Current Status of Healthcare and its Challenges

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Christmas of 2009 I was attacked by my dog and ended up at the ER of the nearest branch of the rather large hospital chain in the area. I did not have insurance because I was consistently denied every year for pre-existing conditions (previous athletic injuries etc).

I walk into the ER with a tore up face and most of the bleeding stopped. Yes, I was given a room but before I got any treatment I had to spend over 30 minutes with their billing manager going over my rate of pay, how much was I willing to spend right then and there, what sort of payment plan was I going to take etc. At one point I told the woman that if they'd give me a shot to calm down and take the edge off the pain of my shredded face, I'd me more inclined to sign anything she puts in front of me. I honestly have no idea how she didn't puke as I was not about to cover my face as I was signing the documents. Hell, they wouldn't even give me a bandage or towel to drip into. Heck, even the ER doc was absolutely wretched.

Anyway, thanks to the health care reform I am able to have insurance.

I am all for providing health care to everyone. Heck, I was one of the "ones" who didn't have it because I was denied. No, I certainly couldn't write a check for the $9,000+ medical bills I had that evening, but I ultimately went on a payment plan and satisfied my part.

However, if giving people universal coverage means they are subjected to the experiences I went through, I will have a hard time being for that.

 

[Dharma]

Christmas of 2009 I was attacked by my dog and ended up at the ER of the nearest branch of the rather large hospital chain in the area. I did not have insurance because I was consistently denied every year for pre-existing conditions (previous athletic injuries etc).

I walk into the ER with a tore up face and most of the bleeding stopped. Yes, I was given a room but before I got any treatment I had to spend over 30 minutes with their billing manager going over my rate of pay, how much was I willing to spend right then and there, what sort of payment plan was I going to take etc. At one point I told the woman that if they'd give me a shot to calm down and take the edge off the pain of my shredded face, I'd me more inclined to sign anything she puts in front of me. I honestly have no idea how she didn't puke as I was not about to cover my face as I was signing the documents. Hell, they wouldn't even give me a bandage or towel to drip into. Heck, even the ER doc was absolutely wretched.

Anyway, thanks to the health care reform I am able to have insurance.

I am all for providing health care to everyone. Heck, I was one of the "ones" who didn't have it because I was denied. No, I certainly couldn't write a check for the $9,000+ medical bills I had that evening, but I ultimately went on a payment plan and satisfied my part.

However, if giving people universal coverage means they are subjected to the experiences I went through, I will have a hard time being for that.

I feel bad that you had that experience because it shouldn't go down like that. That said, it sounds like that was either a $hitty ER or a really busy ER that had you lower on triage priority. I worked in an ED for some time and that type of thing wouldn't have happened, assuming an MVA pileup of 10 cars didn't have severely injured patients pouring through the bay doors at the same time you walked in.

In response to providing everyone healthcare (assuming it's the taxes of the haves paying for that of the have-nots) where do we draw the line of right and privilege? Should there be a point where the basic coverage (i.e. whichever baseline coverage the poorest will have) can no longer sustain and the patient has to flip the bill? IMO we all have the right to basic healthcare and I hope reform can accomplish this with reasonable changes, but my idea of basic may differ from that of another's. And I can guarantee a sick/injured individual's idea of basic will differ drastically from someone without a serious health matter in sight. How do we define basic?

(I realize this conversation is veering off from the OP's original question, but this is all a part of the current state of affairs, so this can help him/her see what's going on. It's obviously a subject that elicits emotion and strong opinions. On top of that, it's easy to see that the solution may not be as easy as many hope).

 

[Dharma]

@Dharma (just so I don't have to quote the whole post)

I do think it will make a drastic difference. Not for everyone of course, but in countries with socialized medicine, or with insurers that promote preventive care, people (on average) see their physician as much as 5 times per year. Japan I think was 14 times per year. Is America inherently different? Maybe. They may not see the doctor any more (once every few years), but the statistics from elsewhere say they would.

Those numbers are interesting. It would be nice to find what the golden number is for the optimal visits per year for a patient. Looks like an area for potential research, if it hasn't been done already.

The doctors don't care. I made special note one day of a doctor who didn't even look me in the eyes. Not once. "Any issues with breathing?" Nope. "Ok, no need for further tests." The entire physical was like this. And my direct supervisor happens to be a friend from another job, and he said they contract out the cheapest occmed services around as a company, and they say, "this is what we'll pay." And I work for a very large company so the occmed facility agrees to the set amount because of the volume. This is directly analogous to socialized medicine. If the government says, "this is what we pay" and the physician has no choice but the accept the crap reimbursement, he could take it out on the patient by increasing volume and spending less time both physically and mentally on patients which undoubtedly hurts the patient long term. It snowballs out of control and we aren't better off.

This will hurt the patients AND medicine long term. Many proponents of socialized medicine fail to address this potential problem and many more are just plain unaware that this is how it will be. All too often the focus is on quantity (i.e. how many will be insured) without much concern for quality. With the price of medical education today, it would be very difficult if not impossible to convert to socialized medicine without a severe downgrade in the quality of care.

 

[DO2016]

Thanks for the responses. I love how many of you are passionate about this topic because we are the people that are going to be a part of these changes and shaping American healthcare.

 

[FrkyBgStok]

to address both posts, that is the problem when we try to define basic. No one is going to have a good definition. That is why I propose everyone that may be involved from both parties work to figure out exactly what "basic" means. I feel personally that basic care should be anything that is acute, demonstrably chronic, emergent, or prolonging. Meaning all vaccines, preventative measures, evidenced based treatments, and chronic pain that can be verified and is on a pain scale. Unfortunately, we as a country can't afford to fix every knee that is sore, but if it is excessively painful or inhibiting, then sure. People can pay more for better coverage, but this would be basic.

