With your experience, how would you fix health care?

[186321]

Just curious because I know its an 80% chance I'll be asked during my upcoming interview. I have a few ideas but I don't feel like I'm solid or confident enough in my argument. So, I was wondering what you guys would do personally (if you were in control) to fix health care. Thanks in advance!

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[digitlnoize]

Just curious because I know its an 80% chance I'll be asked during my upcoming interview. I have a few ideas but I don't feel like I'm solid or confident enough in my argument. So, I was wondering what you guys would do personally (if you were in control) to fix health care. Thanks in advance!

There's tons of good info already on the site, but just for kicks:

I have a problem with "fixing" US healthcare. Currently, our healthcare system, while it has problems, allows for much of worlds' medical technology development. If we alter this system to drastically, the money feeding the research and technology will go away. We need to be very careful to avoid the devastating effects this would have on the future health of the US and the rest of the world.

My list of things to "fix".

1. tort reform. I like the idea that no one should be able to sue for more than their life insurance policy is worth. That's a good idea.

2. A universal medical records system. Everyone gets a Health Card they keep in their pocket which is swiped at the provider to provide access to a patients' medical records. They can then be updated as needed. This will allow all health professionals to communicate much more effectively. I would personally prefer the implantable chip in the hand, but people have religious issues with this.

3. Fix the insurance companies. I don't know how to do this, but to me, they are the problem. They're a problem for docs, they're a problem for patients. they should all be forced to be non-profit...or something...their CEO's should not be albe to make millions while they let their customers die.

This will help problems drastically. It doesn't really deal with the uninsured. There are ways to become insured though. I've done it. I've been poor. I make around 5k in 2007 and manage it through student insurance. I used to make 20k a year and could afford it then too. I just did without a PSP and Flat screen tv.

It's all about making smart choices...and I don't want to pay for someone else's insurance that they didn't buy because they got a cell phone instead.

 

[southerndoc]

I agree with digitlnoize. Tort reform, a great university EMR system, and fixing the insurance companies are a great place to start.

I think insurance companies should all be non-profit and shouldn't be allowed to cherry pick only the healthy patients (meaning they must be forced to insure everyone).

Personally, the more I look into it, the more I favor a universal health coverage system where the government becomes the insurer, taxes pay the fees, and all healthcare organizations become non-profit organizations. I'm a supporter of HR676.

 

[digitlnoize]

Personally, the more I look into it, the more I favor a universal health coverage system where the government becomes the insurer, taxes pay the fees, and all healthcare organizations become non-profit organizations. I'm a supporter of HR676.

I see some problems with the US gov't running things though. First, as I mentioned before, people aren't accountable for their own health now...matters will only worsen if it's free. Yeah, people will really watch their weight then

Second, I don't really like the way the gov't runs other things...look at the post office and the DMV...that is the future of gov't run medicine in the US.

I would love to see some type of UNIQUE solution. Our country is different, and what works for the UK, Canada, Japan, Cuba, or France will not work for us. We should use some good old fashioned American ingenuity and come up with the Best Healthcare System Ever...USA style.

Let's show the WHO how it's really done!

 

[southerndoc]

What's interesting is Truman wanted to create a socialized health system in this country after World War II when other countries (France, England, Italy) were also creating socialized healthcare.

A socialized or single payor system in the US will not be without its problems. However, I think the problems of a socialistic health system are beginning to be far fewer in number than our current for-profit system.

A significant number of people who file for bankruptcy for medical bills actually have insurance -- 55% according to one statistic I read. Previously I had thought that those that filed bankruptcy due to medical costs also had large consumer debt. I found out I was wrong when I started reading more about it.

This country will eventually adopt a universal or single payer system, but it isn't quite ready for that yet. The HMO's need to create more turmoil in our healthcare system before we see a drastic change happen. I'm giving it another 10 years before real changes occur.

 

[asuhdds]

I would love to see some type of UNIQUE solution. Our country is different, and what works for the UK, Canada, Japan, Cuba, or France will not work for us. We should use some good old fashioned American ingenuity and come up with the Best Healthcare System Ever...USA style.

Let's show the WHO how it's really done!

Dude, what does this even mean? What evidence can you bring that UHC cannot work in the United States?

