Fix Healthcare

[jIM_Ohio]

Instead of complaining about health care, fix it.

How would YOU fix health care. Be as specific as you can.

When you listen to politicans discuss the issues, do they say anything which makes you think they can fix it?

My favorate quote

The problem with health care is everyone in this country wants something, wants the best care, but is not willing to pay for it.

This was not said by a politician, it was said by a friend of mine which is a children's anesthesiologist.

His comment is my solution. No more insurance- just add the amount paid to premiums to people's paychecks. Then make them pay for all service they need when they show up.

This creates more problems (which I could solve), but curious what other solutions those of you out there have.

This is a thread about solutions!

[boefixepa]

I've thought about this, and this is what I think, of course it will never happen.....but it's the fairest I can come up with.

Get rid of ALL insurance companies, save one not-for-profit one, not the government, but overseen by it.

Set up a tier system of different plans.

The lowest of which would cover all basic medical care, what most people generally use. This would be free to all those below the poverty level, the disabled, the mentally ill, the elderly, vets and their dependents.

The level of plans would go up from there and costs a little more and offer more services, or to pay in part for elective things.

All working americans would have their choice of any of the plans and choose the plans for their depedents and have the amount deducted like their taxes.

This next point is key to me.....if you are an adult, able bodied, and able minded and you choose not to work you just don't get it for 'free'. You have to pay for it, if you don't you aren't covered, if you don't like it get a job! (This wouldn't be for uemployment times , for children, college students, just for people who think life is a free ride.) The children of such parents would be covered under the free plan, all the parents would have to do is apply, but the able minded and able bodied parent(s) would not be.

So my plan would cover most everyone, probably for cheeper then what we are paying now, since soooo much goes to paperwork and the like. But the freeloaders wouldn't like it, but I'm okay with not paying for their health care.

[LivingAlmostLarge]

Increase taxes by 5% and it would cover the cost of a socialized health care plan. Also allow people to buy their way to the front of the line by paying cash for services that are not covered by the government run insurance.

One problem with the current system is if you travel anywhere out of network (basically out of state) you can get Screwed by the charges. It's a different system, different amount the doctors charge, etc. So if we had one standard plan then it wouldn't be risky to say visit your family and get sick.

Also this way you cover everyone if they work. A lot of places like Walmart don't give benefits but you work full time.

Also by regulating medical care so we stop paying to extend people's lives so much at the end. There needs to be some limits imposed instead of just trying every single therapy to extend a person's life. Every other country does value a person's life, except the US.

We don't use our medical when we're young, mostly as we age. And right now it's tough for people who are "savers" to retire before 65 because their medical coverage is tied to having a full time job.

[Scanner]

I think the system in Mass. is probably a best compromise for Conservatives and Liberals.

Mandate everyone buy a health insurance plan much like car insurance. People without car insurance are a nuisance to society; so are people w/out health insurance. Assist the lower income people who can't afford it.

Some say though that there isn't a health insurance crisis - there's a priority crisis.

Americans prioritize big screen TV's and $30,000 cars over health care.

So, obviously, there's money out there. It's just what people want.

I don't know what you can do about that.

People value what they value.

[sweeps]

I used to believe universal health care was the way to go but I've since changed my mind. People must have skin in the game for health care costs to go down. I kinda like Jim's idea... each person gets an account designated toward health expenses. If you have to spend it, fine, but if you don't you get it back as a bonus at the end of the year. (You don't want to give it to people up front or they'll blow it on a plasma TV.)

This would encourage:
a) Consumers to think twice before going to the doctor for frivolous reasons
b) Consumers to think twice before agreeing to frivolous procedures and tests
c) Consumers to shop around for the best price where possible (For example, they may choose to go to one of these new health clinics for minor ailments for a $50 charge instead of the family doctor for a $150 charge or the ER for a $500 charge)
d) Doctors to make pricing and billing more transparent
e) Doctors to be more willing to negotiate on pricing
f) Consumers and doctors to be more willing to choose generic meds and alternative treatments

I think people would still have to buy catastrophic health coverage (for example for medical bills > $5,000). This could follow Scanner's thought about it being required and/or subsidized.