Another problem is that we have to provide this basic coverage from the cradle to the grave. People get off insurance at 65 and go to medicare, so it gives insurance companies a reason NOT to do preventive care, but unamimously people agree that in the long run, preventive care is much cheaper. But I think all parties need a say in what "basic" is.

When people think about anything, they think of themselves, and they think of the opposing outliar, and nothing else. For example, when people talk of tax reform, the say "I am paying a bigger percentage that warren buffet, so the top 5% need to chip in more," but people neglect the non billionaires in that bracket who would feel the burden much more. This is exactly like health reform. The majority aren't doctors and the majority think doctors are overpaid, so republicans and democrats alike only think about the patient. The problem is, as I have demonstrated, if you neglect the doctors and take away their income, while keep malpractice high and education high, it will negatively affect the patients. And that what I want people to understand about social medicine. When start taking money out of the doctors pockets, the patients will suffer much more than the doctors.

 

[Didierdrogba]

To those people who don't think European models perform better in terms of health outcomes and claim that I'm just making up stuff: don't be lazy and go look up the stats and papers yourself. I really don't want to spend more of my time explaining stuff that everyone outside America already knows (global warming, does that ring a bell?).

While it is easy to point fingers at the American lifestyle, we must think about how to intervene to prevent it from worsening. The best thing to do here is to increase the availability of health insurance coverage to each person so people can receive proper consultation and care, ie. preventative measures. The American healthcare system certainly prevents this. When you look at the UK, or Taiwan, healthcare is cheap or free, and people take advantage of utilizing it. Of course, it is on the expense of the doctors, doctors there work more and get paid less, but I must say some doctors in the US are extremely overpaid, 300,000 per year for specialists??? come on!!!! ....but it is not easy for people to accept pay cuts, is it?

And @ FrkyBgStok, you might argue that the negative effects of nationalized healthcare is increased wait time and lack of availability of new drugs, yes, that may be true at the individual patient level. However, if we evaluate a health system, we must look at life expectancy, DALYs, and burdens of diseases, economic impacts, etc, and not just the satisfactory level of each individual patient. I guess this is the difference between public health and medicine.

 

[dntke1518]

to address both posts, that is the problem when we try to define basic. No one is going to have a good definition. That is why I propose everyone that may be involved from both parties work to figure out exactly what "basic" means. I feel personally that basic care should be anything that is acute, demonstrably chronic, emergent, or prolonging. Meaning all vaccines, preventative measures, evidenced based treatments, and chronic pain that can be verified and is on a pain scale. Unfortunately, we as a country can't afford to fix every knee that is sore, but if it is excessively painful or inhibiting, then sure. People can pay more for better coverage, but this would be basic.

Another problem is that we have to provide this basic coverage from the cradle to the grave. People get off insurance at 65 and go to medicare, so it gives insurance companies a reason NOT to do preventive care, but unamimously people agree that in the long run, preventive care is much cheaper. But I think all parties need a say in what "basic" is.

When people think about anything, they think of themselves, and they think of the opposing outliar, and nothing else. For example, when people talk of tax reform, the say "I am paying a bigger percentage that warren buffet, so the top 5% need to chip in more," but people neglect the non billionaires in that bracket who would feel the burden much more. This is exactly like health reform. The majority aren't doctors and the majority think doctors are overpaid, so republicans and democrats alike only think about the patient. The problem is, as I have demonstrated, if you neglect the doctors and take away their income, while keep malpractice high and education high, it will negatively affect the patients. And that what I want people to understand about social medicine. When start taking money out of the doctors pockets, the patients will suffer much more than the doctors.

Totally agree with the bolded. I feel that many people think that healthcare should take care of anything that makes them the slightest bit uncomfortable. I do feel that people should be given the "basic" care that you are talking about (i.e. vaccines, preventative care <= esp this). Just a side note, on your Warren Buffet tax comment, what I feel that majority of people don't understand is that even at his 5% Mr. Buffet pays far more in taxes than those with a higher percentage. Does Mr. Buffet owe the government more for the services that it provides to him as compared to someone with less income? No way. Just food for thought, as this is along the lines of what you describe will happen to doctors, and I totally agree with that.

 

[dntke1518]

Of course, it is on the expense of the doctors, doctors there work more and get paid less, but I must say some doctors in the US are extremely overpaid, 300,000 per year for specialists??? come on!!!! ....but it is not easy for people to accept pay cuts, is it?

No its not easy to take pay cuts when there is a debt load and other expenses that the general population does not think about such as malpractice.

 

[Didierdrogba]

No its not easy to take pay cuts when there is a debt load and other expenses that the general population does not think about such as malpractice.

Then the problems lie in maybe the US has too many private clinics? If this can be nationalized or at least integrated, then this can drive the malpractice insurance rates down since more doctors share responsibilities. For this, I still blame the lack of organization in the US healthcare system.

 

[Dharma]

To those people who don't think European models perform better in terms of health outcomes and claim that I'm just making up stuff: don't be lazy and go look up the stats and papers yourself. I really don't want to spend more of my time explaining stuff that everyone outside America already knows (global warming, does that ring a bell?).

When an individual repeatedly makes strong claims (in your case that European models outperform that of America) it is that individual's responsibility to support such claims with evidence, not that of his audience. If anything it is lazy to just keep repeating the same thoughts without any sources to support your position. Maybe you can point your audience in the direction of the source where you originally acquired this information you speak of...

