OT: in your own case, seen obvious waste in health care services delivery?

[eddief]

I swear, this is meant to be just a poll, not a partisan political pissing contest. But it scares me "to death" that any sort of health care reform is going to blow up as it did during the Clinton admin.

With 50 million uninsured and a certain significant percentage of unsatisfied health care consumers, seems like the congress is going to blow this for one reason or another. I know we don't know what the "this" looks like yet, but it seems millions of us are sitting on the sidelines while the elected screw-ups are being bought off by big insurance, big pharma, and big hospital.

Does it seem like we, the masses, are at the mercy rather than somehow making a populist stink about what's going on?

I, for one, purchase my own at $567 per month. And nearly every transaction with the giant Kaiser Permanente seems to have an element of significant waste. Just last month it took 3 phone calls to have them actually read the details of my coverage and get the billing corrected. Of course I had to raise my voice to the person answering the phone just to get them to pay attention. After yelling, dealing with 5 people, two letters back and forth, they finally got it right. The services delivered were fine. Fighting with the post service bureaucracy sucked me and them dry.

So my real question is: Have you had a transaction with your health insurance delivery system in the last year that would suggest to you there is massive waste in the system?

[Pete Serotta]

They are definitely not on top of things in regard to charging and customer satisfaction with the administration of the plan....This is true for Doctors and patients.


We have not been able to get Medicare or Medicaid right after how many years. They state it is going to break the finances of the country, like they are not already broken :confused: :confused:


So how is this new MUCH BIGGER cluster going to affect things :crap: :crap:

[sloji]

Um, that would be profit. This is American healthcare and credit industries; you have an injury and your insurance covers as little as possible the remainder is your responsibility which means you charge the 20k balance on a credit card which then hopes you'll f'up and they can raise your rate to 28% because we all know you have poor spending habits and deserve to be hosed. Now to pay back the 20k you'll spend the next 15 years to do that and that 20k turns into triple that...nice. It's all your fault and it's going to get worse in the future because now we know you were born a genetic f'up and we can find a job for you in the basement of life.

[93legendti]

Nope.

I have great doctors and wouldn't change for anything.

Just the best medical care in the world. It's so good that people from Canada come to take advantage of-based upon personal experience of living in Ontario for 11 years. Our neighbor had bone cancer and he decided to come to the States for the surgery. Same with out friend who needed open heart surgery. Our dear friend has severe scoliosus and Ontario's govt. run health care told her she can have the operation in 3 years. Because her pain is so bad, she's coming here to have the operation and pay out of her pocket.

Last year her husband waited 1 week for an angiogram. He had 90% blockage. When they finally did the test and determined he needed surgery, he had to go by ambulance to London, Ontario-that's 1 1/2 hrs away. There were no heart surgeons in Windsor, Ontario. The wait time in the USA is 63 minutes for the test.

That 50 million number is made up-includes 11 million illegals, as well as people who choose not to have health insurance (like my friend Steve the architect; he can afford it, he chooses not to have it). Why should my taxes pay for their health care?

If the President was offering health care that is the same plan as that available to Congress, it would be one thing. He's not.

Mitch Albom, a long time Democrat, has turned against the President's "plan", as has Susan Estrich.

Diagnosing disease is not simple and the notion that Drs. order tests to pad their bills rather than save lives is offensive.

I am surprised that people think the Government can expand coverage; lower costs and improve medical care.

[CNY rider]

I work in a small cancer center.....we employ a full time RN (RN's are not inexpensive) just to check patient's coverage, and argue with insurance companies about payment issues. That's her full time job.
Realize that the insurance company is also employing boatloads of people to try to limit their payout to the least possible.
Now multiply the hours and money wasted just in my practice alone, and realize that every other succesful practice has to employ expensive people and waste massive amounts of time wrestling insurance companies.........trust me that's just the tip of the iceberg.

Want to read about what the future might look like?
New York Times article (http://www.nytimes.com/2009/07/25/health/policy/25doctors.html?em)
Now in my ninth year.

[allegretto]

how about those of you in the early part of this thread, who appear unhappy, tell me what your priorities are.

you see, the problem with "reform" is; from what, to what?

so, as relatively uninformed, but concerned consumers of healthcare. what three things are most important?

if you'd like to take the thought experiment further; what three things would you give up to get what you want?

i see much waste. but my interpretation could be different from yours.

[sloji]

1. Stupid wars
2. Insane profit
3. Cars

[allegretto]

agree on #1. odd that we're leaving Iraq and stepping it up in Afgan where i really feel there can be no "victory". in fact, BO said that himself.

the other two? well...

so really, what do you want from healthcare?

you live in SLO? how can you afford that without a little "insanity" yourself?

[Sandy]

eddie,

Not to debate here the healthcare issue as that was not your intent as you clearly stated- However, I don't think the 50 million uninsured number you gave is really a valid number for several reasons- I believe it includes at least 10-11 million illegal immigrants, many young adults, who have decided not to have health insurance since they do not think it is needed at their age, older adults, who can afford health insurance, but have decided to take the risk to go without it, using the money elsewhere, and several million unemployed (an alarmingly increasing number). In addition there is a significant number of people who have heathcare available but are simply not using it- medicaid and existing programs for the poor. I should add that there is also a significant number of able people who do not work (prior to the recession) through choice and who do not have healthcare.

The 50 million number is grossly misleading in my opinion.




Sandy

[Ti Designs]

So my real question is: Have you had a transaction with your health insurance delivery system in the last year that would suggest to you there is massive waste in the system?


I have paid for my own health care plan for the last 27 years, 0 claims. Seems like a waste to me...

My plan does have all kinds of little perks which I'm oh so happy about. They offer free birthing classes should I need them, they'll help me quit smoking, and I get a discount on my gym membership if I'm overweight.

Wait, there's a delivery system? They deliver?? Any chance I can get a cute nurse to come over and give me a sponge bath??? Hey, if I didn't keep a sense of humor about it, I would have to kill someone (which would void their health care)

[rugbysecondrow]

To the OP's actual question, no, I have not had that experience. I have been able to get prompt MRI's for my back, necesary medication for treatment, referrals for PT etc. So no, I like my system. I have to pay for it, but I will gladly pay my portion for a good plan.

To what appears to be the greater point about those falling through the cracks, some fall and some jump. Yes, the system needs work, but it isn't broken. To those who jump they choose not to insure themselves, people who opt to spend their money on other things. How would a public option help people who have already made the financil decision not to purchase that good? How artificially cheap do we need to make the product so we can entice a certain segment to purchase that which is already good for them?

I am admittedly no expert, but it doesn't make sense that the Government will magically take over this system, make it more efficient and cut out all the waste to make it some how viable (financially). If they haven't figured out how to do this with the current government run programs, how are they going to do it with this one? Also, if there was so much waste, wouldn't the profit motive of the HC industry have tried to weed it out? They seem vested in this since they have a strong direct motive.

Also, general principles are not hard to agree with here (lower costs, better service, availability of coverage) but that is not what people are arguing about. The devil IS in the detail and the detail is what WILL directly impact your check each week, impact how you can provide a plan for your family. It is not just politics, but real detail and discussions that should be had.

[sloji]

;) I think they are more efficient than corporations not less and i'd be willing to sacrifice your paycheck for my benefit.

[gdw]

run to a doctor for every little bump, bruise, or minor illness.

I'd like to see the system reformed but the manner in which the President and Democratic leadership have tried to push things through doesn't inspire confidence. Rushing the process will lead to more problems and waste than we already experience.

[caleb]

So my real question is: Have you had a transaction with your health insurance delivery system in the last year that would suggest to you there is massive waste in the system?

I have carbon fiber orthotics. Plastic ones work just as well, and cost half as much. But...insurance was picking up the bill and they looked cool.

Yes, I think there's massive waste in the system because we don't internalize the cost of our own actions/consumption, but rather defer it onto employer-provided health insurance.

Two Modest Proposals:

1) Expand Medicare/Medicaid as is currently being proposed.

2) Publically fund medical school tuition as is done for academic graduate programs. Then, double the number of students. Flooding the market with MDs will create competition and bring costs down.

[Pete Serotta]

;) I think they are more efficient than corporations not less and i'd be willing to sacrifice your paycheck for my benefit.

The second statement is the way to go!!! :) As to effiecient - Must first define it for it means I take more of your $$s and put in my pocket - whether I be gov or corp ;)

[sloji]

Yah, target the doctors because they are so rich...NOT, they are line workers and small potatoes in the scheme of this issue. Most that i've known have been near saints, almost, ok sometimes but they are not the problem and having them work for less would just make the profits go up again. Cheap labor is the goal of capitalism.

[allegretto]

I have carbon fiber orthotics. Plastic ones work just as well, and cost half as much. But...insurance was picking up the bill and they looked cool.

Yes, I think there's massive waste in the system because we don't internalize the cost of our own actions/consumption, but rather defer it onto employer-provided health insurance.

Two Modest Proposals:

1) Expand Medicare/Medicaid as is currently being proposed.

2) Publically fund medical school tuition as is done for academic graduate programs. Then, double the number of students. Flooding the market with MDs will create competition and bring costs down.

medicare/medicaid is already in the red. expand it?

will your second proposal make better MD's? are MD's the cause of "costs"?

[1centaur]

We ought to have an over/under on posts to lockdown.

As neutrally as possible, all bureaucracies have a huge amount of wasted motion. Remember when the government insisted that government run security checkpoints would be more efficient than privately run ones? Hello TSA. No matter what, national health care is about replacing one bureaucracy with another. We can waste time pretending that it could surely be no worse than the current one, but I hope we don't - nobody knows and at least the profit motive makes somebody try to be more efficient.

To the OP, no I have seen no signs of waste in the insurance-led care my family has enjoyed for many years. I have seen indifference, sloth, stupidity, incompetence, and many other signs of behavior typical of low-paid, low-skilled employees trudging through their back-office realities (I have of course also seen plenty of competent, thoughtful, and caring medical personnel). I would expect nothing else of a replacement system, but I would miss the huge amount of money taken from my retirement savings to pay for the health of others, especially non-citizens. I would probably enjoy the potential for a massive health problem not to wipe out those savings when I am old. And I would fear the potential for a bureaucratic decision to ration myself or my wife to death or despair.

I see the need for national health care. I suspect many of us could design a system better than what we have now (in our own opinions). I doubt that a giant bureaucracy of politicians could ever design a better bureaucracy of health care, let alone maintain its superiority in the face of constant demands for more from the voting base.

[allegretto]

Yah, target the doctors because they are so rich...NOT, they are line workers and small potatoes in the scheme of this issue. Most that i've known have been near saints, almost, ok sometimes but they are not the problem and having them work for less would just make the profits go up again. Cheap labor is the goal of capitalism.

i would not agree. PROFIT is the goal

[majorpat]

I once worked in the pharmaceutical sales industry...talk about waste on a truly galactic scale!

I am now spending the rest of my life in atonement for my sins...

[BumbleBeeDave]

I swear, this is meant to be just a poll, not a partisan political pissing contest. But it scares me "to death" that any sort of health care reform is going to blow up as it did during the Clinton admin.

