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Solutions To Reduce Healthcare Costs In The U.S.  
User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Posted (2 years 2 weeks 5 days ago) and read 1821 times:

In the middle of all the debate about Obamacare, what was missing was an honest discussion on how to bring down healthcare costs in the U.S. In a 2,000-page bill you would think there would be some space to add a couple of lines that could have had a meaningful impact on bringing down real costs, but somehow not (or maybe they are there and nobody has figured out what it contains yet). So, two years late, here are a few ideas to achieve just that - comments / suggestions / critiques welcome, and feel free to add any of your own ideas.

Competition across state lines - insurance companies are currently not allowed to compete across state lines. If you live in NY, you cannot buy a health plan that is offered in TX, even if that plan is cheaper and better fits your needs. The result is that you end up with effectively local monopolies in places like Michigan and Maine, and over-priced insurance everywhere as companies are forced to adapt their offerings to 50 different jurisdictions. Allowing insurance companies to compete across state lines could have a meaningful impact in the cost of health insurance and give people the freedom to buy what better fits their needs.

Tort reform - litigation costs in the U.S., and a kangaroo court system where people seem to treat it like a lottery, are a significant drag in the U.S. economy, but in no place is that as evident as in the healthcare industry. Moving malpractice trials to a specialized court where they are seen by a specialized judge (or panel of judges) would go a long way in reducing this unpredictability - some random guy dragged off the street who was not smart enough to be able to come up with an excuse to get out of jury duty is simply not qualified to understand the complexities of medical decision-making, just as he is not qualified to understand bankruptcy law (another area where specialized courts exist). If that is not constitutional, for some reason, eliminate the ability of lawyers being awarded a portion of the winnings. The notion that this could have an impact on medical quality is ridiculous - doctors strive to do the best for their patients in all situations because they have their lives in their hands, not because they fear being second-guessed by some ambulance-chasing lawyer. Air Traffic Controllers have the lives of hundreds of people on their hands too and don't need a lawyer to tell them not to play Angry Birds while planes are on final approach.

Ending subsidies to global healthcare research - U.S. citizens pay higher costs for drugs than other developed countries because those countries have monopsonistic buying authorities that drive down the prices, which they know they can do because they know the drug companies will always have the U.S. to sell drugs into at market rates to recoup the research costs. What ends up happening is that U.S. patients end up subsidizing the medical research for other developed countries. Pass a law by which drug companies cannot sell drugs in the U.S. at a price that is higher than the average they sell it at in all OECD countries (or a relevant subset thereof). This way, drug companies would not have an incentive to be as aggressive when bidding for foreign contracts, as it could reduce the price of all the sales they made into the U.S. market, which would spread out the research costs more evenly (consequence is drug costs would go higher in other developed countries, but that is not a problem for this thread). This measure should be something that truly enjoys bipartisan support - right-wingers would like the reduction in subsidization to other rich countries without affecting medical research, while left-wingers would be able to enjoy all the advantages they believe a monopsonistic buyer would bring without the need for the single-payer system they know they cannot get approved.

Reduction of the barriers to access to the medical profession - in the U.S., medical students need to spend 4 years in college, often having to take totally irrelevant classes, before they go to medical school. In many countries, a medical degree is something you obtain after 5 or 6 years of study straight out of high school (they are pretty intense years, though, so you do kind of miss out on the beer pong technique you could have developed otherwise). This leads to lower barriers to access to the medical profession, because of the lower opportunity cost of the years outside of the workforce, as well as lower tuition costs. Use state universities to create and promote 6-year undergrad medical degree programs. This could be done without increasing overall government expenditure by reallocating resources at the universities if needed - a medical student has a much higher ROI for a state than three underwater basket-weaving majors.


Read this very carefully, I shall write this only once!
67 replies: All unread, showing first 25:
 
User currently offlineajd1992 From , joined Dec 1969, posts, RR:
Reply 1, posted (2 years 2 weeks 4 days 23 hours ago) and read 1825 times:

Best way to do it - add it as a percentage tax, make people pay it based on their income. You can go to the hospital for whatever you need, no questions asked.

Done.

Healthcare is insane in the US - my dad had an epileptic fit in Arizona, 3 days in hospital including scans, MRIs and blood tests came to just short of $21k. Twenty-one THOUSAND Dollars. That's insane.

[Edited 2012-11-09 01:49:08]

[Edited 2012-11-09 01:49:35]

User currently offlineRara From Germany, joined Jan 2007, 2136 posts, RR: 2
Reply 2, posted (2 years 2 weeks 4 days 21 hours ago) and read 1826 times:

Socialize it. The reason why health care is so insanely expensive in America is that it is a huge profit-making enterprise. Doctors carry away shitloads of money; partly because they have to recoup their training and education costs, partly because, well, they like money. Hospitals and care centers are run by huge profit-making corporations – the so-called free market is a travesty, because their risks are next to none (the insurances’ and tax-payers’ teats never run dry). Pharmaceuticals are sold at stellar prices because the industry bribes and blackmails the health sector. In short, a small number of people are getting filthy rich off what really should be a public good.