 

[dntke1518]

Then the problems lie in maybe the US has too many private clinics? If this can be nationalized or at least integrated, then this can drive the malpractice insurance rates down since more doctors share responsibilities. For this, I still blame the lack of organization in the US healthcare system.

I don't think the issue has to do with private clinics... Talking about pay cuts to physicians would cover reimbursments from the government or insurance companies not being adequate no matter where you are. Banding together won't change malpractice rates, there is still the likely event that someone will find some opportunity to be sue happy for something that is most likely not negligence. That is what keeps malpractice rates where they are, not entreprenuership

 

[Didierdrogba]

I don't think the issue has to do with private clinics... Talking about pay cuts to physicians would cover reimbursments from the government or insurance companies not being adequate no matter where you are. Banding together won't change malpractice rates, there is still the likely event that someone will find some opportunity to be sue happy for something that is most likely not negligence. That is what keeps malpractice rates where they are, not entreprenuership

but in my understanding, I could be wrong, don't hospitals or large clinics cover most of malpractice insurance premiums?

When an individual repeatedly makes strong claims (in your case that European models outperform that of America) it is that individual's responsibility to support such claims with evidence, not that of his audience. If anything it is lazy to just keep repeating the same thoughts without any sources to support your position. Maybe you can point your audience in the direction of the source where you originally acquired this information you speak of...

There is a thing called google....

According to the WHO (2000), WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

From the above criteria, the US ranks #37 in the world, and of the 36 countries, 23 are European countries, and of the European countries that rank behind the US, most are former Eastern Bloc countries. As per an article in NEJM (2010) "Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?"

Is this enough for you?

References
http://www.who.int/whr/2000/media_centre/press_release/en/index.html
http://www.nejm.org/doi/full/10.1056/NEJMp0910064

 

[FrkyBgStok]

Didierdrogba- I feel like we keep going round and round. I am not arguing with you on the fact that national coverage would provide better satisfaction to America as a whole. Sure it would. But if we are going to drastically change a system, why not do it right the first time? America already pays the most for health insurance, why not set up the best system?

So again, I agree. A national system like Europe would be better, but it wouldn't be the best. I will admit though, that my experience with occupational medicine has jaded me to a socialized system. If you cut anyones pay too far, you are going to cause problems. Yes, some doctors are overpaid, but the cost of med school is high. Malpractice is also high. Regardless, physicians are going to see a pay cut in the future. Evem, if we stay on the system we have, companies will continue to want to increase their profits and compensation will decrease. It is a fact of life that many physicians need to understand.

 

[Didierdrogba]

Didierdrogba- I feel like we keep going round and round. I am not arguing with you on the fact that national coverage would provide better satisfaction to America as a whole. Sure it would. But if we are going to drastically change a system, why not do it right the first time? America already pays the most for health insurance, why not set up the best system?

Then, what is the best system? I guess my point is that we can't just make something up from scratch, it has to be based on some existing system, and since what they have in Europe works well, why not change our system into something similar to that, rather than trying to simply improve the employer based model that we currently have?

 

[dntke1518]

Then, what is the best system? I guess my point is that we can't just make something up from scratch, it has to be based on some existing system, and since what they have in Europe works well, why not change our system into something similar to that, rather than trying to simply improve the employer based model that we currently have?

Someone at some point had to make something from scratch... Lets not put our abilities in the dirt. Personally, I think the best system is one where basic needs are provided for and other services can be covered by different private plans. Yet there needs to be oversight into curbing the abuse of services provided (i.e. emergency room visits for a sore throat that has been persiting for a week and a half). It has to be a proactive aproach by many different sources... government, private sector, phyisicans, medical schools, and the general public.

 

[FrkyBgStok]

Someone at some point had to make something from scratch... Lets not put our abilities in the dirt. Personally, I think the best system is one where basic needs are provided for and other services can be covered by different private plans. Yet there needs to be oversight into curbing the abuse of services provided (i.e. emergency room visits for a sore throat that has been persiting for a week and a half). It has to be a proactive aproach by many different sources... government, private sector, phyisicans, medical schools, and the general public.

+1.

Why can't we innovate? America used to be all about innovation and trying new things. If we do what everyone else does, we will get the same results as everyone else. We stay on a for profit system, we have this crap we have. If we go to socialized medicine we get the wait times and the diminished coverage (as in not the newest stuff). So if we make a new system we may be able to achieve everything. This is simple business. Find a market and fill it.

 

[unmedicofuturo]

And @ FrkyBgStok, you might argue that the negative effects of nationalized healthcare is increased wait time and lack of availability of new drugs, yes, that may be true at the individual patient level. However, if we evaluate a health system, we must look at life expectancy, DALYs, and burdens of diseases, economic impacts, etc, and not just the satisfactory level of each individual patient. I guess this is the difference between public health and medicine.

Yes, there's the rub. Easy to conjecture in the abstract with no skin in the game. If you embrace the cost control capitation of universal payer, then you inherently also accept the model of population health over individual health. This model presents the following scenario: your 85 yr old grandmother has renal disease, actuarial models decree that she isnt within the criteria to receive EPO to combat anemia, an organ donation is not possible and dialysis benefits are limited i.e., rationed b/c of her age. Still lovin that one payer system? So much for Don't Tread on Me.

But hey, the population as a whole will benefit b/c we aren't wasting money on an end of life scenario AND we solved that nagging public good vs private good debate over healthcare role's in society. Sound like progress?

 

[Didierdrogba]

Yes, there's the rub. Easy to conjecture in the abstract with no skin in the game. If you embrace the cost control capitation of universal payer, then you inherently also accept the model of population health over individual health. This model presents the following scenario: your 85 yr old grandmother has renal disease, actuarial models decree that she isnt within the criteria to receive EPO to combat anemia, an organ donation is not possible and dialysis benefits are limited i.e., rationed b/c of her age. Still lovin that one payer system? So much for Don't Tread on Me.

