Your new biggest problem with the healthcare system...

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What pisses you off enough to say,"God damnit, if we could just do X, then this would be all better." And before you jump on me, this is not for a secondary application. I've filled out 20 of them and I haven't com across a question like this yet. However, I do know that interviewers like to ask this question, so I wanted to develop my problem and answer, or broaden my horizons as to the other perceived problems that med students have. Anyway, moving on!

I don't have enough experience to say with any great certainty, but I think it's the wide spread lack of health and psychology education (and overall motivation to get educated). I can't imagine how many little problems turn into big problems simply because people don't know/care enough about themselves to exercise a little, or to eat a fruit instead of a candy bar.

It's a pretty rampant problem and has no easy fix. I think that I have very healthy eating and exercise habits because of my mother and father's emphasis on them. I wonder what sort of effect this would have in one or two generations if every single parent told their kids the stuff about health that the feds were telling them to say--even if the parents didn't mean it. Maybe the kids would actually grow up a little healthier. Keep on going for 2 or 3 generations and we may get somewhere.

What's your biggest problem and solution?

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Cap "pain and suffering" settlements at some reasonable figure. We can't even imagine what it would be like to practice outside of our current climate of fear.
 
I also think another big problem is patients' opinions of their doctors. I've read some articles indicating that the doctors who get sued the most aren't actually the ones with the most ineptitudes; they are actually the ones liked the least by their patients.


Maybe if doctors spent 35% more time with their patients, and they were screened more rigorously for those who just suck at social interaction, we may be able to greatly reduce malpractice insurance. Sure, we might need 35% more doctors in the field, which means lower wages across the board, but the reduced insurance costs would help counter that. And besides, even if physicians get paid a little less at the end of each day, it's a small price to pay for a more positive public opinion, happier patients, and a more fulfilling practice.
 
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What's your biggest problem and solution?

Problem:

pnhp_growthphysadmin.png


Solution: drive 95% of administrators out into the desert and leave them for dead.
 
Problem:

pnhp_growthphysadmin.png


Solution: drive 95% of administrators out into the desert and leave them for dead.

often the best solutions are the simple ones...:thumbup:
 
What's your biggest problem and solution?

oh, to answer the question: obviously, it all depends on where you are and what you see. our hospital sees TONS of medicare and medicaid pts, and m&m reimburse quite poorly. that's one of the huge factors for having to see as many pts possible per unit time. it also feeds the phenomenon of "sticking it" to Joe Middleclass who actually has insurance; so we charge him an arm and a leg because since he has insurance, we may actually get an arm from him, which helps us because the previous 10 pts gave us jack-sh.t. my unfortunate solution would be to increase m&m payments to a reasonable level (i say unfortunate because the increase would probably just come from raising Joe Middleclass' taxes...)

not that i'm an economist or anything close to it.
 
People not using preventative medicine that is not only readily available, but spoonfed to them.
 
Premeds cross posting the same topic in multiple forums.
 
My anecdote:

A mom taking a 7yo girl with nose bleeding to the ER by an ambulance. It's the first episode of nose bleeding in who-knows-how-many-years. Past medical history unremarkable. PE completely normal. Labs are not even ordered. The girl runs in the room happily. Mom said "they came here just to make sure everything is ok."

I asked her why not just call a cab. She said that's going to be $25 dollars. I said "yeah, but ambulance is like $500 bucks." Response: "yeah but I don't have to pay for that."

Solution: I'd just get myself a cheeseburger and take a nap in the call room instead of thinking about f*ck-uped problems like this in our health system.
 
I asked her why not just call a cab. She said that's going to be $25 dollars. I said "yeah, but ambulance is like $500 bucks." Response: "yeah but I don't have to pay for that."

naive question but in what cases are ambulance rides and ER visits free for patients? Was the mother insured or uninsured?

when I was a kid my parents never took me to the ER when I broke bones or got hurt because the co-pay was more and the wait was usually longer than going to an urgent-care clinic.

if someone doesn't have any kind of health insurance, everything is just free? I know we have indigent care but there should be parameters to avoid abuse. nosebleed =/ free ambulance ride. There are lots to charge people; garnished wages, stockades, debtor's prison, indentured servitude etc. :confused:
 
Yeah, I agree with the people who are citing economic issues as big problems in healthcare, but for the purposes of a med school interview, it might be a bad idea to hone in on those. I.e. med school interviewers are often PhD faculty, not always practicing MD's, and when they are, often from the old school era where they didn't have to worry about this stuff so much. I don't know. If it were me, I wouldn't go in there planning on talking about how it's BS we're getting stiffed with everyone's medical bills. I'm inclined to think they want to hear about how you're going to save the world with your fortitude, world-savvy, worth ethic, and leadership.

So bringing up:
Falling medicare reimbursements? Bad idea.
Shifting from a system that favors acute care to one that favors preventative care? Good idea.

Medical school tuition & student indebtedness? Bad idea.
Trends in physicians that underutilize primary care and overutilize specialists? Good idea.

Just be cognizant of who your interviewer is. If you said it's killing medicine that no one pays and no one buys health insurance you'd be absolutely right, but you really should avoid less palatable opinions.
 
Problem:

pnhp_growthphysadmin.png


Solution: drive 95% of administrators out into the desert and leave them for dead.
I downloaded that PPT and it had some pretty interesting information. None of it surprising (I got to slide 50 and quit because it's late as hell) except for that graph. I wonder why the increase in administrators.