In the United States, government spending on healthcare per capita exceeds any in the world, and we don't even have UHC. On top of that, individual costs (out of pocket, not including gov. spending) per capita run to about $3371 per capita per year, according to the WHO. Really now, even a bureaucratic system with inefficiencies is far superior to the mess we have right now. We're ranked 72nd in overall health (again according to the WHO), and ranked 41st in life expectancy. Yet we pay per capita more than 2x as much as the "most costly" UHC system, in France.

The rest of the developed world has switched from privatized to public healthcare. There is no evidence to support a decrease in cost in privatized medicine; in practice, it has never happened.
And if you're scared about it being "socialized" medicine, why aren't you in favor of privatized firefighters, or privatized lawmen? The proven effectiveness of UHC has made any such argument irrelevant.

Lastly, I find it hard to defend the position "welp it's your fault you can't pay for insurance" when society REQUIRES people to work in low-wage jobs.

"Oh, nevermind that many of the very poor work hard only to be shut down by bad luck, by "choosing" not to succeed in the free markets and not buying coverage, it's only logical that they deserve to die. We must all be captains of industry."

 

[digitlnoize]

Lastly, I find it hard to defend the position "welp it's your fault you can't pay for insurance" when society REQUIRES people to work in low-wage jobs.

"Oh, nevermind that many of the very poor work hard only to be shut down by bad luck, by "choosing" not to succeed in the free markets and not buying coverage, it's only logical that they deserve to die. We must all be captains of industry."

Exactly! You read my mind.

Everyone is assuming that the US either needs to have the current system, or steal someone else's. My point is simply that we can come up with a system that fixes the inequities of our system, while keeping all the things that make us who we are...and yes, this means capitalism.

Capitalism is a major driving force for technological development. You take that out of medicine and I promise you will see negative effects...worldwide.

On the subject of the poor: I have held only low wage jobs for my entire life. I have never earned over 25000 a year. Usually much less. Starving artists and all...I still managed to pay for my health insurance. I just did without other things. We see people come in my hospital every hour with no insurance but with 3 kids who all have PSP's. If they can afford PSP's they can afford insurance.

I have a close friend who grew up in the projects. He worked his butt off in grade school (getting teased and beaten up by member of Dave Matthew Band, oddly enough) and became a very successful Lawyer.

Life is what you make it, not what is handed to you.

That being said, I do believe that there can be coverage for the poor that doesn't encourage sucking on the system's resources. How about tax credit for being healthy? How about body inspections like states do car inspections? The better you do the more money you get back...It doesn't have to be free handouts.

 

[186321]

Thanks for all the feedback! But I have another question...

A doctor I was shadowing made the comment that "70 cents out of every dollar in health care goes to insurance companies". Does anyone know if this is a close estimate? Just curious

 

[southerndoc]

Thanks for all the feedback! But I have another question...

A doctor I was shadowing made the comment that "70 cents out of every dollar in health care goes to insurance companies". Does anyone know if this is a close estimate? Just curious

I've heard from 31-35%.

 

[186321]

I've heard from 31-35%.

That sounds about right. I couldn't believe it would be 70%

 

[J ROD]

I support some kind of a universal healthcare but I think it should be funded through the government and run by the private sector.

We all know how slow government repsonds to things. Private sector will create innovation and efficiency to get those fed dollars.

Eliminate Insurance companies being in charge of the patient's care and put it back into the hands of the docs. Still compensate docs for their education and time but it will be less. But still should be reasonable.

Increased taxes are my only concern. Maybe healthcare costs can be decreased through a better running system.

 

[asuhdds]

I think it should be funded through the government and run by the private sector.

We all know how slow government repsonds to things. Private sector will create innovation and efficiency to get those fed dollars.

The ER is a financial sinkhole because of this. This is why privatized government-subsidized healthcare is wrong.

There is ZERO incentive for anybody to change how the ER is right now, even though it drives costs for everyone ridiculously high. Why? Because no matter what, the government will subsidize the cost. Even though the operational costs of an ER are high, they still make a profit for each ER patient, and especially for ER patients who receive "primary care" at the ER. So they don't mind, because the government will always foot the bill.

