J
D
DeeZire
Guest
Common sense is toast, thanks to corporate interests funding think tanks who devise publicity campaigns designed to scare people away from the single payer option. Personally, I'd rather have a government bureaucrat trying to accommodate my needs than a corporate bureaucrat trying to deny my needs.
J
JAMESBJOHNSON
Guest
DEEZIRE
Lets stipulate that everyone invested in the healthcare system are rascals & bandits...MDs, hospitals, insurance companies, bureaucrats, everybody! So! How do we fix the system?
Here's what I suggest.
The Social Security Administration is maybe the most honest and effective Federal agency when it comes to mailing checks on-time, for the right amount. Let Social Security handle benefit claims for a modest fee. Let Social Security compile several healthcare plans for a variety of prices.
Sign up for whatever plan you want and can afford. Some basic plans cost around $10 a week. If youre a part-time worker-student you may do okay with 5 office visits, 2 ER trips, and 80% inpatient coverage for $10 a paycheck. If your employer's insurance benefit is $500 a month, the employer sends the money to Social Security, they pay the insurance fee, and credit the rest to a medical savings acoount in your name. You can use the money for medication, wheelchairs, inpatient co-pays, any legitimate medical expense.
If you have a family and your employer has the same $500 insurance benefit, the money goes to Social Security, you pick out what plan you want, and apply the $500 toward the cost.
Now! The insurance company has to agree to what I call a SCOPE OF WORK contract. Your MD decides what treatments you need, and the insurance company has to pay for them. No ifs, ands, or buts. BUT! The MD is required to select your treatments from an approved menu. The menu is created by the professional board that certifies your doctor.
Ditto for the hospital. When your MD gives you a diagnosis the hospital is on the hook to provide you what you need based on the diagnosis. NOT every damned thing they can imagine.
Lets stipulate that everyone invested in the healthcare system are rascals & bandits...MDs, hospitals, insurance companies, bureaucrats, everybody! So! How do we fix the system?
Here's what I suggest.
The Social Security Administration is maybe the most honest and effective Federal agency when it comes to mailing checks on-time, for the right amount. Let Social Security handle benefit claims for a modest fee. Let Social Security compile several healthcare plans for a variety of prices.
Sign up for whatever plan you want and can afford. Some basic plans cost around $10 a week. If youre a part-time worker-student you may do okay with 5 office visits, 2 ER trips, and 80% inpatient coverage for $10 a paycheck. If your employer's insurance benefit is $500 a month, the employer sends the money to Social Security, they pay the insurance fee, and credit the rest to a medical savings acoount in your name. You can use the money for medication, wheelchairs, inpatient co-pays, any legitimate medical expense.
If you have a family and your employer has the same $500 insurance benefit, the money goes to Social Security, you pick out what plan you want, and apply the $500 toward the cost.
Now! The insurance company has to agree to what I call a SCOPE OF WORK contract. Your MD decides what treatments you need, and the insurance company has to pay for them. No ifs, ands, or buts. BUT! The MD is required to select your treatments from an approved menu. The menu is created by the professional board that certifies your doctor.
Ditto for the hospital. When your MD gives you a diagnosis the hospital is on the hook to provide you what you need based on the diagnosis. NOT every damned thing they can imagine.
jomar
chillin
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- 27,560
Best practices - they've been trying to move to that forever but there's still significant variation (conservative vs aggressive) across the US. But in this day and age, test and treatment for most conditions is pretty straight forward (assuming competent docs).
In theory I like your plan...for a long time I've thought a tiered plan has to be part of the package. I suspect we're past the point of just the government offering the only plans. If they get in the game they'll be competing against the rest of the healthcare insurance industry and that might be a good thing.
In theory I like your plan...for a long time I've thought a tiered plan has to be part of the package. I suspect we're past the point of just the government offering the only plans. If they get in the game they'll be competing against the rest of the healthcare insurance industry and that might be a good thing.
J
JAMESBJOHNSON
Guest
JOMAR
When I did construction management my contractors bid on a Scope of Work and Specifications. Their professional associations determined what Best Practices were, and Best Practices were revised on a regular basis. But the contractor 'bought' his part of the project and was liable for whatever the work required.
