How would you fix the U.S health care system?

[JMMJ]

Obviously a piece meal approach would not work for the military where a single individual would be helpless against an invading army, but healthcare needs almost always are individual concerns. Neighbors could help neighbors if they had a mindset to do so. And a society that did so would be a stronger one.

This attitude always fascinates me. Have you read about history in the United States, with regards to how life was before public health was taken seriously? Do you really want to walk down the street, or eat in a restaurant, or sit in the movie theater next to someone who has TB but doesn’t have the means to medically address it? I use this just as an example. Yes, people can have TB and not even know it (for months, if not years) because they don’t see a doctor. Or how about a diabetic. Have you ever watched a diabetic die a slow death because the won’t take care, properly? Now what if you have to watch someone die slowly of diabetes because they can’t afford care? Do you want to live in a society where the “haves” (those who can pay for their own care) co-mingle with the “have-nots” (those who can’t pay)? I certainly don’t. I am one of the “haves” and I don’t mind paying higher taxes to get this health care situation straightened out.

 

[Erikaspirit16]

If someone came in with no insurance the service fees immediately got a 50% decrease.

I looked it up (a lot of sites, mostly legal firms). Here is one: Health Care Providers May Waive Patients' Copayment Obligations, But... | Baker Donelson

"Offering patients a time-of-service discount may be a useful and permissible billing practice under limited circumstances when the discount reflects the administrative savings to the practice. However, providers must exercise caution because offering discounts to patients can implicate various federal and state laws. A provider who routinely discounts or waives a patient’s copayment or deductible (collectively referred to as copayment) obligations, for example, can run afoul of the federal antikickback statute, 42 U.S.C. § 1320a-7b, or be accused of false billing by private insurance carriers not receiving the discount. Consequently, a provider must exercise discretion and sound judgment when offering any discount to patients.

Although the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General for the Department of Health and Human Services (OIG) are not alarmed by the occasional waiver of copayment obligations – due to financial hardship or uncollectibility – the routine waiver of copayment obligations under Medicare is clearly problematic.

The federal antikickback statute prohibits the offering of any remuneration to induce a person to purchase or order any service for which payment may be made under Medicare. The routine waiver of a patient’s copayment obligations implicates this prohibition because it reduces the amount that the patient pays for services, and may therefore induce the patient to seek more services that are payable by Medicare. The OIG has promulgated regulations defining and further specifying those payment practices which will not subject providers to penalties under the antikickback statute – so-called safe harbors. When discussing the propriety of discounts, the OIG stated unequivocally that safe harbor protection does not apply to any discount offered to beneficiaries in the form of “a reduction in price offered to a beneficiary (such as a routine reduction or waiver of any coinsurance or deductible amount owed by a program beneficiary).” 42 C.F.R. § 1001.952(h)(5)(iv)."

BTW, my father was a bill collector for doctors in the 1950s-1960s. He got 50% of the first X $ collected, and 30% of the rest. He used his own judgment–if he thought the person couldn’t pay, he would just write it off. That sounds good, but you don’t want hundreds of millions of people being dependent on the good will of individual bill collectors.

 

[Maximus1]

Rearranging the Deck chairs on the Titanic.
Profits must be kept up so some have to give up their seats.
Bankruptsy is a good choice for graduating law students.
The anti kickback statute traditionally increases insurance company profit but little else.
Pre-existing Conditions priced policies out of reach or offers inadequate policies. Either way it leaves no risk management options for many Working people.
Better idea. Improve Obamacare. Add the pilot program the Insurance Industry defeated the first time.
At that point pure competition shows the public option superior and we only loose a small increment of time teaching America what every other advanced nation knows.

 

[Erikaspirit16]

a non profit health plan

Yes, but… The ‘but’ is that non-profit doesn’t mean $ isn’t an incentive. I worked for 25 years for three different non-profit associations. Trust me, they were all keenly focused on making money, and that guided all their decisions. Keep in mind that non-profit Blue Cross plans routinely pay their CEOs in the neighborhood of $10 million a year. My last non-profit paid the CEO over a million $ a year, and a slew of executives made $250,000+.