It could be the mad dash by blue collar employees to entrench themselves in the medical system. Actually, I really have no idea what constitutes an administrator, so a semantic evolution may have actually led to that graph. Who knows? Maybe head janitors are now considered administrators...
 
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An even larger problem than administrators, IMHO, is the current (and growing) travesty that is "end of life" care.

Want to save billions of healthcare dollars each year? Stop keeping people alive who should have been allowed to pass on naturally a long time ago. If there is no quality of life to be had (by this, I generally mean a mental state that allows a person to be more than just a vegetable), then all that is being accomplished is the preservation of both a "shell" and the family's agony. Death is a natural part of life, and while we have made great technological advances in the past decades, people need to be educated that there comes a time when medicine can do no more and it is better to let someone go. The US seems to be the one of the only countries that has this problem, thanks in large part to political correctness and the "climate of fear."
 
I also think another big problem is patients' opinions of their doctors. I've read some articles indicating that the doctors who get sued the most aren't actually the ones with the most ineptitudes; they are actually the ones liked the least by their patients.


Maybe if doctors spent 35% more time with their patients, and they were screened more rigorously for those who just suck at social interaction, we may be able to greatly reduce malpractice insurance. Sure, we might need 35% more doctors in the field, which means lower wages across the board, but the reduced insurance costs would help counter that. And besides, even if physicians get paid a little less at the end of each day, it's a small price to pay for a more positive public opinion, happier patients, and a more fulfilling practice.

while i agree that medical school admissions are largely based on one's academic prowess rather than interpersonal skills, you'd probably have to lower standards some to get the real stiffs from getting into medical school. and anybody can act nice on the interview. And probably a lot of medical students start nice and end up jackasses. It's a difficult problem to change.

Having 35% more doctors would probably be prohibitively expensive. I doubt insurance costs would even change that much with the things you propose. Maybe a little, but not much.
 
An even larger problem than administrators, IMHO, is the current (and growing) travesty that is "end of life" care.

Want to save billions of healthcare dollars each year? Stop keeping people alive who should have been allowed to pass on naturally a long time ago. If there is no quality of life to be had (by this, I generally mean a mental state that allows a person to be more than just a vegetable), then all that is being accomplished is the preservation of both a "shell" and the family's agony. Death is a natural part of life, and while we have made great technological advances in the past decades, people need to be educated that there comes a time when medicine can do no more and it is better to let someone go. The US seems to be the one of the only countries that has this problem, thanks in large part to political correctness and the "climate of fear."

+1. I essentially wrote an identical passage independently on a separate thread today. This is one of my biggest beefs because we could chop out a huge portion of our spending while probably improving QOL. But we don't do it because we are *******. I'm sorry, but that's the truth. Everybody is scared.
 
naive question but in what cases are ambulance rides and ER visits free for patients? Was the mother insured or uninsured?

when I was a kid my parents never took me to the ER when I broke bones or got hurt because the co-pay was more and the wait was usually longer than going to an urgent-care clinic.

if someone doesn't have any kind of health insurance, everything is just free? I know we have indigent care but there should be parameters to avoid abuse. nosebleed =/ free ambulance ride. There are lots to charge people; garnished wages, stockades, debtor's prison, indentured servitude etc. :confused:

well, i asked the same question, and the reason is hospitals and ambulances are required to pick you up and take care of you. clinics are not, so if you are a self-pay patient they will make you pay a little up front. Since these people have no intention of paying, they take the ambulance and the ER visit, since they don't charge any money up front (even though its 10x more expensive), and they aren't paying anyway. Apparently the mechanisms in place for garnishing wages, etc isn't very good, otherwise they wouldn't keep doing it. I don't know what those mechanisms are, but it sounds like pillories, stockades, and systematic torture are probably what should happen next. ;) j/k Seriously, though, they need to do something. Forced labor is a good place to start if you are in debt and can work. Can't find work? No problem! We have a ton of trash that needs to be picked up on the side of the road. We'll pay you minimum wage. If you don't want to work? Well then you can go to jail.
 
insurance company denying coverage for tests that your Doctor wants to run.

:thumbdown:
 
I'll throw in a few of my ideas:
-End employer sponsored health insurance; give every adult consumer a choice for which insurance option is best for them and their family.
-Make Health Insurance more like insurance in other industries- responsible for paying for catastrophic events- surgeries, cancer, MI, etc. Car insurance doesn't pay for your oil change, why should Health Insurance be expected to pay for your hypertension follow up?
-Better Information Technology. How different do you think that Administrators vs. Physicians graph would look if everybody in the country had a single record for all their healthcare information. Immunizations, every doctor visit, every medication ever. Companies seem to have no problem accessing my financial history without a problem...why can't we do the same with my medical records?

I can't believe I JUST discovered this forum. Expect me to be a regular.:D
 
Make Health Insurance more like insurance in other industries- responsible for paying for catastrophic events- surgeries, cancer, MI, etc. Car insurance doesn't pay for your oil change, why should Health Insurance be expected to pay for your hypertension follow up?

that's a silly comparison and would be catastrophic . The number of people that would seek out preventive medicine would drop drastically if their visit to the doctor was not covered by insurance. The same goes for patients that are seeking a diagnosis. If insurance wouldn't cover trips to doctors and specialists then how would they ever be able to afford to find out what was ailing them. It's expensive enough now even with insurance.
 
that's a silly comparison and would be catastrophic . The number of people that would seek out preventive medicine would drop drastically if their visit to the doctor was not covered by insurance. The same goes for patients that are seeking a diagnosis. If insurance wouldn't cover trips to doctors and specialists then how would they ever be able to afford to find out what was ailing them. It's expensive enough now even with insurance.

