What's the Biggest Problem in Healthcare? What would you do to solve it?

[altaskier]

HOW MANY PEOPLE ACTUALLY GOT THIS QUESTION? (WHICH SCHOOL ASKED YOU IT?)

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[SMW]

Originally posted by altaskier:
•HOW MANY PEOPLE ACTUALLY GOT THIS QUESTION? (WHICH SCHOOL ASKED YOU IT?)•••

I got it at both Albany and Columbia.

 

[altaskier]

Yeh I figured Albany would ask this. It sounds like Albany material. Anybody get it at Dartmouth ?

 

[warpath]

In Canada, there's a drastic shortage of doctors. The is, perhaps, the biggest healthcare problem we have. Is physician shortage also a big problem in the States?

 

[shimmer118]

UWashington interviewees definitely get this question.

 

[USeF]

Glad to find this thread and revive it. ALways some fresh opinions and ideas that you'd have to dig through dozens of 'health care reform' books to find these golden nugget of suggestions. bravo, SDN!

ONE suggestion that was mentioned to me while I was in the UK
"I hear you Americans have a system for car insurance where a 'bad driver' (one that gets in accidents) get his insurance raised, right? Well I dont see why you couldn't do that same thing with health insurance. If a guy is gonna smoke after being told to quit, and even given some patches, or another overweight guy that gets a bypass and continues to eat sausages for breakfast - shouldn't those guys have to pay more?"

I remember thinking it made so much sense that it HAD to be good. Then the reality set in of the grey cases of genetic predisposition to obesity, alcholoism and the like. But even so, I'm sure we can think of something better... then I read mpp's idea.

Originally posted by mpp
I prefer the using the medicare program we already have but adjusting it so that you slowly lose coverage if you continue with unhealthy actions (e.g., smoking, poor diet, lack of exercise, etc). This gives an incentive to maintain a healthy lifestyle which I think would do much more to increase the overall health of the nation then adopting some universal coverage plan paid for (or worse performed by) the military.

Now I think this works a step better- creating penalties by losing the insurance over time, rather than having to pay higher insurance (causing insurances to be more bloated).
What does everyone thinK?

 

[Bikini Princess]

Originally posted by NE_Cornhusker1

Increased prescense of AED's in malls, airports, and homes.

How is this a PROBLEM, let alone the biggest problem facing medicine?

Increased availablity of AEDs is a good thing....you don't see firemen fretting about too many fire extinguishers.

 

[Ripley]

Originally posted by SMW
The huge number of uninsured people without access to decent health care is definitely the number 1 health care problem in the U.S. Either Medicaid needs to be expanded to cover everyone who doesn't have employer-provided health insurance, or the government has to mandate that all employees be covered (with provision made for coverage of the unemployed).

Medicaid is incredibly expensive as it is, this would never fly. Nor would docs tolerate it. It is nearly impossible for docs to wrench the very few dollars they get out of medicaid. (turnaround time used to be on the order of 6-9 months)I worked in medical billing for a few years...it's really an insult what medicaid pays you. I'd rather agree to perform my services for free for x amt of hours a month in the local free clinic than deal with medicaid.

 

[Bikini Princess]

Originally posted by Ripley
It is nearly impossible for docs to wrench the very few dollars they get out of medicaid....it's really an insult what medicaid pays you.

Isn't getting paid less by Medicaid worth the contentment of knowing that these people have access to medical care?

And, aren't there federal regulations about billing turnaround times? I think these should apply to Medicaid.

 

[Dr/\/\om]

Originally posted by Bikini Princess


Isn't getting paid less by Medicaid worth the contentment of knowing that these people have access to medical care?

It isn't just a case of getting less money. In many cases, the Drs actually lose money when they see Medicaid patients. Since Medicaid is administered by states, the actual amounts vary a lot.



As to the question about problems with socialized medicine...let me give you the examples I personally know about. I lived in Britain for a year. My father has ankylosing spondylitis (a form of arthritis, basically extra bone forms on the vertebrae). While the spine is fusing, this condition is very painful, but the pain is lessened after it is fused (although you are usually permanently stooped over). There was a medication that my father took in the US that not only alleviated the pain, but also slowed the fusion. When we were in Britain, the healthcare system had a *rule* that the only people who qualified for this medication were those whose spines had already fused...when the medication was no longer useful! Another situation: one of my professors in grad school lived in Britain and his mother was diagnosed with breast cancer. It took months for her treatment to be approved and in the meantime the cancer spread. She ended up dying. Interestingly, this professor was pro-socialized medicine.

In other words, socialized medicine can have the same problems as the HMOs that we love to complain about (denying treatments, only allowing certain meds, etc). Uninsured people is certainly a big problem, but I have yet to find anyone with a really good solution.

 

[Bikini Princess]

It's true that I've heard before the Medicaid is a pain for doctors. In fact, many of them don't accept patients with Medicaid for that reason.