It doesn't mean that a single payer system does not provide good care for those who need it. Please look into the Taiwanese system, where if you are not happy with what the national insurance provides, you can still pay out of pocket...Of course, this is based on the prerequisite that the national insurance is already doing a good enough job of making sure everybody gets adequate care.

The Taiwanese system never rejects patients based on age for medical services, including EPO and dialysis, as long as it is reasonable (rejecting happens way way way less frequently in the rest of the industrilized world than the in the US, where healthcare is supposedly a free choice for people). Plus, as far as organ donation goes, this is just an allocation problem, regardless of what health system you are in, you are basically subject to the same set of rules due to limited resources, thus, my 85 yo grandma WILL NOT get the organ no matter what.

 

[Didierdrogba]

+1.

Why can't we innovate? America used to be all about innovation and trying new things. If we do what everyone else does, we will get the same results as everyone else. We stay on a for profit system, we have this crap we have. If we go to socialized medicine we get the wait times and the diminished coverage (as in not the newest stuff). So if we make a new system we may be able to achieve everything. This is simple business. Find a market and fill it.

same results such as improving life expectancy? Not bad results to me.

 

[FrkyBgStok]

same results such as improving life expectancy? Not bad results to me.

ok you keep bringing up life expectancy, and I HATE using conservative arguments, however I will. When controlling for homicides, accidents, poor diet, and lack of exercise, the US life expectancy is one of the highest in the world. And even if it is true, you cannot base your entire system on one thing such as life expectancy.

 

[dntke1518]

+1.

Why can't we innovate? America used to be all about innovation and trying new things. If we do what everyone else does, we will get the same results as everyone else. We stay on a for profit system, we have this crap we have. If we go to socialized medicine we get the wait times and the diminished coverage (as in not the newest stuff). So if we make a new system we may be able to achieve everything. This is simple business. Find a market and fill it.

Boom. Exactly.

Also, life expectancy might be one thing to look at but really what should be taken into greatest consideration is the quality of life, not how long we can hang on.

 

[Didierdrogba]

.

Also, life expectancy might be one thing to look at but really what should be taken into greatest consideration is the quality of life, not how long we can hang on.

For quality of life, there are measures called DALY and QALY, Americans perform badly in these also.

Anyway, I think it is about time we agree to disagree

 

[FrkyBgStok]

For quality of life, there are measures called DALY and QALY, Americans perform badly in these also.

Anyway, I think it is about time we agree to disagree

No. I need to win and I don't know when to quit.

 

[Didierdrogba]

No. I need to win and I don't know when to quit.

This emoticon represents what will happen to me if I continue

 

[dntke1518]

This emoticon represents what will happen to me if I continue

 

[BlindPilot]

This will hurt the patients AND medicine long term. Many proponents of socialized medicine fail to address this potential problem and many more are just plain unaware that this is how it will be. All too often the focus is on quantity (i.e. how many will be insured) without much concern for quality. With the price of medical education today, it would be very difficult if not impossible toconvert to socialized medicine without a severe downgrade in the quality of care.

Socialized medicine, while havings it own unique set of problems, does not correlate to lower quality of care. Opponents of socialized medicine in the United States seem to forget we have a socialized system of medicine: the VA. Yes, the VA still has its problems and can always find ways to improve but the VA, since it was overhauled in the 90s, is more efficient and effective at delivering better quality care for lower the cost than the private sector of the U.S. healthcare system.

A couple of recent articles on the VA system:
http://www.ncbi.nlm.nih.gov/pubmed/22393093
http://jama.ama-assn.org/content/307/5/442.long

While extending a VA-type of model throughout the whole US health care system will most likely not work, associating socialized medicine with poor quality of care is not accurate.

 

[FrkyBgStok]

While extending a VA-type of model throughout the whole US health care system will most likely not work, associating socialized medicine with poor quality of care is not accurate.

Yes, but just because one system is great for a small group doesn't mean it will work for a large group. And you can't associate socialized medicine with poor quality of care, but using the VA example, you can't exactly associate it with awesome care either.

And there are good physicians and bad physicians. Of course, if you pay physicians $30,000/year there are still going to be some physicians that are amazing. The problem is that when you stick a physician with a $250,000 med school bill, and then you tell him that the only feasible way to pay this and make money is by shear volume, patient quality will take a hit. When the need for speed exceeds the need for quality, any product you ever make or service you provide will decrease in quality. This is how it is.

And with medicare and medicaid paying proportionally much less than other providers, it appears that the government undercuts to save money. And when you have the majority bitching about taxes and government spending, they will undercut as much as possible. And if this happens, the only possible way to make enough to pay the bills is shear volume. Now if we completely changed everything and made med schools free, this would be an ENORMOUS expense for the average taxpayer and opposed heavily by schools, organizations, hospitals, etc. No way this would ever pass.

The biggest reason why socialized medicine can never and will never work in America is simply because not enough Americans care about society as a whole anymore. If we can shift our way of thinking about our neighbor, maybe this idea would be entertainable. You cannot convince people to work together for the good of society until the treat each other as equals.


It is the threads like this that make me consider a DO/MPH.

 

[Didierdrogba]

Socialized medicine, while havings it own unique set of problems, does not correlate to lower quality of care. Opponents of socialized medicine in the United States seem to forget we have a socialized system of medicine: the VA. Yes, the VA still has its problems and can always find ways to improve but the VA, since it was overhauled in the 90s, is more efficient and effective at delivering better quality care for lower the cost than the private sector of the U.S. healthcare system.

