

 

[whatevergirl]

I agree with you. In the past I have attended court cases with physicians and the hospital’s medical records where someone is suing the doctor, the hospital and nursing staff and on and on. A common problem I have seen with this is that tort attorneys make medicine out to be a black and white science and often times it is not. These same lawyers encourage their clients to believe that something happened and SOMEONE must pay. Often times there really is not blame to be placed. But the deep pockets theory so endorsed by our famous torts lawyers has played havoc with the medical profession and with insurance in general. Those huge payouts that uninformed juries give out are running the whole practice of medicine into the ground.

I may be wrong, but I think in some countries with socialized medicine no contingency law suits can be filed. That would sure be a step in the right direction.

excellent points, mary…i think there needs to be tort reform, then you’ll see more changes…and more opportunities for everyone to have healthcare–in a fair and equitable way.

 

[vern_humphrey]

I agree with you. In the past I have attended court cases with physicians and the hospital’s medical records where someone is suing the doctor, the hospital and nursing staff and on and on. A common problem I have seen with this is that tort attorneys make medicine out to be a black and white science and often times it is not. These same lawyers encourage their clients to believe that something happened and SOMEONE must pay. Often times there really is not blame to be placed. But the deep pockets theory so endorsed by our famous torts lawyers has played havoc with the medical profession and with insurance in general. Those huge payouts that uninformed juries give out are running the whole practice of medicine into the ground.

When I was running for congress, a doctor explained it like this to me, “I read about 2,000 mamograms a year. And I’m about 99.9% accurate. Nobody’s perfect. But if you tell me the patient has cancer, and where it developed, then I can be 100% accurate.”

I may be wrong, but I think in some countries with socialized medicine no contingency law suits can be filed. That would sure be a step in the right direction.

Think what the roads would be like if all those lawyers had to make their living as truck drivers.

 

[KathleenElsie]

Yes I read the posts. So that will answer that question to me.

The most simple way to settle this is to have no third party “EVER” pay any persons Dr, druggiest or other health care professional. Note I said PAY.

Now everyone should be required to have some form of coverage that pays them based on the illness or wellness for that matter. If the consumer has X dollars and there are six providers that are wiling to provide the service at <X, X, X> then the consumer will be the one to decide which provider they are willing to pay for.

Insurance would be available for extraordinary illnesses that you wish to be covered for. Cancer, long tern nursing home and any other things you wish. Others can choose or refuse coverage for family planning, abortion, IVF and other services that they would not use (personal choices).

Basic preventative care for the poor should be at a nominal fee. Basic preventative care for children (they can’t choose to have or not have coverage) should also be at a nominal fee. All others can choose to pay for services or not up to them.

Lets open up our Catholic Hospitals again. Lets allow the hospitals to choose what services they are willing to provide.

But contrary to some people’s beliefs we are no all entitled to every innovation that science has come up with.

 

[vern_humphrey]

Yes I read the posts. So that will answer that question to me.

The most simple way to settle this is to have no third party “EVER” pay any persons Dr, druggiest or other health care professional. Note I said PAY.

Now everyone should be required to have some form of coverage that pays them based on the illness or wellness for that matter. If the consumer has X dollars and there are six providers that are wiling to provide the service at <X, X, X> then the consumer will be the one to decide which provider they are willing to pay for.

Insurance would be available for extraordinary illnesses that you wish to be covered for. Cancer, long tern nursing home and any other things you wish. Others can choose or refuse coverage for family planning, abortion, IVF and other services that they would not use (personal choices).

Basic preventative care for the poor should be at a nominal fee. Basic preventative care for children (they can’t choose to have or not have coverage) should also be at a nominal fee. All others can choose to pay for services or not up to them.

Lets open up our Catholic Hospitals again. Lets allow the hospitals to choose what services they are willing to provide.

But contrary to some people’s beliefs we are no all entitled to every innovation that science has come up with.

You’re describing Medical Savings Accounts. You save a certain amount of money, pre-tax (notionally $3,000). You buy a cheap $3,000 deductable catestrophic health plan.

The entity holding your MSA for you issues you a swipe card. When you go to the doctor, you swipe the card, and he’s paid out of your MSA. That, all by itself cuts costs – insurance paperwork eats up about 2/3s of medical expenses, and slow-pay insurance companies force health providers to jack up prices. But with your swipe card, you pay same day, no paperwork.

Since you get to keep any unspent money in your MSA at the end of the year, and roll it over into your IRA, you have an incentive not to over-consume, and to bargain for health care – two other ways to cut costs.