On the other hand, doctors complain about the billing of regular insurance's too, right? For example, one of them told me that they'll sit on the float for interest for a few months before paying the bills. Of course, if I were the insurance co, I wouldn't mind making a few extra $ off those "rich doctors".

 

[Intrepidation]

Redo Primary care.

Train paramedics to the same level as PA's almost, so that many simple ER procedures and tests can be done at someones house, with no need to transport.

Imagine the money+beds saved at ER's if the paramedic could suture and lavage your wound on site.

As calls would take longer, more paramedics would be needed. increase paramedic salary to other comparable health professions to attract new students.

Medical patients can show up at the ER with tests ordered during transport. Imagine if someone has abd pain: The paramedic could call and put in an order for a CT, and give the pt the contrast drink at the scene. 15minutes at the hospital and CT is ready for him. No waiting for a doc to examine, then waiting another hour for the contrast to set in. Imagine the lives saved if paramedics were so well trained they could order an OR for someone who needs surgery and send him straight there, no piddling around in the ER waiting for an OR to open. The golden hour could become a thing of the past, with paramedics trained well enough to make accurate Dx's.

OF course this would only work with an overhauled 911 system where people could call for minor emergencies as well.

Maybe for every major emergency medic unit have two minor emergency ones that respond to everything from a cut toe to rhinitis.

Imagine still the possibilities if these paramedics had a quick-lab machine (they're getting so small they will be able to fit in an ambulance soon) so that bloodwork could be done at scene. This would be a much more cost effective way of performing tests like a CBC and chem panel. If anything shows up out of range, the patient can then be taken to a hospital for appropriate treatment, available upon arrival.


All of this sounds utopian to most (or dystopian for future EM Docs), but it is all possible and all could be beneficial, used correctly.

Maybe once you graduate my new improved paramedic school, you recieve a 'doctor of triage' diploma


_Edit_

if a patient's condition is untreatable by anything normally in a hospital and requires a specialist's opinion, let the new DTM (Doctor of Triage Medicine) write a referal to whatever specialist is needed, thus successfully taking over primary care.

Maybe I should reconsider going into Family Practice...


_edit x2_

Hmm, MTD 'Doctor of Triage Medicine' sounds cooler than DTM ;c

 

[solid snake]

childhood obesity. How to solve: exercise?

 

[Laura JC]

I would like to see the whole donor organ/transplant system overhauled to be efficient and effective. If someone like the Surgeon General could spend his/her whole tenure solving that problem, it would be well worth it.

Another huge problem I see exists because of the number of genetic tests available today. Should a family, for example, with Huntington's disease in the family line get tested, in light of the fact that the children may not qualify for health care coverage as they age if they have a positive test?

 

[Ripley]

Originally posted by Bikini Princess


Isn't getting paid less by Medicaid worth the contentment of knowing that these people have access to medical care?

And, aren't there federal regulations about billing turnaround times? I think these should apply to Medicaid.

Docs LOSE money on medicaid. It's not free to send out claims. You have to pay for every claim sent out to an electronic clearinghouse, which routes it to the applicable insurance companies. As for medicaid in NY, you have to mail in paper claims.
They aren't just simply printed out and sent either. They all have to be SIGNED. I can't tell you how many hours I spent signing doc's names(and my initials to make it kosher )on these forms...many of which were for the reading of a chest x-ray for which we would only receive $4. That normally gets about $10 from medicare and $14-15 from private insurers. An epidural that gets $300-400 from private insurance companies only gets about $20 from medicaid. My SO began working in his practice last August...not a SINGLE medicaid claim has been paid.

I would like to say that though medicare does not pay as much as private ins cos, it's certainly no worse than hmo's(that i've seen from working in NYS), they are incredibly fast on their turnaround time. They have a lot of pain in the butt rules, but they are what most other companies set their standards by.

That said, I would like to restate what I said earlier. I'd feel much better providing care in a free clinic without the headache and hassles of medicaid. And not to generalize, but there is a medicaid persona that I find distasteful. (people that have medicaid and expect you to wait on them hand & foot, walk into your office yelling about having to wait 15 minutes and they are going to be late for their tanning appt!!! highlighted hair, fake fingernails, tommy hilfiger jackets. yet, they are on medicaid! I can't stand when people think I *owe* them something.)

 

[relatively prime]

Originally posted by SMW
The huge number of uninsured people without access to decent health care is definitely the number 1 health care problem in the U.S. Either Medicaid needs to be expanded to cover everyone who doesn't have employer-provided health insurance, or the government has to mandate that all employees be covered (with provision made for coverage of the unemployed).

Why? I don't believe heath care is a right... it's a priviledge.


I think the HMO interfering with a physician's judgement is a much more important issue.

 

[jenv1082]

Two very good points. I do think that both issues are of equal importance though- (HMO's interfering with physician judgement vs. the uninsured population)

I don't, however, think that healthcare is a privilege, it is a right. As a human being, you have a right be taken care of and treated; just because your socio-economic background is lower than your neighbor doesn't mean that you shouldn't be seen as the same.

