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

[Peeps]

if I have terrific health insurance but all the doctors are incompetent,

Here is another huge issue–incompetence of medical personnel, especially doctors.

I have worked in a hospital lab for 28 years in my current city, and six years in my previous city.

Doctors are not gods. They can be incompetent goofs. We have certain doctors that we all swear we would never, ever go see even if we were dying.

I personally think that lawyers who make their money filing frivolous lawsuits are despicable. I also think that it does no good for a family to file a lawsuit once their loved one is dead, other than to obtain money to pay for the expenses of whatever killed them.

Sadly, one of the reasons why health care is sOOOOOO expensive in the U.S. is that doctors must order EVERY SINGLE AVAILABLE TEST and pursue every pathway and jump through every hoop and turn cartwheels–EVERY possibility must be pursued for the sake of helping a patient because the snake—er, lawyer, will find that ONE little avenue that the doctor didn’t go down, and then sue the pants (and everything else) off the doctor to obtain “satisfaction” for the bereaved family.

Grr.

So there are two issues–true incompetence or ignorance on the part of doctors (and unwillingness on their part to ask nurses, lab techs, physical therapists, etc. for advice), and true greed on the part of lawyers.

These two things are driving up the cost of health care in the U.S.

And one reason why nothing gets done by elected officials is that most of them are snakes…er, lawyers.

 

[L_Amoneti]

Its actually a perverse combination of for profit business models, and government regulations that prevent the free market from operating as it should to keep prices in line with the cost of providing service, allowing (as we have observed) virtually unlimited price growth.

The increased revenue is going to various forms of bloat, not to the providers.

 

[L_Amoneti]

I also think that it does no good for a family to file a lawsuit once their loved one is dead, other than to obtain money to pay for the expenses of whatever killed them.

How else should people be held accountable for incompetence/malpractice?

 

[L_Amoneti]

Epic roast.

 

[VictoriaAdAeternam]

Get rid of those in it for profit. It’s meant to help people, not for boards sitting around a table to line their pockets. Hospitals need to get rid of the administration departments as well. Hospitals were once ran by a doctor or a couple doctors and these roles were done away with for the purpose to save money, only in time the administration departments have ended up costing more than the way things were previously done.

 

[Peeps]

Get rid of those in it for profit. It’s meant to help people, not for boards sitting around a table to line their pockets. Hospitals need to get rid of the administration departments as well. Hospitals were once ran by a doctor or a couple doctors and these roles were done away with for the purpose to save money, only in time the administration departments have ended up costing more than the way things were previously done.

I don’t know if this is possible. Every hospital I know (I work in a hospital, and I live Northern Illinois, near Chicago) is not independent, but associated with a large “association” or “corporation”. Even the Catholic hospitals are associated with an “order.”

This means that there has to be a “board” so that the hospital is represented at the corporate headquarters. Doctors and other employees don’t have the time (or the business chops) to attend corporate meetings and events.

And hospitals don’t just draw in customers nowadays by being there. A lot of promotion is done, and this is cheaper when corporate does it (uses the same advertising campaign for all the hospitals under its wing).

And incidentally, there is no such thing as an independent doctor’s office nowadays. They are all associated with the various hospitals, and many times, they take on the name of just one hospital corporation.

I’m not saying I like this. I absolutely HATE having “corporate” dictating to our lab what products we will order, especially what instruments we must order. Our department had recently done a study to determine which Rapid Respiratory Panel instrument we wanted (3 are available), and we loved the instrument that is made in one of the Chicago suburbs, not to mention we loved knowing that the company could be at our hospital in good time if our instrument had any issues. But CORPORATE said “NO,” we have to buy the instrument that all their other hospitals use, and we HATE that instrument!!! It doesn’t work well, and we’ll end up doing double work–running the test on the stupid instrument and then sending the specimen to a reference lab when the stupid instrument doesn’t work!!

Our supervisor came very close to quitting after this–she is planning to retire this spring, but she almost walked out the door early after getting this dictum from corporate. We are all pretty discouraged about it.

But as I said earlier, I don’t think there is much that any hospital can do without a corporate affiliation. It’s just the way things are done in the 21st century in health care. Kind of like using a cell phone–almost everyone has one nowadays, and it’s sometimes impossible to find a phone booth! There are still some hold-outs (I still use a flip phone), but not too many.

 

[niceatheist]

JMMJ:

Do you see any problems with your plan in this situation? Assume the situation of the person making much less money than last year (just enough to make frugal living expenses) at the time of their diagnosis.

Do you see that the plan provides for help? Where do you see an obstacle to updating requests for help?

And how long is that application going to take to be approved? And what if it’s a catastrophic injury, like a car accident? Any negotiating power you have is rendered useless if you’re negotiating after the procedure.