 

[cynic]

No, it’s a smokescreen to hide an ideological positon that we should all be forced to wear the same size shoes, give up all control over our own lives, and create another bloated bureaucracy.

.

You can’t show us how people living in countries with ‘socialized’ medicine don’t have choice - It just requires a level of income to afford the insurance (no different to the U.S)

If I can take out private insurance, why should I need this single-payer system? That’s like saying that I have to buy a certain brand of automobile, which doesn’t run. But if I have any moeny left after I pay for it, I can buy another car – if I can afford two cars.

So really you’re opposed to paying for other people’s healthcare (through tax). ie services that you don’t personally use but nevertheless will treat those less financially secure.

 

[whatevergirl]

welp…i agree with vern in this thread…is there a full moon out? seriously…i don’t believe with one size fits all insurance. the problem can be fixed…it just takes effort. (and time)

 

[boppaid]

If I can take out private insurance, why should I need this single-payer system?

You’re right…the single-payer system may not be the most beneficial to you. But, as you indicated, if you are financially able to secure additional, better coverage, you can. Why do we still need a single-payer system? Simply because some people can’t afford any coverage. Where are their choices?

 

[Trader]

welp…i agree with vern in this thread…is there a full moon out? seriously…i don’t believe with one size fits all insurance. the problem can be fixed…it just takes effort. (and time)

I may be new here, but for the most part I agree with Vern too.

Vern, how could you run for Congress talking about common sense and personal responsibility? If you want to win the formula is to promise to take care of the voter’s every need by taxing someone else.

“Don’t tax me,
Don’t tax thee,
Tax the man behind the tree.”

This question probably belongs in a new thread, but just how do we have so much poverty in a country with so much oppotunity?

I would argue very strongly that the #1 cause of poverty in America is the CHOICE to disrespect marriage. What would our poverty rate be without divorce and out of wedlock births? Any guesses?

Before you think I am totally crazy, I know that many of the poor are still chldren. They live in poverty because of the CHOICE their parents made.

 

[jman507]

You can’t show us how people living in countries with ‘socialized’ medicine don’t have choice - It just requires a level of income to afford the insurance (no different to the U.S)

So really you’re opposed to paying for other people’s healthcare (through tax). ie services that you don’t personally use but nevertheless will treat those less financially secure.

Here in the US we not only pay for other people’s healthcare through taxes, but also through paying our medical bills, and buying insurance which also helps through paying our medical bills.

 

[vern_humphrey]

You can’t show us how people living in countries with ‘socialized’ medicine don’t have choice - It just requires a level of income to afford the insurance (no different to the U.S)

Yes, I can:

1. They can’t opt out. They must pay the taxes, regardless if they use the system or notl.
2. Even in countries with single payer systems that allow private pay or insurance, the high taxes (to pay for the single payer system) leave them fewer choices for an alternative.
3. Persons trapped in the single payer system can only get what the system allows, at the system’s convenience.

So really you’re opposed to paying for other people’s healthcare (through tax). ie services that you don’t personally use but nevertheless will treat those less financially secure.

No. I gladly provide assistance to others in need.

What I object to is creating a monopoly/monopsony system, run by a vast wasteful government bureaucracy, which will control the most intimate and personal parts of our lives.

 

[Al_Masetti]

Here’s a Web site that discusses these “single payer medical systems” in much more detail:

freemarketcure.com/

 

[Al_Masetti]

Here’s another Web site with a lot of information on government control over health care and health care reform:

heritage.org/Research/HealthCare/index.cfm

Please keep in mind that the U.S. government is already deeply enmeshed in the U.S. health care sector. Very few people have ever heard of HCFA (Health Care Finance Admin). In addition, government controls of Medicare and Medicaid drive other parts of the U.S. health care sector.

Finally, there are scads of laws ranging from controls over vaccine producers (that forced U.S. vaccine manufacturers out of business) to law suits (that forced U.S. medicine manufacturers to stop producing certain drugs). For example, an effective anti-nausea drug that was extremely helpful to pregnant women was forced off the market even though the manufacturer won every lawsuit. A manufacturer of medical implant materials was sued into bankruptcy even though it was found that its products caused no injury.

The FDA has dragged its feet for a very long time over allowing certain drugs and medical devices into the market.

And individual states have gone after various practitioners even though they never were able to demonstrate that any harm was caused.

So, the government in the U.S. is deeply involved.

I guess the question could be phrased this way: how badly do you want FEMA or the IRS to be involved in your health care?