Health Policy Questions

[bb88]

Hey all,
How are u guys tackling the two questions:

1: what would you do to mitigate the problem of 45million people that are uninsured and don't have access to decent health care?

2: how would you improve the health care industry overall?


I've had some ideas, but my interviewers have either loved it or hated it...what seems to be working for you all?

thanks

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[uclabruin2003]

1. cover all people some how. but i dont think insurance is just the key. there are other barriers to care even with insurance. lack of translators, lack of communication, etc.
2. focus on the barriers to care.

 

[IAMS]

Hey all,
How are u guys tackling the two questions:

1: what would you do to mitigate the problem of 45million people that are uninsured and don't have access to decent health care?

2: how would you improve the health care industry overall?


I've had some ideas, but my interviewers have either loved it or hated it...what seems to be working for you all?

thanks

Although our country has 45 million people uninsured, the majority of them get their healthcare at the emergency room, which may bill them, but the costs end up coming from other payers and insurance companies who can pay through inflated prices.

What to suggest? Subsidizing. This would make health insurance more affordable by taking the most expensive cases out of the insurance equation, - diabetes, cancer, conditions which require expensive and repetitive treatments - by having the government handle them. This ensures that everyone gets either the care they need or the insurance in case of any incident, and completely changes insurance equations, making it much more affordable for the average person/family.

 

[Brain]

What a proposed plan would essentially do is make health insurance more affordable by taking the most expensive cases out of the insurance equation, - diabetes, cancer, conditions which require expensive and repetitive treatments - by having the government handle them. QUOTE]

Most of these chronic conditions are preventable. Support public health programs aimed at better lifestyle choices (i.e., lost weight, quit smoking) and taxes to discourage people from smoking and eating fast food. Preventing these diseases is much cheaper than treating them. Additionally, prescription drugs cost insurance companies a lot of money. I would suggest government regulation of prescription drug costs as Canada does.

 

[IAMS]

Most of these chronic conditions are preventable. Support public health programs aimed at better lifestyle choices (i.e., lost weight, quit smoking) and taxes to discourage people from smoking and eating fast food. Preventing these diseases is much cheaper than treating them.

I agree, but we live in a democracy which encourages free choice. How many millions of people continue to smoke with all we know? Not to mention the increasing levels of obesity. People are sheep, and policy which depends on them making good choices is bad policy, in my humble opinion.

 

[swifteagle43]

vote republican...thats how u fix the problems of health care

 

[uclabruin2003]

Although our country has 45 million people uninsured, the majority of them get their healthcare at the emergency room, which may bill them, but the costs end up coming from other payers and insurance companies who can pay through inflated prices.

What to suggest? Subsidizing. This would make health insurance more affordable by taking the most expensive cases out of the insurance equation, - diabetes, cancer, conditions which require expensive and repetitive treatments - by having the government handle them. This ensures that everyone gets either the care they need or the insurance in case of any incident, and completely changes insurance equations, making it much more affordable for the average person/family.

making the govt pay for things isnt the answer. think of where the govt gets its money: taxes! so yes taxes (either corporate or individual will go up) pay for these things.

what we need is cost control. more research on health outcomes and cost benefit analysis (CBA)

 

[IAMS]

making the govt pay for things isnt the answer. think of where the govt gets its money: taxes! so yes taxes (either corporate or individual will go up) pay for these things.

what we need is cost control. more research on health outcomes and cost benefit analysis (CBA)

What you suggest is healthcare policy from the last 20 years, doesn't work, sunshine. Wrap your head around 45 million people, that's 1 in 5 Americans.

Think outside the box. If it weren't for subsidation, we'd be paying $5 a gallon for gas. Yes, it comes out of taxes, but it eases the burden for insurance and makes healthcare more affordable.

 

[uclabruin2003]

What you suggest is healthcare policy from the last 20 years, doesn't work, sunshine.

Think outside the box. If it weren't for subsidation, we'd be paying $5 a gallon for gas and $3 for an ear of corn. Yes, it comes out of taxes, but it eases the burden for insurance and makes healthcare more affordable.

Not sure where you are getting your info...but there has not been a big push for CBA, outcomes analysis or costeffectiveness. There are too many examples to even share that show that we arent gettiing more for our money. We are spending the most money out of all countries and yet we continue to get less and less.