In my scheme if you have a simple fracture, the MD and hospital get a flat fee to repair the simple fracture. They pretty well know what resources and skills they need to do the work. Its not rocket science. The fees should cover Best Practice costs.
If the MD or the hospital fails Best Practice Standards, sue them or otherwise penalize them to discourage poor performance. Its very simple. You'll reduce the lawsuits and embezzling to a significant degree.
The psychiatric hospital I worked for itemized everything because they were paid piecework, and it was to their benefit to construe everything as a necessary part of the treatment plan. What got them in trouble with the government was billing for services not performed or without documentation. At discharge, if a nurse hugged you and advised ytou to 'take care,' it was billed as patient education. If the social worker sent you to the desk for a followup appointment, it was billed as social work services, usually for an hour.
When I did construction management my contractors bid on a Scope of Work and Specifications. Their professional associations determined what Best Practices were, and Best Practices were revised on a regular basis. But the contractor 'bought' his part of the project and was liable for whatever the work required.
In my scheme if you have a simple fracture, the MD and hospital get a flat fee to repair the simple fracture. They pretty well know what resources and skills they need to do the work. Its not rocket science. The fees should cover Best Practice costs.
If the MD or the hospital fails Best Practice Standards, sue them or otherwise penalize them to discourage poor performance. Its very simple. You'll reduce the lawsuits and embezzling to a significant degree.
The psychiatric hospital I worked for itemized everything because they were paid piecework, and it was to their benefit to construe everything as a necessary part of the treatment plan. What got them in trouble with the government was billing for services not performed or without documentation. At discharge, if a nurse hugged you and advised ytou to 'take care,' it was billed as patient education. If the social worker sent you to the desk for a followup appointment, it was billed as social work services, usually for an hour.
trysail
Catch Me Who Can
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Only a person who doesn't foot the bill could possibly make statements such as the above. It's the same thought process ( or, more properly, the complete absence thereof ) that doesn't understand why Social Security and Medicare are bankrupt.
Can you spell Fannie Mae? Can you spell Freddie Mac?
J
JAMESBJOHNSON
Guest
An article in the paper today warns that neither insurance companies, government, or MDs advocate for the patient's care and treatment. Each group wants to keep as much of the money as possible. This is true.
The MD who wrote the article suggests that it makes no difference who pays the bills when all of them want to keep the money for themselves, and the money becomes a struggle.
He suggests that the solution is an agency that advocates for the best treatment for the patient.
Mental Health already does something along these lines when government watchdogs advocate for the least restrictive treatments and placements. The agency has no say in the money, but every MD and hospital and insurance company is required to make a case for what they recommend.
The MD who wrote the article suggests that it makes no difference who pays the bills when all of them want to keep the money for themselves, and the money becomes a struggle.
He suggests that the solution is an agency that advocates for the best treatment for the patient.
Mental Health already does something along these lines when government watchdogs advocate for the least restrictive treatments and placements. The agency has no say in the money, but every MD and hospital and insurance company is required to make a case for what they recommend.
CharleyH
Curioser and curiouser
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I think that (mostly, so long as you get rid of the province of Alberta in Canada) Universal heath care works well in Canada. Let's face it. The largest group about to go into the health care system is the baby boomers and they do NOT want to be in a hospital when they die. I can tell you from experience that the Canadian system does not include home care. It does not include a trip to the hospital in an ambulance, either. Canadians either need insurance for these things, or they must pay out of pocket. Universal heath care in the US? It's a little bit socialism, no?
J
JAMESBJOHNSON
Guest
CHARLEY
I think about it this way.
Its a quality of life issue along the lines of sanitary sewers, potable water, garbage collection, schools, etc. Challenges are good but suffering isnt. People shouldnt starve or suffer from pain or need to sleep in refrigerator cartons. And I dont construe quality of life services to be socialism. Healthcare is no more socialism than a street is.
Now! I dont say that I should have a platinum medical card and expect society to make me pretty like I was 40 years ago. But I do think everyone should be able to access acute medical care as problems arise.
Paying for it doesnt seem to be a big problem, the big problem is with the thieves in government, insurance, and the healthcare industry.
