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

[Erikaspirit16]

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

OK. But what if I don’t want my tax dollars to finance the Saudis bombing civilians? What if I think my local library shouldn’t be buying certain books? What if I think the police are using racial profiling? What if I don’t think oil companies should get tax breaks? What if I believe in polygamy? What if I’m an atheist and I don’t believe churches should be exempt from certain taxes? Should I go on? Should we have a system where everyone gets to pick and choose exactly where their tax dollars go? Sounds like chaos (anarchy?) to me.

 

[Erikaspirit16]

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.

Easy. You want to be a doctor? You have to be paid through Medicare. You can’t have private practices. You don’t like it? Do what Trump keeps suggesting–leave the country. I hear Paraguay is nice this time of year.

 

[Peeps]

. Whenever I heard someone complain that they had to wait two hours or more to be seen in the ER, I’d think…well, because you weren’t an emergency!

OT, but one way you can be rushed through the door before you even finish answering questions is to have an allergic reaction.

I have been in the ER several times with tongue and throat swelling (allergic to NSAIDs, and possibly certain spices, but the only trigger the allergy doc was willing to name was the NSAIDS). The first time it happened, I went to the ER and when they asked why I was there, I pointed to my tongue–I couldn’t speak clearly, but I tried to say, “Allergic reaction?” –

–and I was rushed, and I do mean RUSHED through the door to a room and immediately hooked up to an IV!

My poor husband had only recently sat in the ER waiting room for almost 4 hours crying with a kidney stone! When I hurt my shoulder last summer, I spent almost 6 hours sitting in the ER waiting room, but didn’t feel sorry for myself, as a teenager (14 years old) had broken his wrist, and it was SIDEWAYS–like something out of a movie!–and he was crying, but he waited over two hours!

And a swollen tongue gets immediate service!

But I do understand that allergic reactions can quickly block breathing and kill me, so I’m grateful! However, I can’t help but feel badly for those who are in terrible pain and have to wait.

I now carry meds in the event of an allergic reaction.

 

[otjm]

Well, in all seriousness, I wish you health/

You will need it.

I take it you have not had need for any major health incidents, or you are just tired of the conversation.

 

[Peeps]

How about being forced to pay for roads? Or the military? Or libraries? Or schools? Or… What exactly is different about healthcare that exempts you from contributing–

Not sure about schools and libraries, but roads and the military are specifically listed in the U.S. Constitution as services that the federal government is mandated to supply to the people in the United States. It is our DUTY as American citizens to contribute taxes to pay for these services.

So those who don’t want to pay for these basically need to move away from the United States, or lobby Congress to amend the U.S. Constitution.

Again, not sure about schools. I personally believe that private and home schools do a better job of educating than publicly-funded schools.

But then, I live in Illinois. The public schools in our city have abysmal test scores–only 15% of our students achieve MINIMAL competency scores on the standardized tests, while 85% of the students do NOT achieve minimal competency scores.

Our public schools, which is what the largest percentage of our tax pie goes to, are essentially failing to educate nearly 85% of our population. And blaming bad family life is not going to cut it with me–in the past, plenty of kids came from horrible homes, but still managed to at least achieve minimal competency scores and many excelled because they KNEW that a good education was their way out of their miserable lives. I believe that it is part of a teacher’s profession to figure out how to educate ALL children, not just the ones from good families.

 

[otjm]

The government does some things reasonably some of the time. as to building roads, the government may determine where the road will go, but it is a corporation which actually lays down the asphalt; and, as occurred a few years back, did a poor job because government bureaucrats in an attempt to cut corners, had a contractor laying asphalt so thin the road was falling apart within 3 years.

As to hospitals, there are many non-profit hospitals. One in my area actually did about $100 million a year or two ago in reduced fee or no fee treatment to the poor. So no, the primary consideration is not necessarily profit. And the health care system is not for the rich; it is the poor who receive much of the treatment often because they have not taken care of their health over the years. some of the best health insurance policies pre Obamacare were held by union workers - hardly what anyone would call the rich; and they were seriously impacted by Obamacare changes.