The government already pays such a huge share of overall health care expenditures (~60%). What they need to do is to reallocate it in such a way to provide care for everyone. We basically already spend enough money on healthcare to cover everyone. A lot of money is spent and wasted on procedures and treatments that do not get any benefits.

We need to analyze the benefits that we are getting from our prescriptions. I mean is there that big of a difference between Nexium and Prilosec (OTC). Is one so much better than the other? There are thousands of examples out there (not just prescriptions...). my 2 cents.

 

[IAMS]

We need to analyze the benefits that we are getting from our prescriptions. I mean is there that big of a difference between Nexium and Prilosec (OTC). Is one so much better than the other? There are thousands of examples out there (not just prescriptions...). my 2 cents.

Okay. Who makes these analyses, and how do you keep pharmaceuticals out of this process, when you start trying to say one thing is better than another in terms of policy, that is where you start taking power away from practitioners.

 

[uclabruin2003]

Okay. Who makes these analyses, and how do you keep pharmaceuticals out of this process, when you start trying to say one thing is better than another in terms of policy, that is where you start taking power away from practitioners.

Well this was what I did in undergrad. Costeffectiveness analysis is useful...

Not sure how you keep the pharm companies out of this process....or why would need to?

Most HMOs have formularies meaning that they will only let you have certain drugs out of a range of drugs. Meaning if there are 3 cholesterol lowering drugs...they will typically take what they think is best and recommend that. They will then make you buy that (at a cheaper rate) or if you want something else (you pay more).

I am currently studying health policy so yes...policy in some manner does take away power from physicians, etc. Thats why physicians dont like policies like these and with their strong lobbying group...thats why certain policies dont get passed. The AMA is very strong...

 

[IAMS]

I am currently studying health policy so yes...policy in some manner does take away power from physicians, etc. Thats why physicians dont like policies like these and with their strong lobbying group...thats why certain policies dont get passed. The AMA is very strong...

It's all about power when it gets boiled down, and what we need is a balance of interests that doesn't leave the patient high and dry, financially speaking. I imagine studies, or analyses, take time and resources, and in the fast changing world of medicine, that may be why I'm from the school that seeks simpler broader solutions. I'm going to specialize in health policy as well. Anyway, I see the validity in your points, thanks for the exchange.

 

[Brain]

I agree, but we live in a democracy which encourages free choice. How many millions of people continue to smoke with all we know? Not to mention the increasing levels of obesity. People are sheep, and policy which depends on them making good choices is bad policy, in my humble opinion.

True, I totally agree that knowledge of smoking causing lung cancer, cardiovascular disease and other problems doesn't cause people to quit. Just look at all of the physicians who smoke. But use of tobacco and alcohol is strongly correlated with price. A 1% national sales tax on cigerettes contributed toward healthcare goes a long way and has the added benefit of getting people to quit because they aren't will to pay the high prices.

 

[Dr. AYY]

You each have some very interesting points and I was thinking about this one for a while and obviously none of us have the clear cut answer or else we would try and implement it and save the American healthcare system. However, after looking at some other countries methods of socialized medicine I realized that their care is not as advanced as ours. To this notion I offer the following proposition to alleviate the burden of cost to taxpayers as well as achieve a more universal healthcare policy:

1)Looking at foreign countries (UK, Canada, Israel etc.) with some form of national healthcare program I realized a common feature: HIGH TAXES. Now in that regard we have to realize the 200+ million Americans that currently do have health insurance each pays on average $70-250 a month for their policies. If that money is pumped into governmental bonds and used to fund a national healthcare program we could possibly achieve a universal healthcare policy (not to mention increase the value of the dollar). Now I am not an economist and this is just my speculation, but the interest accrued from the money taken from these health insurance fees would be substantial leading to the ability to fund more free or more likely subsidized (to a similar level that many people pay co-payment with their health insurance plane) clinics around the country. This is just an idea I have been throwing around in my head for a while and I would be extremely interested to get some feedback on it.

2)The current state of the American healthcare system tends to accentuate specialization and more so today then ever sub-specialization. I truly believe that this feature is what differentiates the American system as the best in the world. At the same point we have to have a more progressive movement towards preventative medicine in order to alleviate the stresses on a system that is already struggling to survive (our current healthcare crisis). I believe that there needs to be a balance between the preventative care and the specializations as each serves a vital role in a successful healthcare system. Specialists are crucial in diseases that are not preventable, while maintaining a policy of preventative medicine will alleviate some of the burdens faced by physicians today wrt the progression of diseases that were easily preventable but given the time became a larger problem and burden on the healthcare system and insurance companies.