👍

How could I have forgotten to mention anything about the VA??

 

[Dharma]

but in my understanding, I could be wrong, don't hospitals or large clinics cover most of malpractice insurance premiums?



There is a thing called google....

According to the WHO (2000), WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

From the above criteria, the US ranks #37 in the world, and of the 36 countries, 23 are European countries, and of the European countries that rank behind the US, most are former Eastern Bloc countries. As per an article in NEJM (2010) "Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?"

Is this enough for you?

References
http://www.who.int/whr/2000/media_centre/press_release/en/index.html
http://www.nejm.org/doi/full/10.1056/NEJMp0910064

NOPE. Those WHO rankings do not indicate that the healthcare model itself is more effective. (I knew this would be your bread and butter).

 

[Dharma]

This pretty much sums up all this talk of socialized medicine:

Medicine is a fascinating and wonderful profession, but the undertaking demands the highest caliber individual. There are two ways to insure that American doctors remain the best in the world: sustain competitive, free-market incentives, or go completely &#8216;socialist' by paying for the entire process of medical education and training as is done in many European countries. Obamacare does neither, and thus leaves physicians dangling in a precarious position as education costs continue to climb and reimbursements continue to fall.

You can't expect socialized medicine without socialized education to back it up. It just won't work. Quality would suffer. That said, maybe it is possible for an increase in programs like the NHSC to encourage more to enter primary care without the burden of being a quarter mil in debt. I know I'd take the deal...

(For the record, I'm not a fan of the phrase "Obamacare" bc it does have a tone of negativity and I do actually support certain aspects of the reform).

 

[FrkyBgStok]

I would be interested what portion of people that qualify for veteran's healthcare voluntarily pay for and utilize private insurance.

 

[Iliketoytles]

Someone at some point had to make something from scratch... Lets not put our abilities in the dirt. Personally, I think the best system is one where basic needs are provided for and other services can be covered by different private plans. Yet there needs to be oversight into curbing the abuse of services provided (i.e. emergency room visits for a sore throat that has been persiting for a week and a half). It has to be a proactive aproach by many different sources... government, private sector, phyisicans, medical schools, and the general public.

+1.

Why can't we innovate? America used to be all about innovation and trying new things. If we do what everyone else does, we will get the same results as everyone else. We stay on a for profit system, we have this crap we have. If we go to socialized medicine we get the wait times and the diminished coverage (as in not the newest stuff). So if we make a new system we may be able to achieve everything. This is simple business. Find a market and fill it.

I was hoping someone would suggest this. 👍

 

[Didierdrogba]

NOPE. Those WHO rankings do not indicate that the healthcare model itself is more effective. (I knew this would be your bread and butter).

OMG.... I'm not sure if you are just trolling or really know nothing about the evaluation of healthcare systems...

how else are you supposed to measure the effectiveness of healthcare systems?

 

[Dharma]

You will find many who find the methods utilized by the WHO to be flawed and the conclusions it has arrived at are debatable. (More later... typing on first gen android phone is cumbersome).

 

[Wolverines83]

Lots of great points in this thread. I can't remember the last time I read a thread this long without going "oh God, just another endless debate..." and tuned out. There's so much info that I admit I breezed through a lot of it so spare me the flamethrower of online anger if this was included deep in some of those paragraphs.

Aside from fixing obvious lifestyle problems (fast food, zero exercise, diabetes damn near being "cool"), there needs to be an incentive to see a physician for health maintenance and/or preventative care. Or at the very least we should try to limit the disincentive of going.

A couple people here spoke of non-profit for basic care and for profit after that (or some variation thereof). To put a spin on that, how about a cost-free system (for the patient) that provides for all patients to see primary care x times per year. Anything above that (ie, you didn't see your primary care and woops, now you're going to the cardiologist because you ignored PCP advice) is private/supplemental/etc. It basically would entail saying "Hey, get yourself checked out, it's free, or damn near free." And if you choose to not maintain yourself, you're accountable for the cost overruns.

At first glance that sounds exactly like dental insurance but since we're playing with big bucks for patients here (root canal vs hip replacement), that model won't fit exactly. It'd almost be like buying "procedural" insurance. Plus, theoretically, going to the PCP should reduce "procedural" premiums as it makes you less of a risk.

My major objection to having a single payer for every procedure is that, quite frankly, I should not pay premiums to keep my government insurance pool solvent so it can pay for cancer therapy for smokers or for statins for someone who refuses to eat healthy and exercise. I eat right and exercise, why should I be penalized for someone else's failure to maintain their health? That would be like charging the entire state of X more in auto premiums because all of a sudden the population was full of young males and they're more likely to crash. That wouldn't go over well. Extreme example I know...but still.

I think making it easy, affordable and even financially beneficial for patients to see their PCP is the way to go. Preventative care pays for itself in reduced procedures.

 

[Dharma]

OMG.... I'm not sure if you are just trolling or really know nothing about the evaluation of healthcare systems...

how else are you supposed to measure the effectiveness of healthcare systems?

The WHO rankings are not as an objective as reports have led the general public to believe. In terms of how the WHO arrived at their statistics, there are some factors that make sense and demonstrate objectivity, while others do anything but.

Health Level (25% of total score) does demonstrate such objectivity, however it fails to address factors that are not indicative of the success (or failure) of a particular health care system, such as homicide, poverty, diet, smoking, exercise, etc. To assume that these factors do not significantly contribute to life expectancy is to truly let logic pass one by. Regardless, the health level index proves to be the most objective of the bunch, along with Responsiveness (12.5%), which is not as difficult to measure.