It is not a silly comparison, and would only be "catastrophic" if people did not assume some sort of responsibility for their own health. First off, everyone needs to recognize that "preventative medicine" still has a long way to go before it proves any semblence of cost efficacy.

http://www.ncpa.org/ba/ba188.html

Secondly, some portion of the risk must be transferred back to the individual -- without such a mechanism there are few consequences to that extra twinkie, pack of smokes, or cheese fries... whether people like it or not, their routine medical care (up to a defined ceiling, yet to be determined) must be a personal tab item if we ever hope to change the health of the country. What really jerks my chain is the fact that people are not complaining about fixing the health problems of the country; rather, they are complaining about having to pay or finance their own healthcare.

The point made was quite valid -- auto insurance does not pay for oil changes, tune-ups, gasoline, tires -- but does pay for collisions, flooding, etc. While homeowners (which, in my opinion, is a better model) does not pay for small repairs or upgrades, it will cover catastrophies such as flooding, wind damage, etc after a deductible is met.

If we hope to maintain any private health coverage this is the model that must be implemented; the days of no deductible and $5 copays are gone.
 
It is not a silly comparison, and would only be "catastrophic" if people did not assume some sort of responsibility for their own health. First off, everyone needs to recognize that "preventative medicine" still has a long way to go before it proves any semblence of cost efficacy.

http://www.ncpa.org/ba/ba188.html

Secondly, some portion of the risk must be transferred back to the individual -- without such a mechanism there are few consequences to that extra twinkie, pack of smokes, or cheese fries... whether people like it or not, their routine medical care (up to a defined ceiling, yet to be determined) must be a personal tab item if we ever hope to change the health of the country. What really jerks my chain is the fact that people are not complaining about fixing the health problems of the country; rather, they are complaining about having to pay or finance their own healthcare.

The point made was quite valid -- auto insurance does not pay for oil changes, tune-ups, gasoline, tires -- but does pay for collisions, flooding, etc. While homeowners (which, in my opinion, is a better model) does not pay for small repairs or upgrades, it will cover catastrophies such as flooding, wind damage, etc after a deductible is met.

If we hope to maintain any private health coverage this is the model that must be implemented; the days of no deductible and $5 copays are gone.

an automobile is a luxury. It's not a necessity. Healthcare is a necessity. So it's apples and oranges.

I don't think you realize what the blowback would be if such a system were applied to our health care. It would be drastic. It wouldn't affect the well off but everyone from the middle class down would see a decline in life expectancy and quality of life.

It's expensive already with insurance if you come down with a disease. Multiple doctors visits, bloodwork, specialists, medications etc. That all costs money for the patient. Don't kid yourself thinking that the insurance company pays for that.
 
an automobile is a luxury. It's not a necessity. Healthcare is a necessity. So it's apples and oranges.

I don't think you realize what the blowback would be if such a system were applied to our health care. It would be drastic. It wouldn't affect the well off but everyone from the middle class down would see a decline in life expectancy and quality of life.

It's expensive already with insurance if you come down with a disease. Multiple doctors visits, bloodwork, specialists, medications etc. That all costs money for the patient. Don't kid yourself thinking that the insurance company pays for that.

I beg to differ -- automobiles are only luxuries to those who live in areas where public transportation or walking are viable options -- so try taking that argument to the millions of Americans who absolutely rely upon their automobiles for transportation to and from work, to obtain food, get healthcare, etc.

Have you looked at any EOB's lately? While health insurance is not what it was 10 years ago, they still pick up the bulk of the tab for large medical bills. I am not a huge fan of "high deductible" plans -- I believe that the concept is only good as long as it is indexed for income -- there is a huge difference between a $5k deductible for someone making $250k and someone making $20k.

As far as the "blowback" associated with requiring folks to pick up the tab for routine, non-preventative, non-catastropic care (up to a maximum out of pocket expense, which is the model that I favor) -- some of this is both necessary and good, and will provide the catalyst that is absolutely necessary for the needed societal changes.
 
an automobile is a luxury. It's not a necessity. Healthcare is a necessity. So it's apples and oranges.

I agree that in a lot of ways, it's apples and oranges, but really comparing health insurance to anything these days is apples and oranges. Yet, most other insurance industries (AIG aside) seem to have be profitable and the public is generally satisfied. So I often think about other industries when I'm thinking about healthcare.

I think it's apples and oranges because with car insurance, you have a great deal of control over what car you buy. If you're a 22 y/o male, and you really want a corvette, YOU CAN HAVE ONE! As long as you are willing to pay the insurance. With health insurance, the 'uninsurables' are basically stuck with driving blindfolded in a standard BMW and that's no fault of their own.

But there are some good things to learn from the industry:
Consumers have the choice for who insures their vehicle. And people might argue that healthcare is too complex for individuals to decide what insurance policy is best. I would argue the same is true for auto insurance, but people and companies learn and adapt and everyone seems to get by.
People are responsible for the maintenance and upkeep of their vehicles, not insurance companies. I have no scientific, but I strongly suspect there's an underlying lack of individual responsibility for many conditions; Metabolic syndrome comes to mind.