No one will disagree that politics (mainly lobbying) plays a vital role in the structure of our healthcare system and governmental healthcare policy as a whole, but I believe that this is still a democracy (a representative one but we can settle for that) and the public opinion still has the greatest impact on public policy the only problem is how do we get the message out that in order to better the healthcare system the people voice must override the political lobbyists' (both the AMA, Pharmaceutical companies, health insurance companies and of course lawyers).

I am sorry for the long post but I can honestly say that this is one issue that I feel is crucial to the rest of my life and I believe to all of ours and therefore believe we should think about very carefully.

 

[IAMS]

1)Looking at foreign countries (UK, Canada, Israel etc.) with some form of national healthcare program I realized a common feature: HIGH TAXES. Now in that regard we have to realize the 200+ million Americans that currently do have health insurance each pays on average $70-250 a month for their policies. If that money is pumped into governmental bonds and used to fund a national healthcare program we could possibly achieve a universal healthcare policy (not to mention increase the value of the dollar). Now I am not an economist and this is just my speculation, but the interest accrued from the money taken from these health insurance fees would be substantial leading to the ability to fund more free or more likely subsidized (to a similar level that many people pay co-payment with their health insurance plane) clinics around the country. This is just an idea I have been throwing around in my head for a while and I would be extremely interested to get some feedback on it.

I'm not an economist either, but one issue we have to take into account is the amount of retiries we will encounter very soon with the baby boomers approaching retirement age. This is what threatens social security, so how do you weigh demographics with this type of structure - Who pays, who benefits?

Anyway, it's simple enough, I like it.

 

[uclabruin2003]

I'm not an economist either, but one issue we have to take into account is the amount of retiries we will encounter very soon with the baby boomers approaching retirement age. This is what threatens social security, so how do you weigh demographics with this type of structure - Who pays, who benefits?

Anyway, it's simple enough, I like it.

you are right. health care is such a complex animal. you have to constantly think about the proponents and opponents. sometimes, there isnt a right or a wrong. its not all black and white. in any case, this is probably one of the better and more thoughtful threads on this forum. you all rock!

 

[IAMS]

I had another thought on the power thread.
I have to admit I'm biased against Pharmaceuticals, and their power needs to be limited. I'm alarmed at the influence they have over the FDA, evident in the whole fiasco with Vioxx. I've had close friends who became addicted to anti-depressants, one of whom stopped taking it and committed suicide.

When you get down to it, Pharmaceuticals are geared toward not curing disease, but making profit - which is done by creating clients who will take medicine every day for the rest of their lives. Still, we are very dependent on these companies to ease suffering. Just another issue to consider.

 

[Dr. AYY]

I had another thought on the power thread.
I have to admit I'm biased against Pharmaceuticals, and their power needs to be limited. I'm alarmed at the influence they have over the FDA, evident in the whole fiasco with Vioxx. I've had close friends who became addicted to anti-depressants, one of whom stopped taking it and committed suicide.

When you get down to it, Pharmaceuticals are geared toward not curing disease, but making profit - which is done by creating clients who will take medicine every day for the rest of their lives. Still, we are very dependent on these companies to ease suffering. Just another issue to consider.

Ingamina is definetely right. The Pharmaceutical companies have way too much control, in fact over half of the budget of the FDA is paid by the pharm companies, that is just messed up. I read articles about FDA monitors that were fired for not approving a drug (and they were absolutely correct in doing so as it was an unsafe drug in clinical trials). When the pharm companies have the control over the federal regulations then in essence there are no regulations on the drugs that are released. The sad truth is that medicine has become a business first and a means to better the human condition second. Any suggestions on what we can do about it ????\

I think we should have a third party regulation committe to review the drugs (in essence what the FDA is suppossed to be) or at least make sure the pharm companies aren't the main proprieter of the FDA. just my thoughts

 

[skoaner]

I think I muffed this kind of question in an interview. I started bumbling about opportunity frontiers and needing to establish a happy medium while satisfying needs on both ends.. Yikes, what was I thinking?!?

 

[IAMS]

Any suggestions on what we can do about it ????\

Getting the FDA to do it's job is what we need. That's difficult, though, when the only moderator who calls for more investigation is asked not to participate due to a "difference of opinion".