Next we have Financial Fairness. This score (worth a 25% of the final ranking) is determined basically by seeing what percentage of total income a household spends on healthcare, and then comparing averages across particular economic subsets of the population to determine this so-called fairness. Obviously, poorer households will spend a larger percentage of total income on healthcare. That said, they will also spend a larger percentage of their total income on other items as well (food, housing, etc). The financial fairness score is based on the ideology that that those in the population with higher incomes should carry more of the financial burden of healthcare. (Should we extend this ideology to other factors such as food and housing? Sounds a bit "Red" to me...)

The WHO Financial Fairness factor awards the nation whose government flips more of the health care bill (that is, by having those households with higher income burden the cost; in other words, the more socialized systems receive higher scores). This obvious lack of objectivity is based on a particular value judgement. Whether you agree with this judgement or not, you cannot claim objectivity. That's a huge issue when these rankings are stated as concrete statistical results- results that many within the general public take at face value without knowledge of the methods used to determine the final outcomes. Now this does not mean that determining how much our poor are spending on healthcare is not important or should not be taken into consideration to some degree. However, its use in these rankings is highly debatable, due to the lack of objectivity and reliance on a particular ideology (clearly based on a socialistic stance ), especially when the rankings are presented as objective data.

Next we have the Health Distribution (25%) and Responsiveness Distribution (12.5%) which are, again, measures of inequality- neither of which are a measurement of healthcare outcomes; they are instead measures of the differences in quality of care across population subsets. The larger the difference between the lowest quality and the highest quality of care, the lower the score. The country that provides lower quality across the board (hence demonstrating a higher degree of equality) could receive a higher score than that of another whose population with higher incomes receive better quality of healthcare than that of it's poorer populations, even if the level of quality received by that poorer population is equivalent to that of the first country mentioned. So, again, we see the use of ideology to determine significant portions of the WHO rankings, this ideology being that all citizens should have access to the same quality of healthcare, regardless of income or the possibility that those with more income may be more likely to spend more on healthcare. (Again, I'll ask: should this ideology be extended to things such as food, rent, etc?) Regardless, of one's political ideology, one can, again, do anything but claim that these statistics are exclusively objective.

The above are just some of the issues of the WHO rankings. Others such as how the information was collected and compiled via random sampling (with high uncertainty percentages) or the use of OP (overall performance) vs OA (overall attainment) rankings prove to be problematic, as well as how those results were calculated. (When people quote WHO rankings they are often using the OP not the OA, which does change up the rankings quite a bit. The determination of OP is a tweaking of OA via formulas, and the methods used to derive this number are debatable). Point being, utilizing the WHO rankings for the purposes of determining how effective our healthcare system proves to be is not as straight forward as many would like it to be. (e.g. Stating that the US spends so much per person but with lower life expectancy is quite misleading without a clear explanation of the methods use to determine such 'statistics;' manipulating stats in one's favor is nothing new and something we should all be well aware of). The methods used to arrive at these rankings lack objectivity; their inclusion of a political ideology (that many do not share) tarnishes its reliability, unless of course, one shares a similar ideology and wishes to use its results to push an agenda.

All of this said, I do not think anyone truly feels that things can continue as is. The status quo does not suffice. As someone mentioned earlier, Americans are some of the most innovative people since the dawn of the man, and we will arrive at our own solution. While the WHO rankings may help highlight some areas where improvement is necessary, its current methods are flawed, lack objectivity, and are not capable of determining how effective our current system is relative to that of the rest of the world.

 

[Dharma]

A couple people here spoke of non-profit for basic care and for profit after that (or some variation thereof). To put a spin on that, how about a cost-free system (for the patient) that provides for all patients to see primary care x times per year. Anything above that (ie, you didn't see your primary care and woops, now you're going to the cardiologist because you ignored PCP advice) is private/supplemental/etc. It basically would entail saying "Hey, get yourself checked out, it's free, or damn near free." And if you choose to not maintain yourself, you're accountable for the cost overruns.

I'm not sure how well our incompetent politicians can construct such a system, but I like the sound of this. Incentives are definitely a necessity, along with some kind of public health education and marketing to get the word out in efforts to mobilize the public should such a system set into place. I also like the idea of there being somewhat of a disincentive to not go see the PCP X-times a year, that being the financial risks associated with negligence.

I think making it easy, affordable and even financially beneficial for patients to see their PCP is the way to go. Preventative care pays for itself in reduced procedures.

Primary care and preventative medicine must be strong on the front lines. Now if we can only encourage future physicians who truly have an interest in internal and family medicine to get in the trenches, then we'd be on our way at improving the bottom line here in the US. Right now, many see that debt creeping up from overpriced medical education and it steers them away from the field and towards a more lucrative one. Potentially empty promises of loan forgiveness (that is, those that could possibly not be around by the time we finish our residencies) are not enough to overcome the fear for many. Regardless, we should have some of our best and brightest physicians in primary care if we want to see a significant improvement. So, if we want healthcare reform to truly work, it needs to include the financial aspect of medical education as well, at least in terms of the education/training of (future) primary care physicians.

 

[Wolverines83]

I'm not sure how well our incompetent politicians can construct such a system,

Man isn't it sad that your main doubt is our politicians? By the way, it's my main doubt as well.

Last time I checked, in this country, people who don't do their jobs get their asses fired. And last time I checked Congress worked in DC which, being part of the US, means their non-performing asses need to get fired. It's just a matter of voting them out in a mass exodus.

I know I'm beating the same drum that many others have beaten but I feel like no one takes that thought seriously. Imagine the message it would send if half of congress changed overnight.