But addressing the uninsured population issue: couldn't there just be one big reform on Medicare? (Correct me if I'm wrong, I'm kinda new to the issue) Could we not make/alter Medicare so that it isn't as much of a "hassle" or loss to doctors therefore increasing the probablity that doctors will choose to accept patients on Medicare.

Could we also not increase funding for Medicare (therefore increasing coverage to a greater percentage of the population) not by raising taxes, but by decreasing extravagent government spending or decreasing the amt of money given to certain departments that could do without (military?). I'm not sure how feasible this idea is with the whole reality of polictics and their logistics but Government spending should be looked into more in depth which could result in a ton of money being saved and re-routed to more important/immediate issues such as healthcare for our society...

The idea of slowly "losing insurance" in patients that continue unhealthy actions even after treatment sounds real good. It could save insurance companies money and save doctors their time/effort; if the patient is unwilling to take care of themselves, why should anyone else care?

The topic of socialized med is also interesting to me. (I got into an argument about this with my boyfriend just recently ) I took the side against socialized med but on the pretenses that taxes would be raised. But taxes don't have to be raised if gov spending on areas such as military were decreased. Could the money recovered from extraneous gov spending be spent on creating a socialized med policy here in the US? I still don't like the waiting pds that are associated with free healthcare since there are definately medical procedures that need to be taken care of immediately, but do the pros outweigh the cons?

Just my two cents...

 

[Ripley]

Just to clarify for those who don't know....

Medicare: coverage for the elderly (65 and over) and for people who have been in kidney failure >18 months.

Medicaid: for the poor. I believe that medicaid is primarily funded by county taxpayers.

 

[DW]

Originally posted by Ripley
Just to clarify for those who don't know....

Medicare: coverage for the elderly (65 and over) and for people who have been in kidney failure >18 months.

Medicaid: for the poor. I believe that medicaid is primarily funded by county taxpayers.

Medicaid is funded primarily by the states, and the federal government matches a percentage of the money the states put up depending on the needs of the state, on average its 60 percent. Also, the states are responsible for determining who is medicaid eligibile and who isn't (if you income is 133 percent or lower of the federally designated "poverty" level, single parents, disabled and under 65, etc).

 

[relatively prime]

When (if) I am a physician, no one will have a birth right to my services (i.e. health care). No one has the right to come up to me and say "I have a right to heath care and I demand that you give it to me." In fact, if someone said that to me, I'd call the police.

No one has a right to the goods and/or services belonging to another person... be that health care or watermelons, it doesn't matter... no one has a right to something that isn't theirs. Health care is a service, it's a product produced by individuals... people do not have a right to it. If you want to say that people have a right to health care, then in the same breath you could say they have a right to a house, a car, a dog, nice clothes, a yaught, and a rolex...

Saying that people have a right to health care implies that health care professionals MUST treat everyone that asks for health care, regardless of if they can pay. This is ludicrous... you wouldn't demand that an automechanic fix cars for free... so why would you insist that doctors see patients for free?

 

[lola]

Originally posted by jenv1082

The topic of socialized med is also interesting to me. (I got into an argument about this with my boyfriend just recently ) I took the side against socialized med but on the pretenses that taxes would be raised. But taxes don't have to be raised if gov spending on areas such as military were decreased. Could the money recovered from extraneous gov spending be spent on creating a socialized med policy here in the US? I still don't like the waiting pds that are associated with free healthcare since there are definately medical procedures that need to be taken care of immediately, but do the pros outweigh the cons?

Just my two cents...

I do think the pros of socialized medicine outweigh the cons, if we can find a system that will minimize cons. The amount of money this country spends on health care is more than enough to cover costs for the entire country. Yet a significant portion of our population does not have access to health care. These days, even if you're insured, there's not a guarantee that the doctor will accept your health plan. This is such bull**t. It is also really annyoing that I was told my by health insurance that they cannot assign me to a doctor -- that I must see a resident. Ok, I don't mind seeing a resident sometimes, but if I have a really big problem, I want to have a doctor. Is that too much too ask?

I studied in England for a year, and one semester was spent taking a seminar about the NHS and shadowing doctors in the UK. At the end of it all, I was the only one (or the only vocal one) who thought a national health care system was a good thing. I really saw nothing about the system there that turned me off to national health coverage. Sure, there were long waits for things, but I don't see why that couldn't be improved. I certainly don't mind taking a small pay cut if it means everyone in this country will have health care. Maybe I'm just naive, but this is how I see it...

 

[Ripley]

Originally posted by DW


Medicaid is funded primarily by the states, and the federal government matches a percentage of the money the states put up depending on the needs of the state, on average its 60 percent. Also, the states are responsible for determining who is medicaid eligibile and who isn't (if you income is 133 percent or lower of the federally designated "poverty" level, single parents, disabled and under 65, etc).

