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

[JamesATyler]

Government takes over emergency care and response financing. Probably subsidizes preventative medicine. Private insurance covers the gap between.

 

[Erikaspirit16]

drug companies could no longer afford to devote large sums to R&D. Now the US does most of the drug R&D, which means two things – the R&D burden is borne by Americans, and fewer new drugs are developed.

Your staff didn’t do a good research job! If you dig a little (just a little…) you’ll find that there has NEVER been a disclosure of the cost of a drug–in terms of a breakdown of how that cost was arrived at. The number generally used was thrown out there by a drug trade association years ago, and it was their estimate. They didn’t take into account tax effects, and they double counted several things. The “real” (as real as can be determined…) costs of a drug were a fraction of what the trade assoc. claimed. (No, I’m not going to go dig around for the reference, but it’s out there.)

I worked for a vaccine company in marketing, and I’m an MBA. The “costs” are exactly what management wants them to be. If you know anything about accounting, you know that they are a variety of ways to do most things, particularly account for fixed costs. “Cost” is a fiction. Of course there is a cost, but if you shut 10 accountants in a room, they could come up with 10 totally different costs.

As for the Europeans not developing new drugs, you must have heard that on Fox news.

 

[Erikaspirit16]

As others have pointed out the “problem” is the elephant in the room that no one wants to address ie the enormous insurance liability expense doctors, nurses and hospitals need to pay.

That’s a myth perpetrated by the doctors and hospitals. Without looking it up yet again, I think it amounted to about 3% of health care costs–and that INCLUDED the insurance premiums to protect against it.

 

[Erikaspirit16]

There is a huge flaw in almost all the proposals here–including the original one. The flaw is simply that it divides the population into “haves” and “have nots.” This is the very thing Romney pounced on when he talked about the 40-some % leaching off the hard-working Republicans. (Never mind that this counted Social Security recipients, Veterans’ benefits, etc.) As soon as you have a program (school lunches, etc.) that say “OK, poor folks over here and rich folks over here” you are creating a social problem. Everyone needs to have equal access. (And, no, the poor guy who needs to get $200 out of his medical savings account to see a doctor does NOT have the same access as the guy making $200,000 and who thinks $200 is the price of a nice lunch.)

To all those who actually believe in free markets (like me!), I’d like you to consider the marks of a free market, and how health care in the US has NOTHING to do with free markets.

1. No barriers to entrance or exit to/from the marketplace. Cost of a new hospital? Medical education? Restrictions on how many doctors are accepted at med school? And on and on. Restrictions and barriers galore.
2. buyers have perfect knowledge of the market. Are you kidding? Most of it is secret. Have you ever been told to get a certain procedure and tried to find out the price?
3. No one seller is big enough to affect the price of the good or service. So…one hospital in your county…one heart specialist in your county…Can we say “monopoly”? Drugs? even worse.
4. United Health Care, through one of their subsidiaries has a total monopoly on the data insurance companies use to calculate “usual and customary” charges. They can manipulate the data as they like–no one audits them. Virtually no one understands this.
5. All buyers are treated alike in a free market. If doctors (as currently is the case) are free to accept or reject individual patients or classes of patients (Medicare/Medicaid), buyers are NOT equal in the marketplace.
6. Homogeneous products. Doctors, hospitals, and drug companies spend most of their time trying to differentiate themselves from their competitors. Terrific. But can an average person find out if Doctor A is better than Doctor B? No.

So is the current system a “free market” system? Absolutely not. Not even close.

 

[Peeps]

Paperwork makes up 1/3 to 1/2 the cost of healthcare. With this system, almost all the paperwork goes away – there’s almost as little paperwork as there is at Wal Mart.

I like your post, but this is questionable, IMO.

I have worked in the hospital lab (microbiology) for around 34 years. Paperwork and computer “paperwork” is the bane of our workday. So many errors!

When the papers are done by hand, we can’t read the writing and have to call, that costs us money, and we pass on the costs to patients in the form of higher costs for lab work.

If someone enters the wrong test code (happens several times a day), we eat the cost of doing the wrong test and pass on the costs to the patients in the form of higher costs for lab work.

If someone enters duplicate testing, the patient and the lab usually eat the cost, as the insurance companies don’t cover duplicate testing (for good reasons). Lab passes on the cost to patients in the form of higher costs for lab work.

If we don’t have paperwork, but just a phone call telling us that it is on its way, and we set up the test and do it, and the paperwork never comes, and we call ($$) and they tell us that the test was cancelled, we eat the cost and pass it on to patients in the form of higher costs for lab work.

Paperwork is frustrating for everyone. One thing that Pres. Obama talked about, but never was able to get going, is a “universal medical record system” that would utilize the SAME computer system at every health care facility in the U.S. This would be awesome! It would simplify everything for all of us who work in healthcare; e.g., making it possible for us to make sure that the patient isn’t receiving duplicate lab testing at another facility across town. I do not feel the Pres. Obama was one of our best presidents ever, but I did LOVE his idea and think it would really help cut health care costs for patients, and streamline health care “paperwork” for providers.