It scares me that you could post a subject like this and NOT know how high the probability is that it WILL turn into a "partisan political pissing contest."

Fortunately Pete is participating and can lock it down when the inevitable huge flames erupt. :eek:

BBD

[Idris Icabod]

I once worked in the pharmaceutical sales industry...talk about waste on a truly galactic scale!

I am now spending the rest of my life in atonement for my sins...

I work in research at a large pharma and I agree, your marketing budget makes our research budget look like a tiny accounting error and they just slashed it yet again. I need to go read something about the Lance/Alberto pissing match now otherwise I would be fired up all night about the problems we face and how most people looking to do good are generally villified.

[allegretto]

Also, general principles are not hard to agree with here (lower costs, better service, availability of coverage) but that is not what people are arguing about.

cheaper, better, more plentiful. all laudable goals.

but

tell me what commodity in a free market offers all three without a true breakthru in technology?

[allegretto]

I work in research at a large pharma and I agree, your marketing budget makes our research budget look like a tiny accounting error and they just slashed it yet again. I need to go read something about the Lance/Alberto pissing match now otherwise I would be fired up all night about the problems we face and how most people looking to do good are generally villified.

understood

they would tell you there is no point to making them if no one buys 'em

[eddief]

you may not have ever felt how the current system of for profit health care is rationing services. So, much as I thought, this is way way complicated with many points of view, interests, and god knows --- special interests. I heard the CEO of the Mayo Clinic interviewed by Charlie Rose. I would like him to be the Health Care Guru. He was speaking of long term vision. The Mayo has that. As far as I can tell it exists nowhere in the gov that runs the entire country on behalf of us 350 million people.

[Lifelover]

I have Federal Employee Blue Cross Blue Shield and I am 100% satisfied!

You can find waste in every big business if you look hard enough.

[93legendti]

Is "waste" the proper question? I sense that is the President's "concern".

Why isn't the focus quality, availability and survivability?

[MilanoTom]

I have paid for my own health care plan for the last 27 years, 0 claims. Seems like a waste to me...

My plan does have all kinds of little perks which I'm oh so happy about. They offer free birthing classes should I need them, they'll help me quit smoking, and I get a discount on my gym membership if I'm overweight.

Wait, there's a delivery system? They deliver?? Any chance I can get a cute nurse to come over and give me a sponge bath??? Hey, if I didn't keep a sense of humor about it, I would have to kill someone (which would void their health care)

You've never gotten a check-up or diagnostic test?

[rugbysecondrow]

cheaper, better, more plentiful. all laudable goals.

but

tell me what commodity in a free market offers all three without a true breakthru in technology?

Agreed, that is the point...not realistic is it?

[MilanoTom]

I worked in health insurance law for about 16 years (I'm not in the field currently). Most was spent in Medicare recoveries (getting money back for the government) and a few in Medicare medical review (mostly ensuring that duplicate procedures weren't paid and that claims for things like prostate exams for females didn't make it through the claims system).

One reason that costs are so high is that everybody seems to want expensive technology. The hospitals are happy to provide it, because they have to make back the money (and then make profit) on their investment (MRI machines don't come cheap). Hosptials advertise their "state of the art" machines and patients want those services (whether or not a lower cost alternative is available). Docs also pressure insurers (including Medicare) to pay for high profit procedures of dubious worth (e.g. hyaluronan injections to "lubricate" knees).

We also have an a**-backwards way of compensating docs. The primary care docs who help keep people healthy make substantially less than the ones who fix the problems that occur when people neglect their health. If we paid more to docs to help people stay healthy, we might not have to pay quite as many bypass claims. Unfortunately, Americans as a lot would rather pay to have something fixed than to take the steps to keep it from getting "broken."

Finally, a lot of money is spent on expensive end-of-life care. I was at a health insurance conference and during a session comparing health care systems in other countries (Germany's is pretty good, by the way), and the speaker noted that a collegue from a European nation (with excellent health care, as I recall) told him, "You Americans just don't know when to give up."

There is also some number of doctors who are just plain lousy, and if they don't cost the system in terms of malpractice cases, they cost it for the services that are needed to fix the mistakes or care for the conditions that can't be fixed. For some reason, however, licensing boards don't seem to have any sense of urgency when it comes to getting rid of bad docs, and the medical societies don't care about it either. I don't understand that. I don't want unethical and/or incompetent lawyers in my profession, and I'd be willing to be that most lawyers would agree. If a lawyer is disbarred in one state, he or she is usually automatically disbarred in whichever other states he or she was licensed. Why don't we see the same thing in the medical professon?

One thing I don't think contributes a lot to health care costs is medical malpractice judgments. Judgment levels aren't on the average that high compared to years past. Malpractice insurance, however, is probably far higher than it needs to be (party to cover bad investments by the insurers). Rather than take on the insurers, however, the medical societies would rather try to pass legislation to limit "non-economic" damages (you know, like pain and suffering) from malpractice cases. To me, the ramifications are scary. As a lawyer, I don't really need legs to practice my profession. If a doc f**ks up and I lose a leg, that would be considered "non-economic." If I can never ride a bike, no biggie - it's not like I did it for a living. Economic damages basically include things like loss of income. Just think - the same error will cost the malpractice insurer less if done to someone with lower income (like a bike mechanic), than someone with higher income (like another doctor). I don't know about you, but I figure that an error done to a poor person is just as bad as one done to a rich person.

It's a tough and complex issue... the stakes are high, so there is a lot of misinformation being thrown around by those who don't want to see their stakes diminished. I recognize that some forumites may disagree with my take on this. I respect your positions; I ask that you respect mine.

Regards,
Tom

[rbtmcardle]

well, i have a different thought altogether, atmo, it doesn't really matter what we do RIGHT now, keep it the same, add to it, its irrelevant, we cant legislate morality, nor can we legislate personal responsibility, our problem in so many facets of this culture is entitlement mentality... not in a political entitlement sense but in a personal entitlement sense, just because you can win the lawsuit, does it mean you should sue, just because no one will ever KNOW you hurt your back riding, NOT on the job, is it right to claim it as workers comp...

Forget all the generations that are already here, sure many will suffer needlessly, many will die too young, some miracles will occur but bye and bye "life and death" will happen... we need to focus on teaching and establishing some real personal integrity in kids.. this is a battle that was lost before i was born or around when i was born... guess what, that Pepsi i drank tonight, there is a consequence for that choice i made, all that candy i ate as a kid, yep, i lost some teeth over it... its not the manufacturers fault, its not tv's fault.. it MY fault, MY choice. our legal system has the same troubles... guess what its not the legal system OR the lawyers... its the mentality of our culture that is at fault. you can make all the rules, laws, government bureaucracies - none of that matters... change the mentality of the culture and real change will occur. so the next time you see a toddler, spend time and teach them, it will take a generation or two, but its the only way.

too many generations have not been taught that simple phrase used in Disney's The Jungle Book (and elsewhere long before ;) ) - greater love hath no man than this, than he lay down his life for his friend. Maybe we don't have to lay down our life, but can we lay down our sense of selfishness for our children's children?

[allegretto]

I worked in health insurance law for about 16 years (I'm not in the field currently). Most was spent in Medicare recoveries (getting money back for the government) and a few in Medicare medical review (mostly ensuring that duplicate procedures weren't paid and that claims for things like prostate exams for females didn't make it through the claims system).

One reason that costs are so high is that everybody seems to want expensive technology. The hospitals are happy to provide it, because they have to make back the money (and then make profit) on their investment (MRI machines don't come cheap). Hosptials advertise their "state of the art" machines and patients want those services (whether or not a lower cost alternative is available). Docs also pressure insurers (including Medicare) to pay for high profit procedures of dubious worth (e.g. hyaluronan injections to "lubricate" knees).

We also have an a**-backwards way of compensating docs. The primary care docs who help keep people healthy make substantially less than the ones who fix the problems that occur when people neglect their health. If we paid more to docs to help people stay healthy, we might not have to pay quite as many bypass claims. Unfortunately, Americans as a lot would rather pay to have something fixed than to take the steps to keep it from getting "broken."

Finally, a lot of money is spent on expensive end-of-life care. I was at a health insurance conference and during a session comparing health care systems in other countries (Germany's is pretty good, by the way), and the speaker noted that a collegue from a European nation (with excellent health care, as I recall) told him, "You Americans just don't know when to give up."

There is also some number of doctors who are just plain lousy, and if they don't cost the system in terms of malpractice cases, they cost it for the services that are needed to fix the mistakes or care for the conditions that can't be fixed. For some reason, however, licensing boards don't seem to have any sense of urgency when it comes to getting rid of bad docs, and the medical societies don't care about it either. I don't understand that. I don't want unethical and/or incompetent lawyers in my profession, and I'd be willing to be that most lawyers would agree. If a lawyer is disbarred in one state, he or she is usually automatically disbarred in whichever other states he or she was licensed. Why don't we see the same thing in the medical professon?

One thing I don't think contributes a lot to health care costs is medical malpractice judgments. Judgment levels aren't on the average that high compared to years past. Malpractice insurance, however, is probably far higher than it needs to be (party to cover bad investments by the insurers). Rather than take on the insurers, however, the medical societies would rather try to pass legislation to limit "non-economic" damages (you know, like pain and suffering) from malpractice cases. To me, the ramifications are scary. As a lawyer, I don't really need legs to practice my profession. If a doc f**ks up and I lose a leg, that would be considered "non-economic." If I can never ride a bike, no biggie - it's not like I did it for a living. Economic damages basically include things like loss of income. Just think - the same error will cost the malpractice insurer less if done to someone with lower income (like a bike mechanic), than someone with higher income (like another doctor). I don't know about you, but I figure that an error done to a poor person is just as bad as one done to a rich person.

It's a tough and complex issue... the stakes are high, so there is a lot of misinformation being thrown around by those who don't want to see their stakes diminished. I recognize that some forumites may disagree with my take on this. I respect your positions; I ask that you respect mine.

Regards,
Tom

there is a great deal of truth in your assessment.

however

i don't see you arguing that Insurance Co. profits are huge

the idea that med-mal settlements/awards are not that great is true if one looks macroeconomically. however, physicians do practice defensive (CYA) medicine to avoid not just the expense, but the pain-and-suffering of a suit. estimates range from 10-15% of the dollar. this is an unintended, but inescapable consequence.

and the business about weeding out bad docs? i'm sure many would like to do just that. however, as soon as a doc tries in some cases at least, the accused bad doc "lawyers up". funny about that, huh?

finally, just what do primary care guys do to make patients more healthy? patients for the most part have to want to be healthy, and then they do it. most primary guys are up to their eyeballs in hypertension (drugs, anyone?) depression (drugs, anyone?) and diabetes (pumps, implants, transplants). and colds, headaches etc.

[RPS]

Considering that as a group we the American people on average must pay more into the system (insurance premiums, taxes, higher cost of goods, etc…) than we on average get back in medical services, it should be obvious that to improve the system we have to make it significantly more efficient; otherwise all we are doing is redistributing and/or reallocating costs/coverage/accessibility etc….