And as to thinking the people are the government, that works fine until you run in headlong to a government worker who targets you. One of the most common unpleasant contacts with the reality that the “people” are not the government is a tax audit.

 

[Erikaspirit16]

I take it you have not had need for any major health incidents

Wrong. I’ve had several. The last was a week in the hospital two years ago. Would I have gotten better care in, say, Portugal? Perhaps. It certainly would have been cheaper, and I wouldn’t have a 2-inch folder full of paper work and bills still arriving two years after the operation.

 

[Erikaspirit16]

Our public schools, which is what the largest percentage of our tax pie goes to, are essentially failing to educate nearly 85% of our population.

First, I think I guess I didn’t make my point clear. I’ll try again: You, personally, have a moral issue with taxes funding abortion, etc. Good for you. But others have moral issues about a host of other things they object to. Good for them. But taxes can’t be based on what a small minority thinks about a certain issue (the latest Gallup Poll says only 17% of the population in the US thinks all abortions should be illegal–that’s a tiny sliver of the population.). If enough people feel strongly enough about something, the tax law will be changed. Until then, we all pay taxes, even though we don’t like what they pay for all the time.

Education: Some schools are excellent, some not so good. As you should know, excellent academic results correlate most strongly with family income. The OECD PISA tests (every 4 years–the latest results won’t be available until Dec.) show that not only is the US abysmally bad in health care, it’s abysmally bad in education: In science, the US ranked #25 (Canada was #7). In math, the US was even worse: #38. Latvia and Hungary did better. (Canada was #9). In reading, the US was #27. (Canada was tied for #2). These are the latest (2015) scores available https://www.oecd.org/pisa/pisa-2015-results-in-focus.pdf

It seems to me that the US has two choices: 1) It can bury its head in the sand and repeat over and over again, “The US has the best health care system in the world. The US has the best education system in the world…” or 2) It can do something about it. I prefer option #2.

Now call me crazy, but if I were a superintendent of schools in the US, I think I’d take a little drive up north and see why Canada ranks in the top 10 in all subjects tested. I don’t think it’s playing hockey or eating doughnuts that’s making them score better. I think it’s the organization of the education system.

To give just one example I’ve researched, teacher turnover. In the US it’s a major problem. In my own county, there are 25 steps in the teacher pay scale. At each step you get a relatively small raise, usually less than $1,000. That’s pretty easy to walk away from. In Ontario, there are 9 steps in the pay scale. Raises per year are significant, $3,-4,000. That’s harder to walk away from. Teacher retention is much higher. And does it cost more overall? No. It costs less.

 

[Erikaspirit16]

there are many non-profit hospitals.

Again, please read my earlier comments about “non-profits.” And make sure you look at the IRS 990 forms for your favorite non-profit on the website I provided. Then come back and we’ll talk about how noble non-profits are.

Their primary consideration is not necessarily profit, but the comfort and lifestyle of the executives who run non-profit hospitals. I’d like to see a non-profit hospital where the administrator gets a salary of $75,000 or less because he/she wants to help humanity. Feel free to post examples…oh wait, there aren’t any…(perhaps some religious ones).

some of the best health insurance policies pre Obamacare were held by union workers - hardly what anyone would call the rich; and they were seriously impacted by Obamacare changes.

Again, we are talking past each other. I’ll try again. I don’t really care how good your health insurance is. I care about the quality of care you receive. In other words, if you tell me your union has cut a deal with a local auto dealer so you can buy any of their cars for 50% off, that’s a great deal–like a good health insurance plan. But if the auto dealer only sells inferior cars, who cares? Even at 50% off, it’s a bad deal.

Go back to my post above and my link–
http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393#deaths-from-all-causes
The bottom line is “Are you more apt to die from disease X in the US?” And for the most part, you are. You’re better off with Portuguese or Finnish health care. This is not some random result, it’s because the entire system is better. Again, you’ve got two choices: 1) Ignore all the statistics and keep repeating “The US has the best health care system in the world.” or 2) See what other countries are doing better and copy them.