So here’s what to do.

- Create a National Health System that employs doctors, nurses and other staff. Pay them decent wages, but nothing exorbitant. Of course doctors are free to practice independently as well, but then patients have to pay the full costs of going to them instead.

- Make sure everyone, all across the country, has access to proper healthcare and is ensured adequate, state-of-the-art treatment.

- Always purchase the cheapest pharmaceuticals on the market. Make transparent calls for tender and choose the best offer. Publish all relevant data on the internet. This will eat deep into the profit rates of the industry giants; they will cry and howl with rage and claim they can’t do research anymore. Don’t believe a word of it – it’s their stockholders who will really suffer.

- Do a lot of in-house research. Increase the NIH’s budget. Cooperate with excellent universities. Jointly run university hospitals where young doctors can be trained and do research at the same time.

- Make sure young people can afford to study medicine and don’t have to go into debt to do it. Make the selection based on merit – take the brightest.

- Make patients self-responsible. Here’s how: give everyone an annual “health budget” which they can administer themselves. Preventive medical check-ups are always free. For regular treatments, the first 500 dollars you use are also free – you have to sign them off, but you can use your budget for them. The next 2,000 dollars have to be paid out of your own pocket. Any expense larger than will again be covered by your health budget. If you stay below your initial 500 dollars budget in one year, you can take up to 1,000 dollars into the next year with you. Whatever treatment you receive from your doctor will have to be signed off by you, so that you always have a good grasp of what it costs. What this will achieve is that people will really think twice whether they actually need a certain treatment or medication. It will prevent unnecessary trips to the doctor, but it will also make sure that if you’re really ill and need treatment, you won’t go broke over it.

- Finance the system via a progressive income tax. People will have to pay more taxes, but it will save them a lot of money in the long run.

- Insurance companies can continue to exist, but you will need them only for additional services that are not covered by the Health System, or if you want to visit doctors who practice independently.

If you now say “that’s totally impossible to implement”, you’re right. But think about why that is so. Who would benefit and who would lose, and who has which way to influence the decision-making process.



Samson was a biblical tough guy, but his dad Samsonite was even more of a hard case.
User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 3, posted (2 years 2 weeks 4 days 21 hours ago) and read 1823 times:

Frankly, I have no idea what Americans should do, nor do I wish to come up with suggestions.
But I disagree with the following:

Quoting ajd1992 (Reply 1):
You can go to the hospital for whatever you need, no questions asked.

Please do let them ask questions like "why do you have the feeling that you need to come to our hospital with nothing more than a common cold?"

Let them do something to minimize "doctor hopping", and let patients know what costs they produce. You could make patients sign (and control!) the bill and implement a small fee when they see a doctor. The 10 Euro we charge over here, might indeed be too high for the poor, but how about five? Only exception would be the general health check-up and cancer screening every two years or a specialist referral.

Quoting ajd1992 (Reply 1):
3 days in hospital including scans, MRIs and blood tests came to just short of $21k. Twenty-one THOUSAND Dollars. That's insane.

Indeed, it would probably be a low 4-digit number here in Germany. In 2008 I spent 9 days at a hospital in a 2-bed room, got an x-ray, 2 MRIs, blood test and some other examinations, and my health insurance ended up with a bill over less than 4,000 EUR.



I support the right to arm bears
User currently offlineajd1992 From , joined Dec 1969, posts, RR:
Reply 4, posted (2 years 2 weeks 4 days 21 hours ago) and read 1824 times:

Quoting NoUFO (Reply 3):
Please do let them ask questions like "why do you have the feeling that you need to come to our hospital with nothing more than a common cold?"

Let them do something to minimize "doctor hopping", and let patients know what costs they produce. You could make patients sign (and control!) the bill and implement a small fee when they see a doctor. The 10 Euro we charge over here, might indeed be too high for the poor, but how about five? Only exception would be the general health check-up and cancer screening every two years or a specialist referral.

Well, maybe not everything but there are people in the US who won't go to hospital because they can't afford it but are seriously ill. It's insane the price they charge.

Quoting NoUFO (Reply 3):
ndeed, it would probably be a low 4-digit number here in Germany. In 2008 I spent 9 days at a hospital in a 2-bed room, got an x-ray, 2 MRIs, blood test and some other examinations, and my health insurance ended up with a bill over less than 4,000 EUR.

Here it would have been free - barring any prescriptions. Free healthcare is better even if it involves a slight tax increase as in the long run it's cheaper.


User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 5, posted (2 years 2 weeks 4 days 21 hours ago) and read 1824 times:

Quoting ajd1992 (Reply 4):
Here it would have been free - barring any prescriptions. Free healthcare is better even if it involves a slight tax increase as in the long run it's cheaper.

Well, somebody will have to pay for it, and I guess a 5-Pound fee for every day you spend at the hospital would be reasonable. After all you get food, electricity and water.

Furthermore, I would really wish to keep health insurances to maintain competition as long as you can freely choose your doctor and hospital.

Edit: But, yes, I am all for making health care mandatory. Still, that's just an opinion - not a suggestion to Americans.

