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

[Erikaspirit16]

Why not start with the government paying for the emergency response and care? That would be the ambulances, helicopters, and emergency room units.

Second, the government could assist or even outright cover preventative care.

You’re right, these changes would help, and they are related.

Let me give a personal example for each. My son had appendicitis. Our insurance at the time didn’t cover the local hospital (I know, really weird…but not really, since one HUGE problem with managed care plans is that they are centered on large cities. The further you live from a large city, the fewer doctors and hospitals participate. We lived 50 miles from the large city the managed care plan operated out of.) So, because we knew that if we took him to the local hospital and they said “Appendicitis? No…it’s indigestion. Go home.” We would be on the hook for the whole cost. So we waited overnight. And in the morning the appendix burst. We drove 50 painful miles to the nearest covered hospital. And instead of a 2-3 day stay in the hospital, it turned into a week-long stay. Bad for my son, bad for us, bad for the insurance company.

Preventive care: For a few years I was covered by Medicare. But there is a deductible–I forget exactly, but it was around $180 a year. It doesn’t sound like much, but when you realize that you are going to pay $100+ to say “Hello” to your doctor, you don’t go to the doctor unless there’s a big problem. I switched to a Medicare Advantage program, and for the last two years I’ve been able to see my doctor (who is in the program) for a $5 copay per visit. So will I go see him for what I think is a minor issue for $5? Yes. For $100+? No. And in the long run, as you point out, this will save everyone money.

A few other points. People keep asking Bernie and Elizabeth “Where will the money come from?” The average cost of an employee’s health insurance is over $17,000 a year, paid by the employer. The average employee also pays over $5,000 a year. So that’s over $22,000 a year per employee. Do the math. Then factor in the fact (I pointed it out earlier) that insurance companies can keep up to 30% of premiums for “expenses.” About 27% of that is not necessary. And the gov. is forbidden by law from negotiating with drug companies about the cost of drugs in Medicare Part D. And that is where the money will come from.

Also, someone else wrote above that the federal gov. ALREADY pays for most healthcare in the US: Medicare, Medicaid, the VA, Tristar (for active and retired military and their families), CHIP (for children).

Finally (for now), Peter Drucker (the management guru) had a core principle when looking at ANY management problem: Is the current system something you would set up if you were starting from scratch? And, as someone else above pointed out, the US healthcare system evolved over decades. It’s a patchwork. No one in their right minds would say “Oh, I want a healthcare system just like the US!” Funding emergency care and preventive care would be helpful, but the real answer is changing the entire system.

 

[TheLittleLady]

This would give you a heart to make sure no other family has to lose their family home, to lose everything, because of a medical diagnosis, one would think.

 

[Pattylt]

While this sounds nice, we already have a problem with people treating ERs as basic healthcare clinics. What’s to stop anyone from just always going to the ER when they should be seeing a GP?

And if you put in the provision that any ER care that should have been treated by a GP isn’t covered, you run into the problems of chest pains that could be a heart attack (true emergency) vs. chest pain that turned out to be indigestion (non emergency).

Over half of our ER visits are non emergency. No appointments needed, top quality care and most are off the hook for paying for any portion of it. Hospitals have the dilemma of the ER being the entry face of the hospital and a huge money losing department. More and more they split the ER into two departments…one is full on emergency care and the other a clinic with PAs. Patients are triaged into which area they go to and many get fuming mad when they’re treated in the clinic area! Their tooth ache is an emergency! And no one can be refused to be seen!

 

[DarkLight]

Over half of our ER visits are non emergency. No appointments needed, top quality care and most are off the hook for paying for any portion of it. Hospitals have the dilemma of the ER being the entry face of the hospital and a huge money losing department. More and more they split the ER into two departments…one is full on emergency care and the other a clinic with PAs. Patients are triaged into which area they go to and many get fuming mad when they’re treated in the clinic area! Their tooth ache is an emergency! And no one can be refused to be seen!

Honestly part of this is already the problem that no one can be refused - which means people who would be refused at a regular doctor due to their inability to pay go to the ER instead. We’re also having more use of urgent care clinics in urban areas, but not everywhere has one. They’re good for stuff that doesn’t need to be seen right away but can’t necessarily wait a couple of days either. But there are also some things that can’t be done there. For example, IV migraine treatment often isn’t available outside of the ER even though it’s not strictly an emergency. And fun fact from experience: the better insurance you have, the easier it is to get a last-minute appointment.

