Health Care

[SeaCat]

So what are your perceived problems with Health Care in the United States. What are your ideas for fixing it?

Being in the industry I'm interested in your views and ideas.

Cat

 

[Stella_Omega]

I cannot afford most health services, and I cannot afford to buy insurance.

the first trip to the emergency room for my finger, when I cut the tendon, is valued at 5,000 dollars. This included 1 xray via super-duper brand-new digital equipment, two hours wait on a cot, one disposable surgery drape and fifteen minutes of a nurse-practitioner's time with a needle and catgut.

Then she advised me to go to L.A. county hospital for the tendon surgery.
Altogether I owe twelve thousand dollars, which I will be paying off for a very long time.

That's my percieved problem with health care. If i were a recipient more often....

 

[john-the-author]

So what are your perceived problems with Health Care in the United States. What are your ideas for fixing it?

Being in the industry I'm interested in your views and ideas.

Cat

We need some kind of national basic health care. Just the cost for Social Security disability claims each year that we WOULDN'T be processing if people got the preventive care they needed would be ~$50 billion annually. Add to this a minimum of another $50 billion for just those people who aren't using up ER services, Section 8 housing, local/regional social services, and so on. That's $100 billion annually that would be freed up with a national basic health care system. I think we could come up with something that would work for that kinda money. It's a boat load of money, and it doesn't even take into account the money that these people might actually be able to pay in taxes as functioning members of society instead of people who are collecting <$800/month and largely waiting to die, NOR does it take into account the people who don't apply for SS disability but could be in better health.

The Babe says it nicely: "What kind of society are we choosing to live in? One that takes care of people or one that throws them aside like used condoms as soon as they're not useful?"

Personally, I think even the greediest Republican fuckwit could look at $100 billion/year and say "Even though I don't give a shit about anyone else, I'm sure we could all make money off of this somehow. The fact that people are getting healthier may mean nothing to me--'cause I got mine, after all--but we can save/make money as a result of national health care system." The fact that they don't look at it like this continues to be a mystery to me, but that's the way it goes.

 

[shereads]

So what are your perceived problems with Health Care in the United States. What are your ideas for fixing it?

Being in the industry I'm interested in your views and ideas.

Cat

The problem is that I don't have it and can't get it. I don't even ride my bicycle anymore because a broken bone could wipe me out financially.

If you have a lapse in coverage, and have any preexisting condition, good luck finding anyone to insure you. I let COBRA lapse after I was laid off two years ago (couldn't pay the nearly $500 a month for single-person coverage while also paying for the repairs necessary to put my house on the market). In recent months I've been turned down for coverage by three different companies because I'm on antidepression meds. I knew there would be a problem getting coverage for a pre-existing condition - but I was stunned to learn that medical history would be a reason to be denied coverage for ANY accident or illness.

I see a doctor just often enough to get my prescriptions renewed - about every six months; I eat smarter, and I look both ways before I cross the street. That's about all I can do.

The doctor who renewed my Celexa told me I'm overdue for a PAP smear (duh), a mammogram (I knew that) and that I should consider having a colonoscopy, bone density test, and other routine diagnostics for a woman my age. He also suggested that a thyroid imbalance might be aggravating my depression, and said I should get that checked too.

It's that, or pay the rent. I choose rent.

 

[trysail]

Many, many years ago when we were at that stage of trying to figure out what we wanted to do when we grew up, one of my classmates said he wanted to be a physician. He went on to say, "When people are sick, they don't ask 'How much?' "

After four years of Stanford, three years of medical school at Duke, a two year internship and a three year residency, he was finally able to go to work. Like the majority of physicians these days, he wasn't remotely interested in being a general practioner. Eighty percent of medical school graduates want to be specialists because they don't want the inconvenience of irregular hours. So, he became a radiologist and is today the head of radiology at a local hospital. I guess he makes $500,000 a year. The hospital administrators make $1,000,000. All the physicians I know hate the paperwork and they hate the bureaucracy that characterizes modern medicine. Above all, they despise the ambulance chasers who advertise 24/7 on television, billboards, radio and on the Internet promising "the money you deserve."

