Health Care and the alternative point of view

[jIM_Ohio]

Failures and examples of waste are easy to find. Please explain how these instances make a blanket statement such as "government run anything is bad" correct?



Demonstrate that the SS increase is due to waste and not other factors, such as the increase in life expectancy. And I don't know what higher taxes you're referring to; they are no higher now than they have been in the past.

FICA & SECA Tax Rates

1937-49 the rate was 1% TOTAL (and self employed people did not get double taxed)
1951-53 the rate was first time self employed paid the second half, but the rate was not double)
1966 the rate for SS was 3.85% and was the first year medicare tax was instituted. Medicare was .35% back then.

1990 was when rate was kicked up to current 6.2% for SS and 1.45% for medicare.

Please check link as I only highlighted certain rate increases, you can see from the chart that rates increased frequently over time- my point was SS was not a 6.2% tax in 1937 when it was created.

If taxes are based on a rate, showing them compared to GDP means little (to me) and comparing them to GDP is a way to make politicians feel good about themselves. Its not fair to tax workers more and more to live up to promises the government made to people, but was not smart enough to think through and make sure it could live up to... in case of SS the politicians of the 1950's-60's and 70's used the surplus to fund wars and other projects... that should not cause my tax rates 50 years later to increase because they were bad stewards of my parents and grandparents money. If taxes as a percent of GDP are low, and the tax rate was INCREASED, shouldn't the value of the SS benefit maintain its spending power as a percent of GDP? When in fact the spending power of SS has gone down (because of inflation) over time, yet the SS tax rate keeps going up, that is a clear sign the government cannot run anything correctly (to me).

Yes people live longer, but they did not index age to collect SS to life expectancy, they just tax workers and pay retirees. If there are more retirees, they tax workers more. Eventually workers will pay more in taxes than they take home in earnings. That is not right IMO.

I am not trying to point out that SS rate increases were due to inefficiencies

Demonstrate that the SS increase is due to waste and not other factors, such as the increase in life expectancy.

I am demonstrating the government will institute something (like health care reform), pay for it now with something, then change the taxes later because it did not forsee the problems it created or how the actual implementation would work.

Example 1- the government created SS. It spent its surplus in the 1940s-50's-60's-70's and 80's
it did so whether it was a republican president (like Eisenhower-Nixon-Reagon-Bush or Bush) or a Democrat president (such as Kennedy-Carter-Clinton or Obama)
It is running at a deficit now and cutting back benefits (not increasing with inflation). If the taxes are proportional to GDP, how come benefits shown as a proportion of GDP are not on same graph?)

Example 2- the government created medicare. It added another tax to fund this, yet the program still does not have revenues exceeding expenses. Its solution in this case was to reimburse doctors less. It increases its tax rate over time, yet it is not solvent (spends more than it takes in right now).

Example 3- Obamacare. The current tax to pay for this is not know to me... however if examples 1 and 2 are any indication, the government cannot plan its expenses and balance its budget, so more than likely whatever tax is passed, it will change, increase or a new tax gets created to fund this program.
I do not like adding a layer of taxation which cannot be removed or lowered. I pay enough in taxes now, and I have health care. Asking me to pay more in taxes to fund health care I already receive makes little sense to me.

My conclusion again is I have private insurance and its reasonably good. I have my complaints, but nothing in Obamacare is addressing my complaints (which are about my rights within the current system). I belive government run anything is bad, because most politicians are not accessible, where as corporate CEOs are.

I see my CEO or hear from my CEO more often than I see or hear from my 2 senators or representative. Elected officials are so out of touch with the people they represent I do not trust them as people, and therefore conclude "government run anything is bad".

[feh]

I pay enough in taxes now, and I have health care. Asking me to pay more in taxes to fund health care I already receive makes little sense to me.

Unless you're making more than $250K per year, I don't believe you'll be paying more in taxes to fund the new health care law.

[jIM_Ohio]

Unless you're making more than $250K per year, I don't believe you'll be paying more in taxes to fund the new health care law.

Today
but nothing suggests that tax doesn't change later

consider that SS started as 1% tax for everyone and is now 6.2% for me and 12.4% for someone which is self employed. That is a 1200% rate increase over 50 years- well ahead of inflation.