I think it's different in each state, I know for NY, it gets a LOT of it's cash from the counties. There is a high # of medicaid recipients in my county and there is a huge hue & cry going on because the county simply can't afford it anymore.

 

[relatively prime]

Originally posted by lola

This is such bull**t. It is also really annyoing that I was told my by health insurance that they cannot assign me to a doctor -- that I must see a resident. Ok, I don't mind seeing a resident sometimes, but if I have a really big problem, I want to have a doctor. Is that too much too ask?

Well, you know what.... you can dump your insurance company and go to whatever doctor you want... you just have to pay in cash. If you want luxuries you have to pay for them... that's life.

 

[Ripley]

Originally posted by lola

I certainly don't mind taking a small pay cut if it means everyone in this country will have health care. Maybe I'm just naive, but this is how I see it...

I wish I knew more about this subject. I do know that one of my SO's partners is British. He came to practice in the US b/c he couldn't stand the system there. You're not rewarded for productivity, for being good at what you do. Apparently, it takes YEARS to get attending status. (outside of what you have done for residency) But take this with a grain of salt, things may have changed since then.

I think it would mean more than just a small pay cut.

 

[jenv1082]

Relatively Prime- you bring up a good point. I never really thought of it that way...

 

[relatively prime]

Originally posted by jenv1082
Relatively Prime- you bring up a good point. I never really thought of it that way...

cool.


I mean... I think it would be great if everyone had access to good health care.... I just don't think the government should take on a RobinHood role to make sure everyone gets Health Care. I would rather see every physician set aside 5 hours a week to give free health care to anyone who was uninsured... but doing this of their own free will and out of the goodness of their hearts... not by force.

The fact of the matter is that any and all of the services that the government provides are almost entirely paid for my the more well-off portion of the country. The top 5% (economically) of this country pays over half of all taxes paid. That basically means that if you want a universal health care system, it's going to be paid for mostly by the rich... who wouldn't need it. It's so RobinHood-esque it's disgusting.

 

[Zoobaby]

Hey Prime, I think you're on to some good thoughts. I agree with you and I don't. There are some kinds of medical care that all people should (read: idealism) have access to. These things are rights, and I believe the status of something as a "right" is determined by how much it costs vs. how much pain it can prevent. No child should die of strep throat when every poster on SDN has enough money under the couch to by the antibiotics necessary to treat the infection. On the flip side, if every person had the "right" to see the best doctors in the world and have the most up to date and expensive treatments (and most Americans if asked DO hold the opinion that this is the case) the back of the system would be broken in very short order.

These are both extreme examples, and I think the reality is somewhere in the middle. We need to lean up the system (i.e. don't go to the ER for a cold) and determine what truly is a right and what you'll have to pay for if you want it.

I also agree with earlier posters that destructive behavior should be met with reduced coverage

 

[DW]

Originally posted by relatively prime


cool.


I mean... I think it would be great if everyone had access to good health care.... I just don't think the government should take on a RobinHood role to make sure everyone gets Health Care. I would rather see every physician set aside 5 hours a week to give free health care to anyone who was uninsured... but doing this of their own free will and out of the goodness of their hearts... not by force.

The fact of the matter is that any and all of the services that the government provides are almost entirely paid for my the more well-off portion of the country. The top 5% (economically) of this country pays over half of all taxes paid. That basically means that if you want a universal health care system, it's going to be paid for mostly by the rich... who wouldn't need it. It's so RobinHood-esque it's disgusting.

solid line of reasoning RP, but now I think we're kind of wading into a free market/captalism versus socialism argument . You contend that healthcare is NOT a fundamental right that the government should pay for?

What of plenty of other services the government pays for? Do all Americans have an implicit right to be "defended" by our military (which is coincidentally where an enormous part of tax dollars go)? Is it fair to those richer tax payers that a criminal who otherwise wouldn't be able to afford it have a public defender assigned to them? Where are we drawing the line? Is it too "Robin-hood" ish to take the tax revenue from the rich to educate the poor? What is special about drawing the line at healthcare? While being very expensive, it doesn't cost as much on a overall scale as some of our other basic expenditures such as law enforcement and education.

And, if you think about, we're not covering as large a population deficit in health care as opposed to education. I dont know the numbers exactly but I'd guess sure a larger percentage of people use public education than the percentage of people that would require some governmentally provided healthcare. But then we get into arguments over school vouchers and the merits of compulsory education, which i wont even deal with her, but if you believe in compulsory education and DONT agree with universal health care, you'll need to explain that one to me.

Just playing devil's advocate for the sake of debate

 

[lola]

Originally posted by relatively prime


Well, you know what.... you can dump your insurance company and go to whatever doctor you want... you just have to pay in cash. If you want luxuries you have to pay for them... that's life.

but why should i pay in cash when i'm already paying for health insurance through work and benefits are seen as part of your work salary?? i can't exactly change now b/c it's not the time of year when you can change plans, and neither can the woman i know whose doctors will no longer accept her insurance. i don't really consider having a doctor a luxury.