[m3racer]

Originally Posted by sweeps

e) Doctors to be more willing to negotiate on pricing

sound like a used car dealership...lol

[m3racer]

Originally Posted by Scanner

Americans prioritize big screen TV's and $30,000 cars over health care.

So, obviously, there's money out there. It's just what people want.

I don't know what you can do about that.

People value what they value.

well said

[sweeps]

Originally Posted by m3racer

sound like a used car dealership...lol

You laugh, but if I go to a car dealer and he wants to charge me $2,000 more than the dealer down the road for the exact same car... he needs to bring his price down or I'm walking. (Granted, "negotiation" doesn't apply for all situations -- If I'm suffering a heart attack, I'm not going to ask to be transferred 50 miles away where treatment would be cheaper -- but it does apply to many situations.)

I disagree about health care being a priority crisis. Anyone in their right mind chooses health care over anything else. The real problem is that people are able to pay for health care with someone else's money. If insurance covers a medical procedure, test or prescription, people go ahead and do it. What's there to lose? It doesn't cost the consumer anything beyond his initial co-pay. When marginal cost is 0, demand is infinite. Basic economics.

[PrincessPerky]

Originally Posted by sweeps

I used to believe universal health care was the way to go but I've since changed my mind. People must have skin in the game for health care costs to go down. I kinda like Jim's idea... each person gets an account designated toward health expenses. If you have to spend it, fine, but if you don't you get it back as a bonus at the end of the year. (You don't want to give it to people up front or they'll blow it on a plasma TV.)

ditto that. have a base amount that is essentially your deductible, but you can get it back at the end of the year if you don't use it. Of course if you get cancer you will use it up and then move on to the actual insurance portion of the deal. And that deductible should be bloody high....Dr visits for colds are annoying! (some of your 'insurance' keep back could go to that 'over 5K' coverage, or it could be a separate 'rider' - IE keep out 6K a year, use or get back 5K)

As to folks without the job, health care on my tax dollar shouldn't cover experimental and 'make you feel good' drugs. It should cover basic immunizations and basic needs. Sorry I know healthy teeth are important, but do you really deserve a root canal at the cost of pointing a gun to my head? That is what taxes are, money taken at the point of a gun (yes they will come eventually with guns if you will not comply with the written code) You think folk willingly walk into jail for tax evasion? No they go there cause of the gun they want to avoid.

Also on the 'pay to the front' essentially Drs should have the right to charge more, Dentists get to do that with their 'spa dentistry' why can't Drs? So it is a waste of money, so long as it is your money to waste go right ahead and get a spa Dr. (though no quacks please). Not to mention the number of Drs going out of business due to lowering pay..they aren't allowed to charge more right now, and a Midwife can barely cover insurance bills, how am I supposed to get a good midwife when they can't practice due to not being able to ask enough to cover the cost of malpractice?

[m3racer]

Originally Posted by PrincessPerky

.......cover the cost of malpractice?

You have to love our litigious society. The number of frivolous medical lawsuits in America is ridiculous.

[disneysteve]

Some may have noticed that I didn't jump right into this thread. That was intentional for 2 reasons. 1) I wanted to see what others had to say and 2) I don't have a good solution. Let me make a few general comments.

1. I agree that people put more value on services that they pay for personally, so giving patients more direct financial responsibility makes some sense. The problem is that many people will choose the money over the care (sorry sweeps but I see it all the time - health care is not a priority for a great many people). This is what is currently being seen with the grow of HDHP-HSA plans. People are voluntarily skipping care to avoid spending the money in their accounts. So that's a problem that needs fixing.

2. Health insurance needs to stop covering nonsense like cold medicines, Rx versions of drugs available OTC, "lifestyle" drugs and other non-essential care.

3. The malpractice system needs an overhaul to avoid frivolous lawsuits. Even a ridiculous lawsuit where the patient doesn't have the slightest chance of winning can cost thousands of dollars to prepare for and defend. This just sucks money out of the system.