Insurance premiums for gynecologists in the state of Maryland are on the order of $200,000 per year and the threat of lawsuits are a constant anxiety. All it takes is the loss of one lawsuit to destroy them. The statute of limitations ( and, thus the necessity to carry insurance for up to twenty years after they stop delivering babies ) forces most of them out of the baby-delivering business by the time they're forty-five or so ( because they're going to have to buy insurance for the next twenty years to protect themselves from the legal parasites ). Gynecologists are fleeing the state or closing up shop. There are enormous costs that are incurred because physicians have been forced to engage in defensive medicine by the threat of lawsuits. The physicians have a perverse set of incentives to order every test and procedure known to man in order to defend themselves in the event of a legal shakedown.

An increasing number of physicians in private practice won't even participate in insurance reimbursement schemes at all because they find the mandated reimbursement rates abhorrent and intolerable ( not to mention the paperwork headaches ). The physicians despise the adversarial nature of insurers v. practictioners and the overweening interference in the physician-patient relationship.

 

[TheeGoatPig]

I haven't had any problems with health insurance up to this point in my life. Every time I have been to the doctor or the hospital things have worked out fine.

I am furious with this countries car and home insurance policies (racketeering is the word that I like to use for those), and I would really like drastic changes there.

 

[glynndah]

It needs fixed. I have a 23 year old son with autism. He's universally denied coverage because that's a pre-existing condition, one for which he takes no medication (never has) and has never been under any treatment for. One insurance agent told me the reason could very well be that if a "cure" comes down the pike, they could be obligated to pay for it.

And if the autism isn't enough to deny him coverage, they consider acne to be a pre-existing condition (He does take antibiotics for that -- $20.00 for a three months' supply and that's without a co-pay.) and deny him coverage on that basis of that.

He's in fine company, though. He's listed along with super models, coal miners and deep sea divers on the forms.

 

[cloudy]

Many, many years ago when we were at that stage of trying to figure out what we wanted to do when we grew up, one of my classmates said he wanted to be a physician. He said, "When people are sick, they don't ask 'How much?'"

After four years of Stanford, three years of medical school at Duke, a two year internship and a three year residency, he was finally able to go to work. Like the majority of physicians these days, he wasn't remotely interested in being a general practioner. Eighty percent of medical school graduates want to be specialists because they don't want the inconvenience of irregular hours. So, he became a radiologist and is today the head of radiology at a local hospital. I guess he makes $500,000 a year. The hospital administrators make $1,000,000. All the physicians I know hate the paperwork and they hate the bureaucracy that characterizes modern medicine. Above all, they despise the ambulance chasers who advertise 24/7 on television, billboards, radio and on the Internet promising "the money you deserve."

Insurance premiums for gynecologists in the state of Maryland are on the order of $200,000 per year and the threat of lawsuits are a constant anxiety. All it takes is the loss of one lawsuit to destroy them. The statute of limitations ( and, thus the necessity to carry insurance for up to twenty years after they stop delivering babies ) forces most of them out of the baby-delivering business by the time they're forty-five or so ( because they're going to have to buy insurance for the next twenty years to protect themselves from the legal parasites ). Gynecologists are fleeing the state or closing up shop. There are enormous costs that are incurred because physicians have been forced to engage in defensive medicine by the threat of lawsuits. The physicians have a perverse set of incentives to order every test and procedure known to man in order to defend themselves in the event of a legal shakedown.

An increasing number of physicians in private practice won't even participate in insurance reimbursement schemes at all because they find the mandated reimbursement rates abhorrent and intolerable ( not to mention the paperwork headaches ). The physicians despise the adversarial nature of insurers v. practictioners and the overweening interference in the physician-patient relationship.

Gee, those poor, poor doctors.

Give me a damn break. People are dying for lack of preventive care because they can't afford insurance premiums and you want us to feel sorry for someone that makes it even fucking harder to get treated?