In my opinion the greatest opportunity to make the system more efficient is to reduce insurance coverage and make individuals more responsible for their own costs; thereby eliminating the middle man as much as possible/practical. If insurance was used primarily to cover catastrophic and normally-unanticipated events rather than everyday “somewhat expected” medical care, then the system could be more efficient, we’d have less waste, less fraud, etc….

So to answer the OP question: IMHO every time I go to the doctor and pay through my insurance company there is a huge amount of waste. Rather than pay the bill in full directly and go home to get better, I pay a co-pay, have the provider send the insurance company a claim on my behalf, have the insurance company send the doctor a partial payment with a statement of why they won’t pay the rest, send me a copy of the statement, have the doctor’s office send me a bill for the remainder of what the insurance company didn’t pay, have me compare the different statements to see if they even make sense, have me send the doctor another payment to cover the difference, and then I have to send the insurance company a check so they can pay my doctor, their employees who filled out the forms and rejected the full payment, plus whatever profit the insurance company thinks they owe their stock holders.

The only good thing about this crazy system is that a lot more people have jobs because it is so inefficient. I’d eliminate most of it.

[caleb]

medicare/medicaid is already in the red. expand it?

It's a publicly funded program. It's not supposed to be profitable.

will your second proposal make better MD's? are MD's the cause of "costs"?

The quality of health care is already very high, so increasing quality is not a goal I see as an urgent one. Quantity seems much more pressing to me.

I cannot imagine that the salaries of health care professionals (MDs, DPTs, and various specialists) are not a significant part of health care costs. Yes, there are systematic inefficiencies (i.e. insurance administration), there's an overabundance of expensive technology (i.e. MN has more medical imaging machines than the entire country of Canada), but some of it comes down to what we're paying people. Medical salaries are being kept artificially high by restricting access to the professional schools, and increasing access would lower salary costs.

[Ti Designs]

In my opinion the greatest opportunity to make the system more efficient is to reduce insurance coverage and make individuals more responsible for their own costs

I'm really not about single issue politics, but you have my vote.

[malcolm]

I worked in health insurance law for about 16 years (I'm not in the field currently). Most was spent in Medicare recoveries (getting money back for the government) and a few in Medicare medical review (mostly ensuring that duplicate procedures weren't paid and that claims for things like prostate exams for females didn't make it through the claims system).

One reason that costs are so high is that everybody seems to want expensive technology. The hospitals are happy to provide it, because they have to make back the money (and then make profit) on their investment (MRI machines don't come cheap). Hosptials advertise their "state of the art" machines and patients want those services (whether or not a lower cost alternative is available). Docs also pressure insurers (including Medicare) to pay for high profit procedures of dubious worth (e.g. hyaluronan injections to "lubricate" knees).

We also have an a**-backwards way of compensating docs. The primary care docs who help keep people healthy make substantially less than the ones who fix the problems that occur when people neglect their health. If we paid more to docs to help people stay healthy, we might not have to pay quite as many bypass claims. Unfortunately, Americans as a lot would rather pay to have something fixed than to take the steps to keep it from getting "broken."

Finally, a lot of money is spent on expensive end-of-life care. I was at a health insurance conference and during a session comparing health care systems in other countries (Germany's is pretty good, by the way), and the speaker noted that a collegue from a European nation (with excellent health care, as I recall) told him, "You Americans just don't know when to give up."

There is also some number of doctors who are just plain lousy, and if they don't cost the system in terms of malpractice cases, they cost it for the services that are needed to fix the mistakes or care for the conditions that can't be fixed. For some reason, however, licensing boards don't seem to have any sense of urgency when it comes to getting rid of bad docs, and the medical societies don't care about it either. I don't understand that. I don't want unethical and/or incompetent lawyers in my profession, and I'd be willing to be that most lawyers would agree. If a lawyer is disbarred in one state, he or she is usually automatically disbarred in whichever other states he or she was licensed. Why don't we see the same thing in the medical professon?

One thing I don't think contributes a lot to health care costs is medical malpractice judgments. Judgment levels aren't on the average that high compared to years past. Malpractice insurance, however, is probably far higher than it needs to be (party to cover bad investments by the insurers). Rather than take on the insurers, however, the medical societies would rather try to pass legislation to limit "non-economic" damages (you know, like pain and suffering) from malpractice cases. To me, the ramifications are scary. As a lawyer, I don't really need legs to practice my profession. If a doc f**ks up and I lose a leg, that would be considered "non-economic." If I can never ride a bike, no biggie - it's not like I did it for a living. Economic damages basically include things like loss of income. Just think - the same error will cost the malpractice insurer less if done to someone with lower income (like a bike mechanic), than someone with higher income (like another doctor). I don't know about you, but I figure that an error done to a poor person is just as bad as one done to a rich person.

It's a tough and complex issue... the stakes are high, so there is a lot of misinformation being thrown around by those who don't want to see their stakes diminished. I recognize that some forumites may disagree with my take on this. I respect your positions; I ask that you respect mine.

Regards,
Tom


Tom I agree with a lot of what you say, but a bunch of it is just not true or misguided.
Medicare screws doc probably more that docs screw them. Most medicare frauds I've seen aren't elaborate scams but recurring errors in billing etc. and seldom intentional, understandable if you had any idea how much billing criteria change on a whim. Granted some are schemes and they should loose their license.
For instance I get $8 from medicare for crutches that cost me over $16, same for most durable goods. The government has created a system that forces you into gamesman ship if you want to survive and pay the bills. I have to hire a company to make sure I have all the catch words covered in order to recover enough to get by and as soon as you learn what they want and become efficient at it they change the criteria.

As far as bad docs go. The medical profession does a horrible job of policing its ranks, but if you've lost your license in one state for malpractice or what ever you have to list that on your application in another state and most hospitals wont let you practice there if they are aware.

Doctors for the most part are paid by risk. The higher risk stuff you do the more you make, some exceptions radiology, plastic surgery.

The system is broken, but I don't think the government is the answer they have created most of the problems we have now. All insurance companies take their cues from medicare.

I hope we find an answer, I certainly don't know what it is.

[MilanoTom]

there is a great deal of truth in your assessment.

however

i don't see you arguing that Insurance Co. profits are huge

the idea that med-mal settlements/awards are not that great is true if one looks macroeconomically. however, physicians do practice defensive (CYA) medicine to avoid not just the expense, but the pain-and-suffering of a suit. estimates range from 10-15% of the dollar. this is an unintended, but inescapable consequence.

and the business about weeding out bad docs? i'm sure many would like to do just that. however, as soon as a doc tries in some cases at least, the accused bad doc "lawyers up". funny about that, huh?

finally, just what do primary care guys do to make patients more healthy? patients for the most part have to want to be healthy, and then they do it. most primary guys are up to their eyeballs in hypertension (drugs, anyone?) depression (drugs, anyone?) and diabetes (pumps, implants, transplants). and colds, headaches etc.

Your points are well taken.

I purposely avoided discussing health insurer profits because it goes to a bigger question that we might not want to start arguing. Do we want to consider health insurance (at least the publicly-traded companies) part of the free market economy and beholden to shareholders (in which case it can be argued that there is no such thing as an obscene profit), or do we want to consider it something too important to be subject to free market economy? If we decide that it is more than a "commodity" on which profit is the goal, are we saying that it's really too important to be something we buy if we can afford and don't buy if we can't? If that's the case, we inch closer to calling access to afforable health insurance a "right" - and many see that as one step close to the demonized "socialized medicine." I don't think that in this regard, one can have the cake and eat it, too. In some states (Massachusetts comes to mind), most insurers are chartered as non-profits. Sure, the executives may be paid more than we might think they deserve, but surplus is not "profit" - it ensures solvency by providing funds in the event of unforeseen claims submissions (e.g. pandemics).

I would fully expect docs to "lawyer up" and be represented by counsel if brought before a licensing board. Every one of the loads of disbarred and suspended attorneys had counsel when appearing before grievance committees. I personally think that the difference between law and medicine is that in law, there is more of a resolve among the member of the profession and the licensing entity (usually the highest state court) to get rid of those who do not deserve the right to practice. There are plenty of stories centering around docs who lose their privileges at one hospital and pop up at another. If a doc did something heinous enough to lose privileges, how is it that the first hospital did not file a complaint with the licensing board, and if a complaint was in fact filed, how is it that the doc is still out there treating patients?

There is a lot of "defensive medicine" out there, and while a lot of it may be unnecessary, it doesn't seem to prevent a lot of avoidable medical errors. If one looks at the "Sorry Works!" initiative, one can see that the number of malpractice suits drops when physicians admit mistakes, apologize, and discuss fair, upfront compensation for the injury and death (if, in fact, there is no medical error, none of this would be applicable). Unfortunately, the norm is that the "pain and suffering" of a lawsuit pales for many docs when compared to admitting error.

Finally, I don't know what we can do to make the American public want to be more healthy. We do, however have a shortage of primary docs, and that's a direct result of the compensation arrangements with insurers. Improved access with incentives for maintaining health might be a place to start. On a personal level, I don't understand why you think that people on medications are doing so because they chose not to be or become healthy. Despite my cycling and generally good eating habits, I have mild hypertension. It's hereditary, and apparently cannot be controlled without medication. Heart troubles killed my dad and nearly killed my brother (both of whom were "fit and trim"). There was nothing I could do to lower my blood pressure without resorting to medication. I hate the idea of having to take a pill every day for the rest of my life, but it's that or having an increased risk of premature death from a heart attack or stroke. Faced with that choice, I'm going to take my medicine without apologies. I also know a dear friend has been taking insulin since she was four. I don't think her diabetes was caused by bad lifestyle decisions. A couple of years ago, her doc put her on an insulin pump to lessen the risk of some of the bad stuff that results from diabetes. In her case, the insulin pump is probably saving a great deal of cost in the long run. Yeah, there are plenty of folks who could have avoided hypertension and diabetes (I can't really speak to depression), but I think you may be using too broad a brush with the conditions you referenced. Some of us take our meds precisely as the result of our decision to stay healthy, not because we chose to ignore our health.

Regards,
Tom

[MilanoTom]

Tom I agree with a lot of what you say, but a bunch of it is just not true or misguided.
Medicare screws doc probably more that docs screw them. Most medicare frauds I've seen aren't elaborate scams but recurring errors in billing etc. and seldom intentional, understandable if you had any idea how much billing criteria change on a whim. Granted some are schemes and they should loose their license.
For instance I get $8 from medicare for crutches that cost me over $16, same for most durable goods. The government has created a system that forces you into gamesman ship if you want to survive and pay the bills. I have to hire a company to make sure I have all the catch words covered in order to recover enough to get by and as soon as you learn what they want and become efficient at it they change the criteria.

As far as bad docs go. The medical profession does a horrible job of policing its ranks, but if you've lost your license in one state for malpractice or what ever you have to list that on your application in another state and most hospitals wont let you practice there if they are aware.

Doctors for the most part are paid by risk. The higher risk stuff you do the more you make, some exceptions radiology, plastic surgery.