I have o so much more to type but I have to get up early tomorrow.
 
I beg to differ -- automobiles are only luxuries to those who live in areas where public transportation or walking are viable options -- so try taking that argument to the millions of Americans who absolutely rely upon their automobiles for transportation to and from work, to obtain food, get healthcare, etc.

Have you looked at any EOB's lately? While health insurance is not what it was 10 years ago, they still pick up the bulk of the tab for large medical bills. I am not a huge fan of "high deductible" plans -- I believe that the concept is only good as long as it is indexed for income -- there is a huge difference between a $5k deductible for someone making $250k and someone making $20k.

As far as the "blowback" associated with requiring folks to pick up the tab for routine, non-preventative, non-catastropic care (up to a maximum out of pocket expense, which is the model that I favor) -- some of this is both necessary and good, and will provide the catalyst that is absolutely necessary for the needed societal changes.

I find too many holes in what you're saying. Say for example you have a disease...lets give you a complicated disease like lupus. You don't know what's wrong with you but you know you need to see a doctor. Under the plan your advocating that doctor visit wouldn't be covered by insurance. You go anyway and your primary care physician suspects something might be wrong and sends you to a rheumatologist. Again your insurance doesn't cover this visit. This time it's a specialist and much more expensive than your regular doctor. After labwork and several more visits you are diagnosed and begin treatment and several thousand dollars lighter in the wallet. That's the best case scenario with the worst case being you don't make it past that first doctor visit because you can't afford to pay up front that much money.
 
I believe that the concept is only good as long as it is indexed for income -- there is a huge difference between a $5k deductible for someone making $250k and someone making $20k.

Agreed, as I understand it, that sort of deductible rate would basically be a "flat tax". How do you think this scenario would change the healthcare landscape:
1. Keep the private sector involved, and make people responsible for insuring themselves up to a certain level based on income. After that amount, you are covered by medicare.
Positives: The private sector is still doing the majority of the care, but nobody goes bankrupt because of medical bills. I always thought it was unacceptable for people who do everything right, are productive members of society, and make sure their families are insured, go bankrupt because their medical insurance "ran out" at $800,000 or whatever.
Negatives: I guess this increases government involvement to a point, and I guess establishing those required levels of insurance would be difficult to assign nationwide. Maybe states could be responsible for the levels then?

WHAT SAY YE SDN??
 
How so? I don't own a home = No knowledge base.

Homeowner's insurance is largely catastrophic insurance, serving insurance's primary purpose for existence -- shielding you from unexpected and catastrophic events. It does not pay for a roof that needs repair, sidewalks that need repair, a deck that needs repair, plumbing, electrical, heating, air, flooring, termite damage that goes undetected and unrepaired, etc. It does, however, pay for unexpected costs such as repairing a roof after wind or hail damage, basement flooding, fire, etc. -- after a deductible is met.

Why in the world should people be completely shielded from the costs associated with their own personal consumption of healthcare services? The argument that "people will forego care b/c they won't want to pay for it" is based largely in an enabling mindset -- I don't want to pay for termite damage or roof damage, but if I do not, my house will crumble and depreciate significantly -- same thing goes for the human body. I do not want to pay for my oil, coolant, or transmission fluid to be changed, but the same argument applies.

I, contrary to some, believe that many of the tools and options out there in the private health insurance industry are quite good -- if they can be afforded. The deductible should not be crushing, and the definition of "crushing" varies with income level (and, in my opinion, this is the most evasive component in the equation -- I do not believe that a progressive taxation model is the best model for every situation) I would like to see a coinsurance style program, where the costs are split 50/50 up to the point where the deductible is met -- then shifts to an 80/20 split up to a maximum out of pocket expense, then the individual pays nothing.

There also has to be some form of price controls built into the system as well -- I have witnessed far too many abuses within the current system -- and these price controls have proved to be very difficult to both conceptualize and implement. The affordability of health insurance is directly tied to the costs incurred by the insuring entity -- without some effective form of cost controls the system falls apart.
 
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I find too many holes in what you're saying. Say for example you have a disease...lets give you a complicated disease like lupus. You don't know what's wrong with you but you know you need to see a doctor. Under the plan your advocating that doctor visit wouldn't be covered by insurance. You go anyway and your primary care physician suspects something might be wrong and sends you to a rheumatologist. Again your insurance doesn't cover this visit. This time it's a specialist and much more expensive than your regular doctor. After labwork and several more visits you are diagnosed and begin treatment and several thousand dollars lighter in the wallet. That's the best case scenario with the worst case being you don't make it past that first doctor visit because you can't afford to pay up front that much money.


Alex,

There are precious few "holes" in what I am saying -- everyone needs to accept some responsibility for the costs associated with their own personal consumption of healthcare services. I am not advocating going it alone; I am saying that some of the risk must lie with the individual, otherwise there is no tangible incentive for health maintenance.

Several incorrect assumptions here, and I blame these on either presumed lack of experience or a misunderstanding of the actual workings of the current medical care model -- let's start with the example given. PCP eval for suspected lupus -- PCP will likely order some labs rather than just pull the trigger and refer to a rheumatologist. Amount billed would be for a new patient level 3 (most likely) and some labs... now assume that these tests come back suggestive for lupus at which time the PCP refers to the rheum... rheum then bills a level 2 or 3 consultation, should not repeat the labs (assuming, of course, that the PCP ordered an appropriate panel of labs and did not omit anything). The rheum's bill is then lower than the initial visit. Therapy costs are the same regardless of ordering physician, E&M costs are the same (for like levels of care) regardless of the specialty of the physician, etc.