 

[john-the-author]

The problem is that I don't have it and can't get it. I don't even ride my bicycle anymore because a broken bone could wipe me out financially.

If you have a lapse in coverage, and have any preexisting condition, good luck finding anyone to insure you. I let COBRA lapse after I was laid off two years ago (couldn't pay the nearly $500 a month for single-person coverage while also paying for the repairs necessary to put my house on the market). In recent months I've been turned down for coverage by three different companies because I'm on antidepression meds. I knew there would be a problem getting coverage for a pre-existing condition - but I was stunned to learn that medical history would be a reason to be denied coverage for ANY accident or illness.

I see a doctor just often enough to get my prescriptions renewed - about every six months; I eat smarter, and I look both ways before I cross the street. That's about all I can do.

The doctor who renewed my Celexa told me I'm overdue for a PAP smear (duh), a mammogram (I knew that) and that I should consider having a colonoscopy, bone density test, and other routine diagnostics for a woman my age. He also suggested that a thyroid imbalance might be aggravating my depression, and said I should get that checked too.

It's that, or pay the rent. I choose rent.

We've got two bumper stickers on the #1 car.

Gay marriage doesn't scare me. No health care does.

Our national health policy: "Don't get sick."

As Barbara Ehrenreich pointed out in her classic book, "Nickeled and Dimed," the ability of a lot of people who aren't making a ton of money and who have no health insurance is that to survive is a function of how well they can ignore pain and just work through things. I've got enough money and a decent job and great insurance and if I lost this job--Gods forbid!--the Babe has good insurance with her position with the Fed... but we are both of us really clear on how easy it would be to lose all this through misadventure. I'm diabetic and have had heart problems; I have to have group insurance to get any kind of coverage for stuff that's otherwise horribly expensive. I spent a night in the hospital for my heart last February and the total bill was $4500. My insurance is covering most of it, but without it, I'd be in deep shit.

 

[amicus]

So what are your perceived problems with Health Care in the United States. What are your ideas for fixing it?

Being in the industry I'm interested in your views and ideas.