If you're concerned about taxes, we should look to how Australia handles things. One of the biggest arguments against UHC in the US is that UHC works only in countries with highly dense populations, (i.e, Europe and Eastern Asia). But Australia has roughly the same population density as the United States. As a result, the running costs per capita are higher than any other UHC-using country. They levy a 1.5% tax to fund UHC, but they still pay, per capita, less than half what we pay per capita, and they have UHC!

 

[Pharmavixen]

I see some problems with the US gov't running things though. First, as I mentioned before, people aren't accountable for their own health now...matters will only worsen if it's free. Yeah, people will really watch their weight then

But: Americans are the only western country that doesn't have universal health care, and they are also the fattest.

This country will eventually adopt a universal or single payer system, but it isn't quite ready for that yet.

Yes.

 

[digitlnoize]

But: Americans are the only western country that doesn't have universal health care, and they are also the fattest.

The question is: Are we the fattest because we don't have UHC? Or, are we the fattest because of our culture and lifestyle?

No other country eats the crap we do. No other country has the lazy, consumeristic culture we currently live in either. This has led to our obesity problem. France's lack of an obesity problem is not thanks to their UHC system. They are thin because their culture dictates they eat normal portions of healthy foods.

Have you seeeen Super Size Me? The problem starts with the marketing and advertising done to our kids. No other country watches the amount of TV we do, OR is subjected to amount of commercials we are.

We are addicted to sweets, soda, caffeine (I just got a WATER that has caffeine in it WTF!!!), high fructose corn syrup, and TV. This needs to change, but UHC will not fix this problem. It will just spread the costs of other people's obesity to me and you.

Do you really want to pay for someone's diabetes that they got because they watch too much Dr. Phil and Oprah?

I don't. (rant over).
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The type of UHC that I would like to see is a system that charges people more for not managing their health problems. Similar to car insurance...if you get in a butt load of accidents, it's gonna cost more to insure your car.

Everyone gets coverage...from the gov't even...but if someone is not following their doctor's weight treatment plan their cost goes up, and up, and up until they lose coverage for non-payment, or manage their problem.

I don't believe in the current system of charging people more for health problems they cannot control. That's just rude. But for manageable health problems like obesity, or SMOKING, those people should have to pay more.

I will never pay for a smoker's lung cancer. Nor should I have to.

 

[Pharmavixen]

The question is: Are we the fattest because we don't have UHC? Or, are we the fattest because of our culture and lifestyle?

Your rant is right on! My point (as you probably surmised) is that UHC doesn't make any difference in how well people take care of themselves. It's all culture, lifestyle, or other, personal reasons.

For instance, I live in a country with UHC and could go to the doctor any time I like, not paying a dime. But...I haven't been in 4 years, partly because I've been in good health, but mainly because I'm a procrastinator about such things (strong family hx for early cardiovascular disease--should really get my cholesterol checked).

The type of UHC that I would like to see is a system that charges people more for not managing their health problems.

But the American experience shows that just doesn't work. Even though Americans pay through the nose for their health care (twice as much, per capita, as I pay through taxes) they continue to make self-destructive lifestyle choices.

Much as it annoys me that people like me are subsidizing people who don't look after their health, threatening people by withholding their health care wouldn't make the slightest bit of difference because nobody believes the big bad is going to happen to them (and even if it does, they remain in massive denial, even intelligent people).

A way to improve health care would be public health initiatives like more preventive programs. Like all the anti-smoking campaigns that have cut down on smoking.

 

[asuhdds]

Much as it annoys me that people like me are subsidizing people who don't look after their health, threatening people by withholding their health care wouldn't make the slightest bit of difference because nobody believes the big bad is going to happen to them (and even if it does, they remain in massive denial, even intelligent people).

Well. As it turns out in a recent study, the obese and smokers actually incur less total health care costs than healthy people because they don't live as long. You're the burden, teehee.

 

[Pharmavixen]

Well. As it turns out in a recent study, the obese and smokers actually incur less total health care costs than healthy people because they don't live as long. You're the burden, teehee.

Yeah; I saw that study, too.

"They say smoking takes ten years off your life. But you know what? They're the ones at the end! The wheelchair, adult diaper, kidney dialysis years. You can have those years--we don't want 'em!" --Denis Leary

 

[digitlnoize]

Well. As it turns out in a recent study, the obese and smokers actually incur less total health care costs than healthy people because they don't live as long. You're the burden, teehee.