4. We, as a society, need to start valuing death as much as we value life. Keeping your loved ones alive at all costs regardless of their condition, quality of life or even consciousness has to stop. We need to learn to accept that death is a natural part of life and people deserve to die in a respectful manner. The percentage of our health care dollars spent on end-of-life care is ridiculous.

5. PrincessPerky said it first, so I hope I don't sound like I'm pushing my own advantage, but medicine needs to be a more free market environment. Doctors need to be able to charge what they feel is appropriate for the care they deliver. If a pizza shop has to pay more for sauce and cheese and toppings, they can raise their pizza prices. If a car manufacturer sees their production costs rising, they can charge more for their vehicles. Doctors, however, have no control over what they charge. Our rent goes up. Our staff expects raises. Our overhead is always rising, but we can't raise our fees to compensate. Physician income in this country has been steadily declining. Right now, Medicare is planning a 10% decrease in reimbursement rates in 2008. Would anybody else like to see their income cut 10% next year?

6. Keep pushing generic drug use. The $4 Wal-Mart plan has made great strides in this area and I hope it continues to grow.

7. Insurance companies need to simplify things. Get rid of referrals. Get rid of pre-certification and prior authorization procedures. They cost a fortune in administrative costs and save little to nothing in actual health care costs. And get rid of closed drug formularies. Make all meds available at an appropriate price.

It's late so I'll stop there for now. I'll follow along and add comments as I think of them.

[sweeps]

Assuming you're right... people really don't care about their health, then that would make the plan I am advocating even more important. I don't want to have to pay for the expensive medical care the people who choose not to take care of themselves will eventually need. With UHC, we all pay dearly for the bad choices people make. It's just another social safety net -- and we know how those turn out. No thanks.

If someone chooses to not go to the doctor so he can pocket his health care money at the end of the year, so be it. If he wants to wreck his life, that's his choice. I don't see how any of the other plans out there -- especially UHC -- solve that problem.

EDITED TO ADD: I would submit that part of the reason people don't go to the doctor is... frankly it sucks. You can never get an appointment when you need it. When you get there, you wait for an ungodly time. Lots of times the people in the office (particularly the receptionist and desk staff) are not friendly. The doctor spends maybe 3 minutes with you but charges a minimum of $100. The bills sent to you are often inaccurate and no one is willing to help fix it. The list goes on and on... People would rather go to the drugstore, buy some crap off the shelf, and self-medicate rather than go through that exercise.

[disneysteve]

Originally Posted by sweeps

EDITED TO ADD: I would submit that part of the reason people don't go to the doctor is... frankly it sucks. You can never get an appointment when you need it. When you get there, you wait for an ungodly time. Lots of times the people in the office (particularly the receptionist and desk staff) are not friendly. The doctor spends maybe 3 minutes with you but charges a minimum of $100. The bills sent to you are often inaccurate and no one is willing to help fix it. The list goes on and on... People would rather go to the drugstore, buy some crap off the shelf, and self-medicate rather than go through that exercise.

If that's been your experience, I'm sorry to hear it and I'd suggest changing doctors. Nothing that you list goes on in our office, nor did it go on in my previous practice. Patients are seen by appointment, almost always on time or within 10-15 minutes of the scheduled time. Sick visits are seen same day or possibly next day if they called late in the day. My staff spends hours on the phone and computer with insurance companies trying to straighten out bills for patients.

I work in a relatively poor area, so my patients aren't so quick to buy OTC remedies. They'd much rather see the doctor and get a prescription that will be covered by their insurance.

[sweeps]

My current doctor is pretty good, but my last three were pretty rotten. And I know of lots of other people who feel the same way about going the doctor -- there's just not a lot of value for the time and money in going. Obviously that needs to change.

[disneysteve]

Originally Posted by sweeps

I know of lots of other people who feel the same way about going the doctor -- there's just not a lot of value for the time and money in going. Obviously that needs to change.