[Edited 2012-11-09 03:33:56]


I support the right to arm bears
User currently offlineflipdewaf From United Kingdom, joined Jul 2006, 1578 posts, RR: 0
Reply 6, posted (2 years 2 weeks 4 days 20 hours ago) and read 1823 times:
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Quoting Pyrex (Thread starter):
(they are pretty intense years, though, so you do kind of miss out on the beer pong technique you could have developed otherwise).

In my experience medical students are the drunkest of the lot.

I thinkt that it should be understood that Medical care does not run under normal freemarket conditions.
1. When you go to hospital quite often you are ill and may need treatment quickly, you aren't going to shop for prices.
2. You aren't spending your own money (insurance) (at least it doesn't feel like it) so you actually don't care about prices, this manifests itself in making things more expensive.

Quoting Pyrex (Thread starter):
what was missing was an honest discussion on how to bring down healthcare costs in the U.S.

Shocking that they didn't see this, this is the biggest barrier for many in the states as far as I can tell.

Fred


User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Reply 7, posted (2 years 2 weeks 4 days 20 hours ago) and read 1823 times:

Sigh... as expected, seems like some people failed to read the topic at hand.

Quoting ajd1992 (Reply 1):
Best way to do it - add it as a percentage tax, make people pay it based on their income. You can go to the hospital for whatever you need, no questions asked.

The question was not who should pay for it, the question was how to bring the total cost of the service down, regardless of who pays for it. Please stay on topic.

Quoting ajd1992 (Reply 1):
Healthcare is insane in the US - my dad had an epileptic fit in Arizona, 3 days in hospital including scans, MRIs and blood tests came to just short of $21k. Twenty-one THOUSAND Dollars. That's insane.

How much do you think that costs in Europe? Oh, that's right, you have no idea because you have been led to believe it is somehow "free". It ain't. Again, the question is how to reduce the $21k, not how to have someone else pay for it.

Quoting flipdewaf (Reply 6):
1. When you go to hospital quite often you are ill and may need treatment quickly, you aren't going to shop for prices.

Which reminds me of another idea - medical providers should have in a visible location and on their webpage a detailed price schedule to allow for comparison shopping. And unless it is on an emergency, life-or-death situation, no medical work shall be performed without first giving the patient an estimate of the costs - if auto mechanics can do it, so can doctors.



Read this very carefully, I shall write this only once!
User currently offlinepvjin From Finland, joined Mar 2012, 1366 posts, RR: 0
Reply 8, posted (2 years 2 weeks 4 days 20 hours ago) and read 1823 times:

Quoting Pyrex (Reply 7):
How much do you think that costs in Europe? Oh, that's right, you have no idea because you have been led to believe it is somehow "free". It ain't. Again, the question is how to reduce the $21k, not how to have someone else pay for it.

National government funded healthcare comes cheaper in the end. Private sector one just wastes money on useless stuff to allow charging even more from people in need of healthcare.



"A rational army would run away"
User currently offlineajd1992 From , joined Dec 1969, posts, RR:
Reply 9, posted (2 years 2 weeks 4 days 20 hours ago) and read 1823 times:

Quoting NoUFO (Reply 5):
Well, somebody will have to pay for it, and I guess a 5-Pound fee for every day you spend at the hospital would be reasonable. After all you get food, electricity and water.

It's paid for from taxes, so we pay for it anyway just indirectly.

Quoting Pyrex (Reply 7):
The question was not who should pay for it, the question was how to bring the total cost of the service down, regardless of who pays for it. Please stay on topic.

I am on topic. Paying for it via a tax would make it significantly cheaper as it's expennsive in the first place because there is free reign on what doctors charge. Check up for $500? Who can stop them? Nobody, and that is the issue with the cost of healthcare. Greed.

Quoting Pyrex (Reply 7):
How much do you think that costs in Europe? Oh, that's right, you have no idea because you have been led to believe it is somehow "free". It ain't. Again, the question is how to reduce the $21k, not how to have someone else pay for it.

For a start, don't group Europe into 1. We're different countries with vastly different healthcare systems.

I don't think it's free - it's paid for via tax regardless if you use it or not. I don't work anyway so to me, it IS free.

Taxing it would be cheaper - the reason it's expensive is because of greedy doctors.


User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Reply 10, posted (2 years 2 weeks 4 days 19 hours ago) and read 1823 times:

What is up with people that you can't have an honest discussion about healthcare costs without getting bogged down in ideology? Is this why nobody tried during Obamacare?

Quoting pvjin (Reply 8):

Nice attempt at a spin, but you didn't answer my question. How much does that treatment cost in Finland? You know, the amortization of the cost of the hospital and the MRI machine, the salary of the doctors, nurses, technicians, janitors, hospital administrators, etc., the cost of the drugs, the overhead at the Ministry of Health, the extra staffing at the IRS required to collect the taxes, etc.

Quoting ajd1992 (Reply 9):
there is free reign on what doctors charge

Of course there is. Of course, there is no free reign on what insurance companies are willing to pay.

Quoting ajd1992 (Reply 9):
Greed.