This may be true in theory, but in reality it breaks down. Why? Because dead people don't pay taxes. If all those obese smokers lived 20 years longer, the taxes they would cumulatively pay (and the interest on them)would more than make up for the difference in costs.

Lame studies suck. Some people will do anything for a little publicity.

 

[asuhdds]

This may be true in theory, but in reality it breaks down. Why? Because dead people don't pay taxes. If all those obese smokers lived 20 years longer, the taxes they would cumulatively pay (and the interest on them)would more than make up for the difference in costs.

Lame studies suck. Some people will do anything for a little publicity.

I don't follow your logic.

Are you saying that if the obese and smokers lived longer, the taxes they would pay... would make them even cheaper than healthy people, in terms of total cost in healthcare spending? How does that in any way help your attempt to discredit the study?

Where did you get the idea that the study assumes that the dead DO pay taxes?

 

[Medifix]

Just curious because I know its an 80% chance I'll be asked during my upcoming interview. I have a few ideas but I don't feel like I'm solid or confident enough in my argument. So, I was wondering what you guys would do personally (if you were in control) to fix health care. Thanks in advance!

Since UK introduced NHS and started offering free healthcare, things have really got out of hand, similarly in USA where Healt care insurence companies took control. Free advice is usually not accepted nor respected by any one nor does this carry any value.

As doctors we have to start thinking ways of offering healthcare to all. In UK the doctors (Gp)are paid £6.6-£10/patient (Agency pay £40-£60/Hour to see 6 patients/hour) and as a trainee doctor (after pasing your PG Exam and may be PhD) you are paid approx £130/day. This is less than I pay for child care or cleaner, so after working for 25 years as a doctor, I am begenning to think where did I go wrong ? NHS in UK is said to spend £150-£200/patient and so £188 is spent on managing me and my work.

The same thing applies to Insurence companies, so we need to start thinking of alternatives to cut these middle men who are living and thriving on our knowledge and expertice.

How can we set this right ? we are all entangled in this mess and so are now less respected in the community.

 

[digitlnoize]

I don't follow your logic.

Are you saying that if the obese and smokers lived longer, the taxes they would pay... would make them even cheaper than healthy people, in terms of total cost in healthcare spending? How does that in any way help your attempt to discredit the study?

Where did you get the idea that the study assumes that the dead DO pay taxes?

The study concludes that the obese and smokers are cheaper to care for because they die sooner and don't incur the high medical costs of the elderly.

What I am saying is that the study neglects to see the ways in which these people would contribute to society of they DID live longer, and were healthier.

They would be more productive while alive, and would contribute taxes in the years in which they were alive...not dead.

It is simple economic nonsense to conclude that dead people are better for the economy than live ones...no matter how they died.

These dead obese smokers do not pay taxes, buy stuff, make stuff, work, or do any of the other things that make money for society or make it go. Them being dead is hurting the bottom line FAR more than if they lived longer, more productive lives.

The flaw in the study is that they looked ONLY at health care costs. In a UHC system like the Swiss have, you can't do that...you have to look at the entire gov't budget. GDP and all included. The dead people are hurting other governmental income/economy much worse then they are helping the healthcare costs. Thus, they cost MORE to care for than healthy people.

Get it now?

 

[southerndoc]

As doctors we have to start thinking ways of offering healthcare to all. In UK the doctors (Gp)are paid £6.6-£10/patient (Agency pay £40-£60/Hour to see 6 patients/hour) and as a trainee doctor (after pasing your PG Exam and may be PhD) you are paid approx £130/day. This is less than I pay for child care or cleaner, so after working for 25 years as a doctor, I am begenning to think where did I go wrong ? NHS in UK is said to spend £150-£200/patient and so £188 is spent on managing me and my work.

Primary care physicians in the US see similar amounts of patients (4-6 patients/hour) thanks to HMO's.

At £40-£60/hour, that's still a pretty good salary. That's $80-120/hour in the US, which is a very good salary for a primary care physician.

If a physician in the US earns $150,000/year on average, and that physician only works 40 hours/week (unheard of for most specialists in the US), and takes 4 weeks vacation per year, his pay would be approximately $80/hour (£40/hour). It seems GP's in the UK are paid about the same as PCP's in the US.