Alright, political rant over....but yeah, I think it's completely possible that we can successfully reform our system, as long as those bums in DC stow their egos and get on board with the rest of us actual job-performing working Americans. ok, now political rant is REALLY over.

 

[FrkyBgStok]

Man isn't it sad that your main doubt is our politicians? By the way, it's my main doubt as well.

Last time I checked, in this country, people who don't do their jobs get their asses fired. And last time I checked Congress worked in DC which, being part of the US, means their non-performing asses need to get fired. It's just a matter of voting them out in a mass exodus.

I know I'm beating the same drum that many others have beaten but I feel like no one takes that thought seriously. Imagine the message it would send if half of congress changed overnight.

Alright, political rant over....but yeah, I think it's completely possible that we can successfully reform our system, as long as those bums in DC stow their egos and get on board with the rest of us actual job-performing working Americans. ok, now political rant is REALLY over.

This is what the Occupy movement is all about. We as a country elect politicians, and these politicians go to washington and vote for our wellness. Then a democrat gets a huge NRA donation right before a vote and all of a sudden, that democrat votes in favor of deregulating guns. Occupy is/was big because the 99% don't have money to directly influence politicians. They should be fired. But how can we expect our democratic leaders to vote for tax reform when they make $10 million per year? How can we make a universal system when the insurance companies, big pharm, and hospitals don't want it bad enough and they donate to politicians. It is real.

The problem with a free system is that someone has to pay for it. Dental insurance isnt free. But if we paid a monthly premium, we could do away with copays. But people elsewhere utilize the physicians much more, and they do it because they aren't worried what the doctor will say and how much insurance will pay. They know that whatever the problem is, it will be covered. And we need push preventive care. Hard. People need to know that a yearly physical is important. And I will put my BS aside. Other than my trucking physicals, I don't see the doctor. I am a big guy and my occmed doctors didn't care. I feel like I would have made healthier choices if I wad more accountable earlier. I maybe see a direct family physician for physicals once every few years. Hell, I am going to be a doctor. Doesn't make sense.

 

[Wolverines83]

The problem with a free system is that someone has to pay for it. Dental insurance isnt free.

Oh of course someone has to, no doubt. I know all about the insurance industry (used to work in it) and I realize dental's not free. What I was referring to was that dental plans encourage people to get regular checkups by covering those fully and by not covering cavities, root canals, etc fully. It creates an incentive to use a "free" service.

Person A goes to the dentist regularly and pays no copay, nothing out of pocket for routine checkups. Person A enjoys relatively good dental health, all things considered.

Person B has the same plan but doesn't go to the dentist because it's annoying and they don't like hearing that their teeth aren't healthy. Well, couple years down the road he has wicked tooth pain and has to get 2 root canals done. Those root canals cost $2000 and he's on the hook for $800 of it and the insurance company is out $1200. Or he's got perio disease and for the rest of his life has to see a periodontist basically out of pocket.

Patient B should have utilized his "free" biannual checkup (by free I mean he's still paying premiums...but let's say that came from tax dollars). It's good for the patient and for the insurance company. Honestly, the only reason those companies offer the "free" checkups is to keep their own long term costs down, but it still works. Now as far as the dentist? Probably not quite as good as cranking out root canals but oh well.

EDIT: Another thought...the reason medical insurance doesn't cover preventative the way dental does? Your physician is worried about lawsuits in the back of his mind. Defensive medicine would make it unsustainably expensive to implement the type of plan I mentioned. Two words: Tort Reform.

 

[FrkyBgStok]

Oh of course someone has to, no doubt. I know all about the insurance industry (used to work in it) and I realize dental's not free. What I was referring to was that dental plans encourage people to get regular checkups by covering those fully and by not covering cavities, root canals, etc fully. It creates an incentive to use a "free" service.

Person A goes to the dentist regularly and pays no copay, nothing out of pocket for routine checkups. Person A enjoys relatively good dental health, all things considered.

Person B has the same plan but doesn't go to the dentist because it's annoying and they don't like hearing that their teeth aren't healthy. Well, couple years down the road he has wicked tooth pain and has to get 2 root canals done. Those root canals cost $2000 and he's on the hook for $800 of it and the insurance company is out $1200. Or he's got perio disease and for the rest of his life has to see a periodontist basically out of pocket.

Patient B should have utilized his "free" biannual checkup (by free I mean he's still paying premiums...but let's say that came from tax dollars). It's good for the patient and for the insurance company. Honestly, the only reason those companies offer the "free" checkups is to keep their own long term costs down, but it still works. Now as far as the dentist? Probably not quite as good as cranking out root canals but oh well.

And this is a perfect example of why our system doesn't work. It is much cheaper to prevent problems before they occur, or fix small problems. A cavity is cheaper and better than a root canal (for the patient). A breast lump is better than stage 4 cancer. Definitely agree with you. But as a health insurance company with profits as the main concern, paying $50 for each physical (no idea of the cost, just using broad numbers for calculation) for 65 years is plus a ancillary stuff is a few thousand dollars times millions of people. But not pushing preventive care, they keep profits and push the sick patient on medicare at 65, a time when health costs skyrocket normally. The dental example is a perfect example.

We need an organization that spreads the importance of preventive care. Like Susan Komen or whatever that breast cancer awareness one is.

And to address your edit: I have mentioned many times in this thread that tort reform is a must. Doctors run too many tests, but they have to, or else they get sued.