If it is so easy, why don't you go through medical school and go through life of the psychological impact of seeing people die every day?

Quoting ajd1992 (Reply 9):
I don't think it's free - it's paid for via tax regardless if you use it or not.

I know it is. How much do you pay for it?



Read this very carefully, I shall write this only once!
User currently offlineajd1992 From , joined Dec 1969, posts, RR:
Reply 11, posted (2 years 2 weeks 4 days 19 hours ago) and read 1826 times:

Quoting Pyrex (Reply 10):
Of course there is. Of course, there is no free reign on what insurance companies are willing to pay.

Which is the problem. You asked how to make it cheaper, the easiest way is regulate the prices they can charge (which are borderline criminal, IMHO), or add it as a tax and make everybody pay it.

Quoting Pyrex (Reply 10):
If it is so easy, why don't you go through medical school and go through life of the psychological impact of seeing people die every day?

Firstly because I have no interest, and secondly I lack the intelligence to do it. Nobody forces them to be a doctor, if they can't handle death without charging a lot to make themselves feel better, maybe they need a different job.

Quoting Pyrex (Reply 10):
I know it is. How much do you pay for it?

Nothing. I don't work, so I don't pay tax.


User currently offlinepvjin From Finland, joined Mar 2012, 1366 posts, RR: 0
Reply 12, posted (2 years 2 weeks 4 days 19 hours ago) and read 1822 times:

Quoting Pyrex (Reply 10):
Nice attempt at a spin, but you didn't answer my question. How much does that treatment cost in Finland? You know, the amortization of the cost of the hospital and the MRI machine, the salary of the doctors, nurses, technicians, janitors, hospital administrators, etc., the cost of the drugs, the overhead at the Ministry of Health, the extra staffing at the IRS required to collect the taxes, etc.

According some site 6% of GDP. Anyway, high quality healthcare and education system are some of the very few things that make this country with horrible climate and cultural issues worth living so I rather keep these things just like they are now, high quality and available for everyone.



"A rational army would run away"
User currently offlineMir From United States of America, joined Jan 2004, 21803 posts, RR: 55
Reply 13, posted (2 years 2 weeks 4 days 17 hours ago) and read 1821 times:

Quoting Pyrex (Thread starter):
Competition across state lines - insurance companies are currently not allowed to compete across state lines. If you live in NY, you cannot buy a health plan that is offered in TX, even if that plan is cheaper and better fits your needs. The result is that you end up with effectively local monopolies in places like Michigan and Maine, and over-priced insurance everywhere as companies are forced to adapt their offerings to 50 different jurisdictions. Allowing insurance companies to compete across state lines could have a meaningful impact in the cost of health insurance and give people the freedom to buy what better fits their needs.

Sounds good, but what will ultimately end up happening is that insurance companies will pay off one or two states to write laws that are very beneficial to them, and will relocate their businesses to that state. So if you live in NY, there won't be any policies in NY to buy, or policies in TX - you'll have to buy a policy from SD and live by SD's rules. Rules that you can't change, since you're not an SD voter. It happened with credit cards, and it will happen with healthcare. Costs will go down, but only if you're healthy and don't expect to have significant medical expenses. If you do expect to have significant medical expenses, your costs would go up because everyone else would be leaving your pool for cheaper insurers elsewhere. Raising costs on those who already pay more doesn't seem to be a sound healthcare strategy.

You could mitigate that somewhat by creating some federal standards for coverage sold across state lines, and in that case at least the insurance providers would be able to gain some efficiencies from not having to cater to the laws of 50 different states.

-Mir



7 billion, one nation, imagination...it's a beautiful day
User currently offlineflyingturtle From Switzerland, joined Oct 2011, 2456 posts, RR: 14
Reply 14, posted (2 years 2 weeks 4 days 16 hours ago) and read 1821 times:

The U.S. already have an efficient healthcare system. It's called Medicare and Medicaid. Add to that the VA hospitals.

Now they should be expanded to the general population.

Quoting Rara (Reply 2):
Doctors carry away shitloads of money; partly because they have to recoup their training and education costs,

Yes. At my university, you can study medicine for 1500 $ a year. That's the only fee the university demands. The Harvard Medical School's tuition comes in at 50'000 $.

Do they train better doctors? I wouldn't say so. But a framed and well-positioned Harvard diploma makes a good impression in the office...



David



Keeping calm is terrorism against those who want to live in fear.
User currently offlinepu From Sweden, joined Dec 2011, 748 posts, RR: 13
Reply 15, posted (2 years 2 weeks 4 days 16 hours ago) and read 1822 times:

One reason the cost of service is high is because providers have to recoup the costs of serving those who can't pay. In a big city ER maybe half or more are being treated without any expectation of being paid for services rendered....

....this is what the anti-Obamacare folks don't get is that you're still paying for everyone's healthcare NOW in the so-called world of private insurance, because the uninsured are getting lots of free services (though not all)....

....you've already got socialsied medicine, except you've got it while ALSO funding insurance company and big healthcare provider proftis.

.... you're paying for a huge apparatus of people imvolved in insurance billing, insurance staff, and paying insurance company profits which is a self-serving process of INCREASING COSTS.