Remember “In Search of Excellence” from the early 1980s? One of its examples was Stew Leonard’s Dairy Store in Connecticut. Stew would send all his employees out to rival stores every month or so. Then they would have to write a report about all the things the rival stores were doing better, so that Stew could copy them in his own store. There’s also a suggestion box in every store. And customer focus groups. In other words, Stew wanted to get better and better, and he was happy to borrow ideas from anywhere. No hiding his head in the sand and saying “We have the greatest store in the world!”

 

[RuthAnne]

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.

Well said.

 

[JanetF]

A chest x-ray would determine if you had pneumonia, but she shouldn’t have asked you that, she would have been told by the dr/np seeing you that you needed one.

 

[on_the_hill]

Exactly. As a patient, I’m not qualified to make that determination when I first walk in.

 

[otjm]

I hear Protugal is a nice place to live.

 

[Erikaspirit16]

Somehow an otjm post about leadership mysteriously disappeared. I’m all for anyone saying anything, so it wasn’t me! If I remember correctly, it challenged my sense of reality about how valuable leadership was (as a response to my saying that it would be nice to have a non-profit hospital administrator make $75,000 or less).

So let me respond to the phantom question. I have had 8 full times jobs in my life. Only one (the vaccine company) was with a large corporation–probably 2,500 employees. All the other jobs were with organizations with fewer than 100 employees. The CEO’s / presidents of these companies have been two former Congressmen, a former governor, and a retired Lt. General. These nice folks all made about $1 million a year. For the most part they were clueless. The best, I have to say, was the retired Lt. General. If you are familiar (I’m showing my age) with the Peter Principle, they all personified it. The Peter Principle (after the book of that name) was simply that people rose to the level of their incompetence. If someone was a perfectly good VP, appointing him/her CEO is often a huge mistake. They simply can’t do the job.

Let me illustrate with one of my favorite stories. It’s not about a CEO, it’s about a much lower position, but it illustrates my point. As a director, I had to go to board meetings and board dinners. At least I got a good meal out of it. At one meeting, I was at a table with a bunch of board members (all CEOs of large insurance companies) and a co-worker, a young woman who was a lobbyist for the federal affairs dept. Of course all the attention was on the young woman (22?), which was fine with me. I could get on with eating my nice dinner. So the conversation went like this: “So, Mary, you’re a lobbyist. Did you study political science in college?” Mary: “No.” “Did you study business or negotiation?” Mary: “No.” There were similar questions. Then I decided I would put them out of their misery: “Mary, did you babysit for Chip (our president)?” Mary, beaming: “Why yes, I did. He has lovely children.” So Chip hired his babysitter to be a lobbyist in federal affairs. What a surprise. She was probably a good babysitter; I’m not sure how well she could lobby Congress. This is how business works in the US, as far as I can see. There probably ARE great leaders out there. I just have never seen one. And certainly I’ve never seen anyone worth $1 million a year.

 

[Canvas]

the military are specifically listed in the U.S. Constitution as services that the federal government is mandated to supply

Show me in the Constitution of the United States where a large, ridiculously expensive standing military establishment is called for…

I won’t hold my breath.

But I could direct you to Article 1, Section 8, Clause 12 of the US Constitution:

To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

 

[gazelam]

gazelam:

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?”

I don’t really care how good your health insurance is. I care about the quality of care you receive.

You’ve now contradicted yourself. You really do want to control how other people’s money is spent on health care because you think it’s possible to come up with a better plan via the government than by individuals shopping around in a free market. I see this as nothing less than elitism.

 

[whatistrue]

How about “To provide and maintain a Navy”. No mention of appropriation limits there. Or do you somehow think that military is only Army? ETA: And ships are by their very nature ridiculously expensive by my standards.