 

[relatively prime]

DW: You're right... at this point we would enter a debate of capitalism vs. socialsim or individualism vs. collectivism. And that's a philosophical issue I don't want to get into right now.

But let me explain why I draw the line at health care. The military protects the entire country... so anyone giving money towards it is benefiting from it. A universal health care system would benefit primarly the poor at the expense of the wealthy. Wealthy people will get heath care no matter what. They have no need for charity health care from the government. National security is a bit different... the more money the rich put into the military (by way of paying taxes) the more they benefit along with everyone else. If there were no military, then the rich would have to pay for private for-hire armies to protect themselves which would end up costing a lot more and would hurt everyone, including the rich. A univerisal health care system only benefits the poor... and would be a burden to the wealthy.

To figure out what people have a right to and what they don't... I think of it this way: people come together into a society to achieve things they couldn't otherwise (by living out in the wild as nomads). So then any member of a society should have no less than what the natural world could offer them (i.e. food, water, shelter). And so, in my opinion, those are a person's only rights as far as material things go. When it comes to non-material rights... I believe that all members of the society should be given the oppertunity to advance so long as they are willing to work hard (i.e. I believe in programs like ROTC and government subsidized loans (sp?) which give anyone and everyone the oppertunity to go to college). With the exception of some severely handicapped people, I do not consider free health care necessary to advance in society.

Now I suppose you're going to ask me why I don't think free health care is necessary to advance in society. Well, I'll tell you. While you are a child, you are covered under your parent's plan. Once you turn 18, you should do one of two things... go to college... or get a good job (if one is available... otherwise, go to more school(CC, trade school... or whatever)). If you get a good job, you'll have health care coverage. If you go to college... every college I know of offers a very cheap or even "included in tuition" health care plan. After you're out of college you should be able to get a decent enough job that provides health care insurance. So basically, the people who are uninsured are children with dead-beat parents... or people who refuse to work.

Even jobs at Burger King have health care benefits... so basically you'd have to be pretty pathetic to not be able to get health care coverage.... i.e. not contributing much to society.

Now I understand that life can throw even the most hard working people a curve ball (I'm thinking lay-offs and stuff like that)... and certainly there should be some temporary safety nets in place... like welfare. TEMPORARY being the key work... 6 months to a year max.

Now about those poor children of dead-beat parents... yes, the government shoud make sure they have health care coverage.

So a member of a society only has a right to as much as they contribute. Someone who doesn't work or doesn't bother to get an education, should not expect much from the rest of society. Basically I have the "you get what you give" philosophy.

::Sigh:: That was a long one...

 

[Bomb#20]

Originally posted by DW


And, if you think about, we're not covering as large a population deficit in health care as opposed to education. I dont know the numbers exactly but I'd guess sure a larger percentage of people use public education than the percentage of people that would require some governmentally provided healthcare. But then we get into arguments over school vouchers and the merits of compulsory education, which i wont even deal with her, but if you believe in compulsory education and DONT agree with universal health care, you'll need to explain that one to me.

The healthcare expansions that have been discussed sofar are to make it so that all of the poor have access to healthcare, but funding this but taxes is taken mostly from the rich, as prime stated. The rich get no government aid with healthcare, still having to pay on their own insurance policies; a monetary loss for the taxes, and no gain with coverage.
But for public education, every child is given an education, ignoring the socio-economic status of their family. Rich kids can attend public school alongside the poor.
To the argument that will surely come up about private schools and the such, the rich willingly pay extra for their children to attend ritzy private schools, it is not because they are denied a chance at public education.
The difference in both scenarios is having a choice to go one way or the other..
So, you can agree with one (having a choice with public education or paying for private) and disagree with the other (paying for someone else's healthcare while not having the choice to get insurance for yourself)

 

[Bomb#20]

Prime beat me, and said it better. Oh well

 

[missbonnie]

Look around you. About half of all Americans are overweight, don't exercise (less than half do I
think), eat well or have bad habits (smoking for example, not wearing sunscreen). This is what I
see in NYC, where more ppl go the gym than most other US cities (I'm generalizing here but I read
somewhere that the east and west coast are more physically active than in between).

I believe that the US is ridden with problems unlike other countries because of over consumption
& lack of health education. When it comes down it, most ppl have no clue that they are eating
wrong and have bad habits -- they don't even know that they don't know. People here want quick
fixes..you're fat? Take the fat pill. Smoke? Put on a patch. Obesity is even "accepted" here
which I think is well, not a good thing.

I recently read the book "What Color is your Diet?" and thought it had a lot interesting points.
For the first time I know what "anti-oxidant" means, what "free radicals" mean...all the buzz
words that are floating around, especially in cosmetics...