Anyone can see the IRS 990 tax returns of non-profits (including salary and benefits for key personnel) at https://www.guidestar.org All you have to do is register on the site (for free). If you have an hour free someday, it’s fascinating reading.

As I’ve pointed out above, legal expenses can include things like private islands, executive retreats in Tahiti, a fleet of corporate jets, membership in exclusive country clubs for all executives, etc. etc. Most people think “expenses” are for paperclips and xerox machines. Not quite.

 

[RuthAnne]

A blanket statement like “the government is inefficient” is simplistic and wrong.

It’s not simplistic nor is it wrong. Sure, you might be able to find an exception here and there but for the most part it’s a fair statement.

 

[Maximus1]

Medicare has been well run and successful. As long as they don’t steal from the account.

 

[gazelam]

Do you want to live in a society where the “haves” (those who can pay for their own care) co-mingle with the “have-nots” (those who can’t pay)? I certainly don’t. I am one of the “haves” and I don’t mind paying higher taxes to get this health care situation straightened out.

Well, if you willing to pay more in taxes you most certainly can donate to worthy causes right now.

2 Corinthians 9:7-9
Each must do as already determined, without sadness or compulsion, for God loves a cheerful giver.

8 Moreover, God is able to make every grace abundant for you, so that in all things, always having all you need, you may have an abundance for every good work.

9 As it is written: He scatters abroad, he gives to the poor; his righteousness endures forever.

We need to become nations of cheerful givers.

And there is no guarantee that a government program will make things better. Do nuns really need to be forced to have contraception as part of their insurance plans?

 

[JMMJ]

Well, if you willing to pay more in taxes you most certainly can donate to worthy causes right now

Wow. That sounds pretty judgemental. I give plenty, already to many organizations that assist with unanticipated health care expenses. I also give my hard earned cash to people I know personally who are struggling in this regard. And yet, I still don’t mind paying higher taxes to have a system that provides good quality health care to all.

Save your bible quotes. They have nothing to do with taking care of each other because it is the decent and right thing to do.

I would never go to a Catholic hospital for care. I don’t want the care I am given to be guided by religious values I may not subscribe to. That is one reason why I believe the government could do a much better job in this realm. Care should be comprehensive and provided for all, regardless of religious beliefs.

I know. I know. Gasp. A “Have” who actually believes in a single payer system. Go figure.

 

[otjm]

Comparing other countries’ health system to ours is a bit like comparing bananas and lemons. Thre are different philosophies at play, and unless and until all of that is put on the table in an understandable way, all we end up with is people “preferring” one system over another without any substance behind their “likes”.

Our health system in general is excellent. what is at a debatable point is how we pay for that system, which is the issue of health insurance, not the health system itself.

However, what we decide about the insurance end of it could have the effect - intended by some, unintended by those who do not understand what is at play - in the health system itself.

 

[Canvas]

And there is no guarantee that a government program will make things better. Do nuns really need to be forced to have contraception as part of their insurance plans?

There is nothing intrinsic to universal health care that means that birth control or abortion would be funded. You could have it provide only care deemed medically necessary (for pregnancy termination, only truly grave cases like an ectopic pregnancy, for example, could be mandated) .

 

[otjm]

I happen to be within the VA health system, and like many things, there are good and bad areas.

One of the problems in the past is that the system had many flaws with few if any people (meaning those in Congress and those within the upper echelons of the system itself) seeming to have any real drive to straighten the system out.

I happen to be in Oregon, and the VA Hospital is literally next door to OHSU - Oregon Health Science University, and so I have been treated by a number of Residents, both in surgery and in oncology. The treatment I have had has been excellent; for example I had laparoscopic surgery; the senior Resident had studied such in Australia and was head of the team which included surgeons with years of experience.