And none of this addresses the moral hazard of going down the road that you suggest (and the country is currently on) -- assuming the financial liabilities and risks from everyone and furthering what amounts to an increasing socialized / centralized welfare state.

Someone with insight beyond his years on this very forum made a very good point some time back -- it can be reasonably argued that government's only justifiable role in the healthcare arena, as defined by our very governing document, is in the aspect of infectious disease and public health. Beyond that, it is a personal issue that needs to be dealt with accordingly.

The greater the size of the federal crutch provided, the greater the number of cripples needing it.
 
Agreed, as I understand it, that sort of deductible rate would basically be a "flat tax". How do you think this scenario would change the healthcare landscape:
1. Keep the private sector involved, and make people responsible for insuring themselves up to a certain level based on income. After that amount, you are covered by Medicare.
Positives: The private sector is still doing the majority of the care, but nobody goes bankrupt because of medical bills. I always thought it was unacceptable for people who do everything right, are productive members of society, and make sure their families are insured, go bankrupt because their medical insurance "ran out" at $800,000 or whatever.
Negatives: I guess this increases government involvement to a point, and I guess establishing those required levels of insurance would be difficult to assign nationwide. Maybe states could be responsible for the levels then?

WHAT SAY YE SDN??

I guess that I fail to see how the level of income should determine the level of insurance offered? What you just proposed sounds like insurance benefit discrepancies based upon income classes -- I don't see how that helps resolve anything. Insurers should not be off the hook based upon enrollee income levels, and the government should not be in the business of reinsuring the private health insurance industry (although now that they own the controlling interest in AIG... :mad:) The risk pool for any given insurance needs to be large enough to capture all levels of income, broad enough to account for the statistical likelihood of illness and disease burden within the covered population.

I agree that productive, working members of society should not be forced into bankruptcy this way (for they are the only people who stand anything to lose in bankruptcy anyway) -- but there are few medical situations that lead to maximum lifetime benefit breaches, and the majority of these individuals would qualify for Medicare in the current system.

And let us not turn this into a State vs federal discussion -- for we got that one wrong in 1885 and have been wrong ever since.
 
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This is about the above graphs showing the inordinate amount of administrators compared to the relatively small amount of physicians. At my interview at UVM yesterday, I got a physician to tell me why he thought the graph looked like that. He speculated that it was the huge amounts of paper work that have to be filed for insurance companies.

I suppose my solution would be automate the whole system so that the 10 million grunt workers doing the paper work get cut out. Any other solutions?
 
Sound logical enough to me, but be ready for a huge spike in unemployment as government and the health care sectors have accounted for the vast majority of job creation over the past few years. I have heard that, if you exclude these two sectors, that the contraction in the workforce has been widespread and sizable.

There is no justifiable reason for a billing "department" -- there needs to be an initiative (probably legislatively driven, unfortunately) that requires insurance companies to provide, in real time, where a person is on their deductible, etc, as well as appropriate IT support for the process -- physician (or staff) enters the codes for the services provided at the time rendered, an EOB is instantly generated which states the insurance company's and the individual's responsibility, and the contractual write-off. These amounts are then debited automatically (& instantly) from the insurance account, and ideally the patient would be responsible on the spot (which is more difficult depending upon the situation).
 
First off: wow. This is a great discussion. I feel like we're actually having an intelligent and mature conversation on SDN!:cool:

I guess that I fail to see how the level of income should determine the level of insurance offered? What you just proposed sounds like insurance benefit discrepancies based upon income classes -- I don't see how that helps resolve anything.

Didn't we just have a discussion how some portion of the healthcare tab has to lie with the individual, and that portion is dependent on their level of income?

Insurers should not be off the hook based upon enrollee income levels, and the government should not be in the business of reinsuring the private health insurance industry (although now that they own the controlling interest in AIG... :mad:) The risk pool for any given insurance needs to be large enough to capture all levels of income, broad enough to account for the statistical likelihood of illness and disease burden within the covered population.

I was trying to come up with a compromise to reconciliate one of the huge differences between health insurance and other industries. With homeowner's insurance, for example, my understanding is that the insurance companies won't spend an infinite amount of money to save or rebuild the house; the insurance coverage simply goes up to the cost of the house. Obviously, human lives are different than any other material goods we insure.
So:
Should companies be expected to insure people to an indefinite monetary ceiling? I say no, b/c it would be bad for profit and difficult for the privat sectore to reconciliate.
If not, does that mean insurance companies can assign a monetary value to each human life? Again I say no, and government financed care was my answer for this question.

I agree that productive, working members of society should not be forced into bankruptcy this way (for they are the only people who stand anything to lose in bankruptcy anyway) -- but there are few medical situations that lead to maximum lifetime benefit breaches, and the majority of these individuals would qualify for Medicare in the current system.

I read somewhere that the fastest growing cause of bankruptcy in this country is Healthcare-related. Sigh...I wish I had time to get actual sources for this info, maybe that would help me understand this aspect of the situation better.
 
First off: wow. This is a great discussion. I feel like we're actually having an intelligent and mature conversation on SDN!:cool:



Didn't we just have a discussion how some portion of the healthcare tab has to lie with the individual, and that portion is dependent on their level of income?