I'm not sure what kind of medicine I want to practice now, but I want to be active in educating
and helping my patients really live a healthy lifestyle -- which will do wonders in preventing
future health complications for them -- which will ultimately tax the health care system less ...
My health insurance PAYS me to go the gym, now that I think is the "right" way of thinking.

This isn't the answer to everything, but it's something I've been thinking about lately.

-bonnie

 

[DW]

Ok RP, so in your military scenario....now if there weren't a public defense, and the rich would just pay for private army, ok so what do poor people do? You can extend that hypothetical to health care rather easily. Wealthy people will get the health care NO MATTER what as you stated, as they will get defense and other perks no matter what, because they can pay for it. So what is the ACTUAL distinction? How would privately paying for the military "hurt" them as opposed to huge amount of tax dollars being taken from them to support it now? And is their such a huge difference between "safety" and "health" that we must maintain to advance our society?

Your "go to college and get a good job" scenario is a lot easier said than done, thats a whole different argument. Less than a fifth of americans make it college. A lot of us have college degrees now and cant find a job. And, yes, maybe a Burger King employee making 7 dollars an hour has the "option" for insurance: but is it affordable if you're trying to pay rent, utilities, taxes, etc? Usually not I'd guess.

"Get what you give philosophy" ehh, ahh boy thats a can of worms, the failure of capitalism. So, a kid who was born in a wealthy family, blows off school and does drugs is getting what he gives in health insurance, versus a poor kid from a broken home making minimum wage and has to decide between health insurance or electricity?

Ok, lets take education: Is there not a severe gradient between public schools in higher income neighborhood versus indigent areas? Every child is getting an education, yes, but are they equal? What makes education more important then health care? How much is education REALLY advancing society? School systems are failing across the nation. You dont technically NEED a degree to open shop and do well. Hell, even Bill Gates didn't finish college.

Boom, you brought it up, so you tell me: Why exactly are we to force every american child into school as compulsory education standards mandate, but at the same time healthcare to all citizens is not mandatory?

Some would argue that health care does have a very positive effect on advancement, as displayed in the "healthy worker effect". Healthier workers, less days of work loss, more productivity and efficiency, increased revenue. You can barely even HAVE a society much less advance one in the extreme example if only a small portion are healthy, look at third world nations for that scenario.
(the devil's advocate steps off his soapbox)

 

[relatively prime]

DW: I don't think it's even possible to compare national security to health care. For one thing, the rich and poor rarely live more than 10-20 miles from each other... so if another conutry attacks a poor community... that's going to threaten the wealthy communities aswell. Whereas, if a poor person breaks a leg... that doesn't threaten any rich person. I don't think it's even possible for a rich community to build up an army strong enough to combate that of, say, Iraq. National security is simply not something the rich can get themselves.... they need a government for that.


I don't buy the idea that not everyone can go to college. There is so so so so much oppertunity in this country. I know because my parents once threatened to cut me off completely... and I researched on the web how I might survive paying for college, etc... and I foudn it's very possible. Anyone who really wants to go to college can... and anyone who really wants to get a job can. Now that's something that's more or less unique to teh United States... so I can't argue this for "the general case."


ah! now I se what you're trying to do! you're trying to trap me into a socialist vs capitalist arguement. Well, it's not going to work buddy! I ain't falling for it!

 

[Hallm_7]

SMW- Taxes aren't the solution, but it seems that liberals always think it is. If you raise taxes to help the health industry (and let's say it does fix it, even though it won't) then there will be another issue come up that you think you must eliminate. So you raise taxes again. And then there's another issue, and another and another. Before long you'll have a completely socialized government and then a full-blown communist government, and any halfway educated person knows those don't work. If taxes were the answer to everything why did the USSR fall? Why is Europe with its huge tax burden falling behind the US? Why is it when Russia just cut taxes down to a flat 13% for all tax brackets that the economy is doing much better?

I think the solutiuon is to cut taxes even further and have people start saving their own money to spend on healthcare. There's so much money lost in the government that this way would be much more efficient. Most people already spend at least $20,000 on a car, a minumum of $100,000 on a house, and when they go out to eat at a medium priced restaurant they spend about $15.00 per person. Think, if you could cut just 10% of all that there would be a huge nest egg sitting around waiting to be used. If people are unwilling to do it, it's there own fault. If they think driving a $20,000 car over a $5,000 car is more important than spending money for their LIFE, they have some seriously messed up priorities.

I think getting rid of (I guess I would settle on limiting) all the trial lawyers would be a help too. That would lower all insurance costs some.

People simply have to take some responsibility for themselves. We've relied on the government too long and too much and it's spoiling us. And that's one of the worse things that could happen to this country.

 

[DW]

I'm not trying to lull you into a capitalism versus socialism argument. If anything, call me a moderate, but I'm keeping my own solutions to the side for the moment unless you're desparate to hear my suggestions.