The system is broken, but I don't think the government is the answer they have created most of the problems we have now. All insurance companies take their cues from medicare.

I hope we find an answer, I certainly don't know what it is.

"Misguided" is an awfully strong word. You and I have different perspectives, and I know my own perspective colors my views.

It's been a few years since I was in the Medicare world, but recurring errors in billing weren't considered fraud, but rather abuse. We handled abuse through education, and we bent over backwards to assist providers in resolving those issues, because they not only cost Medicare, but the inefficiencies cost the provider as well. Fraud is a different matter. One of our regions included southern Florida, and there were parenteral/enteral nutrition (tube feeding-type stuff, for the benefit of forumites not familiar with the term) suppliers who were in cahoots with one or two crooked docs to cook up falsified certifications of need. They'd go into poorer neighborhoods and tell residents that they could sign up for free nutritional supplements. That's a lot different than using outdated coding or software that kicks out duplicate bills.

I'm no big fan of Medicare fee schedules for durable medical equipment. They're drafted by people who have never set foot in a supplier's office. You'll admit, though, that some of the schedules resulted from some pretty crazy allowances when it came to rentals. Under old rules (and we're going back twenty years or more), that sixteen dollar crutch could have been billed for monthly rental until the patient could have bought a batch of them. I understand your concerns, however.

Medicare and commercial insurers don't really look at medical care the same way. For years, Medicare never covered routine examinations (and even now, coverage is extremely limited). Office visits would be denied unless there was a diagnosis code indicating some kind of a complaint. Compare that to the way an HMO approaches care. Usually a couple of routine checkups are covered, but if an insured needs to see a specialist, the insured has to jump through hoops. I can also say that at least in the states where I worked, commercial insurers didn't want to go near Medicare fee schedules.

I think people don't necessarily have a problem with higher risk procedures getting more money, but many are concerned with the disparity between reimbursement for primary care docs when compared to the specialists. We're more than willing to pay for the doc who replaces the knee, but not the doc, who might (if he or she was reimbursed at a rate that would allow for more one-on-one time with the patient) have been able to counsel a patient well enough that the eventual replacement may not have been necessary. I think it's that attitude that will end up leaving us behind the 8-ball. Americans want to take what they think is the easy route - ignore what it takes to stay healty, and expect that it can all be fixed later down the road.

Regards,
Tom

[allegretto]

It's a publicly funded program. It's not supposed to be profitable.



The quality of health care is already very high, so increasing quality is not a goal I see as an urgent one. Quantity seems much more pressing to me.

I cannot imagine that the salaries of health care professionals (MDs, DPTs, and various specialists) are not a significant part of health care costs. Yes, there are systematic inefficiencies (i.e. insurance administration), there's an overabundance of expensive technology (i.e. MN has more medical imaging machines than the entire country of Canada), but some of it comes down to what we're paying people. Medical salaries are being kept artificially high by restricting access to the professional schools, and increasing access would lower salary costs.

yes, it's not supposed to be profitable. but i think you are unaware of the unfunded mandate it implies. Milano can tell you the reality;

right now we cannot afford it for whom we do cover. multiply that by about 6 or so and you have a debt that would stagger your imagination. it simply is not tenable, in any way.

your second POV is confusing. it sounds like you're for "quantity" and then decry all the MRI's in MN. further you say they make too much and then say we need more. i'm not sure where that point is going...

[allegretto]

Your points are well taken.

I purposely avoided discussing health insurer profits because it goes to a bigger question that we might not want to start arguing. Do we want to consider health insurance (at least the publicly-traded companies) part of the free market economy and beholden to shareholders (in which case it can be argued that there is no such thing as an obscene profit), or do we want to consider it something too important to be subject to free market economy? If we decide that it is more than a "commodity" on which profit is the goal, are we saying that it's really too important to be something we buy if we can afford and don't buy if we can't? If that's the case, we inch closer to calling access to afforable health insurance a "right" - and many see that as one step close to the demonized "socialized medicine." I don't think that in this regard, one can have the cake and eat it, too. In some states (Massachusetts comes to mind), most insurers are chartered as non-profits. Sure, the executives may be paid more than we might think they deserve, but surplus is not "profit" - it ensures solvency by providing funds in the event of unforeseen claims submissions (e.g. pandemics).

I would fully expect docs to "lawyer up" and be represented by counsel if brought before a licensing board. Every one of the loads of disbarred and suspended attorneys had counsel when appearing before grievance committees. I personally think that the difference between law and medicine is that in law, there is more of a resolve among the member of the profession and the licensing entity (usually the highest state court) to get rid of those who do not deserve the right to practice. There are plenty of stories centering around docs who lose their privileges at one hospital and pop up at another. If a doc did something heinous enough to lose privileges, how is it that the first hospital did not file a complaint with the licensing board, and if a complaint was in fact filed, how is it that the doc is still out there treating patients?

There is a lot of "defensive medicine" out there, and while a lot of it may be unnecessary, it doesn't seem to prevent a lot of avoidable medical errors. If one looks at the "Sorry Works!" initiative, one can see that the number of malpractice suits drops when physicians admit mistakes, apologize, and discuss fair, upfront compensation for the injury and death (if, in fact, there is no medical error, none of this would be applicable). Unfortunately, the norm is that the "pain and suffering" of a lawsuit pales for many docs when compared to admitting error.

Finally, I don't know what we can do to make the American public want to be more healthy. We do, however have a shortage of primary docs, and that's a direct result of the compensation arrangements with insurers. Improved access with incentives for maintaining health might be a place to start. On a personal level, I don't understand why you think that people on medications are doing so because they chose not to be or become healthy. Despite my cycling and generally good eating habits, I have mild hypertension. It's hereditary, and apparently cannot be controlled without medication. Heart troubles killed my dad and nearly killed my brother (both of whom were "fit and trim"). There was nothing I could do to lower my blood pressure without resorting to medication. I hate the idea of having to take a pill every day for the rest of my life, but it's that or having an increased risk of premature death from a heart attack or stroke. Faced with that choice, I'm going to take my medicine without apologies. I also know a dear friend has been taking insulin since she was four. I don't think her diabetes was caused by bad lifestyle decisions. A couple of years ago, her doc put her on an insulin pump to lessen the risk of some of the bad stuff that results from diabetes. In her case, the insulin pump is probably saving a great deal of cost in the long run. Yeah, there are plenty of folks who could have avoided hypertension and diabetes (I can't really speak to depression), but I think you may be using too broad a brush with the conditions you referenced. Some of us take our meds precisely as the result of our decision to stay healthy, not because we chose to ignore our health.

Regards,
Tom

Tom,

thanks for the reasoned reply. you obviously are familiar with many of the issues. i think notorious docs crossing state lines and setting up shop is less of a problem than it was. there is a national reporting board and states are making it tougher to be licensed. it's not perfect, but it's getting better. could it be better still? put me in charge, make me "Doctor Czar" and 20% will lose their license in the first year, which isn't as bad as it sounds since they should have never gotten out of Med School! yes, just as engineers, lawyers, teachers, you name it, the Bell Curve takes it toll on all populations.

i do think you discount the level of pain a good doc feels and goes thru, and i think many caught in the position you outline would be happy to apologize and make amends. the contentiousness of the current tort system tend to mitigate against that however and makes people "clam up". it's the first thing the med-mal carriers preach in their risk management courses.

yes, errors do happen, in all professions. but they can be minimized in a sensible system.

finally, i think you misunderstood my point. there is no intent of blame on any of the examples you raise. but, there are many who lead destructive lifestyles and then present to the field an irrevocably impaired problem and say, "i'm broken now, fix it". no one, not even primary care docs can fix that i'm afraid. so my point was that "Health" is truly a personal responsibility. our imperfections, hypertension, diabetes and the like can be treated but in the end the patient is responsible for his or her personal care unless severely debilitated.

we have the best system in the world. i'm not for overhaul because 6% of the population (that are citizens) cannot seem to get access to what they need. seems like a fraction of the "Bailout" money would fix that up in no time!

[1happygirl]

I admit I just saw this thread now and will go back and read all the replies later, but I saw and I just couldn't resist. Reforming healthcare WITHOUT THOUGHTFUL ANALYSIS eg just to reform, scares me. I am healthcare and sure there are some wastes, but the majority of people I know that do have coverage (including me) are satisfied with their healthcare. I work with uninsured peeps primarily from other countries and I see that as part of stanching the "waste". Due to this and GOVT remibursement cutbacks, sometimes as a provider I havent been safe with cheap PPE (personal protective equipment like gloves) with holes and tears so big you could drive trucks thru them. They are straining the gnat and swallowing the camel at my place now in an effort to be more efficient. Its like me recycling bags when big business does nothing. A lot of the things proposed are not going to make a difference.

Sure I have a lot of compassion or I wouldn't work with the population I do, but where is the personal responsibility and self-control? Can you legislate that?

Like my patient said when I asked have you done any illegal drugs (knowing we'd found coke in the screen) used to do crack. Informed of above pt said, well I don't know how that got there?

I know I didn't put it there. Follow thru extended resulted in MI and extended stay in hospital via self pay.


TRUE STORY TIME:

My parents worked and paid extra for years to get the top tier coverage when the left the workforce. When Medicare enacted their Part D Drug coverage, their private, job insurance dropped the prescription coverage due to the goverment enacting coverage. NOW (or rather since then) they have been paying more for their drugs.


I know a friends brother who has been INactively looking for jobs, but not outside his comfort zone, wont go back to school to retool, wont relocate, move in with folks as was suggested due to his 'friends' are in the city he 'loves' and lives in (without meaningful job with insurance) etc, and needs coverage. He wont consider places like MCD or WM that give coverage. ????
I just dont know, but these are just personal examples.

Also sometime I can relate my ER visit in GB while on holiday and it was not enjoyable. Well as if any ER visit is enjoyable.


My personal thought, insurance has racheted up costs and we have to charge more to get the same reimbursement. For example, instead of $35 for office visit, charge $70 insurance writes off $35 and we get reimbursed $35 otherwise give services away. My friend ran across her husbands hospital bill from 1955 for appendectomy. They were newly married and scraped together extra $3 (or something like this ) for private room. Total bill for 1 week---$153.00!!!!!! They paid it out and PAID CASH.



My solution get back to paying cash. My friends from the Philipines said you cant get treatment without securing payment 1st (like giving them visa, cash etc)


I know I would be in favor of it and have just catastrophic coverage. In most cases in my life (eg school etc) I would have been better off with cash. My friend and study buddy who was older, worked 7 yrs straight, saved and paid most, NOT all school with cash. Wow, he's not paying off stuff?? hmmm..
I dunno but I think a lot of society was better off in every way paying cash. Saw the Steve Wynn story on 60 min last PM. Said he was flush with cash and saved for this economic downturn. Had done a lot of business mostly cash. I also remember reading about JC Penny who was at that time I think in his 80s in the late 60s/70s. The board wanted credit cards. He said it was bad for the consumer (his reasoning following Christian principles) to overspend what you didnt have. Consequently they voted him out.


Sorry for the tired, rambling post, but I think cash may be a viable option.