Maybe this is what we need to be addressing. What do people feel they need in order to feel they are getting value for their healthcare dollar if they don't feel that is true today? Personally, I have never felt that way so I don't look at the situation from that point of view. Anytime we've had health problems, I've thought the treatment was worth every penny we paid for it, but clearly others don't share that view. But I'm one of those people who puts a high priority on health and wellness. How do we get people with different priorities to place more value on healthcare?

[LivingAlmostLarge]

I rarely see the doctor and I have insurance, great in fact. I dread making appointments, I have a standing 1 year appointment for my Ob/Gyn. Why? Because if you don't make one when you are standing there, there is NO ROOM. WTF???

And I sit there still and wait at least 1-2 hours to get in. Even a regular primary care, we needed to see for a physical for DH's job application/drug test, it was an all day thing.

I wish we had walk in clinics which saw you quickly. Turns out even the clinics you need a "Referral.". HA.

[simpleyme]

I hate going to the Dr and since we moved we do not have a family Dr.

we never had good luck ,we found a Dr paid the new patient fee we received a letter the next month he was retiring!

My kids had a Dr's. that were married, they would close up the office and go on vacation if you got sick their phone service would tell you to use the ER
then when they got back they did not even care enough to follow up

we have used urgent care clinics they used to be affordable about 60-100 bucks out of pocket but when my son pushed his tooth clear thru his lip at the pool the receptionist said it was not so bad and told us to go home

last year when my son needed stitches after being hit with a snowball and required 3 stitches it cost me 375 out of pocket after insurance at the clinic,
they opened a fancy restaurant and day spa their so we are in search of a new clinic there is suposed a good one about an hour away that we will try next time


we have always had health insurance what we never had is health care , we find having insurance will get you into the Dr but does not seem to asure that you get care ,but just ensures that you will owe the DR money ,that is why I always liked clinics as you were forced to pay in advanced so you knew what you would really owe, no suprise bills for later

[irmanator]

I have a feeling due to an article i read years ago i think came from readers digest, that doctors are getting paid for prescribing certian medicines. I about half believe that because my last dr said everything was my allergies and prescribed ecpensive meds like 75mo that didnt seem to do anything. leading me to doubt my allergies were that much of a problem. I asked one time if they could prescribe a cheaper med they told me they were all about the same. I quit buying it. I use tylenol cold and sinus and feel better than ever. just a personal observation.

[Scanner]

I do have one more thing to add to DisneySteve List:

8. Attach a $1000 copay for any alcohol related injury/illness in the ER.

Working the ER on Saturday nights as a CAT scan tech., I would say half of my night is spent dealing with alcohol related injury and illness. Sometimes these are immigrants or indigent with no means of paying for the care they are receiving.

It's frustrating to see valuable healthcare resources being flushed down the hopper. You could cut the staff in half or at least by a 1/3rd in the ER on weekends if you didn't have this happy horse-hockey.

You know. . .a little history lesson here.

Most people thought that Prohibition failed. That it was a failed Noble Experiment.

Actually it didn't and that conclusion is kind of looking at history backasswards.

Prior to prohibition, Americans almost drank beer swill like water (because you didn't know if the water was good). Alcoholism was rampant (and this is in the 1890's - the good old days before autos). Jails were full of drunks. Unfortunately, alcoholo was even the main ingredient in people's medicines.

Historians estimate Prohibition reduced alcoholism rates by 50%.

I am not suggesting Prohibition Amendment Part 2 (I like a good belt or snort now and then) - but I am suggesting that the "sins" (alcohol, tobacco, drugs) are huge part of the health care problem and never doubt the ability of a heavy-handed gov't action to bring about change.

Freedoms/schmeedoms. I say trample on those freedoms.

The ER (the most expensive place you consume healthcare) should be for diabetic emergencies, auto emergencies, acute appendicitis, not taking care of Billy Bob Jimmy Boy who decided to quaff a case of beer.

[disneysteve]

Originally Posted by simpleyme

we found a Dr paid the new patient fee we received a letter the next month he was retiring!

What the heck is a "new patient fee"? I've been a doctor for 17 years and have never heard that term before.