[feh]

Today
but nothing suggests that tax doesn't change later

The fact remains you aren't being saddled with more taxes, as you mentioned. Let's try to discuss things as they are today, and not potential future scenarios.

[cptacek]

The fact remains you aren't being saddled with more taxes, as you mentioned. Let's try to discuss things as they are today, and not potential future scenarios.

There are new taxes in this law and many of them can hit someone who makes less than $250,000. Some don't take effect today, but at least one will by this summer.

Kiplinger.com

(Is kiplinger ok as a source? Hope it is not to right wing for you.)

[jIM_Ohio]

The fact remains you aren't being saddled with more taxes, as you mentioned. Let's try to discuss things as they are today, and not potential future scenarios.

Tackling the future is what politicians do, and much of this is the future (certain things don't start until 2011 or 2012).

Insurance is all about the future, its not about the present anyway, so projecting tax rate histories into the future is just like projecting GDP and comparing it year over year.

Plenty of middle class families will get hit with this tax

6. A limit on the amount that employees can contribute to health care flexible spending accounts to $2,500 a year, but the cap won’t take effect until 2013.

and another example here

7. A ban on using funds from flexible spending accounts, health reimbursement arrangements or health savings accounts for the cost of over-the-counter medications, starting in 2011.

And this is a middle class tax increase too

9. A hike in the 7.5% floor on itemized deductions for medical expenses to 10%, beginning in 2013. But taxpayers age 65 and over are exempt from the cutback through 2016.

and this one as well

11. A new tax on individuals who don't obtain adequate health coverage by 2014. The tax is be phased in over three years, starting at the greater of $95, or 1% of income, in 2014, and rising to the greater of $695, or 2.5% of income, in 2016.

The blanket statement argument you made earlier goes both ways.

[feh]

There are new taxes in this law and many of them can hit someone who makes less than $250,000. Some don't take effect today, but at least one will by this summer.

Kiplinger.com

(Is kiplinger ok as a source? Hope it is not to right wing for you.)

Thanks for the link; I knew there were other funding sources, but didn't have a bookmark for them.

Except for #10 on that list, I don't see them amounting to much for the average family. It would be interesting to see what percentage of the funding is anticipated to come from this list (not all of which are taxes), versus the tax on high earners.

[geojen]

[QUOTE=jIM_Ohio;256501]Two points-
feel free to document HOW and WHY medicare has lower administrative costs? Probably because they set such a low price on their reimbursement and the choice is accept the lower price or do not get reimbursed. In this same thread there is a document that this technique costs you and me each another $1700-$2500 in health care costs per year (assuming we have coverage thru an employer or on our own).


QUOTE]


Actually, the reasons that private insurance companies have higher adminsitrative costs aren't all that hard to figure out, if you think about it. I read a book recently, called "Money driven Medicine" that did a pretty good job of documenting why insurance companies have such high overhead. Now, this is of course just one source, but I think it bears mentioning.

1) Insurance companies must turn a profit, Medicare does not
2) Insurance companies spend, on average, 5% of their costs enrolling and disenrolling customers. Medicare customers stay put, because their insurance is superior to what they could find on the private market.
3) Insurance companies have marketing costs. Medicare doesn't.
4) Insurance companies pay large salaries to CEO's and lavish bonuses for good market performance. Medicare doesn't.
5) Insurance companies spend millions of dollars on Washington lobbyists, Medicare doesn't.

The list goes on for why private insurance has higher administrative costs than Medicare, none of which has a thing to do with what Medicare charges for reimbursement rates.

I respect that we probably have an ideological divide as to whether single-payer would work for Americans or not. I don't want to start a politcal war here, I have been enjoying the exhange of ideas thus far.

[jIM_Ohio]

[QUOTE=geojen;256517]

Two points-
feel free to document HOW and WHY medicare has lower administrative costs? Probably because they set such a low price on their reimbursement and the choice is accept the lower price or do not get reimbursed. In this same thread there is a document that this technique costs you and me each another $1700-$2500 in health care costs per year (assuming we have coverage thru an employer or on our own).


QUOTE]


Actually, the reasons that private insurance companies have higher adminsitrative costs aren't all that hard to figure out, if you think about it. I read a book recently, called "Money driven Medicine" that did a pretty good job of documenting why insurance companies have such high overhead. Now, this is of course just one source, but I think it bears mentioning.