Cat

~~~

Cat, you are usually pretty straight on things, I trust you are in asking this question also.

Trysail's post is a reminder of what it takes to become a medical practitioner, I suggest it also requires a higher than average intelligence quotient.

It will come as no surprise that my answer is based on maintaining human rights, liberties and freedoms, and the only system that guarantees that is the free market place.

One of the problems is a shortage of physicians, an artificial shortage as the AMA controls the number of medical students who are permitted to become doctors. The United States is even importing foreign doctors because our medical schools are not permitted to expand to meet the demand.

Another problem is with insurance. Government employees started the insurance craze with Federal and State employees getting the best treatment money could buy...paid for by the tax payers. All large Unions followed suit, including the vast Teacher's Unions and the powerful automobile and coal industry unions.

Another problem with insurance is what they will and will not cover and of course, government employees got what they wanted including cosmetic surgery and a whole host of non critical procedures that ended up stressing the system to the breaking point.

Japan faced the same problem and began to 'insist' upon early diagnosis and preventative care and even enforcing dietary regimes to improve health.

For those that think Government is a panacea for health care, one should consider the bankrupt Social Security and Medicare systems as examples of government run systems that have failed.

The solution that would best answer the inherent problems of providing adequate medical care to all, are impractical in that it would require a completely free market place in medicine and that is not about to happen until a full fledged disaster strikes world wide.

Given a free market place and an abolishment of all rules, regulations, controls and restrictions, you would find a medical clinic on almost every street corner with as much regularity as you now find a Taco Bell or a McDonald's.

Instead, look forward to the US government, conscripting, 'drafting' doctors, forcing them to work according to government rules as to whom and how they will provide treatment.

As no one else is likely to offer a solution akin to mine, I thought I should step up.

Amicus...

 

[DeeZire]

So what are your perceived problems with Health Care in the United States. What are your ideas for fixing it?

Being in the industry I'm interested in your views and ideas.

Cat

I keep hearing about Obama wanting to get patient info computerized. That would be a good first step.

I'd like to see members of congress buying their own health insurance instead of getting free coverage. A couple of years of that and a single-payer national system would be a reality.

As Trysail mentioned, tort reform would be a good idea. Of course, the devil is in the details.

Another issue is elder-care. What's the point of extending the life of a dying patient if that patient is ready to accept death?

Our country is a laughingstock when it comes to healthcare. Sure, we've got great technology, but we've also got people dying from treatable conditions because they can't afford care. For them, the American Dream is a nightmare - the kind you don't wake up from.

The more conservative we become in our policies on healthcare, the more we regress to a time when beggars died in the streets. If our society is a reflection of us as a people, we should all be ashamed.

ETA: Okay, that's a little over-dramatic, since beggars qualify for medicare. The sad part is, if you're middle class and you have a health care crisis, the only remedy is to become homeless. And we say we have the most advanced society on earth?

 

[JAMESBJOHNSON]

I posted this information on another thread.

The citizens of this county pay a one penny sales tax to fund indigent health/dental care. The fund is supposed to cover medical needs for people without health insurance.

But what happened was a major hospital in the county almost closed because of poor management and the county/city gave all the indigent care money to the hospital to save it. The hospital, in return, agreed to take care of the indigents for free.

But what they do is refer the indigents to the state health department and to charities. You get 2 aspirin and a list of local charities when you appear at the emergency room. And the private hospital gets the tax money.

 

[Guest]

I see several problems with health care in this country, some of which previous posters have already mentioned--bureaucratization, tort reform, etc..

Underlying it all, though are three things--the first is that health care is the only commodity where we expect and demand to receive the absolute best available whether we can pay for it or not. This does not apply in any other area of life. We drive the vehicles that we can afford, we eat at restaurants that fit within our budgets, and we don't expect to wear nothing but designer clothes. Health care, though, is viewed differently. I'm not criticizing that view, just noting it.

I think that's why we, as a country, get so outraged when we hear of socialized medicine in which some patients are triaged by severity of condition and available resources. Our presumption is that each and every person will receive state of the art treatment regardless of willingness or ability to pay.

That attitude also drives prescriptions. Few new medications offer substantial benefit over older ones; most offer, at most, marginal improvements. Yet there's the expectation that we get the "latest and greatest" even if it's five times more expensive and only slightly better than a product that's available in generic form. Yes, there are exceptions, but in the main it holds true.