I think about it this way.
Its a quality of life issue along the lines of sanitary sewers, potable water, garbage collection, schools, etc. Challenges are good but suffering isnt. People shouldnt starve or suffer from pain or need to sleep in refrigerator cartons. And I dont construe quality of life services to be socialism. Healthcare is no more socialism than a street is.
Now! I dont say that I should have a platinum medical card and expect society to make me pretty like I was 40 years ago. But I do think everyone should be able to access acute medical care as problems arise.
Paying for it doesnt seem to be a big problem, the big problem is with the thieves in government, insurance, and the healthcare industry.
CharleyH
Curioser and curiouser
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I guess I thought you were Amicus for a second. Sorry for the mistake.
J
JAMESBJOHNSON
Guest
CHARLEY
I'm not opposed to the good that government is capable of, I oppose how government is controlled by bandits & thieves.
Lemme give you an example.
In my county we pay extra taxes for our library and recreational facilities. We voted to levy special taxes to pay for these services, and they are top shelf.
Now the county has a serious budget crunch and the revenues are way less than what is needed. But the special taxes havent decreased because theyre added on to the tax bill regardless of what the economy is doing.
So the county manager decided that he'd close the libraries and rec centers, and use the money to pay the salaries of the 200 fat-asses who assist him. The county manager in an adjoining county did the same...she fired 500 peasants and gave her guys raises. I'm really paying a fat ass tax instead of a tax for libraries and rec centers.
I'm not opposed to the good that government is capable of, I oppose how government is controlled by bandits & thieves.
Lemme give you an example.
In my county we pay extra taxes for our library and recreational facilities. We voted to levy special taxes to pay for these services, and they are top shelf.
Now the county has a serious budget crunch and the revenues are way less than what is needed. But the special taxes havent decreased because theyre added on to the tax bill regardless of what the economy is doing.
So the county manager decided that he'd close the libraries and rec centers, and use the money to pay the salaries of the 200 fat-asses who assist him. The county manager in an adjoining county did the same...she fired 500 peasants and gave her guys raises. I'm really paying a fat ass tax instead of a tax for libraries and rec centers.
amicus
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Hi, Charlie, meant to say hello during the exchange with Lauren....
I particularly like the 'McDonald's' plan, with health clinics being as available as fast food outlets placed so as to satisfy the buying public.
It takes a little more time to train a physician than it does to train a franchise manager for a business, but then every business has different requirements.
I know most do not wish to view health care as a commodity, but it is exactly that and should be treated as such without government interference or subsidy.
There is a 'litmus' test within the workings of a free society where individual rights are supreme and that, 'test' is one the insists upon the rights of the individual being protected whenever a 'system' is presented as a solution to a problem.
What most don't seem to realize or be attentive to, is that all the 'national health plans' in existence, be it Canada, England or Sweden and I am guessing that Communist Portugal is within the category, all, 'ration' health care as the demand exceeds the supply. In addition to rationing, each of the above countries have extremely long waiting lists for patients, some of whom die before the waiting period expires.
That does not seem humane to me and it certainly does not protect free choice in terms of the consumer.
I assure you than any system 'imposed' on a population and controlled by government will inevitably fail. That being so, why even experiment with the method?
Let freedom ring!
Amicus
I particularly like the 'McDonald's' plan, with health clinics being as available as fast food outlets placed so as to satisfy the buying public.
It takes a little more time to train a physician than it does to train a franchise manager for a business, but then every business has different requirements.
I know most do not wish to view health care as a commodity, but it is exactly that and should be treated as such without government interference or subsidy.
There is a 'litmus' test within the workings of a free society where individual rights are supreme and that, 'test' is one the insists upon the rights of the individual being protected whenever a 'system' is presented as a solution to a problem.
What most don't seem to realize or be attentive to, is that all the 'national health plans' in existence, be it Canada, England or Sweden and I am guessing that Communist Portugal is within the category, all, 'ration' health care as the demand exceeds the supply. In addition to rationing, each of the above countries have extremely long waiting lists for patients, some of whom die before the waiting period expires.
That does not seem humane to me and it certainly does not protect free choice in terms of the consumer.