 

[Erikaspirit16]

You’ve now contradicted yourself. You really do want to control how other people’s money is spent on health care because you think it’s possible to come up with a better plan via the government than by individuals shopping around in a free market. I see this as nothing less than elitism.

I don’t see how I’ve contradicted myself. The ultimate goal is good healthcare. The means to get there is health insurance of some type. But good health insurance does not necessarily mean good healthcare–if I have terrific health insurance but all the doctors are incompetent, it doesn’t matter much. The ideal healthcare system would include education for doctors, nurses, etc. and quality checks on hospitals, etc.

As I carefully explained above, there IS NO FREE MARKET for healthcare, so the notion of “individuals shopping around in a free market” is fantasy, pure and simple. A two-tier public / private system simply leads to the best care being given to the rich; a system where all doctors are forced to provide care to anyone with gov.-provided health insurance solves that problem. In Canada, for example, all doctors participate in the federal / provincial health care plans. You can choose any doctor you like. The only barrier is that if a doctor is known to be excellent, they might be booked up far in advance.

Elitism? If fairness and competence = elitism, I’m guilty. The average person–even the far above average person–simply doesn’t have the knowledge to “shop around.” Even if credentials, prices, etc. were transparent (which they aren’t) it would still be a daunting task. And of course by its very nature, healthcare is not like buying a car. How much can you “shop around” for a cardiologist when you’ve had a heart attack?

The federal gov. is the only organization powerful enough to collect information on doctors, hospitals, etc. and negotiate prices. Private insurance companies simply create a system with multiple prices, and worst of all, a profit motive behind every procedure and decision.

 

[John10]

Granted not everything will work, however we must work hard to fight inequity, specially in terms of health care, since it is not a luxury but rather a human right.

 

[Peeps]

The ultimate goal is good healthcare. The means to get there is health insurance of some type. But good health insurance does not necessarily mean good healthcare–if I have terrific health insurance but all the doctors are incompetent, it doesn’t matter much. The ideal healthcare system would include education for doctors, nurses, etc. and quality checks on hospitals, etc.

This is something I can agree with to a certain extent. The question of what is “good health care” is hard to answer.

For some people , good health care means “any means, any meds, anyTHING that will help me get better!” Spend money like water–that’s what “good” health care is–to leave no stone un-turned, no path untravelled, to try to make someone “well.”

For others, good health care means wellness care. A yearly-physical and regularly-scheduled screening tests (e.g., annual mammogram, colonoscopy every 5 years or more if you are at risk, annual screen for testicular cancer, BMP to screen for lots of conditions like diabetes, stroke risk, etc., weight, height, cognitive abilities, etc.).

I would tend to go along with this, BTW. I think that if everyone in the U.S. could have this level of wellness care paid for by someone (the government, philanthropists/foundations, churches, insurance companies, employers, individuals, etc.), we would require a lot less expensive “after the fact” care.

And how about pain-relief–is that “good health care?” Some people like me live with osteoarthritis, which severely impedes my mobility. But it doesn’t kill me (at least I don’t think so–there are studies demonstrating that chronic inflammation is the cause of heart attacks). I’m allergic to NSAIDS so the only pain med I can use is acetaminophin in very limited doses (a few times a week) as it destroys the liver. I should get a knee replacement, but I’m waiting until I’m old enough that I will outlive the fake knee!

But pain relief is not healthcare…or is it? It certainly impedes my quality of life, but not owning a Corvette also impedes my quality of life! So why should a knee replacement be paid for by anyone other than me?! (I think if I had a Corvette, my knee would stop hurting!)

And how about addictions? Health care? Should rehab for heroin addiction be paid for? How about repeat rehab for heroin addiction–over and over again? (Heroin addiction is tough to beat!). How about gambling–should rehab be covered? Is this health care? Many would say YES, but others would say, “Just say no.”

How about abortion and birth control? Or fertility treatments? Healthcare? A woman does not have to have a baby–or not have that baby–to be healthy.

This is one reason why we in the U.S. have such a hard time coming up with a “national health care plan.” There is not agreement on what, exactly, is health care.