Propose your healthcare reform

[urge]

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Obama said it was coming. We probably know what they have in mind, cut payments for services rendered. What is your alternate healthcare reform?

 

[niranjan162]

Obama said it was coming. We probably know what they have in mind, cut payments for services rendered. What is your alternate healthcare reform?

id say start with tort reform

 

[Bertelman]

Drunk snowmobiling at 2 a.m. leading to a thoracic burst fracture is no longer covered under Medicare. Patient covers all bills.

 

[proman]

I didn't see most of the speech but is this accurate?:

Obama vows to increase number of soldiers...
Obama vows to seek cure for cancer 'in our time'...
Obama says bank bailout may cost more than expected...
Obama promises universal EDUCATION THROUGH COLLEGE...
Obama promises universal health care...

 

[aaydemi]

I didn't see most of the speech but is this accurate?:

Obama vows to increase number of soldiers...
Obama vows to seek cure for cancer 'in our time'...
Obama says bank bailout may cost more than expected...
Obama promises universal EDUCATION THROUGH COLLEGE...
Obama promises universal health care...

...don't forget he promised all that while halving the national debt by the time he's out of office. He can say anything and people will continue to drink his kool-aid. And I couldn't STAND Nancy Pelosi...she looked half crazy.

Disclaimer: I voted for the guy.

 

[urge]

I didn't see most of the speech but is this accurate?:

Obama vows to increase number of soldiers...
Obama vows to seek cure for cancer 'in our time'...
Obama says bank bailout may cost more than expected...
Obama promises universal EDUCATION THROUGH COLLEGE...
Obama promises universal health care...

Pretty much that's what he said. The cancer thing was really striking.

College education for everybody kills me. America is in economic trouble because workers are too expensive compared to the value of their production. Now you are making them even more expensive by having them all go through college? That's nuts. We need people to pump out Fords for 1 buck an hr, so that they can compete with the Koreans, etc. Not the other way around. Imagine a guy with an MBA making $50/hr on an assembly line.

He just said what people wanted to hear, not what needs to be done.

"Irregardless", we know paycuts are coming.

 

[Monty Python]

College education for everybody kills me. America is in economic trouble because workers are too expensive .

I'm hoping he was thinking along the lines of what the GI Bill did for returning vets after world war 2. Guys (like my dad) who would have had no financial ability to attend college suddenly had the chance ... those untold tens of thousands of college grads in the early 1950s led to a huge cadre of scientists, engineers, business leaders, etc, who helped set the stage for the US economic boom post-world war 2 (of course, having the industrial base of Europe and Asia in a shambles helped). But several leading business magazines have repeatedly said the GI Bill was the smartest thing the US government ever did, and has repaid itself many times over.

If we do that again with what Obama is proposing maybe it will be for good. Especially if the gov't-sponsored education is limited to the sciences and other real-world areas, but majors like art history and fashion merchandising would be off-limits. One would hope.

 

[Lasvegas]

id say start with tort reform

Tort Reform -YES!!

If you look at the medical setup in Spain, New Zealand, & OZ for example, they do not have any where near the issues we have in the states but still provide great care - and one of the main reasons is you can't sue doctors there in same way as in the states.

They have a system that weeds out the bad doctors and does everything possible to protect the public, but when things go wrong, as they sometimes do, the P does NOT get to make huge $$$$$ taking it to court. There is a certain inherent risk when going under the knife - even with the best of the best in the OR. The public needs to get this fact through their head.

As doctors we spend SOOOOOOO much money in this nation on insurance to protect ourselves, and hospitals spend even more on defensive med. Worst of all, the ones who seem to benifit most from this are the Attorneys!! (If I remembor correctly, that would include John Edwards for example.)

Massive Tort reform would go a very long way to lower the cost of health care in my view.

 

[Southpaw]

College education for everybody kills me. America is in economic trouble because workers are too expensive compared to the value of their production. Now you are making them even more expensive by having them all go through college? That's nuts. We need people to pump out Fords for 1 buck an hr, so that they can compete with the Koreans, etc. Not the other way around. Imagine a guy with an MBA making $50/hr on an assembly line.

If I were 18 again, I'd learn carpentry, construction, or plumbing and work for 4-5 years, then decide on the direction of my life. Cost vs. benefit, a college education could be the biggest mistake some people make.