1) Insurance companies must turn a profit, Medicare does not
2) Insurance companies spend, on average, 5% of their costs enrolling and disenrolling customers. Medicare customers stay put, because their insurance is superior to what they could find on the private market.
3) Insurance companies have marketing costs. Medicare doesn't.
4) Insurance companies pay large salaries to CEO's and lavish bonuses for good market performance. Medicare doesn't.
5) Insurance companies spend millions of dollars on Washington lobbyists, Medicare doesn't.

The list goes on for why private insurance has higher administrative costs than Medicare, none of which has a thing to do with what Medicare charges for reimbursement rates.

I respect that we probably have an ideological divide as to whether single-payer would work for Americans or not. I don't want to start a politcal war here, I have been enjoying the exhange of ideas thus far.

Focus on 2 and 5...

I don't agree that medicare is superior
I agree their is cost savings by not having open enrollment.

This is a great example of reforming the system without government needing to be everyone's friend. Make policies portable, keep them consumer friendly, and people will not change them so much. The fact the private insurance companies need to change plan rules every year suggests that there is a problem (the changing of plans is a symptom, find the problem).

On medicare being "superior" LOLOLOLOLOL

Do the people using medicare have another choice?
Do the doctors have a choice? Some practices do not accept medicare. Doctor's not accepting a "superior" LOLOLOL product suggests to me it is not superior, and points again to a symptom of a bigger problem.

The (retirees) can insure privately, but it costs more (in premiums).
Medicare provides the person similar coverage at a cheaper (much cheaper!) rate. Many insurance companies would want to avoid insuring the people medicare covers because of high costs (high probability they have to payout) and its possible the economics suggest private insurance in some cases is not good business for the insurance company. I am sure there are statistics to this effect, but I don't have any.

So its an endless cycle- why is medicare cheaper, it provides doctors less in reimbursement, therefore it can charge cheaper rates to its "clients" which really have no other choice- because the care they get is almost the same (some medicare patients get a supplement to cover expenses medicare does not cover).

Depending on where you enter that loop, we just go around and around. I do not agree medicare is superior. Its a competitive alternative, but not a superior alternative. Make sense?


If the insurance companies are lobbying washington, one could argue that they are "protecting their profitable turf" and my suggestion is to "go against" the lobby with any reform. I do agree the lobby increases the cost.

That same discussion should also have that "private insurance" is subsidizing medicare costs.


Basically the government has some funny math to answer to...

Because medicare is better for the patient (in terms of cost)
but private insurance is better for the patient (in terms of what is covered with a single policy)

Private insurance is better for the doctors in terms of what the doctor is paid, when compared to medicare, but most doctors will tell you that the insurance companies still prevent doctors from making a fair wage.


If this is true reform, as I posted previously, we should look at 3 things:

1) Who is covered? Obamacare addresses this, IMO (and only this)
2) Quality of care. Maintaining this is important or the current legislation will get repealed. A vast majority of americans have health coverage they like, if they dislike their care, they will demand it be reset to what they had (customer service is everything).
3) How the quality care is administered (The rights of the patient, the rules we follow, the computer systems, privacy and other issues). Obama care touches on this, but what I have read, it is not very specific in this regard.

Without looking at why we have quality care, and building on that, I don't think reform will work. Just adding more insured people to the system does not maintain or improve quality of care.

[markusk]

Single payer could either remove inefficiencies or add more inefficiencies- depends on your interpretation of the problems, interpretation of supply and demand as it pertains to health care, and many other factors.

Here is why I am against single payer:

1) It is now up to whoever that single insurer is to pay for things. This is permanent price fixing, which will be bad for quality of care. Because people will provide care to meet the "certified cost", but not work to exceed the standard of care that provides.

1a) I mentioned fixing prices earlier in this thread, and most did not like that. Most doctors will tell you if the government sets prices like they do for medicare, they would go out of business faster than they are now.

In the current system, there is already "price fixing" by the insurance industry. This is already a fact.