 

[skiracer90]

Would it be possible to stop pharm companies from funding the FDA? Wouldn't the eliminate this bias? Or, would the FDA tank because they are so dependent of the pharm funding?

 

[IAMS]

For one, tighter restriction on what uses a drug is passed for, meaning limit the mass marketing of drugs to large audiences when it's only intended for a specific group of people with any side-reactions taken into account. But the FDA lacks authority and resources to do this. They can't tell people that drugs are effective. They rely on studies performed by the pharmaceuticals, and only those studies the pharmaceuticals wish to disclose.

 

[bonez318ti]

1)Looking at foreign countries (UK, Canada, Israel etc.) with some form of national healthcare program I realized a common feature: HIGH TAXES. Now in that regard we have to realize the 200+ million Americans that currently do have health insurance each pays on average $70-250 a month for their policies. If that money is pumped into governmental bonds and used to fund a national healthcare program we could possibly achieve a universal healthcare policy (not to mention increase the value of the dollar). Now I am not an economist and this is just my speculation, but the interest accrued from the money taken from these health insurance fees would be substantial leading to the ability to fund more free or more likely subsidized (to a similar level that many people pay co-payment with their health insurance plane) clinics around the country. This is just an idea I have been throwing around in my head for a while and I would be extremely interested to get some feedback on it.

The money collected by insurance companies don't just sit in bank accounts. They are used to cover existing claims (that is the premise of insurance). In order for there to be enough interest acrual to pay for universal coverage, you are looking at an impossibly huge number.

There are pros and cons to our method of insurance vs. the socialist countries. As much as people say we have a crappy health care system, in terms of quality, choice and accessibility, we are the BEST. The worse part is that it is relatively expensive and leaves a substantial portion of our population uncovered. Countries like Britain suck in terms of accesibility and choice, but most people are covered. Before you condemn our system, ask yourself.. if you are 65 years old and you have cancer, do you want to be told that "sorry, there is nothing we can do for you" (aka: what you would hear in britain) or do you want to hear "do you have the 500,000 for treatment?" (what ou would hear in the states). Assuming you are uninsured in the US, sure, it sucks to hear that you gotta find 500k.. but atleast it gives you an OPTION. Under the socialist system, you dont even have a choice. (their perspective is, that 500k used to treat a 65 year old person can obtain much more benefit in.. say.. treating a 30 year old patient.. longer life expectancy.. so higher benefit to cost ratio)

Its not that it is impossible to find a solution to this problem, it is that the pill is too hard to swallow for any one generation. (its just simply unfair).. Bush's plan in forcing consumer driven healthcare is a step in the right direction. It will show consumers the true cost of healthcare, and make them more aware of how expensive it is. This will hopefully make consumers make an informed decision of the 'value' they are getting for their healthcare dollar, and hopefully reduce elective surguries.

As for the uninsured:
middle class uninsured: Making health costs come from pretax dollars should spur people to contribute to their HSA accounts.. and purchase the high deductible insurance.. thus giving them coverage..

lower income uninsured: Medicaid/Medicare

 

[jefguth]

There are pros and cons to our method of insurance vs. the socialist countries. As much as people say we have a crappy health care system, in terms of quality, choice and accessibility, we are the BEST. The worse part is that it is relatively expensive and leaves a substantial portion of our population uncovered. Countries like Britain suck in terms of accesibility and choice, but most people are covered. Before you condemn our system, ask yourself.. if you are 65 years old and you have cancer, do you want to be told that "sorry, there is nothing we can do for you" (aka: what you would hear in britain) or do you want to hear "do you have the 500,000 for treatment?" (what ou would hear in the states). Assuming you are uninsured in the US, sure, it sucks to hear that you gotta find 500k.. but atleast it gives you an OPTION. Under the socialist system, you dont even have a choice. (their perspective is, that 500k used to treat a 65 year old person can obtain much more benefit in.. say.. treating a 30 year old patient.. longer life expectancy.. so higher benefit to cost ratio)

True, the USA probably has the best system in terms of available quality, choice, and accessiblity. However, I must disagree that countries with universal health insurance rank far below the US (in your words "suck"). Patients in Canada, UK, France, etc. have access to exactly the same medical treatments as Americans. However, where we fall behind (at least in Canada) is in terms of immediate treatment and the distances that some people have to travel for tertairy care since very specialized care in provided only in the largest cities. Waiting times have dramatically increased in Canada since the early 90's because the governemnt reduced funding, closed under utilized facilities, and did not expand the level of service even as the population grew. Although ill Canadians may have to wait for treatments, the principle of triage is still practiced and no person goes without medically necessary care when needed.