 

[urge]

I'm hoping he was thinking along the lines of what the GI Bill did for returning vets after world war 2. Guys (like my dad) who would have had no financial ability to attend college suddenly had the chance ... those untold tens of thousands of college grads in the early 1950s led to a huge cadre of scientists, engineers, business leaders, etc, who helped set the stage for the US economic boom post-world war 2 (of course, having the industrial base of Europe and Asia in a shambles helped). But several leading business magazines have repeatedly said the GI Bill was the smartest thing the US government ever did, and has repaid itself many times over.

I humbly disagree. I think it was just coincidential. We were a rich country back then because we had oil. We were the biggest exporter of oil in the world back then. Saudi Arabia had nothing on us back then. No matter what we did, we would be rich because of the oil. The country even did great with all the f-up hippies. Can you imagine America surviving now with all the youth doing nothing but sex and drugs for the next 10-20yrs? Don't be fooled. America wasn't great because of its people. It was great because of its oil. We don't have oil anymore and look at the deep sht we are in.

 

[huktonfonix]

tort reform and gotta make some unpopular decisions. Beginning of life and end of life care have to be regulated and more "heroic measures" may have to be denied. Just because we can keep someone alive doesnt mean we should. Especially when their function is gonna be nil.

 

[niranjan162]

I'm hoping he was thinking along the lines of what the GI Bill did for returning vets after world war 2. Guys (like my dad) who would have had no financial ability to attend college suddenly had the chance ... those untold tens of thousands of college grads in the early 1950s led to a huge cadre of scientists, engineers, business leaders, etc, who helped set the stage for the US economic boom post-world war 2 (of course, having the industrial base of Europe and Asia in a shambles helped). But several leading business magazines have repeatedly said the GI Bill was the smartest thing the US government ever did, and has repaid itself many times over.

If we do that again with what Obama is proposing maybe it will be for good. Especially if the gov't-sponsored education is limited to the sciences and other real-world areas, but majors like art history and fashion merchandising would be off-limits. One would hope.

I also disagree. Jobs which provide a service, i.e. doctor, lawyer etc. all have an associated higher standard of living. But this also in turn (in part) raises the standard of everyone else (especially when they flood the market). This makes prices raise for manufacturers and thus they outsource factories to countries where the standard of living is lower, people are less educated and will work for less.

But this also has the effect of creating jobs in those countries and boosting the economy. Manufacturing jobs are one of the easiest ways to increase the economy, but its not cost effective for companies to have these jobs in the US anymore.

This is also why war used to be good for the economy. There would be increased production of things. Now however, our companies that manufacture things can barely compete (car companies).

 

[ProRealDoc]

id say start with tort reform

Difficult to make it happen with Obama being an attorney and having the ATLA knocking on his door.

 

[maceo]

Pretty much that's what he said. The cancer thing was really striking.

College education for everybody kills me. America is in economic trouble because workers are too expensive compared to the value of their production. Now you are making them even more expensive by having them all go through college? That's nuts. We need people to pump out Fords for 1 buck an hr, so that they can compete with the Koreans, etc. Not the other way around. Imagine a guy with an MBA making $50/hr on an assembly line.

He just said what people wanted to hear, not what needs to be done.

i would start by getting rid of the insurance companies.

"Irregardless", we know paycuts are coming.

the gist of it was.... . He said too many kids in america are dropping out of high school. furthermore, we cant compete as a nation when everyone is dropping out of highschool or barely graduating high school. We need a nation of literate educated people. Barely educated people do barely educated stuff which hurts the nation. At least we can strive for an associates degree for everyone. Too many people view education as job training. Why cant education be for educations sake.

btw, i saw the beginnings of katie couric's broadcast tonite and health care reform is coming.. in the way of "trimming payments to insurance companies and doctors" I saw on the set. alas

 

[bubalus]

You have to get your BMI below a certain level before a total joint, and if you want a revision, it's got to be below 30, or perhaps lower. No destination VADs. Strict criteria for BTT VADs. Strict adherence to a pharmaceutical formulary.