 

[goout]

Make everyone completely responsible for their personal health care decisions.
There is too much separation between health care decisions and paying for them. And this leads to overuse of the system, and overuse leads to rising costs.

Abolish group plans that use buying power as a club to procure boutique health plans. Give every household control over plan selection and how it is paid for.

 

[niceatheist]

And what happens when I pull out of an intersection on a green light, and I’m t-boned my someone running a red light? What if I get cancer because I lost the genetic lottery? Not every illness or injury can be applied to personal conduct.

 

[goout]

And what happens when I pull out of an intersection on a green light, and I’m t-boned my someone running a red light? What if I get cancer because I lost the genetic lottery? Not every illness or injury can be applied to personal conduct.

That’s not what I meant. I was speaking of health care decision making not accidents.
Which insurance plan to accept.
High deductible vs low.
How often to see the doctor and for what level of health issue.

For many people these decisions are moot because the employer provides a plan, and the employee simply uses it to the extent it is available.

For instance:
Provide the employee a benefit amount. Allow the employee to pick a high deductible plan and pocket the difference if that is what they want. This incentivizes the employee to make prudent decisions rather than reflexively consume health care. That is the point of my post: for the individual household to think before acting. And make prudent decisions.

Currently the health care system is burdened by overuse, which leads to rising costs.

 

[Erikaspirit16]

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

It looks like we agree (except for one thing…following post). But the US shouldn’t approach “what is good health care” as if it is a new question. This has been debated ad nauseum in the US, and of course all other developed countries have come to conclusions about it–what is covered by the national health system, and what is not. The is no need to re-invent the wheel. You just have to do a bit of research, which I’m sure someone has already done.

Preventative care is important, as you pointed out, and is discouraged by the current US insurance system. I pointed that out above when I described a case of appendicitis, how the local hospital wasn’t covered by insurance, and how delay brought on a burst appendix, making the costs (to the patient, the health care system, the employer) all multiply. Could some people overuse preventive care? Of course. But overall, it seems to me to be clear it’s more efficient and more effective on a large scale.

Part of the huge cost of health care in the US is the cost of people who sit in offices somewhere, look at individual cases, and say “We’ll cover this.” or “We won’t cover this.” This is crazy. There should be general agreement. Should cosmetic surgery be covered? Probably if you were in an accident. But not it you don’t like the shape of your nose. And yes, someone needs to make those decisions, but it should be an expert medical team doing it once for everyone, not on a case-by-case basis. But there could be individual appeals. These decisions should not be made by the government or (worse) insurance companies. However, the team could be appointed by the government.

And cost certainly is a factor. I always throw up my hands when I read another announcement of a “miracle drug” that will cost $10,000 a dose. That’s almost worse than useless.

And what of people who refuse to exercise, eat the wrong things, and expose themselves to unnecessary risks? Should you be free to do those things? Sure. Should there be a penalty? I think so. If you want to sky dive, good for you. But you should be forced to take out special insurance to do that. You want to overeat? Go ahead…but your taxes should be increased for each point over the optimum BMI. And so on.

One of the best articles I’ve come across on health care costs is by Atul Gowande in the June 1, 2009 New Yorker. He compares McAllen and El Paso Texas: similar populations, similar medical facilities, and yet McAllen’s Medicare bills were more than twice as high per capita as El Paso’s.

The July Atlantic has a good article The U.S. Leads the World in Health-Care Spending - The Atlantic that blames the US population for its own health problems.

 

[Erikaspirit16]

I personally think that lawyers who make their money filing frivolous lawsuits are despicable. I also think that it does no good for a family to file a lawsuit once their loved one is dead, other than to obtain money to pay for the expenses of whatever killed them.

Sadly, one of the reasons why health care is sOOOOOO expensive in the U.S. is that doctors must order EVERY SINGLE AVAILABLE TEST and pursue every pathway and jump through every hoop and turn cartwheels–EVERY possibility must be pursued for the sake of helping a patient because the snake—er, lawyer, will find that ONE little avenue that the doctor didn’t go down, and then sue the pants (and everything else) off the doctor to obtain “satisfaction” for the bereaved family.

Where we part company is lawsuits. It’s a myth (I pointed this out above) that it contributes significantly to US health costs. The true cost of lawsuits–and the premiums that doctors/hospitals pay for malpractice insurance–is about 3% of total healthcare costs. It’s not nothing, but if you eliminated that 3% overnight, it wouldn’t come close to solving the problems of the US healthcare system. And, as I pointed out before, to me it’s not about lawyers getting rich, etc., it’s about holding people and institutions accountable. If I’m a careless doctor, and I don’t have to worry about lawsuits, why would I be less careless? If I know I’m going to pay a penalty–either in increased malpractice premiums or in penalties–I’m at least going to consider being more careful. In other words, lawsuits prevent bad behavior in the future. I don’t see any other way to do this. Certainly in my state there is story after story in the press of obviously incompetent doctors who are still practicing. The medical societies almost never revoke or suspend licenses. So if they won’t police their own, who will?