Having a single payer for all customers means that the payer has price control, and any provider who doesn't want to accept the price will simply be out of work. This is the evidence from Europe: single payer healthcare systems lower costs, while acheiving the same or better results.




Pu


User currently offlineflipdewaf From United Kingdom, joined Jul 2006, 1578 posts, RR: 0
Reply 16, posted (2 years 2 weeks 4 days 16 hours ago) and read 1822 times:
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Quoting Pyrex (Reply 10):
What is up with people that you can't have an honest discussion about healthcare costs without getting bogged down in ideology?

We were describing ways of maing healthcaare cheaper. Lets not get bogged down into who makes threads into rants about ideology. The data will prve that other nations healthcare systems are substantially cheaper then the US system.

This, Pryex, makes it relevant to the discussion:
Quoting pu (Reply 15):
This is the evidence from Europe: single payer healthcare systems lower costs, while acheiving the same or better results.

This!

Fred

[Edited 2012-11-09 08:25:29]

User currently offlinewingman From Seychelles, joined May 1999, 2315 posts, RR: 5
Reply 17, posted (2 years 2 weeks 4 days 16 hours ago) and read 1822 times:

The only thing ideological in this debate is the inability of some Americans (or Portuguese) to ever see the positives in anything done by other countries. We should run this country like a business, and part of that means continuously examining and evaluating the "competition" for better ways of doing things.

You may want to call European healthcare, or Canadian healthcare, or Asian healthcare...Socialist. But the fact of the matter is that each of these countries spend between 1/2 and 1/10 per year per capita on healthcare vs. the United States. And shock horror...the citizens of virtually every other country in the OECD live longer and healthier lives than Americans. Call it Socialism, Communism, whatever you want to, to me it's just a better way of providing healthcare.

Obamacare will evolve over time and with true political and industry cooperation, it will get better. The important part of it was just to get it on the board. We can't stand alone in the OECD as the wealthiest nation on the list and have the shittiest healthcare system, one that leaves tens of millions without proper insurance or treatment. It's not only economically stupid (see per capita spend chart), it's also morally repugnant.


User currently offlineDocLightning From United States of America, joined Nov 2005, 20246 posts, RR: 59
Reply 18, posted (2 years 2 weeks 4 days 14 hours ago) and read 1826 times:

Hi. I'm like...a doctor...and stuff.

A BIG problem with healthcare spending in this country isn't tort reform. It isn't insurance companies. It isn't preventative care.

It's incompetent physicians, NP's, and PA's.

Example: My friend has had cough, fever (100.2F/38C), headache, congestion, and green/yellow nasal discharge for three days. He gets "sinusitis" three times per year. He went to his doctor and got a prescription for a "Z-pack" (that's an azithromycin pack where you take 500mg on the first day and then 250mg daily for the next four days).

However, the Infectious Diseases Society of America says that one should not treat for a bacterial sinusitis unless symptoms have been present for 7-10 days AND there is: facial pain OR persistent pus from the nose OR persistent fever >102F/39C. The recommended empiric therapy for bacterial sinusitis is amoxicillin/clavulanate (AUGMENTIN). As an alternative, a third-generation cephalosporin such as cefdinir (OMNICEF) or in the truly penicillin-allergic patient, doxycycline. Macrolides like azithromycin, erythromycin, and clarithromycin are only to be used in the penicillin-allergic pregnant patient.

So there was a waste of a $30 pack of antibiotics that was the wrong choice for a misdiagnosed disease. In the mean time, the physician gets to bill more because the level of complexity for bacterial sinusitis is higher than just for a viral cold.

Example: 3yo boy presents to the emergency room with fever of 8 hours' duration, fussiness, low energy, and poor eating, but otherwise no specific symptoms. Drinking fine, urinating fine, still playful, smiling, improves greatly when given ibuprofen or acetaminophen (called "paracetamol" in the civilized countries). He gets a catheter shoved up his penis for a urinalysis and culture, blood cultures, complete blood count, comprehensive metabolic panel, chest X-ray, abdominal X-ray, and finally an injection of ceftriaxone (a "big-gun" antibiotic). Yes, parents take their kids to the ER for this sort of horsepiss all the time. And then he gets sent home. The discharge diagnosis is "fever."

Now, NONE of that was necessary. The bill is now over $5,000. What SHOULD have happened was that the mother should have been reassured that this was most likely a viral syndrome, keep the kid drinking, give him fever/pain medicine for comfort, don't try to force him to eat if he's not hungry, and a few warning signs to watch out for (like seizure, respiratory distress, signs and symptoms of dehydration). Then pat the kid on the head, give him a SpongeBob sticker, and send him home. Total cost: $300.

These are not isolated incidents. In fact, of children presenting to our local emergency room with fever, cough, and congestion, last year about 75% were diagnosed with "pneumonia" on chest X-ray (newsflash: you don't diagnose pneumonia on a chest X-ray. You diagnose it with a stethoscope, a second-hand on a watch, your eyes, ears, and your BRAIN.) and sent home usually on the wrong dose of the wrong antibiotic. I had parents coming in tears wanting specialist consults because their kid had pneumonia four times this year alone. When I reviewed the X-rays with them, I had good news: "Your kid never had pneumonia. Not even once. Now, please stop going to that emergency room."