I should also point out that our system does NOT use any cost-benefit analysis to determine what patients will recieve a treatment (65 yo vs. 30 yo) or even what treatments will be provided. The only instance in which a scenerio of the type you present might even be considered is when an ethical commitee has to decide who gets what organs when there are conflicting demands for organ transplantation.

Furthermore, any procedure that costs $500K in the USA will cost much less elsewhere. Why? Partly because our system allows us to contain expenses: Physicians do not make the exorbanent salaries they do in the USA (and rightfully so because their education is HIGHLY subsidized by the state), pharmaceutical prices are regulated by the state, insurance is non-profit and admistered by the state, judicial precedent has not resulted in massive malpractice awards and thus malpractice insurance in MUCH less expensive.

All in all I think that we are able to maintain very similar levels of care (if not better; Canadians have a longer life expectancy and studies have shown that negative outcomes are more likely in private hospitals) more efficiently and at reduced expense because it is all done without private companies (insurers, hospitals) taking their profits off the top.

 

[IAMS]

Okay, let's not have this degrade into a US vs Canada thread. Canada has it's own system with definite merits, but what we should concentrate on is health policy situations today, what problems, and improvements we might make to it.

 

[ASDIC]

i was asked these questions at an interview in NYMC.

I am an economics major and everybody thinks that socialized medicine is the best way to solve the 45 million uninsured problem...unfortunately thats not the best way.

The best way to solve it is to make healthcare affordable and how can we do that? The govt needs to subsidize healthcare to employers so that they can pass on these benefits to the employees.

The subsidies may come from taxes or through public investment in government securities like bonds. Furthermore, the govt needs to create jobs, so that more jobs provide more benefits to to the employees.

 

[uclabruin2003]

why isnt socialized medicine the best answer? if you are referring to socialized medicine as they have it in other countries...yes thats not the best. but socialized medicine doesnt have to be exactly how it is done in the UK or Canada.

one remark about MSA/HSAs: they arent really good about making you feel the cost of healthcare. most of the healthcare costs in the country are not because of these small visits you have to the doctor and your everyday prescriptions. most of the costs are borne by people who have chronic illness, require big treatments and procedures. MSas/HSAs would be combined with a catostrophic insurance plan....so for example if you already spent 5000 out of pocket...the insurance will pay the rest. in reality MSAs/HSAs dont curtail people's use of healthcare. yes it may lower some costs of the everyday person who doesnt use health insurance anyways but the amount saved will relatively be small. the people who need more healthcare will still use it. thats why MSAs wont work.

i think somewhere around 60-70% of medicare costs are spent within the last year of life of a medicare patient. that is a big sum. how can we control those costs? i dont want to sound cruel to old people but hey thats a big portion of the pie that doesnt yield much results.

 

[bonez318ti]

The subsidies may come from taxes or through public investment in government securities like bonds. Furthermore, the govt needs to create jobs, so that more jobs provide more benefits to to the employees.

This is flawed. The last thing employers want to do is be responsible for the health care of their employees... they want to help, but there is a problem when the largest business expense is for healthcare.. (ie: rather than cost for raw materials for manufacturers)

our current system shelters the real cost of medicine from employees (ie: 5$ copay = real cost of a visit to the consumer) leading to high utilization and an increase of costs on the system (driving up insurance premiums)

 

[bonez318ti]

True, the USA probably has the best system in terms of available quality, choice, and accessiblity. However, I must disagree that countries with universal health insurance rank far below the US (in your words "suck"). Patients in Canada, UK, France, etc. have access to exactly the same medical treatments as Americans. However, where we fall behind (at least in Canada) is in terms of immediate treatment and the distances that some people have to travel for tertairy care since very specialized care in provided only in the largest cities. Waiting times have dramatically increased in Canada since the early 90's because the governemnt reduced funding, closed under utilized facilities, and did not expand the level of service even as the population grew. Although ill Canadians may have to wait for treatments, the principle of triage is still practiced and no person goes without medically necessary care when needed.

Im sorry, I didn't mean to say they 'sucked'.. typed it without thinking about it. In reality, both systems have their pros and cons. But something that Americans value is choice and of course we hate waiting.. thats why an outright socialist system will never happen here.