Yeah, we did -- but one of the problems with short discussions in forums such as these is that it is quite difficult to summarize the intricacies of a problem like healthcare. Yes, everyone needs to be responsible for some portion of their healthcare tab, and no, I do not believe that a "progressive responsibility" is the right approach necessarily. The point that I was trying to make is that health insurance premiums cannot be so expensive that they consume an ever increasing percentage of one's income -- which comes back to the point of cost containment. I would not like to see a two tier private insurance situation where benefits (and premiums) are totally indexed to wages. This is where the tax credits come in.

I was trying to come up with a compromise to reconciliate one of the huge differences between health insurance and other industries. With homeowner's insurance, for example, my understanding is that the insurance companies won't spend an infinite amount of money to save or rebuild the house; the insurance coverage simply goes up to the cost of the house. Obviously, human lives are different than any other material goods we insure.

Yes, but there are a couple of notable differences here -- if you have a 150k house your premium is much lower than if you have a 1.5mill house, and in both cases the house is only insured for its replacement value. It would prove quite difficult to assign this sort of value to a person. Essentially, for the purposes of health insurance, everyone's home is of equal value; therefore premiums should star out at an equal baseline. They should rise or fall based upon body habitus and behaviors -- much like storm insurance along the coast, earthquake insurance out west, etc. THe relative affordibiltiy will always be present, just as it is in every aspect of life. Through tax credits and larger risk pools this cost should be containable -- and I do not believe that we need the Federal Gov't to create this large risk pool for us.


So:
Should companies be expected to insure people to an indefinite monetary ceiling? I say no, b/c it would be bad for profit and difficult for the privat sectore to reconciliate.
If not, does that mean insurance companies can assign a monetary value to each human life? Again I say no, and government financed care was my answer for this question.

I agree -- but this is largely negated through a movement away from employer sponsored plans into individual plans through a large risk pool. Cost containment is the issue here -- it begins here and ultimately ends here. We, as the house of medicine, need to determine what interventions work and what does not, and then determine if the cost of the intervention is justified. The second part needs to be out of doctor's control -- that is a payer issue -- and left up to the public and private sectors. Not to say that we cannot help direct the conversation, but neutral parties we are not...



I read somewhere that the fastest growing cause of bankruptcy in this country is Healthcare-related. Sigh...I wish I had time to get actual sources for this info, maybe that would help me understand this aspect of the situation better.

Yeah, I have read that as well -- but it is very difficult to sort truth from fiction with many of these things, and, much of the time, there are multiple factors leading up to the tipping point where a bout of pancreatitis or gall bladder attack breaches the threshold... and ends up getting blamed for the whole problem.
 
I would not like to see a two tier private insurance situation where benefits (and premiums) are totally indexed to wages. This is where the tax credits come in.

So help me understand: how is providing tax credits, that I'm assuming would be dependent on individuals wages also, would be better than having an indexed ceiling?


Essentially, for the purposes of health insurance, everyone's home is of equal value; therefore premiums should star out at an equal baseline. They should rise or fall based upon body habitus and behaviors -- much like storm insurance along the coast, earthquake insurance out west, etc. THe relative affordibiltiy will always be present, just as it is in every aspect of life.

I agree they should rise and fall based on health factors, but that line gets fuzzy. The easiest example I can think of is aging. Unlike weight and behaviors, you can't control it, and it incrementally increases everyone's risk of serious injury/disease. In other industries, you can rebuild away from the coast, sell the Porsche, etc. But with health, there are several factors you simply can't change.


Through tax credits and larger risk pools this cost should be containable -- and I do not believe that we need the Federal Gov't to create this large risk pool for us.

Would including the uninsured-another 17 million-including many 'uninsurables', really have a positive affect on the risk pool?
 
So help me understand: how is providing tax credits, that I'm assuming would be dependent on individuals wages also, would be better than having an indexed ceiling?




I agree they should rise and fall based on health factors, but that line gets fuzzy. The easiest example I can think of is aging. Unlike weight and behaviors, you can't control it, and it incrementally increases everyone's risk of serious injury/disease. In other industries, you can rebuild away from the coast, sell the Porsche, etc. But with health, there are several factors you simply can't change.




Would including the uninsured-another 17 million-including many 'uninsurables', really have a positive affect on the risk pool?

Most policies have a benefit ceiling - one of the the reasons for having a broad risk pool is to avoid such discrepancies in benefits. Now this is not to say that the ceiling cannot be raised or lowered according to chosen levels of coverage, but I would want to avoid a system where we end up essentially asking for the default payer to be the tax payer.

One reason that I find the idea of tax credits appealing is that it provides some incentive to work and produce... not sure if "credits" is the proper term here, but basically I would favor some form of pre-tax benefit for individuals for the purchase of their health care aside from the "use it or lose it" flex plans.

It is also important to point out that there will be no perfect solution -- in any system "winners" and "losers" will be created. I am still working through this myself, as is everyone; this is evident b/c if anyone had a perfect solution we would not be having this discussion.

Aging is somewhat problematic -- but Gov't already has in large part already addressed this issue when they agreed to pick up the tab in the form of Medicare. Most folks who live a moderately lifestyle (actually, most who do not live a healthy lifestyle) manage to maintain their health pretty well through their early sixties. We, as providers, lose perspective as we are always dealing with the sickest of any given population, giving us a slanted view of what is going on across broad sections of the populace.