We don’t want to perpetuate a system that encourages people to wait until it’s an emergency because of the costs of non-emergency care. This is particularly a problem with conditions that need maintenance and can become emergencies if not managed properly. It’s also frankly against public interest, since emergency care tends to only stabilize people even in cases where long-term care could return someone to the workforce or otherwise assist in gaining and maintaining overall functioning.

And you’re right that it’s also hard to rule on people using the ER because some things might not be obvious to end users whether it’s an emergency or not. We don’t want to punish people for not knowing, even when it might seem obvious to someone else that it’s not an emergency. I actually think the triage is a good idea because it would provide quick assistance in determining what’s an emergency for people who don’t know.

 

[RuthAnne]

In other words, it does exactly what private insurance companies do now, but 10 times more efficiently in terms of cost,

That’s where you lost me and where I stopped reading. Government and efficiency don’t even belong in the same sentence. If you want to waste money, turn it over to government. If you want to make a big project out of a simple one, turn it over to government. If you want to really screw up a machine turn it over to the government. Government consists mostly of people who are unqualified to function in the real world with the responsibilities or expectations of doing things right.

Take public schools, for instance. My kids go to school for 3 hours a day from 9 til noon. They get better education than public schooled kids and at virtually no cost to tax payers. And I raise my kids instead of some strangers who only care about a paycheck.

Government is not the answer to health care or just about anything else. We don’t need Mommy to run our lives. We need to act like grownups.

 

[Peeps]

Is Pharma the best place for R&D to take place? Or would NIH grants to university researchers be better?

I don’t know if this is an issue or not, but wouldn’t universities have a difficult time finding large numbers of volunteers to join the study because they would be limited to their own area of the country? But Pharma can go everywhere and ask every doctor, every hospital and clinic, and even seek out volunteers in the media and online. Not sure if universities can do that.

 

[TheLittleLady]

are and most are off the hook for paying for any portion of it.

Except that is not so. If one is uninsured, you get a bill in the mail. You can make a payment arrangement, but, if you miss a payment you go to collections and they will haunt you. You will get credit checked for a new apartment, for a job, and not pass.

 

[Erikaspirit16]

That’s where you lost me and where I stopped reading. Government and efficiency don’t even belong in the same sentence.

I think you’re letting ideology trump (pun intended) reality. “Government” depends on what government, what personnel, what task, etc. To say that “the government” is inefficient is as silly as to say “private industry is inefficient.” It depends. Idiots are everywhere. Please keep in mind that NO ONE is advocating that the federal gov. PROVIDE healthcare, just pay for it. I think they’re pretty good at writing checks.

 

[RuthAnne]

To say that “the government” is inefficient is as silly as to say “private industry is inefficient.”

Poor comparison. An inefficient private industry will fail as many do. Government doesn’t have to be efficient as there is no real threat to its inefficiency.

 

[Pattylt]

I actually think the triage is a good idea because it would provide quick assistance in determining what’s an emergency for people who don’t know.

ERs have always triaged at entry. I remember a time when they could send patients away! It ended when legislation required all to be assessed and stabilized as there were horrible abuses of hospitals turning away some pretty seriously ill people when the didn’t have insurance yet seeing the toothaches that did. But triage is always done. Your chest pain will be seen immediately and that toothache may have to wait hours. 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!

 

[Pattylt]

but wouldn’t universities have a difficult time finding large numbers of volunteers to join the study

Not really. They use the same tactics that Pharma does…recruitment including paying a stipend, working with doctors…especially alumni and cooperation with other universities. They would have to expand to a larger population for some tests or certain phases of tests but if initial small studies show promise, Pharma is usually more than willing to join in at that point…provided they get the exclusive patent.

 

[Pattylt]

I should have been more specific…those on Medicaid or certain insurance plans don’t have to pay out of pocket. The uninsured always get screwed…they have to pay and they get no discount and are turned over to collections. I do have to say, some hospitals seem to turn over people to collections at the minute they’re late on payment but some hospitals are quite generous and don’t do this. They may even just drop the bill and write off the loss. Yes, some really do that! The problem is you can’t tell which is which by looking at it and NO hospital advertises that it is that generous…they just quietly do it. And, it’s not always from the goodness of their hearts either…they get great write offs for it! Hospital billing is a mystery almost as deep as the Trinity!