I think with the changes proposed with the Bush administration, we will move towards a tiered healthcare system, which marries the best of both systems.

Regarding your comment about costs in the US vs. costs abroad.. one reason why healthcare is so expensive in the US is because it is so cheap elsewhere (since costs are federally mandated). The R&D that goes into drugs and medical projects are real... When a government interferes with the market pricing of products, the additional cost is borne by those markets whos governments don't regulate the cost. So a drug can cost 3$ in Canada and $30 in the US.. but if prices werent regulated, theer will likely be more pricing parity.. and it may be $12 vs $16 (or whatever). Pharm profits are another discussion.. but I am not against pharms wanting to make a profit.. if there was no pot of gold at the end of the rainbow, we would not have innovation.

 

[bonez318ti]

why isnt socialized medicine the best answer? if you are referring to socialized medicine as they have it in other countries...yes thats not the best. but socialized medicine doesnt have to be exactly how it is done in the UK or Canada.

one remark about MSA/HSAs: they arent really good about making you feel the cost of healthcare. most of the healthcare costs in the country are not because of these small visits you have to the doctor and your everyday prescriptions. most of the costs are borne by people who have chronic illness, require big treatments and procedures. MSas/HSAs would be combined with a catostrophic insurance plan....so for example if you already spent 5000 out of pocket...the insurance will pay the rest. in reality MSAs/HSAs dont curtail people's use of healthcare. yes it may lower some costs of the everyday person who doesnt use health insurance anyways but the amount saved will relatively be small. the people who need more healthcare will still use it. thats why MSAs wont work.

i think somewhere around 60-70% of medicare costs are spent within the last year of life of a medicare patient. that is a big sum. how can we control those costs? i dont want to sound cruel to old people but hey thats a big portion of the pie that doesnt yield much results.

Some stats:
Only 2 people in 1000 incur over 100k in annual health care costs
10% incur over 10k
71% incur less than 500
38% spend nothing
(source: Towers-Perrin)

Ideally, if people started their HSA's while they are young.. they will likely continue to accrue assets in their HSA accounts since young people typically have very low medical expenses. The reason why HSAs allow you to roll over your money year to year (vs. FSAs where you lose it if you dont use it within a year).. is so people will have more to use once they get older, alleviating the burden from the public system. What they need to do is to say that you can ONLY spend HSA $$ on health care, and you cant withdraw it for any reason except for medical care. Currently it can be withdrawn at 65, which lends itself to abuse (ie: people using it as a tax shelter and then withdrawing it all and relying on medicaid anyway)

But you are right.. A concern of consumer driven health care is adverse selection. (ie: People with high costs will stay in traditional plans and only healthy people will switch to HSAs)

 

[uclabruin2003]

HSAs will def spell trouble bc there will definitely be a selection bias. no questions. this means that people who are in the HMOs are more likely to be "unhealthy" and spend more money. of course if they spend more money...the risk is shared less between the unhealthy and so those who are unhealthy will see their premiums skyrocket. therefore the healthy people end up paying less and the unhealthy people really "pay" for their healthcare. there will be less spreading of risk for the unhealthy and then we will run into another problem.

 

[IAMS]

I agree, the Bush plan, if passed, will leave even more people without healthcare. What is morally acceptable, and this is where opinions may differ, is how do we make healthcare more accessible?

I don't see the United States getting rid of insurance companies and replacing them with a government finance bureaucracy.

By the way, I'm from Utah. I"m very worried for the department of Health and Human Services under Mike Leavitt.

 

[uclabruin2003]

I agree, the Bush plan, if passed, will leave even more people without healthcare. What is morally acceptable, and this is where opinions may differ, is how do we make healthcare more accessible?

I don't see the United States getting rid of insurance companies and replacing them with a government finance bureaucracy.

By the way, I'm from Utah. I"m very worried for the department of Health and Human Services under Mike Leavitt.

No I dont see the US ever getting rid of insurance companies....in one short note...we're too American to give up something like that.

I believe there is a big difference between health care coverage and accessibility to healthcare. Most people who have health care insurance cant even see a specialist for a long time. Others who only speak foreign languages are stuck.

Anyways why are you so worried about Utah regarding the new appointment at DHHS?

 

[IAMS]

Anyways why are you so worried about Utah regarding the new appointment at DHHS?

Not worried about Utah. Worried about DHHS.