As far as the "uninsurables" -- if they have a chronic, lifestyle limiting illness they likely would qualify for one of the programs already in place. The real victims in this health coverage problem are the low wage earners who work their tail off for either an employer who does not, or cannot afford benefits as well as the self employed, day labor, seasonal labor, etc who find themselves in the same situation. I would much rather direct my efforts into helping those who try to help themselves; once this is accomplished perhaps we can address the rest. Reverse triage if you will.....
 
Sound logical enough to me, but be ready for a huge spike in unemployment as government and the health care sectors have accounted for the vast majority of job creation over the past few years. I have heard that, if you exclude these two sectors, that the contraction in the workforce has been widespread and sizable.

There is no justifiable reason for a billing "department" -- there needs to be an initiative (probably legislatively driven, unfortunately) that requires insurance companies to provide, in real time, where a person is on their deductible, etc, as well as appropriate IT support for the process -- physician (or staff) enters the codes for the services provided at the time rendered, an EOB is instantly generated which states the insurance company's and the individual's responsibility, and the contractual write-off. These amounts are then debited automatically (& instantly) from the insurance account, and ideally the patient would be responsible on the spot (which is more difficult depending upon the situation).
I think that this is one of the greatest boons of a universal healthcare system. Universal computer automation is difficult at the moment because of the discontinuity in healthcare filing practices across the US. So it's going to be hard to initiate the creation of one universal automated filing section so that ALL of our tests results, x-rays, MRIs, etc are stored on one national--maybe internation--server that can be accessed by any physician we visit. That alone would cut a very large need for administrators. Couple that with the fact that NOW we don't need to file 80% of the insurance paper work, and that cuts that need even more.

I think that universal healthcare is a good idea mostly for those reasons. It's just a more capable system for streamlining the way we provide healthcare.

And yes! Good discussion!
 
I think that this is one of the greatest boons of a universal healthcare system. Universal computer automation is difficult at the moment because of the discontinuity in healthcare filing practices across the US. So it's going to be hard to initiate the creation of one universal automated filing section so that ALL of our tests results, x-rays, MRIs, etc are stored on one national--maybe internation--server that can be accessed by any physician we visit. That alone would cut a very large need for administrators. Couple that with the fact that NOW we don't need to file 80% of the insurance paper work, and that cuts that need even more.

I think that universal healthcare is a good idea mostly for those reasons. It's just a more capable system for streamlining the way we provide healthcare.

And yes! Good discussion!

But why is "Universal Healthcare" necessary to make these changes? Lack of proper incentive and political will maybe? IT standards could be developed in very short order, and if physician offices and hospitals were appropriately incentivized (perhaps through some tax incentive program tied with payment boosts for adoption of the technology) we could get something accomplished without handing the enitire payment obligation to the tax payer.

Medicare is insolvent and faces a $53 trillion -- with a T -- shortfall over the next 20 years. This equates to over $400k debt to every household in America; in twenty years every single dollar collected by the federal government will go to pay the interest on the entitlement programs without drastic and dramatic changes. If you believe that docs will not be hung out to dry through this process you are grossly mistaken. Why in the he** would we welcome with open arms any proposed increase of these entitlement programs??????
 
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So it's going to be hard to initiate the creation of one universal automated filing section so that ALL of our tests results, x-rays, MRIs, etc are stored on one national--maybe internation--server that can be accessed by any physician we visit...I think that universal healthcare is a good idea mostly for those reasons. It's just a more capable system for streamlining the way we provide healthcare.

I think calling for more uniformity in medical records in addition to pushing technology forward is a better route to go. Look at people's credit reports. These are handled by the private sector and they can be easily accessed just about anytime people want to buy anything.
 
But why is "Universal Healthcare" necessary to make these changes? Lack of proper incentive and political will maybe? IT standards could be developed in very short order, and if physician offices and hospitals were appropriately incentivized (perhaps through some tax incentive program tied with payment boosts for adoption of the technology) we could get something accomplished without handing the enitire payment obligation to the tax payer.

UHC wouldn't be a requirement, but I was just stating that this ability to streamline health care is one of UHC's boons. However, you're correct in saying that the health care system could be streamlined in the same way that we are discussing without UHC. But I do think that a UHC system would make the job easier.


Medicare is insolvent and faces a $53 trillion -- with a T -- shortfall over the next 20 years. This equates to over $400k debt to every household in America; in twenty years every single dollar collected by the federal government will go to pay the interest on the entitlement programs without drastic and dramatic changes. If you believe that docs will not be hung out to dry through this process you are grossly mistaken. Why in the he** would we welcome with open arms any proposed increase of these entitlement programs??????
Can you elaborate as to how Universal health care will inevitably cause our nation's health system to progress down this path regardless of implementation? I guess I'm just not familiar enough with the implications of UHC to see the connection right off.
 
UHC wouldn't be a requirement, but I was just stating that this ability to streamline health care is one of UHC's boons. However, you're correct in saying that the health care system could be streamlined in the same way that we are discussing without UHC. But I do think that a UHC system would make the job easier.


Can you elaborate as to how Universal health care will inevitably cause our nation's health system to progress down this path regardless of implementation? I guess I'm just not familiar enough with the implications of UHC to see the connection right off.

Medicare's insolvency is before accounting for any expansion of benefits, and it does include the projected >40% physician pay cuts.