If I charge insurance company A for a specific service rendered to their patient, I know that the most I can get is 75% of what I charge. For insurance company B, for the exact same service, I will only, at most, get 70% of what I charge. I qualify and use the words "at most" because if I did not document that service in the chart and the bill in a specific way, I will actually get reimbursed less than 75% from A and 70% from B -- but I won't know exactly how much until about 2-3 months after the fact. Most people do not know this but there is a delay in payment from the insurance companies to physicians and can vary by 3 - 12 weeks! I know that to break even and (barely) feed my family, I need to get at least 60% of what I charge. If an insurance company only reimburses 60% of what I charge, I will stop accepting that insurance in my office. If that same insurance company represents a significant % of the insured patients in my area, I will have to move my practice to another city or state.

1b) if the single payer system resembles medicare, realize that medicare is going bankrupt. Meaning you need to reform the system the reform is directing towards (if the first reform is single payer, then the system everyone is moving to will need further reform because its heading to bankruptcy). I feel like single payer would be racing to what happens next- US goes bankrupt, I die, or the system gets fixed. My money is on the bankruptcy if these are the 3 choices.

I have nothing to say here. It is complicated, agreed.

2) That single insurer is government run (probably) and last I checked, the government can't run anything right. Toll roads need paving, bridges over rivers are collapsing and now I want to put my health into hands of these same people? Give me any other option. Government run anything needs a second choice to compare to.

2a) my take is if health insurance companies (the current system) have a level playing field- meaning they market their products like life insurance or car insurance companies, or other tax incentives for people which self insure are added, the competition between the insurance companies will be better than removing all the insurance companies.

3) I agree with this part of your post

The system you want (computerized access to all records) goes against other laws the government has in place (HIPPA).

I have been thinking alot about folks here who are "against more government." And I just want to say a few general words.

To say that the government is not the answer, when we are fighting two wars (Iraq, Afghanistan), trying to contain Iran, trying to recover from our version of the Great Depression and retooling of the American economy is -- short sighted. "Government" has to be the leader or a silent partner is all of these projects.

Okay, lets move on.

I am not naive to point where I think single payer is the fix to the problem. This is because what really needs to be done to solve problem is see what works in our system:

1) The quality of care is second to none, If you need health care, our system will give you the best care in the world, bar none.

Many people are going to say this (and I agree): it's also the most expensive in the world. By every objective measure, infant mortality rate, life expectancy, etc, we are low in the totem pole. Sure, we have rich oil emirates who fly in to get their care at places like Mayo, but that's just it, you have to have money to have access to "the best care in the world, bar none."

2) If you have insurance, care is generally readily accessible. If I have to wait 12 hours for an appointment when I need my doctor (not a doctor, but MY doctor), that 12 hours is a LONG time. Its usually closer to 4-6 hours, and sometimes even less. If I call at 9am, I can often see my doctor before 5pm, and sometimes before lunch.

This is really impressive; I really mean that. I am assuming you are talking about your primary care provider? I assure you, your experience is the exception, and not the rule. I bet specialist care will be a delay. Either your physician is very efficient, or he/she is not that busy for whatever reason.

3) Most people have insurance. The numbers given earlier were 300 million insured to 30 million uninsured. Other people have suggested 60 million are uninsured. Regardless, if ration is 3:1 or 4:1 insured to uninsured, most people have access to insurance.

The sad fact of the matter is, everyone in the US is only one sickness away from bankruptcy. If you have a job and are healthy, there is nothing to worry about.

As for some of your comments:

If you want all records on one system, can I opt out of that system? Do not tell me my records have to be online. NO WAY. That means I am one hacker away from my records being made public.

Could you imagine the uproar if Barak Obama had erectile disfunction and someone found that record when looking for my records? Of course that might explain a lot, but I digress.

I don't know about you but I do my banking/investment stuff online. How about you? If you are not afraid to use the internet for your finances, I don't see why the same type of security can not be done for Electronic Medical Records (EMR). As DS stated earlier, EMR used by physicians, hospitals and pharmacists can be an intranet system with a firewall and with no access by the outside world.

If keeping consistent records is needed, what needs to happen is doctors need to work together and hospitals need to work together. I have been told in most cities hospitals compete with one another. In Cincinnati they work together. One of my kids was transferred from Good Samaritan Hospital (where he was born) to Cincinnati Children's hospital (I believe he was 7 weeks old when transferred).

When the transfer happened, all his records were transferred, and nurse stayed with him for first 4 hours at Children's to cover any gaps. The staff at both hospitals (and a third- University Hospital) rotate. The Neo Natologist at Good Sam has an office at Children's. The residents do rotations at each of the 3 hospitals. Cincinnati Children's is considered a top 5 hospital in the WORLD and it shares its staff within the city.

