So how do we control cost?

[Isoprop]

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I'm trying to figure out what my position is on health care reform, and I was hoping to get some opinions and feedback. Here's what I understand so far.

Main Problem: 45 million people uninsured; 75% of that 45 million can't afford health insurance.

Cause: Health care is too expensive. Health spending wasted on administrative cost.

Solution: Make health care more affordable by cutting unnecessary cost.

To people who don't support a single payer system, how do you propose we cut these costs?

 

[MOHS_01]

Same way that it would be accomplished through the single payer system -- rationing and restriction with higher out of pocket expenses for therapies with minimal marginal utility.

 

[SeminoleFan3]

I think it also bears mentioning that of the 47 million uninsured, about 10 million of them are illegal immigrants, and that shouldn't fall on Americans to pay for their insurance.

Like other posters around here have said, there needs to be some serious re-examining of the amount of money that's poured into end-of-life care in this country.

 

[st0w]

Cause: Health care is too expensive. Health spending wasted on administrative cost.

It seems to be a popular misconception that our healthcare is too expensive due to unnecessary administrative costs brought about by HMOs and insurance companies. I'm not saying you're suggesting it, because it's not clear from your post if you're saying just administrative costs are the factor, or whether general healthcare costs coupled with administrative costs are contributing to it. But it's not clear that you're not saying it, either.

Many studies have shown that the biggest single factor contributing to our expensive healthcare system is unnecessary tests, medications and care. Kaiser has some information online at http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358 and they say "Some experts estimate that up to 30% of health care is unnecessary, emphasizing the need to streamline the health system and eliminate this needless spending." The same document suggests 7% of costs are due to administrative, with Medicare being less, at under 2%. It's pretty idealistic, but if we can get 20% of unnecessary costs eliminated and administrative costs reduced to those associated with Medicare, that's 25% of our healthcare costs eliminated.

We need to control costs, both administrative and medical, if we're ever going to make this managebale - universal healthcare or not. We provide a lot of expensive coverage that other countries simply don't do. We spend a lot of money prolonging people's lives for a few short weeks that other countries don't. Patients demand expensive, unnecessary treatment and medication, and rather than educate them, doctors just prescribe it. There are a whole host of reasons why these things happen.

We need to put limits on lawsuits against physicians and healthcare providers. Doctors have a huge expense in malpractice insurance, and plenty of people suggest that a big reason so many unnecessary tests are ordered is because of the fear of lawsuits.

There's a whole host of things we need to do to reduce costs, and just moving to a single-payer system alone won't fix it. (I'm not advocating for or against a single-payer system in this dicussusion, I'm merely stating that the cost reduction is a huge issue to tackle either way)

 

[Dr McSteamy]

more taxes.

and putting a cap on lawsuit awards.

put a cap, and watch all costs go down. Dr's won't have to charge so much just to make up for the malpractice insurance loss in income

 

[countthestars]

Tort reform would significantly help control costs

 

[Pianoman32]

Jenny Craig.

A new study showed that 10% of all healthcare expenditures are due to America being Obese. This translates into an additional $1500 per person per year.

 

[VassarLiberal]

Rational rationing, taking into account ethical factors, would certainly make things cheaper. http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html

 

[RGMSU]

Go back to the HMO style nobody liked but everybody will have to learn to live with. Make the PCP a gatekeeper. Increase the salary of PCPs to attract an adequate supply of quality talent. Empower the PCP to engage in cost cutting without having to worry about practicing defensive medicine. This coupled with an insurance cooperative for people who can afford a premium and a public option for people who can't would go a long way toward solving the problems of access and cost. The sincere fact is that there are lots of fancy diagnostic and procedural treatment options that are very difficult to afford and must be utilized less frequently if saving money is going to be the goal of our system.

 

[Pianoman32]

Go back to the HMO style nobody liked but everybody will have to learn to live with. Make the PCP a gatekeeper. Increase the salary of PCPs to attract an adequate supply of quality talent. Empower the PCP to engage in cost cutting without having to worry about practicing defensive medicine. This coupled with an insurance cooperative for people who can afford a premium and a public option for people who can't would go a long way toward solving the problems of access and cost. The sincere fact is that there are lots of fancy diagnostic and procedural treatment options that are very difficult to afford and must be utilized less frequently if saving money is going to be the goal of our system.

Please tell me this is a joke right?

 

[RGMSU]

No joke. Like I said, this is a way it can be done if the goal of the system is to save money. Everybody wants to save money but nobody wants to cut back on spending. Saving money by necessity means rationed care, and the HMO style does work for rationing care. I never said the outcomes would be as good - sometimes yes, sometimes no. I also never said everybody would like it. The forum is "So how do we control cost?" To save money, somebody has to keep the belt tightened. Either specialists can tighten the belt up themselves and use more rudimentary and cheaper methods when applicable or they can have someone help them to tighten it up - enter the PCP gatekeeper. If we go over to a system based on controlling costs, I can promise you the days of checking all the boxes for every diagnostic exam possible just to be sure will be over.

 

[Zoom-Zoom]

Reducing unnecessary tests is huge. Another tort-related cost that is often overlooked is simply the amount of time doctors spend filling out useless paperwork. Hours and hours every day is spent simply filling out CYA stuff that in no way better protects the pt. Of course, other people are hired to sort and file this paperwork, etc, etc...so along with the time costs, there are also administrative ones.

 

[Llenroc]

People whine about HMO's, but the fact is healthcare costs would have risen even faster without them. They corrected a lot of the abuses in the system that were widespread in the 70's and 80's. Talk to some older doctors, and ask them about how they would order any test they wanted without having to show justification, rampant "social" admissions to hospitals, etc.

I think the PCP model does make sense and the gov't should do what it can to enhance pay for Family doctors and Internists.