I assure you than any system 'imposed' on a population and controlled by government will inevitably fail. That being so, why even experiment with the method?
Let freedom ring!
Amicus
Austin8
Literotica Guru
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JB
Right on the money(pun intended) As a small business owner, I just can't afford the cost of health care.
It's difficult for me to budget for health care when it can consume a third or more of my income (and that's after taxes).
It is absolutely absurd that health care and insurance costs so much in the USA. It's gotten to be beyond greed now..........
Right on the money(pun intended) As a small business owner, I just can't afford the cost of health care.
It's difficult for me to budget for health care when it can consume a third or more of my income (and that's after taxes).
It is absolutely absurd that health care and insurance costs so much in the USA. It's gotten to be beyond greed now..........
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J
JAMESBJOHNSON
Guest
AMICUS
If you want a nation like Vietnam or North Korea, your position is correct. Both of those nations restrict healthcare etc to government workers, people sleep in cardboard boxes, and they do American labor for 25 cents an hour. We can have the same here if you get your way, and we can do the cheap labor, too.
In Vietnam they drink the same water they bathe and shit in. We can do that, because water is a commodity. And you can bring along a case of water wherever you go, just so you dont die of cholera.
Why do any of it? Eradicate mosquitos, treat hookworms, control strays, fund research, whatever. Books are commodities, why have libraries?
If you want a nation like Vietnam or North Korea, your position is correct. Both of those nations restrict healthcare etc to government workers, people sleep in cardboard boxes, and they do American labor for 25 cents an hour. We can have the same here if you get your way, and we can do the cheap labor, too.
In Vietnam they drink the same water they bathe and shit in. We can do that, because water is a commodity. And you can bring along a case of water wherever you go, just so you dont die of cholera.
Why do any of it? Eradicate mosquitos, treat hookworms, control strays, fund research, whatever. Books are commodities, why have libraries?
D
DeeZire
Guest
Trysail - I've been footing the bill my entire life, at least until the Bush boys screwed the pooch and my income dipped below the federal poverty level.
My point is that roughly one third of the money payed into private insurance goes to administration, compared to 8% with Medicare. You're a numbers guy, surely you can comprehend that. Plus, the pay incentive for the practitioners is totally out of whack. Their incentive is for procedures, not patient care.
I understand why Social Security and Medicare are bankrupt - it's because our elected representatives stole the money and spent it on other things. I also realize I'll have to pay higher taxes to make up the difference. I have no problem with that. I see paying higher taxes as accepting personal responsibility for the actions of my government. Isn't it odd how conservatives like to preach about personal responsibility, but at the same time they claim no responsibility for who they voted for in the last election?
Another point you constantly miss - the fact that low wage workers subsidize corporate profits. The bumper sticker I want to see reads: "Is my low-wage job subsidizing your mortgage payment?" I realize it's a concept you'll never understand, but some economists (the ones without an agenda) see it plain as day.
J
JAMESBJOHNSON
Guest
Forty years ago most people had no health insurance. Hell! My MD made house-calls. Now health consumes 17% of the economy, and youre damn lucky if the MD see's you longer than 5 minutes at her office.
SeaCat
Hey, my Halo is smoking
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How would I change Health Care?
Well I can't really answer on the part of a single payr system. I see good in it in some ways and I see bad in it, just like in everything.
On the other hand there are some changes I would love to see in Health Care.
Get rid of the For Profit Hospitals.
When the hosptials went "For Profit" they instituted a feeling of competition. Now the hospitals were fighting to get the patients, and the profits. The reason for being a hospital no longer was to take care of people but to suck the money out of them and their insurance companies.
Years ago you went to the hospital for those things that needed to be taken care of. Things that couldn't be healed by staying off your feet for a day or three. You went there for injuries or for an illness that your family couldn't nurse you through.
Now the attitude is that you go there for the little things as well as the big things. The competition has grown to the point where you pick and chose your hospital by how the staff treats you and your family, not your illness or injury.
Years ago the hospital was kind of like the last resort. You went there because the staff there was better at treating you than your family and friends. Those in the medical field were respected even looked up to.