Mike Leavitt is a good face to put on bad policies, that is why they put him in as head of the EPA. Not someone who has a grasp on how to fix problems, but he will tow the administration's line. He has a good track record as far as bringing people together to talk about issues, but his health and human services record in Utah is attrocious.

Again, I agree with you on accessible v. available. It may, and often does, come down to the physician, and how charitable he feels toward a particular patient.

 

[freaker]

I agree, but we live in a democracy which encourages free choice. How many millions of people continue to smoke with all we know? Not to mention the increasing levels of obesity. People are sheep, and policy which depends on them making good choices is bad policy, in my humble opinion.

Tax the bloody living daylights out of tobacco...just a suggestion.

It amazes me our government goes after steroids and baseball like they've been doing and completely ignores smoking.

Jack up the taxes on alcohol while we're at it. Especially for those selling it at public events.

 

[uclabruin2003]

Not worried about Utah. Worried about DHHS.

Mike Leavitt is a good face to put on bad policies, that is why they put him in as head of the EPA. Not someone who has a grasp on how to fix problems, but he will tow the administration's line. He has a good track record as far as bringing people together to talk about issues, but his health and human services record in Utah is attrocious.

Again, I agree with you on accessible v. available. It may, and often does, come down to the physician, and how charitable he feels toward a particular patient.

its not just physicians who make the accessible vs available care. i think i already brought this up but....mediciaid patients in NYC are more likely to be seen in a clinic in a hospital by a resident while privately insured patients are seen by a faculty physician. although patients on both sides can access care...its more apparent that as a medicaid patient...you are getting the shorter end of the stick. its supposedly on the D/L that hospitals whole-heartedly agree with this bc it keeps the medicaid patients (who are mostly minority) out of the faculty practices which then make faculty physicians happy. whatever makes the physicians happy makes the hospitals happy...

 

[IAMS]

Tax the bloody living daylights out of tobacco...just a suggestion.

It amazes me our government goes after steroids and baseball like they've been doing and completely ignores smoking.

Jack up the taxes on alcohol while we're at it. Especially for those selling it at public events.

You're right, the steroid issue is way overblown. We demand the best athletes in the world, and we somehow expect them to resist the temptation to improve themselves with science?

We would have riots if we taxed alcohol more than we do. Who doesn't like a beer or a glass of wine now and then? Like anything else, we can't force people to chose wisely.

The only country in the world to make cigarrettes outright illegal is Bhoutan, starting next month. What a groundbreaking idea. Here's a full story:

http://msnbc.msn.com/id/6606877/

 

[IAMS]

its not just physicians who make the accessible vs available care. i think i already brought this up but....mediciaid patients in NYC are more likely to be seen in a clinic in a hospital by a resident while privately insured patients are seen by a faculty physician. whatever makes the physicians happy makes the hospitals happy...

This is what I didn't get about John Kerry's plan. He often said that he had blue-cross and blue shield, and that he wanted to make his senator coverage available to everyone. I'm not sure how well that idea panned out among physicians and hospitals.

 

[bonez318ti]

its not just physicians who make the accessible vs available care. i think i already brought this up but....mediciaid patients in NYC are more likely to be seen in a clinic in a hospital by a resident while privately insured patients are seen by a faculty physician. although patients on both sides can access care...its more apparent that as a medicaid patient...you are getting the shorter end of the stick. its supposedly on the D/L that hospitals whole-heartedly agree with this bc it keeps the medicaid patients (who are mostly minority) out of the faculty practices which then make faculty physicians happy. whatever makes the physicians happy makes the hospitals happy...

I'd think it would be illegal to differentiate treatment for people based on medicaid..

but then again, I've heard of stories from hospital administrators who cringe at the thought of having medicaid patients sit in the same waiting room as their regular patients (this was at a suburban hospital that mostly served very well to do patients)...

 

[bonez318ti]

Tax the bloody living daylights out of tobacco...just a suggestion.

It amazes me our government goes after steroids and baseball like they've been doing and completely ignores smoking.

Jack up the taxes on alcohol while we're at it. Especially for those selling it at public events.

I agree.. there should be an economic disincentive against products that have the potential to increase the costs of public health. Lets add an excise tax to stuff like all junk food, fast food, sodas, alcoholic beverages etc.. We would solve the budget crises AND shore up health care for generations to come!