Ok, you yourself stated above that the richest 5 percent of the country contributes 50 of tax revenue. Ok, extend that to the richest 10, 15, 20 percent. I think they'd have enough money to operate a military by then. Its not like the government makes all the technology that drives today's modern military (i.e. private defense contractors making boku bucks). Besides (september 11th nowithstanding) when has the last time there has been a "military" attack on mainland soil? But thats an aside......

The devil's advocate still wants his question answered....why are we pumping out money so that every american child goes to school (whether or not the school is substandard/failing and we're teaching kids "ebonics" for gods sakes) but we aren't making sure all Americans get some minor level of health coverage? WHY? The rich are hurting finanically cause of education expenses too!! Hell, if all healthcare was public, they'd still have the better hospitals and such if you extend the public school location gradient to healthcare, and the ratty run down healthcare would still be thrust upon the poor. Who's complaining?

Hell, why don't we just get rid of all taxes and privatize everything? All private schools, private sanitation, law enforcement, private road maintenance, private armies, etc, and make everyone pay for their own. Sounds good to me. Why pay taxes for anything?

Damn right we pay too many taxes, lower the education budgets nationwide now!!!! All these kids cant be doctors or lawyers, who needs a college, even high school degree these days? Besides, if ALL these kids REALLY had the opportunity and drive to go to college, that would just mean more money out of my pocket to pay for them!!! Hell, just keep these kids healthy enough so when they're working on my construction site they wont be taking so many damn sick days!!!!

(the devil's advocate sits back down)

 

[salud80]

Originally posted by Nikki
over use of the emergency room, basically seen by many patients as their primary care provider.

Part of this is due to lack of insurance and the patients know the ER has to treat them.

Part of this is due to the fact that some physicians that are members of HMOs are overworked and are hard to make appointments with in order to receive primary care.

This might be a stupid question, but are ER free, if the uninsured go there for treatment to avoid the cost. I had always thought that ER fee are even more exorbitant.

 

[Bikini Princess]

Originally posted by missbonnie
Look around you. About half of all Americans are overweight, don't exercise (less than half do I think), eat well or have bad habits (smoking for example, not wearing sunscreen).
I'm not sure what kind of medicine I want to practice now, but I want to be active in educating
and helping my patients really live a healthy lifestyle -- which will do wonders in preventing
-bonnie

I applaud your idealism, it shows you haven't been in medicine long enough to get discouraged about these things. There are doctors who say not to worry about patient lifestyle problems, because there's really little you can do about it. You can't control what the patient does.

If you examine hundreds of chronic smokers, at what point do you stop trying to make them quit? Trying to change patient diet or lifestyle takes tremendous effort, and most physicians, understandably so, would rather let these things go - it's like trying to pee in the ocean to raise the tide.

granted, each patient you manage to quit smoking may be a life saved, but remember it takes multiple attempts to ultimately quit smoking. You hardly have time to talk to patients with 15 min exam times, let help them change their lifestyle. Patients may even dislike you for it, and switch PCPs. And realistically, you get paid the same whether they quit smoking or not - this may not be important to you now, but it will be when you're a physician.

By the time you're pgy-3, I hope you still have your idealism; most don't. You may find medicine a bit messier and disheartening than when you started ms-1. If only you could save your idealism in a box, and keep it for when you're a physician..

Just trying to point out that the situation is a bit more complicated than "When I'm a doctor, I'm going to.." etc.

 

[jot]

that was rather condescending bp (shame shame ! - idealists change the world (hah - that was an idealistic statement) - missbonnie has a good point - and thinking about its longterm represcussions, it could well be one of the biggest problems facing healthcare - its closer to the root

 

[DW]

Originally posted by jot
that was rather condescending bp (shame shame ! - idealists change the world (hah - that was an idealistic statement) - missbonnie has a good point - and thinking about its longterm represcussions, it could well be one of the biggest problems facing healthcare - its closer to the root

agreed. Regardless of whatever direction you lean politically, if you just sit there and say "oh well, we cant change anything so we shouldn't bother to think about it", well what good is that?

If there is ANY profession that just cant take the "oh well" approach in our future, its healthcare at all levels. Costs are spiraling, millions of people are ininsured, antibiotics are failing, there are crazy people with anthrax and smallpox ready to be unleashed on innocent civilians, nosocomial infections are killing thousands unneccesarily each year, children are overweight, et cetera. I dont think the "lets give up cause we cant change society" approach works, we need solutions, not excuses.

 

[jaboy]

bump

 

[relatively prime]

Actually... the biggest threat to medicine right now (and to the whole world for that matter) is a plague. You guys ever seen the movie "Outbreak"... well unlike most movies that SO COULD HAPPEN. If you haven't already, read "The Coming Plague" and you'll see how real a threat a plague is.