 

[Wolverines83]

And this is a perfect example of why our system doesn't work. It is much cheaper to prevent problems before they occur, or fix small problems. A cavity is cheaper and better than a root canal (for the patient). A breast lump is better than stage 4 cancer. Definitely agree with you. But as a health insurance company with profits as the main concern, paying $50 for each physical (no idea of the cost, just using broad numbers for calculation) for 65 years is plus a ancillary stuff is a few thousand dollars times millions of people. But not pushing preventive care, they keep profits and push the sick patient on medicare at 65, a time when health costs skyrocket normally. The dental example is a perfect example.

We need an organization that spreads the importance of preventive care. Like Susan Komen or whatever that breast cancer awareness one is.

And to address your edit: I have mentioned many times in this thread that tort reform is a must. Doctors run too many tests, but they have to, or else they get sued.

That's a good point about pawning off the expensive patients on medicare. Maybe I didn't outright state it above, but I was eluding to a government funded program to ensure preventative care with people having the option to acquire "procedural" insurance privately.

Of course that might lead to higher taxes (the thought of which I loath) BUT...this prevention is money saved by reducing medicare's payment for chronic illnesses developed during a lifetime of smoking/drinking/injecting pure glucose into our veins. So who knows, it might be cheaper in the long run.

And yeah, we are in serious need of a general attitude adjustment...some celebrity should get on TV and say HEY, YOU DIABETICS ARE BANKRUPTING AMERICA (kidding...sort of...) But we really do need some of those "this is your brain, this is your brain on drugs" commercials. Remember them? With the eggs?

 

[FrkyBgStok]

And yeah, we are in serious need of a general attitude adjustment...some celebrity should get on TV and say HEY, YOU DIABETICS ARE BANKRUPTING AMERICA (kidding...sort of...) But we really do need some of those "this is your brain, this is your brain on drugs" commercials. Remember them? With the eggs?

[YOUTUBE]http://www.youtube.com/watch?v=kTBa0Ohwauc[/YOUTUBE]

 

[Wolverines83]

[YOUTUBE]http://www.youtube.com/watch?v=kTBa0Ohwauc[/YOUTUBE]

I have to admit that is the exact scene that made me mention those commercials, lol. that's hilarious....the exact thought

 

[Poliscidoc]

After my last healthcare finance exam for my MBA program. I can say that no one knows a true solution. But we can perfect complicating healthcare like no other.

Well my brains fried, time for a shot to cool it down.

(insert cheers emoticon)

 

[donkeykong1]

Healthcare should not be treated as a commodity, should not be viewed as a product set for exchange. Rather it is a right which morally should be available to every individual whatever their risk just like every child in the U.S has a right to a public school education. Thus in my eyes the individual mandate has been long overdue.

Until the government forces all physicians to accept patients on the public option, nothing really will change. The crazy overhead costs which come from a privatized system also has not been solved. Salaries for mid-levels and PCPs might go up, procedural specialties might see salaries go down since it appears the focus of the Affordable healthcare act will be more on prevention. just my 2 cents.

 

[FrkyBgStok]

Until the government forces all physicians to accept patients on the public option, nothing really will change. The crazy overhead costs which come from a privatized system also has not been solved. Salaries for mid-levels and PCPs might go up, procedural specialties might see salaries go down since it appears the focus of the Affordable healthcare act will be more on prevention. just my 2 cents.

I was talking to my brother-in-law about this just tonight. My problem with Obama's plan is that it doesn't change the system, it just forces insurance companies to abide by certain rules. But the for profit system will say, "we aren't reducing profits, so where we are paying out more here, we will take away over there."

 

[donkeykong1]

I was talking to my brother-in-law about this just tonight. My problem with Obama's plan is that it doesn't change the system, it just forces insurance companies to abide by certain rules. But the for profit system will say, "we aren't reducing profits, so where we are paying out more here, we will take away over there."

Totally agree. Other than an individual mandate which really basically brings in more clients for insurance companies nothing has changed. Obama unsurprisingly caved into the insurance companies. And I say unsurprisingly because dollars from Goldman Sachs and JP Morgan are what fed his 2008 presidential campaign and it looks like they will do the same this year. Healthcare insurance companies make up a large amount of the portfolios of those juggernauts and there's no way Obama would disappoint them. Most people don't realize this and buy into the doom and gloom of healthcare reform, when in fact there really isn't any reform here at all, just another thick piece of do nothing legislation.

 

[ManBroDude]

I think the main problem with the way health care is delivered in the US is the way the system has evolved since the 40's and 50's to giant insurance companies (and subsequently, hospital system insurance programs in order to get a piece of the pie). I think the single best move would be to outlaw insurance companies. Yeah, that's right. Their overhead costs (administrative, executive pay, etc) are ridiculous, sometimes over 30%, which is what's plaguing America right now. Take away insurance companies, and we're forced to have a single-payer system and specialists and PCP's all have to shift around until they find something that works, which is to group up into 50-100 provider groups in hospitals and get paid based on production and level of quality (capitalism). The hospital/group doesn't have good outcomes/production? Patients can get the same stuff done at the one across town, and this would be the motive force driving competition. PCP's would be paid more (I hope) as they are more critical and foundational in the group than they are currently in the current system and in private practice. Investor-owned groups would all be bought out and and converted into the single payer model. Big pharma would stop charging billions of dollars in R&D just to add a methyl group to a medication that's up for patent expiration.

This is sort of what Arnold Relman, MD said in his book A Second Opinion: Rescuing America's Health Care (2007). He was the former Editor in Chief of the NEJM for years and years as he watched the current system go down the tubes in the 70's and 80's.

 

[DrCalculi]

Always follow the money. While Americans were bickering over the "death panels" and whatnot, the health insurance executives couldn't be happier with the individual mandate, and the drug companies with their no-negotiation drug prices for Medicare. One doesn't need a tinfoil hat to know who is running our government and the media.