First of all, I am glad you got really good care for your children. As a father myself, I know that I would do anything to make sure my children got the best care possible. I am very glad everything worked out (eventually).

I am not sure what you mean by "work together." In the pediatric world, subspecialists, like neonatologists, are scarce so it is not uncommon for them to have offices and privileges in more than one hospital but usually they have a "home base" hospital which means the hospital they cover when they are on call (the trend in the neonatologist world is to do over night call inhouse, that is they sleep in the hospital). You may recall what I said about Children's hospitals in the US being money losers and are non-profits (you won't find any of them listed in the stock exchange) -- some have large endowments, sponsors, large research grants to supplement the cost of providing care.

Residents and fellows in training are actually over worked and underpaid physicians. For each resident/fellow employed, a university hospital gets somewhere between (I think) 100K to 150K from the government. University hospitals give between 40K to 60K to the resident/fellow and keeps the rest for salaries for the attending physicians and for overhead for providing "education." Without residents and fellows, university hospitals can not exist.

If we want records transferred, my doctor should hook up with an MRI provider, a hospital, and maybe some other specialists in the area. Then they can all choose the same software and system to store records on. That I am OK with because I trust my doctor more than I trust the government.

Who is going to pay for this? Exactly why should they cooperate? What is the incentive? Primary care doctors are the lowest paid!

What this also does is allow different software companies the ability to compete for creating those systems (they exist now). If the government were to pick one software to standardize on, that company would become bigger than microsoft, and realize that microsoft is a monopoly, and last I checked windows sucks. Especially windows 7. If windows 7 was that fat guy's idea, and he's not a programmer, I now understand what the problem was- the person designing the system cannot program. But I digress...

You are now going to force me to defend Microsoft? That's a low blow. Okay Windows Vista sucks! But...

I have heard it argued that if it were not for Microsoft/Windows, we would have a chaotic landscape of multiple software platforms and possibly different computer systems. Microsoft forced standardization so you can buy a computer from HP, Toshiba, Sony, Dell, etc and be reasonably sure they are all going to be able to use the same program from Quicken, Blizzard, Adobe, etc, to the same peripherals like printers, speakers, etc Standardization is not a bad thing.

Which proves my point about the lack of standardization in EMR. Some hospitals use EMR that look like it is in DOS. Most use proprietary software that are very different and can't speak to each other. This is a problem. For the sake of arguement, if Medical EMR has something like 50 platforms in the market right now, each platform may have 0.01% or less of the market. If you are a hospital CEO, which one would you choose? On thing is for sure, it's going to cost alot of money.

Someone, I don't know who, has to come up with, or force, a standard.

In general, reform will be easiest if we tweak the existing system (like regulate the insurance companies and give the patient more rights than the insurances companies currently provide). If single payer is the solution, I am sure it could work, but that would mean higher taxes, and considering I have health care now, and my taxes are low, I do not need taxes to go up to give me something I am already receiving.

I don't have a problem with this. I am making a good living right now and feel very privileged and blessed.

But I see patients every day.

A few, through no fault of their own, have a bad disease. There is no cure. Eventually, some will not be able to work, and eventually they are let go from their jobs. Now they lose their insurance and have to go on disability. I don't see them again because I don't take Medi-Cal (California version of Medicaid). I know it is only a matter of time before they lose their house because they can't make their mortgage.

[markusk]

Like I put in my other post, just because medicare does not have the administative costs of private insurance does not make it a good example. It takes more than a macro statement to use this as a position.

If your position is



Lets look at details of what we know:

1) Medicare reimbursement to health care providers is MUCH lower. Lower MRI reimbursements, Lower surgery reimbursements, lower everything.

This is not true. Depending on what area of the country you are talking about, Medicare can be as profitable as private insurance or slight less than private insurance. For example, if your area is designated as "rural," Medicare will pay about 10% less than a designation of "urban." I kid you not. I don't know who came up with this rule or why certain areas are designated as "urban" when in fact it is rural in every sense of the word, but there it is.

It also depends on the type of office visit, or procedure you are talking about.