Enivronmental distruction + rapid intercontinental transportation + carelessness + large moble population = PERFECT CONDITIONS FOR A PLAGUE

 

[USeF]

Originally posted by relatively prime
::Sigh:: That was a long one...

yea, it sure was.
Somebody get this girl a Secondary, she's on a writing roll!
I really am enjoying this discussion. keep it up.

missbonnie- I saw the same keys to America's individual population-wide problems and still remember being at the same stage as you are. From there I realized to affect the largest number of people, change must be made on a population-level: education and policies. This idea ties into the need for more physicians (and all health-care professionals for that matter) to be involved in the changing landscape of health care/coverage.

method: MPH (Master of Public Health) in Health Policy and/or specialty in Preventive medicine.

 

[freakazoid]

I just read through this discussion (it took me a while), and I've compiled a list of all the good ideas (IMHO):

1. Setting a limit to how much damages you can sue a doc for
2. Start a program to faciliate doctors who want to give free care
3. Prioritize care
--Most common
--Most important
--Cost
--Examples: Immunizations, Mammograms, Prostate Screens
4. Paying tuition for med students who agree to volunteer services
5. Better training for paramedics, nurses
6. Education for ER use
7. Make consumers realize cost of health services

Seven needs a little explanation. I've read this in a couple of places, but it's never been brought up in this discussion. One of the problems is that the people WITH insurance who don't have to pay as much (since insurance covers it) for healthcare have no idea what the REAL costs are and as a result demand more and costlier services. Some insurance programs have tried to address this by setting a tier-system, where the costlier the care is, the more you pay.

Finally, for my eighth and final possible solution, I was wondering if it would be possible to do healthcare like they do financial aid--depending on your income, they can figure out how much money for healthcare you're eligible for. Combined with eligibility as determined by health practices (exercise, smoking, etc., but not genetic stuff, since despite natural predispositions I believe people still have some degree of choice), I think it could really cut down some costs.

That is all.

 

[freakazoid]

*bump*

 

[Bikini Princess]

Originally posted by freakazoid

1. Setting a limit to how much damages you can sue a doc for
2. Start a program to faciliate doctors who want to give free care
3. Prioritize care
--Most common
--Most important
--Cost
--Examples: Immunizations, Mammograms, Prostate Screens
4. Paying tuition for med students who agree to volunteer services
5. Better training for paramedics, nurses
6. Education for ER use
7. Make consumers realize cost of health services

Finally, for my eighth and final possible solution, I was wondering if it would be possible to do healthcare like they do financial aid--depending on your income, they can figure out how much money for healthcare you're eligible for. Combined with eligibility as determined by health practices (exercise, smoking, etc., but not genetic stuff, since despite natural predispositions I believe people still have some degree of choice), I think it could really cut down some costs.

I like your ideas. Some feedback:

Some states are trying #1, but it's almost impossible since juris-lawyer lobbies are strong..

There are programs for #2, often they are to exotic places though like costa rica or guam (surprise-surprise)...probably there is less enthuisastic participation for a free program in downtown detroit or philly.

For #3, HMO's prioritize health care for you..by choosing what to pay and what not to.
(at least that's what they'll tell you )

For #8, it sounds like it comes close to national healthcare..which might make some people antsy, depending on your opinions.

 

[Bikini Princess]

Originally posted by jot
that was rather condescending bp (shame shame ! - idealists change the world (hah - that was an idealistic statement) - missbonnie has a good point - and thinking about its longterm represcussions, it could well be one of the biggest problems facing healthcare - its closer to the root

Ouch sorry - just trying to point out that many doctors start out idealistic...

Maybe I just want to temper her idealism with a small dose of realism. But I hope we can change healthcare for the better.

 

[DW]

Originally posted by Bikini Princess


I like your ideas. Some feedback:

Some states are trying #1, but it's almost impossible since juris-lawyer lobbies are strong..

actually, bush is pushing a bill in congress (he has his moments) that would set federal limits on the liability of all malpractice lawsuits to 250,000 or the cost of the procedure, whichever comes first.

 

[freakazoid]

Bikini Princess,

Thanks for the feedback . . . good to refine ideas and such. For number three, prioritizing healthcare, I was thinking more along the lines of a statewide deal (which came from the quote below) . . . which gets me to thinking, with the number eight thing, would it be a fair compromise if the healthcare eligibility funds idea occurred on the state-wide level rather than nationally? Then each state can modify it according to their own needs . . .

Originally posted by English Chick
Another solution to the problem of covering more people without increasing taxes: Oregon currently has a system of prioritizing the care it provides to Medicaid recipients. Not all care is covered, just care that is perceived to be high priority. Oregon has used the extra funds made available by this prioritization to insure all its residents who live below the poverty line. (Before the new system, only a fraction of poor Oregonians recieved coverage.) One caveat though: I used this suggestion in my UCSF interview and my interviewer wanted to know what services I would consider "high priority." I was _not_ prepared for that curve ball. I kinda stuttered, suggested a couple of obvious things like childhood immunizations and family planning services and told her I'd get back to her in four years. *sheesh* Not smooth at all ...