People blame this behavior on malpractice fears, but I disagree strenuously. Let's consider the case of the 3yo in the emergency room and let's look at the opportunities for malpractice there.

*Inappropriate catheterization of the urethra, which can cause a UTI or direct trauma to the urethra. I do not worry about UTI in the well-appearing febrile child without other symptoms until 72 hours of fever without apparent source.
*Drawing blood cultures and discharging a patient home. Blood cultures take 2-5 days to turn positive if there is a blood infection, so they do not diagnose sepsis. If you think the patient is septic, the patient needs to be admitted right away to a hospital with a pediatric ICU available and held there on broad-spectrum antibiotics until the blood cultures are negative. If you think the patient is likely enough to be septic to draw blood cultures, the patient needs to be admitted. And yet they draw blood cultures all the time. So what if they sent the kid home and now the kid is doing fine and then the cultures grow something??? Now what? I don't know because that's NEVER supposed to happen because that's not how you practice medicine.
*Giving an injection of an antibiotic always raises the risk that you'll hit a nerve or blood vessel and cause damage.
*Giving an antibiotic without reason raises the risk of allergic reaction.

So there you go, not about malpractice, not about paranoia, but simply incompetence.

We younger docs I think are coming out of residency with better training and expectations that we will do continuing medical education, but I do think that there needs to be some element of chart review either by licensing boards or by insurance companies to make sure that people really are providing appropriate and cost-effective care to their patients and not just wildly waving their mental arms around.


User currently offlineAeroWesty From United States of America, joined Oct 2004, 20789 posts, RR: 62
Reply 19, posted (2 years 2 weeks 4 days 13 hours ago) and read 1826 times:

How to control costs:

1) Assign social workers to manage the care of the highest-cost patients. We shouldn't be pouring out a quarter of a million a year for a diabetic (and yes, that happens);

2) Educate patients and caregivers about when to head to urgent care rather than the emergency room. Build urgent care facilities in hospitals, if we need to.

3) Reign in the cost of medications. Drug companies are allowed to corner the market on the raw materials to make some of the popular medications. Anything off-patent only costs pennies to manufacture. Why should generics of 50-year-old drugs cost $300/month? That's criminal.

4) Preventive care. Mandate that physicians mail to every patient a questionnaire asking if they've received basic preventive care appropriate to their gender, age group, known diagnoses, and risk factors every year. I have a great doctor, well at least I think he's great because he doesn't give me any guff over filling my pain meds and does excellent in-office acute treatment. Yet I've never sat down with him or any of his staff to review my overall care or needs for my age group other than have his nurse confirm my medication list at the start of an office visit.

I really wish there was someone who really knew medicine that I could sit down and talk to about my care once a year who would advocate for me. Whenever I ask questions about my long-term care of a few chronic problems that any competent medical professional should be able to manage, I see paranoia setting in. I've even seen medical records where a young doctor wrote in my chart, "patient taking notes during appt. to use against the clinic." What tosh.

5) Reign in the ridiculous amounts of money we spend in the last month or two of someone's life. Seniors near death are a virtual ATM for the medical community.

6) Publish a list of how much medical services cost. Example: I'm required to have a surprise drug screen done every 18 months or so because of the meds I take. The first time I had one done, I had to sign a statement saying I would pay for it even if it wasn't a covered event under my insurance (some don't pay for this since it's not considered diagnostic). I asked how much it was, so I knew what I was committing to. The nurse didn't know the cost and couldn't find out the cost when she tried to answer my question, but she did know that if I didn't have the test done right then and there I wasn't getting my scripts that day, even if it would cause a withdrawal event. Turns out it was a $600 battery of tests that my insurance did cover, thankfully.

Start there. Health care costs will plummet overnight.



International Homo of Mystery
User currently offlinegarnetpalmetto From United States of America, joined Oct 2003, 5423 posts, RR: 52
Reply 20, posted (2 years 2 weeks 4 days 13 hours ago) and read 1826 times:

Quoting Pyrex (Thread starter):

Tort reform - litigation costs in the U.S., and a kangaroo court system where people seem to treat it like a lottery, are a significant drag in the U.S. economy, but in no place is that as evident as in the healthcare industry. Moving malpractice trials to a specialized court where they are seen by a specialized judge (or panel of judges) would go a long way in reducing this unpredictability - some random guy dragged off the street who was not smart enough to be able to come up with an excuse to get out of jury duty is simply not qualified to understand the complexities of medical decision-making, just as he is not qualified to understand bankruptcy law (another area where specialized courts exist). If that is not constitutional, for some reason, eliminate the ability of lawyers being awarded a portion of the winnings. The notion that this could have an impact on medical quality is ridiculous - doctors strive to do the best for their patients in all situations because they have their lives in their hands, not because they fear being second-guessed by some ambulance-chasing lawyer. Air Traffic Controllers have the lives of hundreds of people on their hands too and don't need a lawyer to tell them not to play Angry Birds while planes are on final approach.