Now the hospital is where you go for damned near anything from an ingrown Toe Nail to a major problem. The staff is no longer respected or looked up to. Instead they are your servants.
Years ago you went to the hospital and you were treated with respect because the staff knew they were helping you and you treated them with respect because you knew they were helping you.
Today a person goes to the hospital and demands to be respected even as they treat the staff like shit they would scrape off their shoe.
Years ago if a complaint was registered against a staff member it was brought up to a review board that weighed the complaint on it's merits. Did the person act unproffesionaly or with malice? Was injury the result? This was a serious undertaking on both sides. Those who made claims without reason were punished. It was well known that bringing charges against a staff member in the medical field could ruin their life.
Today if a complaint is filed against a staff member the complainant is usually paid off and the staff member fired without an investigation. It is no longer a question of the staff member being proffesional or acting without malice. It is now how the hospital will look.
So if you want to change the Medical Field lets start with the "For Profit" system and the perceptions it has engendered.
Cat
Well I can't really answer on the part of a single payr system. I see good in it in some ways and I see bad in it, just like in everything.
On the other hand there are some changes I would love to see in Health Care.
Get rid of the For Profit Hospitals.
When the hosptials went "For Profit" they instituted a feeling of competition. Now the hospitals were fighting to get the patients, and the profits. The reason for being a hospital no longer was to take care of people but to suck the money out of them and their insurance companies.
Years ago you went to the hospital for those things that needed to be taken care of. Things that couldn't be healed by staying off your feet for a day or three. You went there for injuries or for an illness that your family couldn't nurse you through.
Now the attitude is that you go there for the little things as well as the big things. The competition has grown to the point where you pick and chose your hospital by how the staff treats you and your family, not your illness or injury.
Years ago the hospital was kind of like the last resort. You went there because the staff there was better at treating you than your family and friends. Those in the medical field were respected even looked up to.
Now the hospital is where you go for damned near anything from an ingrown Toe Nail to a major problem. The staff is no longer respected or looked up to. Instead they are your servants.
Years ago you went to the hospital and you were treated with respect because the staff knew they were helping you and you treated them with respect because you knew they were helping you.
Today a person goes to the hospital and demands to be respected even as they treat the staff like shit they would scrape off their shoe.
Years ago if a complaint was registered against a staff member it was brought up to a review board that weighed the complaint on it's merits. Did the person act unproffesionaly or with malice? Was injury the result? This was a serious undertaking on both sides. Those who made claims without reason were punished. It was well known that bringing charges against a staff member in the medical field could ruin their life.
Today if a complaint is filed against a staff member the complainant is usually paid off and the staff member fired without an investigation. It is no longer a question of the staff member being proffesional or acting without malice. It is now how the hospital will look.
So if you want to change the Medical Field lets start with the "For Profit" system and the perceptions it has engendered.
Cat
TE999
How 'bout a kiss, baby
- Joined
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Random Thoughts on the Health Care Dilemma
I heard or read somewhere that the greatest expenditures for an average persons health care are within the last 6 months of life...keep 'em alive no matter what. I imagine that will be changed if the government controls health care in order to save money. No dialysis for you grandma.
As cat said, people use the ER like a walk-in clinic. I was in an ER recently (being attended to) and while waiting I saw people walk in to get their blood pressure checked, demand a physical exam, want various medicines and generally make a nuisance of themselves...meanwhile the real emergencies involving bleeding and pain were being dealt with ASAP.
Many routine duties that doctors perform can be done effectively by a Nurse Practitioner, a Physicians Assistant and others. People get pissed off if they don't see a doctor. Sorry, he's busy doing important stuff.
One problem with Medicare is that it pays for everything...including visits to the doctor for unspecified problems because someone is just lonely and wants attention. I have heard this happens all the time.
Americans, in the main, are used to a rapid response from their health care system...ain't gonna happen if the government gets ahold of it. Anyone who's stood in line at the DMV or been audited by the IRS has a taste of how it'll prolly work.
I heard or read somewhere that the greatest expenditures for an average persons health care are within the last 6 months of life...keep 'em alive no matter what. I imagine that will be changed if the government controls health care in order to save money. No dialysis for you grandma.