And of course I hope we all know the old joke: “What do you call a medical student who graduated last in his/her class?” Answer: “Doctor.”

 

[lonegreywolf20]

I don’t think you’re quite getting the objection here. A significant current problem is people who officially have enough money on paper to cover their expenses, but don’t in practice because the system isn’t calculating all their expenses. It also doesn’t work well for people who take that “catastrophic” hit every year - when I was on a high deductible plan it essentially amounted to just reducing my income by 7.5k a year, every year. While still being ineligible for aid in other areas because on paper my income was just enough at about 30k a year.

That is where I am at currently. I cannot get help for my inhalers because I have health insurance with drug coverage, but my drug coverage doesn’t cover my inhalers. Forget about going up to the next tier of insurance. I would be working to provide for health insurance and nothing else.

 

[buffalo]

Get the Govt out of it.

Exactly. Subsidiarity works best.

 

[Aquinas11]

If I’m a careless doctor, and I don’t have to worry about lawsuits, why would I be less careless? If I know I’m going to pay a penalty–either in increased malpractice premiums or in penalties–I’m at least going to consider being more careful. In other words, lawsuits prevent bad behavior in the future

Perfect argument why Government run healthcare can never work. Its much harder to sue Government-employed doctors than private doctors due to legal barriers involved in suing Government employees/entities. Hence Government-employed Doctors (e.g. VA) are far more careless than private doctors.

 

[lonegreywolf20]

No he doesn’t. He should give his patients reasonable notice so that they can hopefully find someone else to go to, but he’s not obliged to ensure that they have a doctor to go to.

I am in the medical field as an EMT and the above is correct.

 

[Erikaspirit16]

Perfect argument why Government run healthcare can never work. Its much harder to sue Government-employed doctors than private doctors due to legal barriers involved in suing Government employees/entities. Hence Government-employed Doctors (e.g. VA) are far more careless than private doctors.

Ah, but you are ignoring the fact that instead of answering to a medical association, they would answer to the government. Less need for lawsuits if the gov. takes action to sanction bad doctors/hospitals.

 

[Aquinas11]

if the gov. takes action to sanction bad doctors/hospitals

proving my point again that Govt Run healthcare can’t work. The patient is an afterthought. The Govt will take action…against itself and if it feels like it. We already have VA to know how that worked. Would be akin to relying on a private medical practice today taking action against one of its doctors.

 

[Erikaspirit16]

proving my point again that Govt Run healthcare can’t work. The patient is an afterthought. The Govt will take action…against itself and if it feels like it. We already have VA to know how that worked. Would be akin to relying on a private medical practice today taking action against one of its doctors.

Sorry, but you’ve got it wrong. In the current system, everything is driven by profit. The health or well being of the patient is secondary. In a single-payer government system, there is no profit motive. The only motive is the health or well-being of the patient. If it’s not, you haven’t designed your system very well.

The VA has nothing to do with a single-payer gov. health care plan. In the case of the VA, doctors are gov. employees and hospitals are gov. owned. In a single-payer plan, doctors run their own practices and are NOT gov. employees. Hospitals are privately owned. But everyone would be subject to gov. regulation (which they are now, but not as much as they should be). Only the federal gov. has the power to go after fraud in large corporations. And only the federal gov. can be objective in disciplining doctors and hospitals–certain the AMA and AHA have direct interest in their members. The gov. does not. It’s only concerned with competence.

 

[Aquinas11]

In the current system, everything is driven by profit. The health or well being of the patient is secondary

You’ve already contradicted yourself. If “everything” is driven by profit, patient wouldn’t even be secondary

In a single-payer government system, there is no profit motive. The only motive is the health or well-being of the patient.

First sentence is oxymoronic - there can’t be profit motive since it’s a government monopoly outside free market. Second sentence false again since you now have political profit motive instead of financial profit motive. So have given politicians incentive to now spin, lie, deceive, etc about the care in order to personally profit politically. You also have removed accountability in form of competition since Govt doesn’t have competitor

In a single-payer plan, doctors run their own practices and are NOT gov. employees. Hospitals are privately owned. But everyone would be subject to gov. regulation

False again. If doctors and hospitals are only paid by govt $$, they’re effectively govt employees and govt owned. No private insurance and nobody can choose to have no insurance thus they’re exclusively paid by govt. It’s a distinction without a difference