To paraphrase both Wadsworth and Ms. Scarlet in Clue "Tort Reform was just a red herring" and the only people who truly benefit from tort reform are the insurers. States that have enacted tort reform measures, like Texas, have seen no corresponding drop in med mal insurance premiums. And why should they? You honestly expect an insurance company to reduce rates in a scenario where they get to generate more profit via less/fewer payouts? Also, in terms of your notion of cutting off attorneys fees coming out of the judgement, how, precisely, do you expect tort attorneys to get paid? Having worked for a plaintiff's practice that did workers' comp as well as some PI, including medical malpractice, you're basically advocating robbing Peter to pay Paul. In such cases, the attorney is often fronting money for everything from copies to legal filing fees to depositions (which are not cheap, particularly doctor depositions) to finding/retaining competent expert witnesses. At the end of the day, after a client gets their award these costs come out of the award in addition to attorneys fees which usually go into the basic infrastructure of the firm - rent, utilities, payroll, professional memberships, dues, fees, etc. The sort of system your advocating is one in which only wealthy plaintiffs could even think of filing a med mal claim.

As Doc Lightning points out, unnecessary tests are often *not* done to CYA oneself from a med mal claim and given his experience as a doctor I'm inclined to take his word as gospel.



South Carolina - too small to be its own country, too big to be a mental asylum.
User currently offlineflyingturtle From Switzerland, joined Oct 2011, 2456 posts, RR: 14
Reply 21, posted (2 years 2 weeks 4 days 13 hours ago) and read 1824 times:

Quoting DocLightning (Reply 18):

The pains, THE PAINS!

Your story really made my poor brain bleed. Luckily I've got plenty of ibuprofen and tramadol in stock...

Some weeks ago I had tinnitus, together with muffled hearing. Because I'm deaf on the left side (and disabled on the right), I was worried. When I saw the doctor, I he said he had no reason to worry about a hearing loss, given the stuff I've told him.

I told him that I was an epidemiologist, and then he asked me one great question: "How would you solve the puzzle? What would speak in favour of more intensive treatment, what speaks against it?"

After discussing my answer, I really understood and had to agree with him. In the end, it was a case of a flu gone wrong (in my own experience, a flu is just a really bad cold), and I was just not used to the hearing complications that may appear in any cold.

A recent hearing test showed that my hearing degradation over the last 11 years is smaller than average.


David



Keeping calm is terrorism against those who want to live in fear.
User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 22, posted (2 years 2 weeks 4 days 13 hours ago) and read 1822 times:

Quoting DocLightning (Reply 18):
an injection of ceftriaxone (a "big-gun" antibiotic)

That reminds me of a former friend of mine (let's call him K.), who worked at Charité in Berlin, a hospital centrally located where you see some tourists as well. K had previously worked at a hospital in the U.S., hence he was not only fluent in English but also familiar with medical terms.

His patient, an American, said he was allergic to Lincomycin (I had to look this up, but now I am pretty sure it was Lincomycin), apparently another "big-gun" antibiotic. K. couldn't help but chuckle because (at least here in Germany) only veterinarians use Lincomycin. He said he didn't have the heart to ask if he accidentially saw a vet rather than a doc.



I support the right to arm bears
User currently offlineflyingturtle From Switzerland, joined Oct 2011, 2456 posts, RR: 14
Reply 23, posted (2 years 2 weeks 4 days 13 hours ago) and read 1822 times:

Quoting AeroWesty (Reply 19):
2) Educate patients and caregivers about when to head to urgent care rather than the emergency room. Build urgent care facilities in hospitals, if we need to.

We've opened GP offices in ER units - that has already helped alot. Every non-accident and everything non-life-threatening should be referred to that hospital GP first.

Another idea is telephone counselling. You call a number, and first a nurse or a medical assistant makes a triage. Sooner or later a doctor will call you back and talk you through the symptoms, your medical history, and the treatment options.

My own GP is a HMO which is open from 7 AM to 10 PM, 365 days a year. It's not costlier than a normal GP in his own office. Such HMOs may replace much of what the ER is doing.

Quoting AeroWesty (Reply 19):
5) Reign in the ridiculous amounts of money we spend in the last month or two of someone's life. Seniors near death are a virtual ATM for the medical community.

There is a problem... for-profit hospitals earn money with treating (hopefully) insured patients. They'll gladly keep me in the hospital for three months for a common cold if they would earn money. 

There should be an incentive that rewards caring for patients, not procedures and treatments that will earn the hospital money. The profit margin of a treatment in the hospital is (correct me if I'm wrong) the same for all kinds of treatments. 10000 $ worth of chest examinations will earn the hospital as much as 10000 $ worth of MRI scans.

What will they do? MRI scans, of course. Five MRI scans will take less time than examining 200 chests. If the profit margin is fixed, the only thing you can do is raising the revenue.

And there needs to be a shift of patient's mindset, too. My grandfather was diagnosed with cancer for the second time in his live when he was 82. He choose palliative care. I'll never forget him basking in the sun, only wearing his underpants, smiling and asking me where this and that RJ will fly to...


