Advice to traditional Q: American Healthcare

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

travelingdoctor

Full Member
10+ Year Member
15+ Year Member
Joined
Nov 10, 2006
Messages
62
Reaction score
0
Ok, so I want some of SDN's insight into America's healthcare issues. I got asked this Q and I felt that my answer was decent, but the interviewer didnt think so.

My thoughts:

#1: Lack of insurance coverage: So attack this issue at 2 levels. For low income people, increase state funding and health education. For middle class and upper class, increase the requirement for employers to provide insurance, while government makes it more affordable for employers to do so.

This is general, I know, but how do I add depth to my thinking or is this completely too basic? I dont want to give them the typical answer and show them a creative answer.


#2 Even with insurance, doctors dont get compenstated enough for vaccines and treatments. Government should regulate pharm. industry and make them lower prices.

Again, simplistic and I want to add more insight. Please help! Thank you!

Members don't see this ad.
 
This will probably get moved to sociopolitical.

Funny thing about the government. I think that they actually did try to regulate the price of Cipro when everybody became afraid of anthrax (nevermind that people with Bactrim-resistant bugs in their UTI's get screwed on the price everyday). All it takes is big daddy Bayer to stroll into Washington and introduce some living senators to some dead presidents.

Grease the politicians and bam, no more problem with drug costs.

Circular argument with small businesses. Premiums keep going up, so small businesses will scream about health coverage.

First step would likely be to monitor the practice of assigning full-time employees to hourly status to avoid giving them health benefits at all. I don't think that I've had a health-insured restaurant worker serve me food in the last 20 years. They've got mouths to feed too.
 
I work for one of the Big 5 health insurance companies and I am currently assigned to figuring out how we can bludgeon our way into/pillage/plunder a particular state's Medicaid and other low-income residents' coverage contracts, so I have spent a lot of time recently researching and thinking about how to realistically expand the coverage pool. If I were made Czar of Health Care in America tomorrow, this is how I would respond to your questions:

#1Lack of insurance coverage: So attack this issue at 2 levels. For low income people, increase state funding and health education. For middle class and upper class, increase the requirement for employers to provide insurance, while government makes it more affordable for employers to do so.
Increasing state funding is not a lasting fix in a fiscal context in which cost drivers (based on demographics) are going in the wrong direction--no state, not even the wealthiest ones like Maryland, Connecticut, New Jersey, can afford to commit to expand coverage/spend significantly more on low-income health coverage given what the low-income coverage pool is likely to look like in 10 years' time. As for the Mississippis and Wyomings of the U.S.--you do not want to be poor and live in a Red State in this country--these states cannot even meet their own Medicaid and HCSN statutory obligations as they stand today. The HMOs and provider groups who currently contract to fulfill Medicaid and similar programs are increasingly unwilling, even at higher compensation rates, to participate, because the economies of scale do not justify what they see as an endless black hole of un- and under-compensated associated care.

A novel potential approach that could lessen the burden, IMO, is, instead to focus on the pools of uncompensated care funds which every state, every large provider group, and every hospital network already maintain (as required by law, not out of the goodness of their hearts). When an uninsured person goes to the ER for care (and consumes, say, $1000 worth of services where $100 worth of preventive care could have avoided the necessity of the trip to the ER)--and cannot pay the bill, this bill still gets paid, out of these uncompensated care funds (which every taxpayer and every insured person pays into via higher premiums, dedicated taxes and "fees", etc.) Why not allow low-income people to have access to these funds ahead of time, as collateral to find private sector coverage? These funds are going to be paid out anyway, and for this same group of uninsured people--why not give them access to basic coverage now, enabling them to access primary care, reducing the need for more expensive secondary and tertiary care, and improving low-income health outcomes to boot? Institutional inertia is the only answer I can come up with.


#2 Even with insurance, doctors dont get compenstated enough for vaccines and treatments. Government should regulate pharm. industry and make them lower prices.
This is irrelevant, because increased oversight of the pharmaceutical industry will not happen anytime soon--they have the best lawyers, and spread their money around the political spectrum brilliantly--as a political and policy junkie, I get slightly turned on just thinking about how good they are.
The federal government already has excellent compensation in place for physicians to vaccinate children, via the Early and Preventative Screening, Diagnostic, and Treatment Program (EPSDT)--children in Medicaid and similar programs have better coverage for vaccination and similar standard, early-life care than their private sector counterparts. The problem is poor utilization--how do you get a low-income individual to get their child into the clinic at the appropriate time for the approriate shot when they don't have a phone/moved three times last year/can't be found/can't read. I haven't seen a good model for better communication with and health education for low-income Americans yet--but I hope someone is working on something better than what we've got.
 
wow that was a longer post/rant than I intended--but to respond to the end of your first question--intensifying the connection between employment and coverage is moving in the wrong direction, IMO. We need to reduce this bond (which is an artifact of an odd historical confluence of events during the wage freeze of World War II and has no releveance to today)--you don't purchase your car insurance or insure your home through your employer do you? Why should we treat healthcare differently? Particularly when the impact is hardest on small business (I assume this was the thrust of your question)--why should we force Ma and Pa with their bakery operation to become experts in efficiently insuring their employees? That is irrational and inherently inefficient.

And if the knuckledragging, ***** Republicans who claim to represent the best interests of small business owners would grow a pair and stand up to the C-of-C types who are blocking such reforms, this problem could be addressed
 
Top