Other VA Hospitals are on the list of those whose door I would not darken.

And given that it is a national government system, getting changes made can literally take an “act of Congress”. And too often what needs to be done ends up getting ground through the machinery of compromise. Non-government entities don’t face that machinery and instead face the issue of making the necessary changes or suffering seriously, including the possibility of no longer existing. Even if well meaning individuals want to make what are excellent changes to the VA, the system by its size and control and the inertia of a government entity continues on in spite of the proposals.

 

[Canvas]

I remember I used to work with a guy who said something like “if you want to get rich, start a non-profit.”

 

[otjm]

Washington State decided it was going to “eliminate a middleman” and so did away with independent health insurance agents. At the time they did that, there were 8 different companies selling health insurance in the state.

Shortly after the bill passed, reality started to set in; none of the helath insurance companies were set up to actually sell insurance; they all relied on the independent agents. The net resutl was that iwthin several years, there were only two helath insucarnce companies selling in Washington. Choice was lost to both individuals and to employers seeking insurance coverage, nothing was "saved’ by eliminating the “middleman” and the citizens were the poorer for it.

Often what is referred to as a “middleman” is someone independent of the larger group who takes on the responsibility for doing what the larger group is not equipped to do. Think about it for a minute: no health insurance company is going to “sell” another company’s policy.

It is an easy comment to make; but unless it can be shown that the “middleman” is creating more cost or causing less efficiency, the law of unintended consequences still applies.

 

[Pattylt]

It is an easy comment to make; but unless it can be shown that the “middleman” is creating more cost or causing less efficiency, the law of unintended consequences still applies.

I’m thinking of the middle men in sales of health equipment and supplies as much as insurance. But, you have a point!

There should still be a way for a doctors office to only have to fill out one type of form that all companies accept. Instead, each company has different requirements for paperwork…standardize the thing!

 

[gazelam]

Wow. That sounds pretty judgemental.

Not judgemental in the least, but rather a remark that you can move forward on your preferred course of action without waiting for others to agree.

I give plenty, already to many organizations that assist with unanticipated health care expenses. I also give my hard earned cash to people I know personally who are struggling in this regard.

This is all good. You are able to deliver relief to others without a layer of government between you and the recipient of your generosity.

And yet, I still don’t mind paying higher taxes to have a system that provides good quality health care to all.

Governments will gladly accept taxes above and beyond the legal minimum.

I know. I know. Gasp. A “Have” who actually believes in a single payer system. Go figure.

My concern here is the desire to control how others spend their money. I personally don’t believe that governments know how to care for their citizens better than individuals do.

 

[otjm]

The newest bunch of unadulterated bs coming out of individuals jockeying for a place on the ballot is “Medicare for all”.

It sounds really great, to those who have no acquaintance with Medicare.

In 2000 in Texas, nearly 80% of doctors were taking in new Medicare patients. By 2012 (as in, 7 year ago) less than 60% were, and the number taking in Medicare patients has continued to fall.

Why? For starters, Medicare is supposed to reimburse doctors at 80% of the going rate; but has been lagging behind the continued escalation of costs. The paperwork (as described by medical staff to me) is horrendous and from year to year seems to get worse; and the rules become more and more stringent.

And even with the reduction in doctors taking Medicare payments, in 2017 Medicare cost $704 billion.

The proposals being made by the runners jockeying for nomination is Medicare for all and no other private insurance. Perhaps they intend to hire thugs to go out and hold a gun to doctors’ heads (I am joking); otherwise they do not explain how they are going to cause a massive reversal of the health insurance system and how they will make all doctors, like sheep, will line up for such a system.

Nor do they have any real world numbers upon which to estimate what the costs would be (minus the cost of thugs - ) to provide this for all; but any numbers being floated about are simply guesses, and odds are anywhere from low to extremely low.