 

[uclabruin2003]

I'd think it would be illegal to differentiate treatment for people based on medicaid..

but then again, I've heard of stories from hospital administrators who cringe at the thought of having medicaid patients sit in the same waiting room as their regular patients (this was at a suburban hospital that mostly served very well to do patients)...

you're quite right that is illegal to differentiate on the basis of payment. However, faculty practices are seen as separate entitites therefore the hospitals say that the FP are not affiliated with them….when they very well are. That’s the legal argument. And yes the doctors defend this practice bc of the very thing you said. Many physicians are elitist and racist, plain and simple.

 

[IAMS]

Anyone following or have any thoughts on the pros/cons of medical liability reform? Definite potential to lower costs for doctors and patients.

Congress is taking on the issue of whether or not to impose pain and suffering caps, and this brings constitutionality questions. Specifically right to a fair trial including jury recommendations for awards.

 

[bonez318ti]

Anyone following or have any thoughts on the pros/cons of medical liability reform? Definite potential to lower costs for doctors and patients.

Congress is taking on the issue of whether or not to impose pain and suffering caps, and this brings constitutionality questions. Specifically right to a fair trial including jury recommendations for awards.

There was an article the WSJ recently (11/30) that discussed jury awards.. in reality, although it seems that multimillion dollar judgements are awarded left and right (malpractice and others), very few are ever paid out in full. Most likely, both sides would have agreed to a high-low agreement prior to the jury reading their verdict. The way it works is.. say there was a case where plantiffs were suing for 50 million dollars for some malpractice suit, and the defense thought that there was some chance they may lose. Either side would negotiate a high low of say.. 2-5million dollars (for malpractice cases, the amount is usually correlated to the physicians malpractice insurance limits). So this means that the plaintiffs will win something no matter what, even if the jury comes back with not guilty. On the other hand, if the jury came back with guilty, the defendants would have capped their loss at 5 million. So in reality, even in todays suit happy society, jury verdicts mean very little to the economics of award payouts.

The article also mentioned that most suits that are brought in front of a jury are usually decided in favor of the defendant (27% success rate by plaintiffs). So much so that insurance companies are usually willing to fight out a legal battle even when the plantiffs request to settle for small amounts. (they cited a case down south where the plaintiff said they would settle for as little as 250k, but the insurance company said no.. and the jury ended up awarding a 4.5m).

Of course, the 50 million dollar award headlines do nothing to deter the thousands of frivilous suits where patients are looking to cash in on a poor medical outcome... which is the real crux of the problem.

 

[IAMS]

Of course, the 50 million dollar award headlines do nothing to deter the thousands of frivilous suits where patients are looking to cash in on a poor medical outcome... which is the real crux of the problem.

Why is it that ObGyn's can't afford to do business anymore? It was my understanding it was liability insurance premiums, regardless of whether they had a lawsuit or not.

Insurance for many healthcare related instances have tripled or more since 9/11.. frivilous lawsuits, pain and suffering, malpractice awards.. there's more to it, isn't there?

 

[bonez318ti]

Why is it that ObGyn's can't afford to do business anymore? It was my understanding it was liability insurance premiums, regardless of whether they had a lawsuit or not.

Insurance for many healthcare related instances have tripled or more since 9/11.. frivilous lawsuits, pain and suffering, malpractice awards.. there's more to it, isn't there?

I'm no expert on insurance, but I think the key factor on how insurance companies determine premiums is based on how much 'risk' is involved... the risk being how much monetart exposure they have in case of adverse events.

So for an insurance company covering medical liability, they will charge the highest premiums to the 'riskiest' specialties. Ie: the premiums for OB are much higher than for FP (I am assuming the insurance companies aren't just out to pricegouge doctors, and that they are raising premiums because they can, just to earn more profit) I think that the increase in premiums has more to do with the increase in numbers of lawsuits, regardless of whether these suits have any merit.. since the insurance companies need to waste resources to prove that the suits are meritless.. so I'm guessing the rise in premiums is due to the litigous nature of our society. Also, since the pool of insurees (ie: doctors specializing in OB) are smaller, i think the higher costs of a couple of bad doctors (as defined by those who get sued more often than average) need to be borne by the entire field.. unlike in auto insurance where there is a sufficient population size to single out 'poor drivers' and 'good drivers' to give them different premiums.

I think a solution lies in if we can find a way to reduce frivolous suits without hindering access to people with cases that deserve attention... not an easy problem to solve.