The second is that there's no real penalty for not taking care of ourselves. Smoking, alcohol/drug abuse, obesity, poor diet, lack of exercise, reckless behavior, failing to get regular checkups to catch small, easily treatable problems before they become big, expensive problems, and the list goes on. Some insurers have begun increasing premiums for people who exhibit certain behaviors but this is not an adeqaute deterrent.

Again, there's a sense of entitlement--we can live our lives exactly as we like and expect to receive top-notch medical care regardless of what we do to ourselves or whether we can pay for it.

The third thing is that health insurance is slanted in favor of the insurance companies to an unconscionable degree. In many states, small employers are not allowed to band together to form a larger insured population, thereby obtaining better rates. And, as an aside, I've never heard of a health insurance company going broke because they paid out too much in benefits. The only cases I'm aware of are ones in which the insurer made bad investments. If there are cases where covering the needs of the customer base drove a company into bankruptcy, I'd interested in hearing them.

 

[JAMESBJOHNSON]

GNOME

Much of what you report is right on the money.

I've read, though, that there are MD factors that inflate costs.
1. MDs neglect their professional training. They dont keep up with whats new and improved and better and cheaper. MD skills atrophy.

2. If the MD cant bill for it, you cant get it. Most insurance companies refuse to pay for conduct-centered problems, so MDs call it something else and treat you for something else. Where there's an epidemic, there's a herd of MDs who've discovered something they can bill for.

3. MDs buy a lot of expensive toys they dont know how to use. And if they buy the toy, they expect everyone to use it, so they can bill for it. MDs also invest in diagnostic labs.

I've spent a lot of time in emergency rooms interviewing MDs and nurses, and what I noticed was a clerk running a checklist of billable services for every patient at the ER. I'm serious, if the MD says HAVE A NICE DAY to you it gets billed as patient education. I worked for a variety of mental health facilities, and its true.

 

[trysail]

Do you expect to receive more in insurance company payments than you pay in premiums?

 

[oggbashan]

There was an article in yesterday's UK Sunday Times magazine about a Brit who organises free consultations and health care in the US (and elsewhere) with no questions about ability to pay.

His organisation is swamped by US citizens unable to afford insurance or the cost of healthcare for basic conditions such as tooth extraction. One of the problems he and his organisation has is that doctors and nurses are not allowed to cross State lines to practise medicine even when they are giving the services free of charge. Why can't a doctor practise in a different State? Doctors in Europe can practise across the EU.

Og

 

[JAMESBJOHNSON]

OG

America is a dual sovereignty republic. We're not the united STATE of America, we're the united STATES of america. One nation but 50 distinct STATES.

Our 18th constitutional amendment gives our central government more power than it was intended to have. The intended role of the central government was to be narrow and confined to a few operations: foreign relations, military operations, common currency, and conflict resolution between the States.

The Income Tax Amendment gave Washington the power to collect internal revenue and disburse the money. So most of our federal laws are dead letters unless and until the STATE accepts the money.

 

[xssve]

It's a doozy, not doubt - I don't think there's a quick fix anywhere, teh debate on healthcare reform is like the Israeli Palestine war, it just keep getting more complicated.

Amicus is right in that you do want the free market to do the heavy lifting insofar as possible, meaning cutting out the middlemen as much as possible: insurance companies, etc. - socializing malpractice insurance, might be one possibility, another might be a minimal premium that everybody pays, that goes up a notch every time you use medical services - that might help weed out the hypochondriacs - my ex took my son in for every scrape and sniffle, and she did the same, I wait until somebody is dying.

The insurance industry is a huge obstacle, their natural adversary is the patient, but patients have limited leverage - the free market works when there are competing interests of approximately equal power, i.e., doctor/patient, and insurance companies are really a third party in all of this, they want to get paid, and never have to pay out, naturally enough, leading to the abuses and horror stories that one hears on a regular basis.

On the one hand, patients are denied needed services, and on the other, physicians pad out their expenses to cover their costs and make a profit, and insurance fraud pops up intermittently, often involving entire hospitals, HMO's, etc. - this is all pure free market stuff there ami, no government involvement - in fact the fraud rate in medicaid is actually lower than it is in private HMO's I believe.

In Ireland, I heard, they pay doctors a fixed rate for every patient, sick or not, and this incentivizes preventative healthcare, since the doctor can maximize his free time to treat private patients, play golf, etc. - dunno if they still do that, or if it worked, but it's another idea.

My prediction of course, is that the politicians and the insurance and healthcare lobbyists will conspire to divvy up the loot, and we'll end up with an exorbitantly costly system that everybody will pretend works - kinda like we have now.