Any implementation of a Universal healthcare plan based upon current Medicare or Congress' current health plan would constitute a fee for service system. Medicare's current funding is inadequate to cover its own needs and according to the government accountability office there is not enough potential tax revenue within the entire system to fund its liabilities. If there is not enough potential funding available for Medicare, how can we possibly expand these entitlements? We cannot. Significant cost control measures will need to be implemented. This means rationing. This means higher out-of-pocket expenses. This means further decreased provider reimbursements. So say that we change from a FFS system to a much more highly regulated and restricted system in an effort to curb utilization and costs -- who would want to work in an environment where you are every bit as liable as before but now have to practice with one hand tied behind your back and the other begging on the street?


The real issue is not coverage -- it is affordability. Unlimited access combined with an unlimited demand in an era of limited resources will not work.

As far as my real problems with this system -- from a personal (read provider) standpoint it changes the fundamental risk/rewards of the medical education process. The risks incurred include time lost, income lost, life lost, and educational debt; the rewards have traditionally been high income, respect, and job stability. One must realize that there are unintended consequences for changing the risk/rewards structure in any environment; this is best illustrated by the financial troubles of investment banks who, through deregulation and runaway leveraging created the mess that we are in.

We simply cannot afford Universal coverage without appropriate price constraints and rationing. This will create the work environment that is nothing like anyone in America has seen since WW2, and frankly, one that I want no part of (not that I have to worry, micrographic surgery will not be reimbursed appropriately under Medicare or any proposed Universal healthcare system in all likelihood).
 
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healthcare has been collapsing since the 1960's. However, it's still alive and kicking. Why? Nonprofits. The Church. The local governments. They can't solve it all, but I'm still amazed at what a trained social woker can do for people's medical bills paid/enroll them in coverage.

Now my small solution to a small but important problem:

Every hospital, in order to be accredited, must provide a family practice/first care onsite. Maybe even combine the ER, Hospitalist, and FP docs into one mega practice. Of course this steps on many toes, but it allows the mom with the kid with the nose bleed seen without tying up the ER's time, and perhaps gets the kid established with a FP doc.
This way when the "consumer" thinks they're tricking the system into given them free care, we actually have a chance to trick them and do some preventative care! While I'm wishing on a star, we might even get them to sit down with a social worker and enroll in one of the many local run programs that provides them with coverage.
 
Within all the ideas for health care reform that people have posted, I'd like to see more about letting physicians have more control over how much they charge for their work. And for that fee schedule to be disclosed to patients up front. Price determination shouldn't be just up to insurance companies. Insurance companies can consolidate into massive giants and take over much of the market, yet physicians get anti-trust lawsuits if they ban together to drop a specific troublesome insurance. Even if physicians didn't raise prices, it would be just a little less frustrating knowing that they can control what they get like most businesses can. And, it avoids everybody paying different amounts for the same care depending on which insurance plan they have (or paying tons if they don't have any).

*My experience is mostly with primary care...I don't know how well this applies to specialties/hospitals, but I imagine it does.
 
...I'd like to see more about letting physicians have more control over how much they charge for their work. And for that fee schedule to be disclosed to patients up front...

This does exist in some places in primary care atleast.

Here's one in West Va, Tennessee, North Carolina, Washington, and the list goes on.

The opportunity is there, you just have to stand up to the system and make it happen!
 
often the best solutions are the simple ones...:thumbup:

This is true with just about every aspect of our economy and society......you want to talk about the grip "administrators" have on education??????? LMAO!
 
Better Information Technology. How different do you think that Administrators vs. Physicians graph would look if everybody in the country had a single record for all their healthcare information. Immunizations, every doctor visit, every medication ever. Companies seem to have no problem accessing my financial history without a problem...why can't we do the same with my medical records?

:thumbup: I don't really understand why something like this would be so difficult, and I think it could cut a decent chunk out of overhead costs.
 
well, i asked the same question, and the reason is hospitals and ambulances are required to pick you up and take care of you. clinics are not, so if you are a self-pay patient they will make you pay a little up front. Since these people have no intention of paying, they take the ambulance and the ER visit, since they don't charge any money up front (even though its 10x more expensive), and they aren't paying anyway. Apparently the mechanisms in place for garnishing wages, etc isn't very good, otherwise they wouldn't keep doing it. I don't know what those mechanisms are, but it sounds like pillories, stockades, and systematic torture are probably what should happen next. ;) j/k Seriously, though, they need to do something. Forced labor is a good place to start if you are in debt and can work. Can't find work? No problem! We have a ton of trash that needs to be picked up on the side of the road. We'll pay you minimum wage. If you don't want to work? Well then you can go to jail.

Some of the people who say "it's free" are on medicaid. Medicaid pretty much pays everything, even for OTC meds if there is an RX. When I was in med school, a family called 911 to come to the ED after hours...for lice. They wanted RX for RID so that medicaid would pay for it. God forbid they buy anything for their own health care out of pocket- that might decrease cash available for cigarettes and ETOH.

Uninsured patients are a bigger mix. Some just don't go to the ED at all, since they know there will be a bill and they know they won't be able to pay. Some don't care, and will go and ignore the bill. These are the same people who don't pay rent. They generally know all the rules in terms of exactly how long they can go without paying before eviction proceedings work, etc. They take full advantage of the system. It actually amazes me how much effort some people put into being non-productive citizens. There is a socioeconomic class history of not paying your bills doesn't matter- they function on a cash economy and as many entitlement programs as they can.
 
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