 

[RoseScented]

In a past life I used to be a billing specialist at a hospital. We’d run the survey of outstanding debts every month. Anything $15 and under was immediately dropped. We never told the patients we did it. We never called them first to see if we could squeeze the <$15 out of them.

After that I moved on to the unenviable job of calling the rest. We’d make notes on when we called, what message we left it we needed to leave one, and then would put the person to the side. After the third month of no contact we’d send them to collection. To continue care at our facility there just had to be some form of movement on the account if money was owed. Even if that movement came as 0.05¢ a month. There were some patients who owed more money than they could pay in their lifetime. They all were paying $1 or less on their accounts a month and continued to get care because of it. If someone came in with no insurance the service fees immediately got a 50% decrease.

Hospitals do things that people won’t notice unless they’re paying attention.

 

[Erikaspirit16]

Poor comparison. An inefficient private industry will fail as many do. Government doesn’t have to be efficient as there is no real threat to its inefficiency.

You miss my point. A blanket statement like “the government is inefficient” is simplistic and wrong. As would be something like “all private companies are corrupt.”

And I think you’re wrong about “no threat to its inefficiency.” The press are constantly pointing out inefficiency. The Office of Inspector General in all departments looks at inefficiency. Local, state, and federal governments are constantly investigating inefficiency. What happens to a local government that doesn’t fix potholes? What happens to a state government (say Michigan…) who ignores public health? What happened to the VA in Arizona when its problems were publicized? And so on.

And you overlook lots of private companies that are hopelessly inefficient but have a monopoly on some product or service. How efficient is your local cable company that has exclusive rights to your city? How efficient were the car companies who installed faulty air bags? And so on.

 

[Erikaspirit16]

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

I could be wrong, but I think that’s illegal. Insurance companies would say it was fraud.

 

[gazelam]

No one should be forced to participate in a national healthcare program. If I were on my deathbed, I would not want my neighbor to be forced to contribute to my care - losing his or her freedom in the process. There is no compassion in a program that threatens jail time for those who do not want to pay for the care of others.

 

[Erikaspirit16]

No one should be forced to participate in a national healthcare program. If I were on my deathbed, I would not want my neighbor to be forced to contribute to my care - losing his or her freedom in the process. There is no compassion in a program that threatens jail time for those who do not want to pay for the care of others.

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–even if you don’t use the service (if you have no children, you still pay for schools; no car, you still pay for roads; never take the subway, you still pay for it. Etc.)

Doesn’t paying for all these things make you “lose your freedom”? Or are you an anarchist?

 

[RoseScented]

RoseScented:

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

I could be wrong, but I think that’s illegal. Insurance companies would say it was fraud.

I’m nowhere near being a lawyer, but after looking up what I could find for the time I was working in billing, it looks like it wasn’t illegal and doctors could do it as long as they didn’t have agreements with the insurance companies about not doing such things. I imagine if I went back the landscape would be very different now after all the insurance changes years ago.

 

[gazelam]

gazelam:

No one should be forced to participate in a national healthcare program. If I were on my deathbed, I would not want my neighbor to be forced to contribute to my care - losing his or her freedom in the process. There is no compassion in a program that threatens jail time for those who do not want to pay for the care of others.

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–even if you don’t use the service (if you have no children, you still pay for schools; no car, you still pay for roads; never take the subway, you still pay for it. Etc.)

Doesn’t paying for all these things make you “lose your freedom”? Or are you an anarchist?

All good questions. I’m a small government conservative who is keenly aware of Thomas Jefferson’s quote “A government big enough to give you everything you want, is a government big enough to take away everything that you have.” I do believe that Christ will judge us on how we assist others and He will not care whether our outreach to others if funneled through a government program. 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.

 

[Canvas]

And you overlook lots of private companies that are hopelessly inefficient but have a monopoly on some product or service.

I could tell you stories about the place where I go for mental health care.

And you are correct about another thing—-even if the government is inefficient at getting stuff done, nobody can write checks better than the government. And that is what we are saying: a system that is funded by the government but not run by it. Most people who argue for universal care want a UK style NHS that is a government run system. You could have either a single payer system where the government is the direct insurer (like Medicare) or you could have a system subsidized by tax funds that allows every person to choose a non profit health plan provided by a private health insurer (like in Germany). There are many ways to approach “universal health care” and there are HUGE differences between universal care in Switzerland, where there is no government run healthcare (it is only subsidized and regulated by the government) and the UK’s NHS system (a socialized model).