[jIM_Ohio]

Many people are going to say this (and I agree): it's also the most expensive in the world. By every objective measure, infant mortality rate, life expectancy, etc, we are low in the totem pole. Sure, we have rich oil emirates who fly in to get their care at places like Mayo, but that's just it, you have to have money to have access to "the best care in the world, bar none."

My kids were born at 28 weeks (and 4 days).

In most countries they would have been dead on delivery.
In the USA they are alive and just turned 2.

You cannot give me a comparison of US infant mortality rates to another country unless you can convince me my kids would have survived in that country at birth.

This is really impressive; I really mean that. I am assuming you are talking about your primary care provider? I assure you, your experience is the exception, and not the rule. I bet specialist care will be a delay. Either your physician is very efficient, or he/she is not that busy for whatever reason.

Pediatrician for kids, primary care for me. The Pediatric practice is quite large (more than one pediatrician and more than one location in 50 mile radius).

My primary care is a smaller practice, but he can also see me on less than a 12 hour notice most of the time.

My wife has seen a specialist (neurologist) on less than 48 hours notice, and her second opinion was less than 48 hours after that as well.

The sad fact of the matter is, everyone in the US is only one sickness away from bankruptcy. If you have a job and are healthy, there is nothing to worry about.

I disagree with this- I use an HDHP and have the 7k annual deductible in the bank. The purpose of insurance (to me) is to prevent bankruptcy, not pay for my care.

I don't know about you but I do my banking/investment stuff online. How about you? If you are not afraid to use the internet for your finances, I don't see why the same type of security can not be done for Electronic Medical Records (EMR). As DS stated earlier, EMR used by physicians, hospitals and pharmacists can be an intranet system with a firewall and with no access by the outside world.

If its like the financial world, where my accounts at T Rowe Price and my accounts at 5th 3rd bank are connected only by a routing and account number, that is OK.

However the way most people make this sound, its like there is one common database with all my information in it. I do not want one common database. One common platform is OK.

I am not sure what you mean by "work together." In the pediatric world, subspecialists, like neonatologists, are scarce so it is not uncommon for them to have offices and privileges in more than one hospital but usually they have a "home base" hospital which means the hospital they cover when they are on call (the trend in the neonatologist world is to do over night call inhouse, that is they sleep in the hospital). You may recall what I said about Children's hospitals in the US being money losers and are non-profits (you won't find any of them listed in the stock exchange) -- some have large endowments, sponsors, large research grants to supplement the cost of providing care.

Residents and fellows in training are actually over worked and underpaid physicians. For each resident/fellow employed, a university hospital gets somewhere between (I think) 100K to 150K from the government. University hospitals give between 40K to 60K to the resident/fellow and keeps the rest for salaries for the attending physicians and for overhead for providing "education." Without residents and fellows, university hospitals can not exist.

I think I explained this... but here it goes... there are X number of Neonatologists, there are Y assignments for the Neonatologists, which include being on call, doing research, holding follow up clinics, etc. They have X/Y assignments

for 2 weeks you will be on call at one hospital
for X weeks you do research
for 2 weeks on call at different hospital
for Y weeks do a follow up clinic
etc...

In our 13 week NICU experience we came across about 10 Neonatologists (we have twins, and had two kids in 2 different hospitals, so there is a reason that number is not consistent with 2 weeks of on call).

Who is going to pay for this? Exactly why should they cooperate? What is the incentive? Primary care doctors are the lowest paid!

Its the common platform you mentioned 2-3 replies above this... they cooperate because they probably have common doctors they refer people to (if my doctor uses a certain MRI facility more (like the one downstairs), or he refers people to the same neurologist over and over, its probably wise to standardize on same platform.

I work with technology like this...

The platforms do not even need to be the same (not all applications like this are windows based). languages like xml and sql exist which would allow one office to use apple, one to use linux and one to use windows, and get the data stored properly.

Oracle is a great example of software which is independant of operating system- most applications we run have Oracle behind them (or one of their competitors).

You are now going to force me to defend Microsoft? That's a low blow. Okay Windows Vista sucks! But...

I have heard it argued that if it were not for Microsoft/Windows, we would have a chaotic landscape of multiple software platforms and possibly different computer systems. Microsoft forced standardization so you can buy a computer from HP, Toshiba, Sony, Dell, etc and be reasonably sure they are all going to be able to use the same program from Quicken, Blizzard, Adobe, etc, to the same peripherals like printers, speakers, etc Standardization is not a bad thing.