 

[Llenroc]

Primary care physicians in the US see similar amounts of patients (4-6 patients/hour) thanks to HMO's.

At £40-£60/hour, that's still a pretty good salary. That's $80-120/hour in the US, which is a very good salary for a primary care physician.

If a physician in the US earns $150,000/year on average, and that physician only works 40 hours/week (unheard of for most specialists in the US), and takes 4 weeks vacation per year, his pay would be approximately $80/hour (£40/hour). It seems GP's in the UK are paid about the same as PCP's in the US.

Except that in England, being a GP is one of the most lucrative things you can do in medicine, whereas in the U.S., being in Family Practice is amongst the least lucrative.

 

[southerndoc]

Except that in England, being a GP is one of the most lucrative things you can do in medicine, whereas in the U.S., being in Family Practice is amongst the least lucrative.

Yea, I know. I read a recent article about GP's in the UK now averaging £150-200,000/year.

 

[m3unsure]

Here are some ideas, and make sure that you spread it on the blogs for ALL the candidates. Neither Dem or Rep know anything. Join your local senator or representative and inform them on how medicine really works.

1. Mandate electronic databases NOW with an interface that allows sharing medical information.

2. Take away elective procedure funding for anyone over 75. If you lived that long, you got by longer than other people who need the same chance. This means every part of the bill in the mail, and significant dues upfront.

3. Non-compliant should be banned at the door. Simple as that. Stop the pity.

4. TORT REFORM. Stop the trial lawyers. Or at least expose the politicians who get funded from trial lawyers.

 

[lord_jeebus]

Tort reform, including caps on emotional suffering. Develop a system that allows determination of malpractice to be made by doctors, not uneducated juries. Allow these juries to make determinations of certain cases as grossly frivolous and allow them to fine the plaintiff double the defendant's legal fees.

Gradually extend Medicare to all citizens. Fund this through increased income tax on incomes over 3 million, increased inheritance taxes on inheritances over 10 million, and a phased withdrawal of all American military personnel outside North America with corresponding cuts in military funding. Increase tobacco taxes to cover the estimated cost of tobacco-induced disease. Increase alcohol taxes to cover the estimated cost of alcohol related disease.

Tax credits for citizens meeting objective health maintenance criteria (had a colonoscopy, LDL at goal, etc.)

Allow Medicare to negotiate with drug companies.

Allow physicians to collectively negotiate with government and private insurance companies (which will be allowed to continue to exist for those who do not wish to use Medicare alone).

Electronic medical records as discussed above.

Ban most forms of pharmaceutical marketing -- cutting marketing costs reflected in the cost of drugs.

 

[Miami_med]

Limit damages in medical malpractice to gross negligence, setting the bar higher for a lawsuit. Allow physicians to bill based on risk, garnering larger bills from higher risk individuals.

Start by eliminating all public funding of ICU care for individuals with end stage dementia or individuals with some sort of brain death, with a gradual cutback of public funding in other areas as well.

If you are non-compliant, you cannot be awarded a legal judgement and you cannot receive public funding.

Eliminate EMTALA.

Eliminate the Stark laws and allow physicians the privelege of business as well as scientific innovation.

Allow private competition, with the elimination of "certificates of need."

Get all of the new "clinicians" and "providers" that have largely come into existance by their ability to garner medicare funds off of the teet of the federal government.

Eliminate insurance company friendly laws that locally stifle competition and create a medical funding oligopoly at the local level.

If you are going to have a Medicare or Medicaid at all, atleast have them provide a certain amount of money to the patient, rather than dictating the exact fee that physicians can charge. Let the patient and physician/hospital negotiate the specifics.

Physicians should have the right to bill for services outside of the confines of boarded residency training. No other professional career requires years of servitude to a small number of pre-ordained firms at artificially low prices in order to be allowed to bill for procedures or services.

Bring back the GP (I know I'll get flack for this). There is no reason why an outpatient only physician needs 3 years of in hospital training to practice. Family Medicine boarding should be reserved more for people who want a broad spectrum practice. Training is simply too long for primary care money. Individuals can learn a lot of this on the job as do new lawyers, accountants, managers, etc....