 

[whatistrue]

“universal medical record system” that would utilize the SAME computer system at every health care facility in the U.S.

From a security and privacy standpoint, this is, IMHO, a horrible idea. If there is only one target it is easier to find, and once it is breached (and make no mistake, every system that can be seen can be breached given enough time and talent working the attack) everyone’s data is compromised.

 

[maryjk]

As I read through this, I had so many comments to so many different people, I figured that I would just make them all here.

Like another poster, I have more medical experience than a non-medical professional should have. I’ve taken care of four different people with different chronic illnesses plus I have a few of my own chronic illnesses.

I’ve lived in small towns without a hospital, and near big enough towns for multiple. And I’ve carried various types of insurance. I’ve also been covered under government insurance.

With all of that, I shopped around for a NICU. I chose one that was closed to people that I knew. And had a wonderful doctor for my premature baby. I chose one that was a little more difficult for me to get to, but was better for the baby.

I also shopped around for my specialist. There are two rheumatologists here in town. I drive two hours to see one that I feel is better. He is part of a teaching hospital and because he is also involved in research, I have been part of 2 different drug trials. I am able to see various doctors that are part of his team and although it is quite a drive, I believe that it is worth it. I have lupus, which means that most of the time I can’t drive myself that far. I have to have a friend or family member drive.

The absolutely worst care that I ever received was through the government. Dad was military. And although some of the doctors were wonderful, you couldn’t be sure that you would see the wonderful doctor. Oh, you could make an appointment, but sometimes it was the luck of the draw when you went. I saw a different doctor for every single appointment for an injured foot. If I heard, “lets give it another week,” one more time, I was going to scream. No one wanted to make a decision. And no one person knew everything about what happened. And every single time I went in, I had to go over everything. My parents finally just gave up. And told me to live with it.

Government involved with my health care?? NO thank you. Just look to the Veterans and you know that you don’t want the government involved.

One more comment. As an adult, I injured my foot. (Yes, again. Different problem) The doctor said that he could run an MRI. Insurance would pay for it, in total. (I had great insurance, then.) BUT, if the MRI came back positive, he would put me in a boot for 6 weeks. And if it came back negative, he would put me in a boot for 6 weeks. Then he asked if I wanted the MRI. Um, no. But, according to him, you would be surprised at how many people would have said yes. Since they didn’t have to pay for it, why not have it. Well, I am paying for it. In increased premiums for my company. We both understood that, but so many people don’t.

Free healthcare isn’t free. I know too many people with “free” government health care that never question a test that is run, never question seeing a doctor every 2 weeks and never realize that they don’t need that 800mg Motrin script. (just take 4 over the counter ones.)

So, no, you may not know whether you need a knee replacement. But you should know enough to question replacing a knee that doesn’t really bother you.

 

[vern_humphrey]

So, explain how in your idea the people in a rural, remote town with one doctor will be served when that doc retires and moves to Florida. There is no public transportation in these small towns, so, traveling great distances is not an option.

So, explain how in the current system the people in a rural, remote town with one doctor will be served when that doc retires and moves to Florida. There is no public transportation in these small towns, so, traveling great distances is not an option.

You see? You’re complaining about something that affects the present system just as much as it will affect ANY future system

 

[vern_humphrey]

I do not feel the Pres. Obama was one of our best presidents ever, but I did LOVE his idea and think it would really help cut health care costs for patients, and streamline health care “paperwork” for providers.

The paperwork I’m talking about is the insurance paperwork – medical records are necessary (as you demonstrate) but the blizzard of insurance paperwork is unnecessary (it contributes nothing to the treatment) and expensive.

 

[vern_humphrey]

Your staff didn’t do a good research job! If you dig a little (just a little…) you’ll find that there has NEVER been a disclosure of the cost of a drug–in terms of a breakdown of how that cost was arrived at.

Because there is no standard accepted way to account for the cost. How do you charge R&D for a drug that didn’t pan out?

The method used is to see how it affects the bottom line.

Nevertheless, R&D in Europe has dropped dramatically, and THAT is the point.

 

[TheLittleLady]

I am not the one who claimed that old Doc Retiree must bring in a new doc or break the law. Would you just answer how?

 

[PetraG]

This is a very difficult question to answer for several reasons.
One is that people have built their livelihoods on the present system, which grew up in a very piecemeal jerry-rigged plug-holes-as-we-go way. Anybody can see it is a system that no one in their right mind would have constructed if they were building it from scratch, and yet so much of the health and welfare of so many people relies on it that it simply is not possible to just raze it and start over. Even if there was a “perfect” system for delivering and paying for health care, we couldn’t simply drop what we’re doing and go to that. Deciding how to make changes we decide to make is at least as difficult as making them.

The second is this two-edged sword: Health care is a basic human need and yet people de-value what is provided to them at no cost to them. People abuse give-aways. As much as we want to provide health care to everyone, regardless of need (because unlike the hungry, the sick are usually not in any position to go out and better their situations), we have to recognize that a functional health care system has to rely on patients paying for care to the degree that their means allow.