Where is the reward and attaboy for planning ahead and taking care of your business yourself? Will my insurance and my parents again suffer for planning ahead for a rainy day?


CASH IS THE NEW CREDIT, ATMO.

I am not meaning to inflame, incite, or instigate negative dialogue. Theses are just random questions and thoughts I have in my tired state. I love this forum and the diverse and informative dialogue it supports. I always learn and enjoy the interesting talk that goes on here.




Did anyone watch the tour??? hahaha and now, back to bikes.

[bnewt07]

Duplicate post

[bnewt07]

I do not want to make this a USA bashing thread but to give this some perspective.....

...from across the pond health care provision in the US appears quite appallingly wasteful. The insured are subject to aggressive investigation and treatment which in many cases is unsupported by good evidence. Being able to get that CT scan tomorrow might feel like 'quality medicine' but in a system structured better you might have needed a safer, low-cost intervention without having a scan at all. Your ACL repair may be done next week but the evidence supports conservative treatent over surgery in a significant proportion of cases. Two crude examples where actually less is better-not an easy idea to sell to those who purchase medical insurance.

Defensive practice contributes to this waste, but so does un-tamed consumer demand. The US (not least because of its direct-to-patient advertising) has inordinately higher drug costs because of over-prescribing and the lack of use of cheaper, evidence-proven drugs in favour of the newest and most heavily promoted.

Money spent on high tech solutions could get far more value in simple cost-effective care (and prevention strategies). The lack of emphasis on US Primary Care is at least part of this top-heavy problem.

The inequities for the uninsured are of course another matter entirely. I don't really know the figures but in this thread somebody says it is 'just 8% of the population'. Ths group will have far higher poportionate health care needs due to the inevitable associations between poverty, ethnicity and social deprivation and poor health. Your 8% are those most in need of decent care.

Our own system in the UK is hardly perfect (and we can debate that long into the night) but at least we do not incentivise over-treatment by profiting directly from additional procedures etc. We have a highly cost-effective primary care system. We have essentially equitable access irrespective of earnings or social status.

Alegretto says 'we (the US) have the best system in the world'. Others in this thread allude to how good they think US healthcare quality is.

Boy is that debatable!

The WHO rates the USA health care system as 37th in the world. Chile and Columbia are rated higher!

[Ray]

I'm going to limit my participation in the debate to a simple philosophical position (although thanks to Tom and Malcolm for an informed and civil and enlightening discussion of some of the details). I'm generally in favor of an overhall but I'd probably go all the way to single payer. I think we have the best health care in the world for those that can afford it and among the worst for those who can't and I think that's not the way it should be with healthcare. I think it should be treated like education, as a basic right and societal obligation and should be available to all despite the inevitable inefficiencies and the inequity that would continue (those with means will always be able to find and afford more and better one way or another). This is a basic philosophical position, not a detailed analysis of what works better in a given circumstance. I don't expect most to agree with it.

I have seen waste in my experience and the army of pharma reps who stream through my various doctors offices bearing treats and smiles with seeming instant and total access while patients wait far longer seems twisted on the surface. Despite a very healthy lifestyle, I've had lifelong problems with asthma and sinuses and it costs a small fortune to keep me breathing through my various facial orifaces. The number of mix ups and over prescribing (or over filling?) between my various docs and pharmacies has been pretty high it seems to me.

One other comment - we're not gonna fix the health care system in this country with ANY approach unless we also fix the food system. Of this, I'm convinced. I'm not sure that can be done without pushing more people at the bottom of the economic ladder into starvation, which is surely worse than the bevy of food related problems they have now. Intractable problems, it sometimes seems.

-Ray

[1happygirl]

The WHO rates the USA health care system as 37th in the world. Chile and Columbia are rated higher!


From reading research studies etc, just consider if or how these statistics are compiled.

Not all countries have the same definition for reporting (as in infant mortality rates eg etc)


When talking to peeps about subjects I always ask them their definition so I know we're on the same page!

[goonster]

essentially equitable access irrespective of earnings or social status.
When the achievers have to share a waiting room with the unambitious, Marxists are re-distributing their wealth.

Why do you hate America?

(I'm being sarcastic, but this is, in part, the argument of those who oppose health care reform)

[bnewt07]

From reading research studies etc, just consider if or how these statistics are compiled.

Not all countries have the same definition for reporting (as in infant mortality rates eg etc)


When talking to peeps about subjects I always ask them their definition so I know we're on the same page!


Obviously such a rating is contrived. Details of The WHO report is here. I note that they no longer produce such a table due to the complexity of the task! ebven accepting the vagaries of recording the suggestion that man, many othe developed nations have better systems should make this us-centric forum be a little less certain of the excellence of the current system.


http://www.photius.com/rankings/who_world_health_ranks.html

[caleb]

yes, it's not supposed to be profitable. but i think you are unaware of the unfunded mandate it implies.

Certainly, it's an underfunded mandate. But, the fact that it's unfunded says nothing except that we have not had the political will to fund it. Yes, it's expensive, and I think bringing down costs at all levels should be a major policy initiative.

your second POV is confusing. it sounds like you're for "quantity" and then decry all the MRI's in MN.

When I speak of quantity of care, I'm talking about doctors available to see patients. Medical technology is only tangentially related to the actual care that patients receive, but is extremely costly. Cutting out the expensive fluff while putting resources into basic exam room services would simultaneously increase access and lower prices.

further you say they make too much and then say we need more. i'm not sure where that point is going...

Salaries are not a limiting factor on why people go to medical school currently; nobody says, "I would go to med school, but I just can't make the numbers work out." If salaries were lower the schools would still be full of competent students and future docs. So, why is it not in the public interest to increase the supply of health care, and in the process lower consumer costs?

[nahtnoj]

Nope.



Diagnosing disease is not simple and the notion that Drs. order tests to pad their bills rather than save lives is offensive.



My understanding is that they don't do it to pad bills but rather protect themselves from liability. Even if they are 99.9 certain the cause is x, they will test for y and z because of the potentially sizable lawsuit hanging over their head.

[bnewt07]

When the achievers have to share a waiting room with the unambitious, Marxists are re-distributing their wealth.

Why do you hate America?

(I'm being sarcastic, but this is, in part, the argument of those who oppose health care reform)

Perhaps too subtle an argument for me.

[thwart]

The view from the inside...

Current system is broken, and irretrievably so.

I'm seeing many more of the newly uninsured, and it's a scary picture. Lose your job (in spite of the fact that you are a great employee), and you lose your health insurance at the same time. And if you find a new position, it's likely that your insurance:
1) Won't fully kick in for 3 months, or...

2) Will now have a $30 copay for health care visits, or...

3) Will have a large drug copay.

Of course, in addition to the much bigger chunk out of your paycheck to pay for it.

You can tell from this thread that some folks have never found themselves in that predicament. Less than 8% uninsured, and a lot of them illegal aliens? Right now, in the middle of a severe recession?

Get off your expensive bike (sorry... :D ) and look around.

And it's clear that the driver for current costs is much more the huge cost of new drugs (now advertised direct to the consumer), and the increased use of costly technology (do a little search on any musculoskeletal problem mentioned in the Forum and find how quickly someone posts 'ask your doc for an MRI'). The human costs of delivering health care seem to be shrinking to compensate for this (now, I'm not counting insurance administrators here), as I'm clearly working with fewer and less skilled staff than I did 15 years ago. And anyone who has had a loved one in the hospital may be aware of the benefits of staying in the room with them for the duration to cover the hospital's staffing inadequacies...

And is our current system set up to push pills at people, rather than focus on much more cost effective lifestyle change?
Short visits, which provide inadequate time for counseling (but just enough time to write a Prozac, Lipitor, or some brand name diabetes drug prescription)... Drug reps lurking about... the aforementioned direct to consumer advertising...

Is the answer the Obama plan? I honestly don't know. But something's got to change, and very, very soon.

[malcolm]

"Misguided" is an awfully strong word. You and I have different perspectives, and I know my own perspective colors my views.

It's been a few years since I was in the Medicare world, but recurring errors in billing weren't considered fraud, but rather abuse. We handled abuse through education, and we bent over backwards to assist providers in resolving those issues, because they not only cost Medicare, but the inefficiencies cost the provider as well. Fraud is a different matter. One of our regions included southern Florida, and there were parenteral/enteral nutrition (tube feeding-type stuff, for the benefit of forumites not familiar with the term) suppliers who were in cahoots with one or two crooked docs to cook up falsified certifications of need. They'd go into poorer neighborhoods and tell residents that they could sign up for free nutritional supplements. That's a lot different than using outdated coding or software that kicks out duplicate bills.

I'm no big fan of Medicare fee schedules for durable medical equipment. They're drafted by people who have never set foot in a supplier's office. You'll admit, though, that some of the schedules resulted from some pretty crazy allowances when it came to rentals. Under old rules (and we're going back twenty years or more), that sixteen dollar crutch could have been billed for monthly rental until the patient could have bought a batch of them. I understand your concerns, however.

Medicare and commercial insurers don't really look at medical care the same way. For years, Medicare never covered routine examinations (and even now, coverage is extremely limited). Office visits would be denied unless there was a diagnosis code indicating some kind of a complaint. Compare that to the way an HMO approaches care. Usually a couple of routine checkups are covered, but if an insured needs to see a specialist, the insured has to jump through hoops. I can also say that at least in the states where I worked, commercial insurers didn't want to go near Medicare fee schedules.

I think people don't necessarily have a problem with higher risk procedures getting more money, but many are concerned with the disparity between reimbursement for primary care docs when compared to the specialists. We're more than willing to pay for the doc who replaces the knee, but not the doc, who might (if he or she was reimbursed at a rate that would allow for more one-on-one time with the patient) have been able to counsel a patient well enough that the eventual replacement may not have been necessary. I think it's that attitude that will end up leaving us behind the 8-ball. Americans want to take what they think is the easy route - ignore what it takes to stay healty, and expect that it can all be fixed later down the road.

Regards,
Tom


Absolutely didn't mean to offend and agree with you on many points probably just from a different direction. Maybe instead of misguided, what I meant is you are not seeing things from the clinicians perspective. It is adversarial. I'm trying to survive and it seems as if medicare and insurers are doing there utmost to make it more difficult by the day.

Lets face it most american's want mcdonalds medicine. They want what they want when they want it with no effort or responsibility on their part and then when something goes wrong they want to sue.

Anyway I didn't mean to offend and sincerely apologize if I did. No one would like to see primary care compensated appropriately more than me.

[93legendti]

My understanding is that they don't do it to pad bills but rather protect themselves from liability. Even if they are 99.9 certain the cause is x, they will test for y and z because of the potentially sizable lawsuit hanging over their head.

That and diagnosing can be an art, not a science.
When I hurt my knee I went to 3 different doctors and got 3 different diagnosis':
1. Torn ACL-operate ASAP (team Dr. for the Detroit Lions).
2. Sprained knee-do nothing (Dr. who I had seen for years).
3. I don't know, but your knee is locked, so let's go in and see why it is locked (Dr. recommended by a friend).
I went with #3. During the surgery, the Dr. found a partially torn ACL, a tear in the meniscus and a bone chip that had gotten into the joint. He took out the chip, cleaned up the meniscus and left the ACL alone.
That was 19 years ago.