Which proves my point about the lack of standardization in EMR. Some hospitals use EMR that look like it is in DOS. Most use proprietary software that are very different and can't speak to each other. This is a problem. For the sake of arguement, if Medical EMR has something like 50 platforms in the market right now, each platform may have 0.01% or less of the market. If you are a hospital CEO, which one would you choose? On thing is for sure, it's going to cost alot of money.

Someone, I don't know who, has to come up with, or force, a standard.

There is a difference between everyone running the same application (like internet explorer or word) and having standardized or common or compatible systems.

Earlier in this thread I used the Ford and GM analogy (those are large customers for my company). Each of them has standardized on our software with their suppliers. Some run windows, some run unix, some may even run apple (but I doubt it). Some of their servers are linux with unix clients, some servers are linux with windows clients, some servers are windows with windows clients.

What the supplier has and what GM has do not need to be the same. Its because we use programming independant of operating system.

If the health care industry has not started developing applications like this, a software like ours could do everything you need it to, and we could make it happen in about 6 months, regardless of what the current systems look like (it would take 6 months to develop an interface into current system, if you dropped all records, we could be running within a week).

A few, through no fault of their own, have a bad disease. There is no cure. Eventually, some will not be able to work, and eventually they are let go from their jobs. Now they lose their insurance and have to go on disability. I don't see them again because I don't take Medi-Cal (California version of Medicaid). I know it is only a matter of time before they lose their house because they can't make their mortgage.

My thought is no one should go bankrupt from health care- that is where the government intervention needs to start and end... to me the solution is not about providing everyone with insurance like a majority of americans get from their employer.

Really looking at 2-3 core values

1) a person should not go bankrupt from health care (or have to choose bankruptcy over death)
2) the health care system should not bankrupt the country
3) If you want health care, you should be expected to pay for it. I suggest about $7000 per year, then phase in some tax credits based on income for the working poor to get this back.

My HDHP has a 7000 deductible, that is where I came up with that number. If its 5k or 10k does not matter to me (personally).

My HDHP costs me about $120/month for a family of 4
based on the list costs my employer appears to pay about $300/mo for same coverage, this means my real health care bill is about $13,000 per year.

If everyone saw the LIST price and then realized they already pay 75% of that thru premiums and employer contribtutions, they would realize even 7k or 10k is not really that high.

[jIM_Ohio]

This is not true. Depending on what area of the country you are talking about, Medicare can be as profitable as private insurance or slight less than private insurance. For example, if your area is designated as "rural," Medicare will pay about 10% less than a designation of "urban." I kid you not. I don't know who came up with this rule or why certain areas are designated as "urban" when in fact it is rural in every sense of the word, but there it is.

It also depends on the type of office visit, or procedure you are talking about.

There was an article linked earlier in this thread which was a study done by hospitals- the average medicare payment was X% lower than private insurance for hospitals and doctors (on average). That was where the conclusion came from.

[irmanator]

I also think people need to have some skin in the game. Back when people had HMOs with $2 copays, they'd go to the doctor for every stupid thing you can imagine because it was cheaper to see the doctor than to go to the pharmacy and buy something OTC. Now, copays are more in the $20-$30 range and that creates a bit of a deterrent to running to the doctor for every sniffle without being too big a burden that would prevent most people from seeing a doctor when they really need to.

When my teenager started skipping school in her senior year, faking that she was sick, I told her the very next time she skipped school she would go to the doctor and she would pay the bill herself. Amazing how she was healthy the rest of the school year. So imho raising the deductables and making people realize the cost of their actions could help.

[irmanator]

This is what we need to fix. We need to somehow educate the population about the need and benefits of regular medical care. We need to teach people why they need to treat their BP or sugar or cholesterol or other chronic conditions even if they feel okay. We need to ban the sale of all tobacco products rather than just trying to tax them out of business. And we need to have some massive ongoing concerted effort to truly address obesity. I can tell you that most of my day is spent treating obesity and smoking-related illness. Get rid of those two problems and you will solve the healthcare crisis.

So maybe if non smokers and people who live healthy lifestyles could get discounts??? I don't know just an idea. It might motivate some to do better..... I know It would work for me... well I just wanna be one of the people who can get out and enjoy life and not be a burden.