As cat said, people use the ER like a walk-in clinic. I was in an ER recently (being attended to) and while waiting I saw people walk in to get their blood pressure checked, demand a physical exam, want various medicines and generally make a nuisance of themselves...meanwhile the real emergencies involving bleeding and pain were being dealt with ASAP.
Many routine duties that doctors perform can be done effectively by a Nurse Practitioner, a Physicians Assistant and others. People get pissed off if they don't see a doctor. Sorry, he's busy doing important stuff.
One problem with Medicare is that it pays for everything...including visits to the doctor for unspecified problems because someone is just lonely and wants attention. I have heard this happens all the time.
Americans, in the main, are used to a rapid response from their health care system...ain't gonna happen if the government gets ahold of it. Anyone who's stood in line at the DMV or been audited by the IRS has a taste of how it'll prolly work.
R. Richard
Literotica Guru
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One of the simplist ways to evaluate a single payer health system versus a for profit health system is by considering major expenditures, such as an MRI machine. In a for profit system, the MRI is looked upon as a profit center. People will pay for the advanced treatments possible only with an MRI system. Thus the US for profit system has over three times as many MRI machines per population as does Canada. In a single payer system, an MRI machine is a cost item. Thus, MRI machines are ordered only when the current budget allows the expense. If your life depended upon a diagnosis using an MRI machine, what system would you chose?
There are numerous USA facilities along our nothern border that advertise fee based services for Canadan residents. AFAIK, there are no Canadian facilities that try to recruit USA patients.
There are numerous USA facilities along our nothern border that advertise fee based services for Canadan residents. AFAIK, there are no Canadian facilities that try to recruit USA patients.
amicus
Literotica Guru
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~~~
First off, thanks R. Richard, for one of the few rational posts on this thread.
JBJ, lost a little faith in your ability to reason as a result of your above post. It seems you prefer a government beyond what our Constitution provides for; a semi 'nanny state', treating medical care and libraries or water supplies as part of the obligations of government.
Would you care to single out that portion of our Constitution that enables government to do that? Aside from the 'general welfare clause', if you don't mind.
Amicus
WRJames
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Terrie, the publisher of Club Lighthouse Publishing, lives in Toronto. The health care system in Canada lets her take some chances with a small business without worrying about the need for health insurance.
Ask any small business owner in the US, or would be entrepreneur, how they feel about the need for health insurance.
When I was on safari in Tanzania, one of the people in our group was a doctor from Vancouver. I asked him about their system, and he was very happy with it. He submitted bills and he got paid.
Ask any doctor in the US how happy they are with the current mess. My wife has, and the answer is that they could cut their fees in half if they didn't have to deal with the insurance companies.
Ask any small business owner in the US, or would be entrepreneur, how they feel about the need for health insurance.
When I was on safari in Tanzania, one of the people in our group was a doctor from Vancouver. I asked him about their system, and he was very happy with it. He submitted bills and he got paid.
Ask any doctor in the US how happy they are with the current mess. My wife has, and the answer is that they could cut their fees in half if they didn't have to deal with the insurance companies.
J
JAMESBJOHNSON
Guest
I'd be happy as a clam if the Federal Government limited its Scope of Work to what's specified in the Constitution. But government exists at the state and local levels, too, and the Constitution gives them a license to be as involved as they want.
Locally, we enacted a penny sales tax to fund indigent health care. Clinics were built all over the county. All you needed to qualify for services is proof of residency. It was hoped that the clinics would empty the emergency rooms. And it all worked well until the fund surplus swelled to 150 Million Dollars.
That much money is too much temptation for politicians and special interests to resist. So the county handed over the money and the program to one of the local hospitals, that, coincidentally, was on the brink of bankruptcy. The hospital took the money, replaced the bush bunny in charge plus his entourage , and agreed to service the poor for free.
Fifteen years later we're back where we started. The hospital gets all the tax money and parks the poor in the emergency room where they wait 10 hours for service. At my last visit to this hospital my client sat in the ER from 3pm till 3am.
When private enterprise handled water & sewer around here what they did was suck water out of the river and pump shit back in. This was discovered after the county bought the utilities. About half the county commission was in on the swindle and went to prison.
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