Ironically, some might say seeing 3 different doctors is "wasteful". However, seeing the 3rd Dr. let me avoid an expensive ACL replacement, which was unnecessary.

Will the plan being proposed allow for such careful consideration of the pros and cons of surgery?

[1happygirl]

The view from the inside...

Current system is broken, and irretrievably so.

I'm seeing many more of the newly uninsured, and it's a scary picture. Lose your job (in spite of the fact that you are a great employee), and you lose your health insurance at the same time. And if you find a new position, it's likely that your insurance:
1) Won't fully kick in for 3 months, or...

2) Will now have a $30 copay for health care visits, or...

3) Will have a large drug copay.

Of course, in addition to the much bigger chunk out of your paycheck to pay for it.

You can tell from this thread that some folks have never found themselves in that predicament. Less than 8% uninsured, and a lot of them illegal aliens? Right now, in the middle of a severe recession?

Get off your expensive bike (sorry... :D ) and look around.

And it's clear that the driver for current costs is much more the huge cost of new drugs (now advertised direct to the consumer), and the increased use of costly technology (do a little search on any musculoskeletal problem mentioned in the Forum and find how quickly someone posts 'ask your doc for an MRI'). The human costs of delivering health care seem to be shrinking to compensate for this (now, I'm not counting insurance administrators here), as I'm clearly working with fewer and less skilled staff than I did 15 years ago. And anyone who has had a loved one in the hospital may be aware of the benefits of staying in the room with them for the duration to cover the hospital's staffing inadequacies...

And is our current system set up to push pills at people, rather than focus on much more cost effective lifestyle change?
Short visits, which provide inadequate time for counseling (but just enough time to write a Prozac, Lipitor, or some brand name diabetes drug prescription)... Drug reps lurking about... the aforementioned direct to consumer advertising...

Is the answer the Obama plan? I honestly don't know. But something's got to change, and very, very soon.


I dont have an expensive bike. I agree something needs to be done. Granted I work primarily with uninsured peeps all the time (not that I don't come across the stray insured peep, or previously uninsured peep) even prior to this recession but I HAVE TAKEN TIME TO COUNSEL PEEPS out the wazzoo and when your DM patient can come in with a sonic sugar drink in their hand....

You happen to mention this and its like every day/visit is a new day oh really (they opine)???????


What will universal coverage do different ? we still treat 'em. Can you legislate them when they aren't with me not drinkin a sugar drink? Give me the $5 for your drink instead of the 0 I get now. Cash, cash.

We already have universal coverage. We are already paying for the uninsured, but it appears with greater or the same coverage/treatment insured peeps get. Just treat what they have, it's how it is at present from my experience.

Again I say cash. Had a friend with a joint surgery, insurance charged 10K for surgery (something to that effect). Provider/hosp got 2K. My friend said they could've paid that out of pocket themselves. Hmmm.. I'm still thinking cash here for today in my tired state.
Cash is the new credit, atmo.

[malcolm]

The view from the inside...

Current system is broken, and irretrievably so.

I'm seeing many more of the newly uninsured, and it's a scary picture. Lose your job (in spite of the fact that you are a great employee), and you lose your health insurance at the same time. And if you find a new position, it's likely that your insurance:
1) Won't fully kick in for 3 months, or...

2) Will now have a $30 copay for health care visits, or...

3) Will have a large drug copay.

Of course, in addition to the much bigger chunk out of your paycheck to pay for it.

You can tell from this thread that some folks have never found themselves in that predicament. Less than 8% uninsured, and a lot of them illegal aliens? Right now, in the middle of a severe recession?

Get off your expensive bike (sorry... :D ) and look around.

And it's clear that the driver for current costs is much more the huge cost of new drugs (now advertised direct to the consumer), and the increased use of costly technology (do a little search on any musculoskeletal problem mentioned in the Forum and find how quickly someone posts 'ask your doc for an MRI'). The human costs of delivering health care seem to be shrinking to compensate for this (now, I'm not counting insurance administrators here), as I'm clearly working with fewer and less skilled staff than I did 15 years ago. And anyone who has had a loved one in the hospital may be aware of the benefits of staying in the room with them for the duration to cover the hospital's staffing inadequacies...

And is our current system set up to push pills at people, rather than focus on much more cost effective lifestyle change?
Short visits, which provide inadequate time for counseling (but just enough time to write a Prozac, Lipitor, or some brand name diabetes drug prescription)... Drug reps lurking about... the aforementioned direct to consumer advertising...

Is the answer the Obama plan? I honestly don't know. But something's got to change, and very, very soon.


+10000.......

I know people are struggling, because I'm getting more and more complaints about the co-pay all the time, usually $30. Most of the time it from folks that can probably afford it the most though. I feel bad for the people that I suspect could use that money elsewhere and don't say a word.

Just a for what it is worth because most people obviously don't understand your provider doesn't set the co pay schedule and are mandated to collect it and may well lose their contract with the ppo if they waive it.

Hopefully Obama or someone will get us on a better path. My job has become something I never anticipated.

[RPS]

When the achievers have to share a waiting room with the unambitious, Marxists are re-distributing their wealth.

Why do you hate America?

(I'm being sarcastic, but this is, in part, the argument of those who oppose health care reform)
Not necessarily…… I may be for reform but not in the direction you may think is best. And it’s not about being anti-change; it’s about resisting or questioning what is perceived as “bad” change.

I don’t view health care as a God-given right any more than the right to have 12 kids and then demand the government to feed them, educate them, and care for their health. Philosophically I see the transfer of what should be personal responsibilities as a major cause of social inefficiency.

Unfortunately many need incentives to do what’s most efficient. Having others solve our every problem is not the answer IMHO. I'm all for change, just not in the wrong direction. :)

[goonster]

In my opinion the greatest opportunity to make the system more efficient is to reduce insurance coverage and make individuals more responsible for their own costs

I don't disagree entirely, but:

Providers are currently punishing the consumer for doing this, because of the huge discrepancy between the "retail" prices and "negotiated insurance" prices for services. IMO, this is a fundamental sign that the system is broken.

[1happygirl]

Nobody knows, so this is a rhetorical question, but how will the new coverage effect drug development?

Hilleman, who developed 8? of the current 14 ?recommended vaccines worked for private industry (albeit prob with grants although didnt get that deep into it). Was there waste in developing these? Probably. Will the new system make it better? ????

Is this going to be better with government clamps and regulation of the new healthcare. Research funds are already dried crispy.

Just askin'



Providers are currently punishing the consumer for doing this, because of the huge discrepancy between the "retail" prices and "negotiated insurance" prices for services. IMO, this is a fundamental sign that the system is broken.


yet another plus for my cash system+1

cash in my own life eliminates wash, why not here, now?

[SamIAm]

I always marvel at the confidence some of you have in government run programs. Do you not just question, even a little, whether our elected officials have the combined wisdom and motivation to just hammer out a proposal affecting 1/6 of the GDP in a couple weeks at the behest of a president drunk with power?

You are like drunk girls at a fraternity party and Obama is trying to close the deal before you sober up. You will regret it in the morning.

[goonster]

I don’t view health care as a God-given right
Neither do I, but I do think it is a service which a modern society can and should provide for its citizens at some basic level.

Philosophically I see the transfer of what should be personal responsibilities as a major cause of social inefficiency.
I agree that there are fundamental philosphical differences, which is what I tried to illustrate with my earlier quip. To a European (sorry, I meant socialist) the notion that equitable access to basic care could be perceived as unfair to higher earners is far-fetched.

Philosphically, I see the unwillingness of a wealthy society to treat those unable to care for themselves as immoral.

Philosphically, I think that universal participation and the elimination of for-profit health insurance can result in a leaner, more efficient, affordable system for all.

I agree that maintaining the health of yourself and your family is a personal responsibility, but providing health care is not (directly). We need others to provide that care, and as individual consumers we have no personal control over the costs. Remember that health care is required not only by those who neglect their personal responsibility (lazy, overeating, promiscuous smokers) but also by faultless unfortunates.

[MilanoTom]

Absolutely didn't mean to offend and agree with you on many points probably just from a different direction. Maybe instead of misguided, what I meant is you are not seeing things from the clinicians perspective. It is adversarial. I'm trying to survive and it seems as if medicare and insurers are doing there utmost to make it more difficult by the day.

Lets face it most american's want mcdonalds medicine. They want what they want when they want it with no effort or responsibility on their part and then when something goes wrong they want to sue.

Anyway I didn't mean to offend and sincerely apologize if I did. No one would like to see primary care compensated appropriately more than me.

No problem - I shouldn't post late at night when I'm half asleep and not as diplomatic as I should be.

I've seen a couple of bills pass in Massachusetts (where I last worked) to streamline some of the processes that providers have to go through with insurers. There's a lot more to be done, though. As far as Medicare goes, I wouldn't want to depend on them for my livelihood. From what I remember, the only saving grace with Medicare was that reimbursement was fairly fast compared to commercial insurers. I knew a few docs who loved Medicare for that reason. They handled the same kind of cases over and over, which made the billing process pretty easy, and while they halfheartedly griped to some degree over the fee schedule, they appreciated the cash flow. For every doc like that, however, there's a doc or supplier who ends up with reimbursement rates that don't cover fixed costs. I have to admit that I don't know the fairest way to resolve it.

You're right about McDonalds medicine. Adding to that problem is that they don't want to make the effort to learn how the system works (or doesn't work) before deciding whether or not to support some type of reform. We as a people latch onto catch phases (that sound good) from our favorite politician or talk show host, and that replaces research or logic.

Come to think of it, that's how we as a people make a lot of our decisions. We spend more time researching which washing machine to buy, but not how some of the major issues of the day (e.g. health care reform, illegal immigration, the wars in the Middle East, the economy) might best be resolved.

Regards,
Tom

[bnewt07]

Neither do I, but I do think it is a service which a modern society can and should provide for its citizens at some basic level.


I agree that there are fundamental philosphical differences, which is what I tried to illustrate with my earlier quip. To a European (sorry, I meant socialist) the notion that equitable access to basic care could be perceived as unfair to higher earners is far-fetched.

Philosphically, I see the unwillingness of a wealthy society to treat those unable to care for themselves as immoral.

Philosphically, I think that universal participation and the elimination of for-profit health insurance can result in a leaner, more efficient, affordable system for all.

I agree that maintaining the health of yourself and your family is a personal responsibility, but providing health care is not (directly). We need others to provide that care, and as individual consumers we have no personal control over the costs. Remember that health care is required not only by those who neglect their personal responsibility (lazy, overeating, promiscuous smokers) but also by faultless unfortunates.

Excellent post. To extend it further many of those l'azy, overeating, promiscous smokers' are also victims of inequities in the education system or various other deprivations. Some people do not take care of themselves but can do better. Many, many more do not take care of themselves and cannot ever be expected to have done better.