 

[Jeff05]

1. cut down useless ICU stays. any given MICU(less SICU) in any hospital is 75% demented NH gomers without any insurance coverage. or medicare/medicaid. there for a month. most expensive part of healthcare.
if prognosis is determined to be terminal by a committee of critical care docs/pall care/hospital ethics - fast track to hospice, comfort measures and withdrawal of expensive invasive procedures, meds, icu level care. if family has a problem with this - ie, patient is alive as long as heart is beating (no matter if on 3 pressors with a balloon pump, trach and peg...) they can pay for care out of pocket.

2. japan has this system. if waistlines/BMI of employees of companies (or municipalities) are above a given number, the company has to pay an additional fat tax. company starts investing into health of its workers - free gym memberships, healthy lunch options, nutritionist c/s, etc. so, positively reinforce weight loss and healthier lifestyles. if we could decrease obesity related illness - DM, HTN, OSA, etc we would drastically decrease costs.

3. something must be done about illegals. can't give out free care. not sure how to go about this.

 

[huktonfonix]

1. cut down useless ICU stays. any given MICU(less SICU) in any hospital is 75% demented NH gomers without any insurance coverage. or medicare/medicaid. there for a month. most expensive part of healthcare.
if prognosis is determined to be terminal by a committee of critical care docs/pall care/hospital ethics - fast track to hospice, comfort measures and withdrawal of expensive invasive procedures, meds, icu level care. if family has a problem with this - ie, patient is alive as long as heart is beating (no matter if on 3 pressors with a balloon pump, trach and peg...) they can pay for care out of pocket.

2. japan has this system. if waistlines/BMI of employees of companies (or municipalities) are above a given number, the company has to pay an additional fat tax. company starts investing into health of its workers - free gym memberships, healthy lunch options, nutritionist c/s, etc. so, positively reinforce weight loss and healthier lifestyles. if we could decrease obesity related illness - DM, HTN, OSA, etc we would drastically decrease costs.

3. something must be done about illegals. can't give out free care. not sure how to go about this.

dont forget the beginning of life ICU care also for futile cases.

 

[niranjan162]

Difficult to make it happen with Obama being an attorney and having the ATLA knocking on his door.

very true. But this is the case with anything involving healtcare and doctors. Nobodys representing doctors.

I think its ironic, simply focusing on tort reform could free up alotta money. However once reimbursements drop, shortages occur, lesser qualified applicants will become physicians and then mistakes may go up but there will be no point in suing doctors anymore.

So one way or another it will happen, we should try to make it so that it benefits us at least.

 

[Scrub MD]

1. cut down useless ICU stays. any given MICU(less SICU) in any hospital is 75% demented NH gomers without any insurance coverage. or medicare/medicaid. there for a month. most expensive part of healthcare.
if prognosis is determined to be terminal by a committee of critical care docs/pall care/hospital ethics - fast track to hospice, comfort measures and withdrawal of expensive invasive procedures, meds, icu level care. if family has a problem with this - ie, patient is alive as long as heart is beating (no matter if on 3 pressors with a balloon pump, trach and peg...) they can pay for care out of pocket.

2. japan has this system. if waistlines/BMI of employees of companies (or municipalities) are above a given number, the company has to pay an additional fat tax. company starts investing into health of its workers - free gym memberships, healthy lunch options, nutritionist c/s, etc. so, positively reinforce weight loss and healthier lifestyles. if we could decrease obesity related illness - DM, HTN, OSA, etc we would drastically decrease costs.

3. something must be done about illegals. can't give out free care. not sure how to go about this.

Great Ideas

I'm hoping he was thinking along the lines of what the GI Bill did for returning vets after world war 2. Guys (like my dad) who would have had no financial ability to attend college suddenly had the chance ... those untold tens of thousands of college grads in the early 1950s led to a huge cadre of scientists, engineers, business leaders, etc, who helped set the stage for the US economic boom post-world war 2 (of course, having the industrial base of Europe and Asia in a shambles helped). But several leading business magazines have repeatedly said the GI Bill was the smartest thing the US government ever did, and has repaid itself many times over.

If we do that again with what Obama is proposing maybe it will be for good. Especially if the gov't-sponsored education is limited to the sciences and other real-world areas, but majors like art history and fashion merchandising would be off-limits. One would hope.

The GI Bill is still around. I am at the VA and all the young vets are continuing their education on the GI Bill.