Third: People don’t want to pay for health care until they need it and yet extremely few people have the means to pay for the care they need when they do. This means people both resent a pooled-resource model and yet cannot possibly manage a pay-as-you-go model.

So–even before we get to the brass tacks of what kind of care people need, how innovation ought to be carried out and who is going to pay for it all, we have the two problems of a terrible system and the foibles of human nature to deal with before we even get started. Worst yet, our culture is now in a situation where we are at an all-time low in our attitudes towards the human nature of people we perceive to be different than we are. Those with low means are wary of those with more, those with more are wary of those with less, and so on. Stack on top that everyone wants the smartest and most hard-working people to provide and improve their health care, but we’re in a society in which the compensation that many of the most talented and the most hard-working want is financial. The less we are willing to give anyone respect or social position for the profession they’re in, the more this is so.

I guess I would start by giving financial incentives for people who don’t have the means to get medical training to get it and pay it off by working in under-served areas. We have lots of well-off people getting degrees and going into lucrative specialities in over-served areas. I think it would be good to tap into the talent pool of people who would like to live in under-served areas but have financial barriers to doing it. This is what we did for the power grid, postal delivery and education, and those were all very good investments.

 

[JMMJ]

How is that relevant? Do you know better what you need in the way of heart surgery with your current insurance?

Think about this – how did you pick your current doctor? Most people when asked that question will either lie, and tell about all the research they didn’t actually do, or they’ll say, “Oh, my friend Sam recommended him.”

So you go to the doctor Sam recommends and ask him about prices. And if that doctor refers you to a specialist, you ask the specialist about prices. Under the system I recommend, doctors would probably post their prices on the internet.

You sound like someone who hasn’t had to deal with a health crisis, or someone who hasn’t had to secure care for someone else with a health crisis (or a chronic, severe medical condition). Your proposal is only realistic for those with plenty of assets, free time, and plenty of education.

 

[JMMJ]

The help you receive will be based on your declared income.

From the previous year. How does that work for someone who lost their job 4 months ago, had to take a severe pay cut with a new job, and just got a cancer diagnosis?

 

[Canvas]

That is the essence of my proposal – you pay directly for your treatment, and have catastrophic coverage for unexpected major expenses.

and the vast majority of people in America would be unable to pay for this. Those high deductible plans are awful. Luckily, when I had one years ago (and only a $5,000 deductible, mind you) my employer reimbursed me for things like paying the full cost of medication.

No, this “pay out of pocket” idea is terrible. It would not work.

 

[Canvas]

From the previous year. How does that work for someone who lost their job 4 months ago, had to take a severe pay cut with a new job, and just got a cancer diagnosis?

exactly. Or how about someone who does have a regular job and no cancer? Just pay out of pocket for their regular medication? The cost of a months supply of some medication out of pocket is insane!

 

[Canvas]

Do we really want to choke off drug R&D, new developments in medicine, and so on?

Hogwash. The average pharma company in America spends more money on advertising than research.

Big Pharma Spends More On Advertising Than Research And Development, Study Finds | ScienceDaily

A new study estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim. The U.S. pharmaceutical industry spent 24.4% of the sales dollar in 2004 on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion. The study’s findings supports the position that the U.S. pharmaceutical industry is marketing-driven and challenges the perception of a research-driven, life-saving, pharmaceutical industry.

9 of 10 top drugmakers spend more on marketing than research - Vox

Marketing & Sales (M&S) expenses far exceed that of Research & Development (R&D) expenses in the
pharmaceutical industry
 In 2015, out of the top 100 pharmaceutical companies by sales, 64 spent twice as much on M&S
than on R&D, 58 spent three times, 43 spent five times as much and 27 spent 10 times the
amount.
 Drug companies have not invested in R&D due to low return-on-investment
 Out of the top 100 pharmaceutical companies in 2015, 89 spent more on M&S than on R&D.
 In 2015, the top 100 pharmaceutical companies, on average, spent 8.32% of their revenues on
R&D.

https://nurses.3cdn.net/e74ab9a3e937fe5646_afm6bh0u9.pdf

 

[vern_humphrey]

Hogwash. The average pharma company in America spends more money on advertising than research.

Is that the kind of language ladies and gentlemen use in debates?

Lawyers also advertise. And automobile makers. Does that make them evil?

 

[vern_humphrey]

and the vast majority of people in America would be unable to pay for this. Those high deductible plans are awful. Luckily, when I had one years ago (and only a $5,000 deductible, mind you) my employer reimbursed me for things like paying the full cost of medication.

No, this “pay out of pocket” idea is terrible. It would not work.

Then how DO you propose to pay? Are you not responsible for yourself and family? Shouldn’t you pay for your own needs, if you can?

Let me point out two things:

1. If you can’t pay, you get assistance.
2. Unlike current insurance programs, you get to KEEP all unspent money.

When did your insurance company refund your premiums because you consumed less than the total premiums?

 

[vern_humphrey]

From the previous year. How does that work for someone who lost their job 4 months ago, had to take a severe pay cut with a new job, and just got a cancer diagnosis?

You amend your application, of course!

You do that now for other forms of assistance, if you suddenly need help in the middle of the year.