[goonster]

Hilleman, who developed 8? of the current 14 ?recommended vaccines worked for private industry
I'm glad you brought him up!

First of all, he did some of his most important work as chief of the Army Medical Center.

Second, he was very frustrated by the current state of private industry, which he found too risk averse, beaurocratic, and profit-oriented.

[1happygirl]

First of all, he did some of his most important work as chief of the Army Medical Center.



Didn't remember reading the frustration part with industry. All of his important work and vaccine stuff was done at Merck though.



Robert Gallo, co-discover of the virus that causes AIDS, once said “If I had to name a person who has done more for the benefit of human health, with less recognition than anyone else, it would be Maurice Hilleman. Maurice should be recognized as the most successful vaccinologist in history.”

[MilanoTom]

I dont have an expensive bike. I agree something needs to be done. Granted I work primarily with uninsured peeps all the time (not that I don't come across the stray insured peep, or previously uninsured peep) even prior to this recession but I HAVE TAKEN TIME TO COUNSEL PEEPS out the wazzoo and when your DM patient can come in with a sonic sugar drink in their hand....

You happen to mention this and its like every day/visit is a new day oh really (they opine)???????


What will universal coverage do different ? we still treat 'em. Can you legislate them when they aren't with me not drinkin a sugar drink? Give me the $5 for your drink instead of the 0 I get now. Cash, cash.

We already have universal coverage. We are already paying for the uninsured, but it appears with greater or the same coverage/treatment insured peeps get. Just treat what they have, it's how it is at present from my experience.

Again I say cash. Had a friend with a joint surgery, insurance charged 10K for surgery (something to that effect). Provider/hosp got 2K. My friend said they could've paid that out of pocket themselves. Hmmm.. I'm still thinking cash here for today in my tired state.
Cash is the new credit, atmo.

You bring up a point that adds to the plight of the uninsured. The uninsured get hit with full charges, but commercial insurers pay lower negotiated rates. Some time back, there were news stories about Medicare being charged four dollars for Tylenol tablets in a hosptial. Yeah, it was on the bill, but the hospital didn't expect to get paid for it and Medicare didn't even recognize it. An inpatient claim was paid based on a "diagnostic related group" for the treatment of the particular condition. I suppose the line items on the bill were for accounting purposes, and not much else. That pill could have been billed at ten thousand dollars and it wouldn't have made a difference. On the other hand, if you don't have insurance, the four dollar pill was a real charge, and the patient was obliged to pay it.

In fairness, many providers and hosptials will adjust the bills of uninsured individuals who can't pay the total charges, but to me, it always seemed like a double whammy - it's bad enough that you don't have insurance, and on top of that you have to pay more than an insurer would.

Regards,
Tom

[malcolm]

Philosphically, I see the unwillingness of a wealthy society to treat those unable to care for themselves as immoral.
***************above was someone's quote***********
This is a much harder problem than you may think. I agree with you, it seems inconceivable that we can't provide acceptable health care for everyone.

The first problem occurs if you try and provide anything other than cadillac top tier service to those that can't pay, because they have a right to the same level of care as those that do pay. I'm not arguing if that is right or wrong but that is the way it is.

Second it is difficult to round people up and make them use a system set up for them. An example I can give is a state program where I practiced. It took all medicade pts., primarily young mothers and their children and assigned them docs in their community. Actually it gave them a choice of doctors that participated, but most didn't respond so they were assigned a doc, but allowed to change with a simple form. The doctor agreed to take a given segment into their practice and was paid a flat fee ( no matter if the pt was ever seen or not) plus what medicade paid (not much and limited # of visits). Well essentially nothing changed because the patient wouldn't go, they insisted on coming to the ER. It was a behavior that couldn't be broken. It was expensive to triage them out of the ER to the doctors office, in order to do so you must provide a screening exam to prove that don't have an urgent condition so basically it takes the same effort as to treat them except you recover nothing and now have an angry disgruntled pt on your hands.

Those are just some of the simple aspects of providing care to the uninsured.

As far as quality of health care in this country goes, socialized med vs us will never agree. Statistics don't even come close to explaining it, infant mortality is not an indicator, neonates survive here that wouldn't have a chance elsewhere. From a physicians perspective, that has had this conversation many times with European and Canadian physicians I think if you are ACUTELY ill or have a life threatening condition you get superior care here insured or otherwise. Where we fail is the tweeners, people with things that won't kill them quickly but need to be managed, hypertension, diabetes, chronic insidious disease that requires on going treatment/therapy/mgt.

End of rant. It is broken. I'll be shocked if the government is the answer. I think they have created most of the problems thus far.

[MilanoTom]

I don't disagree entirely, but:

Providers are currently punishing the consumer for doing this, because of the huge discrepancy between the "retail" prices and "negotiated insurance" prices for services. IMO, this is a fundamental sign that the system is broken.

I didn't see your post before I referenced the same issue. You said it far more succinctly than I. I'm not sure I go as far as saying it is a fundamental sign of a broken system. I see it more as a the result of a process that evolved into something that something that is unwieldy, unmanageable, and inequitable.

If somebody proposed the current system of healthcare reimbusement, he (or she) would be dismissed as a lunatic. Because it resulted from gradual change over decades, it is almost seen as normal.

Regards,
Tom

[93legendti]

Philosphically, I see the unwillingness of a wealthy society to treat those unable to care for themselves as immoral.
***************above was someone's quote***********
This is a much harder problem than you may think. I agree with you, it seems inconceivable that we can't provide acceptable health care for everyone.

The first problem occurs if you try and provide anything other than cadillac top tier service to those that can't pay, because they have a right to the same level of care as those that do pay. I'm not arguing if that is right or wrong but that is the way it is.

Second it is difficult to round people up and make them use a system set up for them. An example I can give is a state program where I practiced. It took all medicade pts., primarily young mothers and their children and assigned them docs in their community. Actually it gave them a choice of doctors that participated, but most didn't respond so they were assigned a doc, but allowed to change with a simple form. The doctor agreed to take a given segment into their practice and was paid a flat fee ( no matter if the pt was ever seen or not) plus what medicade paid (not much and limited # of visits). Well essentially nothing changed because the patient wouldn't go, they insisted on coming to the ER. It was a behavior that couldn't be broken. It was expensive to triage them out of the ER to the doctors office, in order to do so you must provide a screening exam to prove that don't have an urgent condition so basically it takes the same effort as to treat them except you recover nothing and now have an angry disgruntled pt on your hands.

Those are just some of the simple aspects of providing care to the uninsured.

As far as quality of health care in this country goes, socialized med vs us will never agree. Statistics don't even come close to explaining it, infant mortality is not an indicator, neonates survive here that wouldn't have a chance elsewhere. From a physicians perspective, that has had this conversation many times with European and Canadian physicians I think if you are ACUTELY ill or have a life threatening condition you get superior care here insured or otherwise. Where we fail is the tweeners, people with things that won't kill them quickly but need to be managed, hypertension, diabetes, chronic insidious disease that requires on going treatment/therapy/mgt.

End of rant. It is broken. I'll be shocked if the government is the answer. I think they have created most of the problems thus far.
I am curious why you think it is a "right" and where this "right" is derived from.

[rugbysecondrow]

I like the notion of paying cash or negotiating services. I have long liked the idea of the Health Savings Accounts, but the system doesn't seem designed to accept them yet. If pricing is set around a medicare payee system, then how do my dollars translate to that? That pushes my comfort level.

As an uneducated (on this issue) outsider, but vested participant (like most Americans), who do we trust? We don't typically like the Health Care companies, but we understand the profit motive. We understand that motive and at least trust it. Most American (specifically voters) are insured and trust they healthcare. Do we trust the Government to provide this service equally or better? Do we trust the competancy of it to provide and administer that which is so important to our families at the same or lesser cost? Do we feel comfortable with their ability to manage our tax dollars and ensure that this vital delivery of care gets met with undue future burdon? The overwhelming answer is no.

This is not a Republican or Democrat statement, just pretty straightforward. With bulging and ever widening deficit, balooning debt and no plan to tackle either one, do we trust that the government can assume this workload, debt load and do so well. Have they proved that they know how to manage dollars effectivly in the delivery of service? I don't think so, and neither do most Americans.

[1happygirl]

CASH CASH CASH
=less waste

and for what my parents are paying for ins a year (GRANTED THEY ARE STILL, GOD BLESS, RELATIVELY HEALTHY) they could scrounge up the cash. Most peeps could scrounge up $5.00.

without insurance involved to jack up costs so after the 'markdown' I get paid the same as a cash rate, why not just be cash?

As it stands now, most of the self pays and peeps without jobs (not the same) don't even pay 5.00 as people say pay the hosp last as they will eventually write it off (which they do) and some hosp have charity programs.

As it is now also no one who needs treatment (from my hosp perspective) is Not, Not (dbl. neg) being TREATED.

For a yearly physical, meds etc my parents and most peeps would come out ahead

'course read my other posts, have catastrophic coverage only perhaps

I'm just talking a possible solution to provide less wasteful coverage, rather than an academic, esoteric discussion on the merits of HC

BTW my ER visit in GB was not better, faster, less waste, or any less wait
I thought the whole idea of 'overhaul' was better, cheaper, faster, less waste

[goonster]

93LegendTi:

What do you think of the healthcare system in Israel?

[KeithS]

I had a couple of procedures in the last year. My own observation has been raised by others, our healthcare industry is "procedure oriented". I got an angioplasty and a second stent scheduled and completed within a couple of hours. On a weekend. When I requested consulting to make sure I was on track with my diet/exercise regimen it was 60 days out. There is no procedure code for helping me improve my own health. My cardiologist said he might have had 8 hours of nutrition curriculum/training in med school. There's lots broken here. It's up to much smarter folks than me to get it fixed.

By the way my two angioplasty procedures cost within a few bucks of each other. Insurance co got a $13.7K discount and paid $17K, I paid $1,500. Glad I'm insured.

I would like to see whatever form our new coverage method takes that those making the legislation are subject to the same rules. Including costs, coverage, restrictions, rationing.... That ain't gonna happen. It reminds me of a Don Novello as Fr.Guido Sarducci from Saturday Night Live - in a bit he had about the Pope regarding birth control. "I don't play the game, I just make the rules."

Thanks to all weighing in with opinions, I really appreciate the inside baseball stuff from providers and the legal community. Nice to hear all sides.

Keith

[eddief]

if we can do it, so can congress.