To which can be added that somewhere between a majority and a great majority of people do not want to lose their current policy. Those running are smart enough to know that young voters are simply uneducated to any degree about Medicare as a system, and are swayed by the emotional “this will fix it”.

When Obamacare was being passed, there were at least 5 distinct offerings from the Republican contingent in Congress, and they never saw so much as the light of day. The number of individuals on either side who are willing to sit down and go through an honest, open give-and-take are dwindling from that low point. What we most likely will end up with is one party or the other being in sufficient power to put what they want into law, rather than working out what actually needs to be hashed out - and we saw how that worked the last time, and we can see what one side wants to do to carry further their idea; the other side is not in a position now to be able to make a proposal. And I would suggest that any proposal from the Republicans would be met at the very least with derision.

In short, I have little hope of Congress actually working on the matter in any effective (as opposed to cram down) manner.

 

[Canvas]

There should still be a way for a doctors office to only have to fill out one type of form that all companies accept. Instead, each company has different requirements for paperwork…standardize the thing!

It is called universal healthcare. Have every company sell a non profit plan to everyone that is subsidized by tax and the same prices are paid for every medicine and service by all companies. Medical care would be regulated like the public utility that it is. That is one advantage that countries that rely on private insurers for standard, universal coverage have—the plan that everyone gets is identical, no matter which company provides it.

 

[Erikaspirit16]

Our health system in general is excellent.

I’m sorry, but as Kelly Anne would say, that’s “an alternative fact.” I won’t give sources for infant mortality or overall mortality, since those are all over the place. The US is usually worse than almost every developed country in those categories.

But more impressive is this site: http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393#deaths-from-all-causes from the National Academies of Sciences, Engineering, and Medicine. It’s a very detailed (you have to keep clicking to go deeper) analysis of the mortality rates of 17 developed countries (mostly Europe, but including the US, Canada, Japan, and Australia). They use WHO statistics. They give very detailed mortality statistics on accidents, injuries, all sorts of diseases, etc.

For example, let’s take “maternal conditions related to pregnancy.” The death rate for Switzerland (the best country) is .0216 out of 100,000. The US? Dead (pun intended) last at .4227. The next worst country? Denmark at .1557–in other words, the US is almost THREE TIMES worse than the next worst country. You can amuse yourself for hours on this site. Let’s take Hepatitis B as another example. The US is “only” 4th from the bottom on this one. The best? Switzerland again. How about something you would expect the US to shine in? “Nutritional deficiencies.” The US is 3rd from the bottom. Best is Finland, at .1456; the US is 1.0249–in other words, SEVEN TIMES worse than Finland.

And of course if you look at healthcare costs in all these countries, the US pays almost twice as much per capita as the next highest country. In other words, the US is paying a lot more money to get MUCH worse outcomes. If you think this is an “excellent” system, I have a bridge I can sell you cheap.

The US has an excellent health care system for the rich. Not for the general population.

 

[yankeesouth]

Start by not tying ‘healthcare’ to forced coverage of contraception, abortion, gender ideology and attacking religious liberty in general.

 

[Erikaspirit16]

My concern here is the desire to control how others spend their money. I personally don’t believe that governments know how to care for their citizens better than individuals do.

It has nothing to do with “controlling how others spend their money.” It has to do with “what can the gov. do that no other organization can?”

Can individuals build roads, airports, hospitals, aircraft carriers, etc.? No. A private corporation might build a hospital, but it would only do so if it thought it could make money from it. Helping people as a motive would come in as a distant second, if that. If the primary consideration is profit, you’re not going to get a healthcare system that is effective. You’re going to get a system–as we have today–that favors the rich.

You–and others–are repeating a basic fallacy. You are putting “government” over in one corner and “individuals” over in another corner. Remember that nonsense Lincoln wrote about “government of the people, by the people and for the people”? Some of us actually believe that. We ARE the government. It’s not some alien entity. It’s us.