 

[drmwvr]

I'm hoping he was thinking along the lines of what the GI Bill did for returning vets after world war 2. Guys (like my dad) who would have had no financial ability to attend college suddenly had the chance ... those untold tens of thousands of college grads in the early 1950s led to a huge cadre of scientists, engineers, business leaders, etc, who helped set the stage for the US economic boom post-world war 2 (of course, having the industrial base of Europe and Asia in a shambles helped). But several leading business magazines have repeatedly said the GI Bill was the smartest thing the US government ever did, and has repaid itself many times over.

If we do that again with what Obama is proposing maybe it will be for good. Especially if the gov't-sponsored education is limited to the sciences and other real-world areas, but majors like art history and fashion merchandising would be off-limits. One would hope.

The pool of applicants for the GI bill was a very select class by today's standard. If he wanted to make that offer on the condition that the recipient have an honorable discharge from the military, it might have more credibilty.

 

[Greenman]

While tort reform is a good idea lawsuits are only a small component of why healthcare is so expensive in the US. This country will not remain competitive globally if we continue to expend double per capita on healthcare than other industrialized nations. The status quo advocates on these forums have offered no solutions to healthcare costs and lack of insurance for Americans. I understand why everyone here want to keep their salary (or future salary). The trouble is that current system is unsustainable and is hurting the nation.

 

[Jeff05]

i've offered specific steps. yes, the system should be altered. what i said before and insurance company regulations.
but, this administration's punishment of achievement and the ongoing liberal tactic of guilting (and forcing) the most productive citizens of this country into greater degrees of redistribution will do nothing to improve the healthcare system.

the actual cost of lawsuits is much higher than you think. many many suits are settled before going to court. but, the real cost is the amount of money spent of defensive medicine. i remember as a medicine intern - every intern would order every test for every patient while they were in the the hospital, even the bs social admits, just in case...

While tort reform is a good idea lawsuits are only a small component of why healthcare is so expensive in the US. This country will not remain competitive globally if we continue to expend double per capita on healthcare than other industrialized nations. The status quo advocates on these forums have offered no solutions to healthcare costs and lack of insurance for Americans. I understand why everyone here want to keep their salary (or future salary). The trouble is that current system is unsustainable and is hurting the nation.

 

[Surfer]

the actual cost of lawsuits is much higher than you think. many many suits are settled before going to court. but, the real cost is the amount of money spent of defensive medicine. i remember as a medicine intern - every intern would order every test for every patient while they were in the the hospital, even the bs social admits, just in case...

That's unneccessary. You only have to meet the "standard of care" which would not change even in a litigation-free society. We will always be held to the same standard. So ordering every test is a waste of money, even if you're afraid of getting sued. in fact, it opens you up to litigation because what do you do with the info you weren't actually looking for? Better to just keep it simple, even without tort reform. Many hospitals encourage this. Where I interned we rarely ordered labs on inpatients unless we were actually looking for something specific. worked well.

 

[Jeff05]

like i said "standard of care" is established during a trial. most lawsuits are settled before going to trial.

 

[MRW]

Implement the death penalty for anyone using the Emergency Room as free primary care.

 

[RxBoy]

Abolish medicaire/medicaid/VA and establish a new Governement policy.

2 plans available: Private vs. Government.

Government: Strict regulations on elective surgeries, ICUs, new/patented treatments. It should be run almost entirely by midlevels from preventative disease to management, anesthesia to minor surgery. Dx/Tx/major surgeries will still be performed by Dr's. Dr will oversee midlevels... maybe something 10 to 1. New tx/elective surgeries can be paid for by "out of pocket" costs

Private: Keep the same system we have now except mostly run by Docs.

Its time a spade calls a spade.

Want national healthcare?
fine rationilize, decrease quality and sell it back to the people. Everyone will have basic care, and if they want more... they can dish out the cost for private. I am pretty sure anyone with a brain and decent income will opt for the latter.