This article certainly does not have the solution, but does an expert job in describing some of the holes that should be on the list to fix. In two cities in TX, just a couple hundred miles apart, the approch to health care is a couple of hundred miles apart. One does it well and cheap, the other sucks the system and customers dry:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

[Jim Braley]

I am a health care consultant and deal with costs and abuses in the system every day. Having said that we have the best healthcare system in the world. I was recently on a bike trip in Italy and had the honor of spending six days in isolation in a Rome hospital because they thought I had swine flu which I did not. Took me 2 1/2 days to get the sheets changed, 2 days to get soap and towels so I could at least take a shower and after two days I just gave up even asking for toilet paper. I took my own temperature, they did all kinds of tests and finally decided I did not have swine flu but never did figure out what was wrong so I signed myself out AMA and flew home and saw my family doctor who told me I likely had food poisoning and that to keep me in isolation for 6 days was ridiculous since I had no symptoms. If we are williing to sacrifice lots then there are solutions--how about rationing care. Should we spend thousands of dollars to keep a 95 year old alive or should we spend those same dollars on a 2 day old with serious heart defects? Those are the kind of issues that we in this country really don't want to address. A very high percentage of Medicare dollars are used to keep people alive in the last 2-3 months of their lives but we don't want to not spend those dollars especially if it is a family member I have yet to see anything that the government does that truly saves money and is efficient so let's all be careful what we wish for. If the politicians would work together and come up with a truly bipartisan solution we would be fine. This is an issue that is not going to go away and we must solve it as costs are out of hand and will do nothing but get worse

[93legendti]

93LegendTi:

What do you think of the healthcare system in Israel?
Good question. I only have 1 experience and that was in ~'73 when I had German Measles and a Dr. came to our home to treat me.

My wife lived in Israel for 4 years and has very negative feeling about their health care.

OTOH, I read often of badly injured motorists coming from Cyprus to Israel for trauma care.

I know Israel has a shortage of doctors and 2 new medical schools are in the works.

Other than that, I do not have enough experience or information to form an opinion.

[RPS]

I agree that there are fundamental philosphical differences, which is what I tried to illustrate with my earlier quip. To a European (sorry, I meant socialist) the notion that equitable access to basic care could be perceived as unfair to higher earners is far-fetched.

Philosphically, I see the unwillingness of a wealthy society to treat those unable to care for themselves as immoral.

Philosphically, I think that universal participation and the elimination of for-profit health insurance can result in a leaner, more efficient, affordable system for all.
People don’t live, function, or make choices in a vacuum. If we build a greater safety net many will simply take greater risks solely because of the lower personal gamble. For me that’s a serious human deficiency that I can’t see a solution around so I side with the next best thing – if a person takes a personal risk then they should pay the consequences of failure. I won’t be “fair” all the time or maybe even most of the time, but it’s the best idea I’ve seen to date. If a person decides to get a new TV, car, or bike instead of buying insurance (or saving) for that which they can't afford and then get sick then IMO they are SOL.

goonster, I understand the shortcomings of both extremes well because within a two-year period I had personal experience at both ends of this medical dilemma. As a child in a matter of months I went from receiving typical middle-class care to a Marxist socialized system that didn’t work for me at all, then to the other extreme of not having access to US care because my caretakers -- new political refugees in the US -- were too poor or uninformed of what options were available (BTW I’m not suggesting present system is the same). Both systems failed me due to lack of funding – in the first case the social medical system was financially broke and in the second my caretakers were financially broke. As is almost always the case it comes down to money – the more we have the more “stuff” we can get – bigger house, nicer car, bike, better food, etc…. Why should health care be any different?

Granted we shouldn’t force anyone to live on the street or go “really” hungry, but to take care of anyone beyond a very basic level indirectly promotes poor choices and other ineffective long-term behavior. IMO as a society we can’t afford unrestrained spending in any endeavor, and regardless of where we draw the line someone will be left out in the cold. I personally know it sucks but then no one said life is fair. The poor always suffer in ways that they shouldn’t. :(

[buck-50]

I do not understand why it's so difficult to imagine a base-level system that covers everyone.

Not a cadillac system, more like a public transit option- not perfect, not super fast, but it will get you where you need to go.

If you lose your job, yer still covered. You don't end up losing your house because your kid got leukemia.

That's the base. If you can afford to buy additional coverage, great.

I look at it like I look at schools- I went to private schools when I was a kid- my folks thought it was best (actually, the church kinda forced them). So they paid extra on top of the taxes they already paid to do so. I got a good education. Was it better than I would have received at public school? I couldn't say.

I have seen enough insurance industry loop-holes, denied claims and stalling to make the educated guess that healthcare wouldn't be any more "rationed" under a federal plan then it already is under a for-profit plan.

I kinda feel like it's time we as a country HTFU and start taking care of our fellow citizens. We're all in it together, and if we want to be the best in the world, we need to start taking care of everyone. This current "let's return to the glory days of the 19th century" trend is getting kinda stale.

[malcolm]

I am curious why you think it is a "right" and where this "right" is derived from.

I don't think it is a right. I think the public at large does.

[93legendti]

I don't think it is a right. I think the public at large does.
Oh, ok. Sorry, I misunderstood your post. Thanks for the clarification.

[67-59]

On a personal level, I don't understand why you think that people on medications are doing so because they chose not to be or become healthy. Despite my cycling and generally good eating habits, I have mild hypertension. It's hereditary, and apparently cannot be controlled without medication. Heart troubles killed my dad and nearly killed my brother (both of whom were "fit and trim"). There was nothing I could do to lower my blood pressure without resorting to medication. I hate the idea of having to take a pill every day for the rest of my life, but it's that or having an increased risk of premature death from a heart attack or stroke. Faced with that choice, I'm going to take my medicine without apologies. I also know a dear friend has been taking insulin since she was four. I don't think her diabetes was caused by bad lifestyle decisions. A couple of years ago, her doc put her on an insulin pump to lessen the risk of some of the bad stuff that results from diabetes. In her case, the insulin pump is probably saving a great deal of cost in the long run. Yeah, there are plenty of folks who could have avoided hypertension and diabetes (I can't really speak to depression), but I think you may be using too broad a brush with the conditions you referenced. Some of us take our meds precisely as the result of our decision to stay healthy, not because we chose to ignore our health.

Regards,
Tom

Your situation applies to me too (exercise daily and eat a healthy diet, but still need to take meds for hypertension), and I certainly agree that lifestyle modifications can't eliminate all healthcare expenditures.

Still, the number of people who end up needing drugs or other treatment for "self-inflicted" medical conditions is staggering. Look at all the obese people out there today...and ask yourself how many will probably need to take meds for conditions like diabetes, hypertension or heart disease as a result. And don't even get me started on the smokers. My guess is that for every person like you and me (who needs to take meds despite doing the right things) there are several who take meds or need treatment because of their lifestyle choices. Manage that, and our healthcare expenditures would plummet in no time....

[caleb]

I do not understand why it's so difficult to imagine a base-level system that covers everyone.

Not a cadillac system, more like a public transit option- not perfect, not super fast, but it will get you where you need to go.

If you lose your job, yer still covered. You don't end up losing your house because your kid got leukemia.

That's the base. If you can afford to buy additional coverage, great.


So easy to imagine that it seems like common sense, but hard to put into practice when those who clearly benefit from the current system participate politically (vote, give) at a much higher rate than those who are clearly disadvantaged by the system.

[MilanoTom]

Your situation applies to me too (exercise daily and eat a healthy diet, but still need to take meds for hypertension), and I certainly agree that lifestyle modifications can't eliminate all healthcare expenditures.

Still, the number of people who end up needing drugs or other treatment for "self-inflicted" medical conditions is staggering. Look at all the obese people out there today...and ask yourself how many will probably need to take meds for conditions like diabetes, hypertension or heart disease as a result. And don't even get me started on the smokers. My guess is that for every person like you and me (who needs to take meds despite doing the right things) there are several who take meds or need treatment because of their lifestyle choices. Manage that, and our healthcare expenditures would plummet in no time....

I absolutely agree, but I doubt it'll ever happen. It's more in the interest of the pham companies to make their products look like an easy fix, and if there's one thing most Americans like, it's an easy fix.

Tom

[MilanoTom]

I don't think it is a right. I think the public at large does.

That leads to another issue - when does something become a right? If the majority of a population believes something is a right, does that mean more than a statutory change or executive decision that may not be supported by the majority of a population?

I don't know the answer and am not intending the above to refer to healthcare access. It's just food for thought.

Tom

[allegretto]

I am a health care consultant and deal with costs and abuses in the system every day. Having said that we have the best healthcare system in the world. I was recently on a bike trip in Italy and had the honor of spending six days in isolation in a Rome hospital because they thought I had swine flu which I did not. Took me 2 1/2 days to get the sheets changed, 2 days to get soap and towels so I could at least take a shower and after two days I just gave up even asking for toilet paper. I took my own temperature, they did all kinds of tests and finally decided I did not have swine flu but never did figure out what was wrong so I signed myself out AMA and flew home and saw my family doctor who told me I likely had food poisoning and that to keep me in isolation for 6 days was ridiculous since I had no symptoms. If we are williing to sacrifice lots then there are solutions--how about rationing care. Should we spend thousands of dollars to keep a 95 year old alive or should we spend those same dollars on a 2 day old with serious heart defects? Those are the kind of issues that we in this country really don't want to address. A very high percentage of Medicare dollars are used to keep people alive in the last 2-3 months of their lives but we don't want to not spend those dollars especially if it is a family member I have yet to see anything that the government does that truly saves money and is efficient so let's all be careful what we wish for. If the politicians would work together and come up with a truly bipartisan solution we would be fine. This is an issue that is not going to go away and we must solve it as costs are out of hand and will do nothing but get worse

your assessments are on the money

folks from elsewhere like to trot out the jiggled WHO statistics and such, but they ignore the political spaghetti bowl that is WHO or the skew of their statistics. the Social Democracies have Universal Coverage, but rationed care and access. We have Universal access, but rationed coverage. the US leads the in survival of most diseases and life expectancy is among the very longest if you control for crime, drug abuse and domestic violence. to our friends from across the pond; tell us if you think more people go to your country for healthcare or to the US?

when i was a child we were of very limited means. i went to the "Board of Health" as my Mom called it, for all my care. it was inconvenient and took all day and we had to follow the colored dots on the floor. but we got care. today the "County Hospital" is a beautiful structure and cranks out superb care, but still inconvenient. so many eschew it's benefits and stay sick. but it IS very much available and as good as any anywhere.

but you have touched on the "third rail" as they say, but it is the hidden pot o gold. should we spend $10000.00 + a day to keep alive someone who will likely never wake up as a sentient creature, or spend it on a child/active person.

if you can make a choice there, you may find an answer.

[buck-50]

but you have touched on the "third rail" as they say, but it is the hidden pot o gold. should we spend $10000.00 + a day to keep alive someone who will likely never wake up as a sentient creature, or spend it on a child/active person.

if you can make a choice there, you may find an answer.

Both my grandfathers got sick at the end of their lives.

My Mom's dad got cancer and it was decided by his wife and by his son (a doctor) was that there's not really a whole lot you can do for a 92 year old man with prostrate cancer. He was give excellent care, he was kept as pain free as you can keep someone who's got a fatal cancer eating them alive, and he died at home in his own bed.

My Dad's dad got alzheimers. I know, apples to oranges. But, his wife spared no expense to get him the best care possible, until she ran out of money and had to sell the house and live at the mason's home. My grandfather was taken, isolated and kept alive in a separate wing, away from his wife (for another 4 years) until he finally died of congestive heart failure.

I can tell you which one I'd want.

You can spend all the money in the world, but there's a difference between living and staying alive.