Ideally, I'd like to see a tiered healthcare system, i.e., GP's focusing on preventative medicine on the first tier, referring to specialists as needed - that seems to be pretty much how it's evolved under HMO management, although they change the rules every couple of months (without telling you), so you have to figure it out all over again every time. So it goes, at least they're trying things out, I'm actually comforted to some degree by it, since trial and error is an indicator that market forces are involved.

I think it's a sound basic model, and I would resist trying to lock anything in too permanently - it one of these things where you have to keep picking at it, trying and comparing different models, and trying to keep the bureaucratic overhead from forming a hard crust that becomes impossible to penetrate - once that happens, there is almost nothing you can do except make a clean sweep and start all over, which is probably where the UK is right about now - a generation of bureaucrats who've "always done it that way". Corporate/bureaucratic cultures, once they become locked in, are very difficult to dislodge.

 

[xssve]

It occurs to me that a good first tier would be GP's who just do annual checkups, and nothing else, which could be universal, i.e., you are entitled to one checkup a year, and then try to sort out any referrals - presumably, one should avoid either incentivizing or discouraging referrals.

One annual checkup and emergency care would be the level to start on, I should think.

 

[xssve]

To add to Gnomes observations, healthcare as a commodity is also unusual in that the costs are all upfront, the benefits less tangible: lost productivity, social stability, etc., sudden catastrophic healthcare costs can utterly wipe families out financially, it is a real problem for the middle class in that Grey area between medicaid and private insurance, and business has been shifting away from coverage anywhere they can, which affects the labor market, i.e., using temps instead of permanent staff, etc.

The biggest proponents of universal healthcare and pensions in fact, are not those with no insurance, it's businesses who would love to get out from under the burden of having to provide healthcare benefits and pension funds.

Oh, and ami? SS and medicaid are not bankrupt, the military/industrial complex is bankrupt, and feeding off SS and medicaid/medicare.

Guns or butter, it's the same old problem.

 

[JAMESBJOHNSON]

XSSVE

Johnsons First Law of Social Intercourse sez that things will continue as they are until a crisis occurs.

Pretty damned soon America is gonna get the bill for Boomer Retirement Benefits, and this means an empty treasury in Washington when you toss in the national debt interest and other entitlements, plus the military. Ten percent of Americans already collect food stamps.

Youre correct. Insurance and Medicaid is a boon for hypocondriacs and mental health players. When I worked at the hospital you knew who the cops would bring in on Friday night, because the same people came in every Friday night, and left Monday morning. It was their social life and their therapists didnt work weekends.

Anyway, when the money runs out we'll get serious about solutions to the problem..but not before.

 

[xssve]

Do you expect to receive more in insurance company payments than you pay in premiums?

Uh, is that not the whole idea behind insurance to begin with?

 

[JAMESBJOHNSON]

XSSVE

There already exist insurance plans that do exactly what you suggest for around $10 per week. You get 5 office visits, 2 ER visits, and inpatient. There's a 2000 deduction. In other words, the office vists are on your dime.

 

[xssve]

XSSVE

Johnsons First Law of Social Intercourse sez that things will continue as they are until a crisis occurs.

Pretty damned soon America is gonna get the bill for Boomer Retirement Benefits, and this means an empty treasury in Washington when you toss in the national debt interest and other entitlements, plus the military. Ten percent of Americans already collect food stamps.

Youre correct. Insurance and Medicaid is a boon for hypocondriacs and mental health players. When I worked at the hospital you knew who the cops would bring in on Friday night, because the same people came in every Friday night, and left Monday morning. It was their social life and their therapists didnt work weekends.

Anyway, when the money runs out we'll get serious about solutions to the problem..but not before.

Crazy people used to be called "local color" - under the current regime of militant normality, driven equally by evangelical conformity and media driven corporate drone values, anybody that sticks out get's hammered - being in therapy is the only decent excuse for being yourself.

I'm probably slightly Schizo, clinically depressed, and ADHD, they just didn't diagnose those things back in my childhood - it's part of my personality, I'd rather ride the waves and weather the chaff than be a Thorazine zombie.

"Yeah, I know I like to walk around naked with a tinfoil hat on, I'm in therapy for it".

"Oh, OK".

 

[trysail]

...SS and medicaid are not bankrupt...

Social Security and Medicare are actuarially underfunded— i.e. the present value of their estimated liabilities substantially exceeds the assets currently available for the payment of benefits.

If a balance sheet was rendered in accord with Generally Accepted Accounting Principals, both would show a negative net worth.

_______________________

On a separate issue, people fail to comprehend that insurance is a form of savings. God only knows why, but people ( in the aggregate ) apparently expect to receive more from insurance companies than they pay in the form of premiums. Like perpetual motion, that is an obvious impossibility.