 

[NotAMD]

Implement the death penalty for anyone using the Emergency Room as free primary care.

this is an area that can save a LOT of money...

people have a problem, they want it addressed, they dont want to wait for an appt in X days they want an answer/pill immediately.. this is the mindset of many of the ER abusers.. so just give them what they want at less cost than an ER..

the govt should open 24hr urgent care centers to see these nonacute people, it can be right next to the real ER, pts can be triaged there or just opt to go there themselves if given the option...


this would cut down on BS er visits...leading to BS admissions.. more hospital related incedents, paperwork, etc...

have a nice neat little primary care clinic open 24hrs, taking everyones insurance, with a little deli-like system so people know they will be seen eventually....

 

[NotAMD]

Abolish medicaire/medicaid/VA and establish a new Governement policy.

2 plans available: Private vs. Government.

Government: Strict regulations on elective surgeries, ICUs, new/patented treatments. It should be run almost entirely by midlevels from preventative disease to management, anesthesia to minor surgery. Dx/Tx/major surgeries will still be performed by Dr's. Dr will oversee midlevels... maybe something 10 to 1. New tx/elective surgeries can be paid for by "out of pocket" costs

Private: Keep the same system we have now except mostly run by Docs.

Its time a spade calls a spade.

Want national healthcare?

fine rationilize, decrease quality and sell it back to the people. Everyone will have basic care, and if they want more... they can dish out the cost for private. I am pretty sure anyone with a brain and decent income will opt for the latter.

We already are decreasing quality and selling it at the same price...CRNAs? PAs? NPs? This is already happening in the current private, freemarket system.

I do believe a scenario like the one your describing will inevtiably be the system...more watered down cost efficient public sector, boutique private section

but it wont be that you have to chose one or two you just automatically get 1 and can opt out to 2, just depends on the degree of suckiness of 1 compared to your standards

and also 2 will have to have SOME midlevels just to function but less cetainly...

 

[RxBoy]

We already are decreasing quality and selling it at the same price...CRNAs? PAs? NPs? This is already happening in the current private, freemarket system.

I do believe a scenario like the one your describing will inevtiably be the system...more watered down cost efficient public sector, boutique private section

but it wont be that you have to chose one or two you just automatically get 1 and can opt out to 2, just depends on the degree of suckiness of 1 compared to your standards

and also 2 will have to have SOME midlevels just to function but less cetainly...

Just change VA's and old run down hospitals to the new "State Hospitals". Have the government buy bankrupted private care clinics and medical buildings for outpatient service. State sponsored lab, psych, rehabilitation, and path facilities. Fill these new buildings to the brim with midlevels. Hire 1 Doc from each specialty, maybe 2 medicine docs for each hosptial. They overlook all PAs. No litigation suits. This will be the standard of care for national healthcare. These facilities should also be the midlevel teaching sites.

Community hospitals will be devoted to the private sector. They will continue with new innovative, patented technology. Elective procedures, new drugs, and quality medical care all covered... of course with a lot shorter ER waitlist. Capitalism will keep pushing medical innovation. As technology further decreases cost and increases efficiency on the private front... it will eventually trickle down to the public.

Academic Hospitals should continue as is, seeing a little of both. Residents simply replace midlevels... Costs stay pretty equal.

If Obama wants health to the masses, than we should focus on quantity care not quality care. Leave quality to the privates. This way everyone is covered, but those that seek quality care always have the option to opt out for private health insurance.

 

[Stitch]

this is an area that can save a LOT of money...

people have a problem, they want it addressed, they dont want to wait for an appt in X days they want an answer/pill immediately.. this is the mindset of many of the ER abusers.. so just give them what they want at less cost than an ER..

the govt should open 24hr urgent care centers to see these nonacute people, it can be right next to the real ER, pts can be triaged there or just opt to go there themselves if given the option...


this would cut down on BS er visits...leading to BS admissions.. more hospital related incedents, paperwork, etc...

have a nice neat little primary care clinic open 24hrs, taking everyones insurance, with a little deli-like system so people know they will be seen eventually....

Most of the ERs I've worked in do have an urgent care or small fast track area that's open to see the 2AM ear aches or cough colds. Otherwise people go to places like Patient First or some other doc in a box. People are pulling away from the idea of a medical home as a result, and it costs to do so.

I say there has to be incentive NOT to go to the doc. There was a study done in a Texas ER where they monitored their census before and after implementing a $1 up front parking fee. It cut their traffic by 20% or so. Small little charges, not much, just make people think 'hey maybe it's not worth it' and can keep the system from overuse.