David



Keeping calm is terrorism against those who want to live in fear.
User currently offlinetugger From United States of America, joined Apr 2006, 5739 posts, RR: 10
Reply 24, posted (2 years 2 weeks 4 days 13 hours ago) and read 1822 times:

Quoting pvjin (Reply 8):
National government funded healthcare comes cheaper in the end. Private sector one just wastes money on useless stuff to allow charging even more from people in need of healthcare.

Actually that is not true. Private sector does an excellent job with money and with allocating resources, however it is the structure of the system that causes much of the problem. The key issue for private sector is that monies need to go into treatment, research, training, education, etc., the key elements of healthcare. Profit is a good motivator but monies need to be mostly redirected back into the system and not out of it. Right now a large amount of money flows out through many channels via the external operations needed to maintain the for-profit nature of the current medical industry. While I don't think the entire profit element should be removed I do think that all core elements of healthcare need to be non-profit and that the for profit peripheral elements slaved to that core nature (in other words to manage the nature of the profit driven support systems to maximize their profits).

Profit is an important motivator in life and the world, it is and can be an important element of a innovative and efficient healthcare system. Having healthcare does not mean that no profit is made within healthcare. Doctors, hospital administrators, healthcare CEO, nurses, technicians, etc, can all still be well paid as "health" is a top-of-the-foodchain need in society. But it does mean that shareholders will not get "profits", that "excess monies" will be redirected back into the system to do the primary task of serving to keep the nation healthy.

Quite honestly I would much rather have, and think it would be a much better use of the status, healthcare be a tax exempt than religion/churches etc.

Quoting ajd1992 (Reply 9):
I am on topic. Paying for it via a tax would make it significantly cheaper as it's expensive in the first place because there is free reign on what doctors charge. Check up for $500? Who can stop them? Nobody, and that is the issue with the cost of healthcare. Greed.

Greed, is Good....   Actually I know what you mean, however "greed" is not the bad evil thing you make it out to be, its just that right now the way things are set up in the USA that $500 covers a lot of extraneous costs that could be improved. From the cost of education to the unlimited liabiility that can arise from treating someone, to the nature of people to not follw doctors orders to office staff etc. the costs are quite a lot to manage. And ultimately they start getting paid at that "office visit". So there is a cost, and as Pyrex is asking, the real question is how do we reduce or manage that cost such that it does not stagnate research and active healthcare and innovation while keeping the infrastructure intact and still adding systems and elements as needed.

Quoting Pyrex (Reply 10):
Of course there is. Of course, there is no free reign on what insurance companies are willing to pay.

  
But right now both insurance companies, and of course the big gripe of many: Government, can very much dictate what they are willing to pay, and there needs to be a better feedback loop, a normal chance of services negotiation rather than the battles that often occurs right now. It is only when not charging to these entities that the doctors and healthcare systems can charge whatever they want and we can see that those charges are high, probably due to the need to recoup costs that the dictated fees don't cover but that the system is other wise obligated to (in addition to creating profit).

Quoting ajd1992 (Reply 11):
Which is the problem. You asked how to make it cheaper, the easiest way is regulate the prices they can charge (which are borderline criminal, IMHO), or add it as a tax and make everybody pay it.
Quoting ajd1992 (Reply 11):
Nothing. I don't work, so I don't pay tax.

Then you are not paying for it and therefore "everybody" is not paying for it. If it is going to be "everybody" then any tax or fee or whatever needs to be linked to something that everybody must pay for. Quite honestly I think a combination between an income tax/fee and a tax on food is a smart balance. I know many might think taxing food is dangerous but it does not have to be a burdensome level.

Quoting Mir (Reply 13):
Sounds good, but what will ultimately end up happening is that insurance companies will pay off one or two states to write laws that are very beneficial to them, and will relocate their businesses to that state. So if you live in NY, there won't be any policies in NY to buy, or policies in TX - you'll have to buy a policy from SD and live by SD's rules. Rules that you can't change, since you're not an SD voter. It happened with credit cards, and it will happen with healthcare. Costs will go down, but only if you're healthy and don't expect to have significant medical expenses. If you do expect to have significant medical expenses, your costs would go up because everyone else would be leaving your pool for cheaper insurers elsewhere. Raising costs on those who already pay more doesn't seem to be a sound healthcare strategy.

You could mitigate that somewhat by creating some federal standards for coverage sold across state lines, and in that case at least the insurance providers would be able to gain some efficiencies from not having to cater to the laws of 50 different states.

You answer your own concerns. As you note credit cards have already done this and have several other industry (why do think that so many company's are incorporated in RI) and it has been the end of things. As you mention you do though then need federal regulations to mange things. I am fine with across state insurance provided the companies are required to then meet the requirements of the individual states that provide insurance into (and I would think an escrow account being required to cover such services to prevent lapses and problem due to bankruptcy or other corporate "maneuvering" would be reasonable) .


Quoting flyingturtle (Reply 14):
The U.S. already have an efficient healthcare system. It's called Medicare and Medicaid. Add to that the VA hospitals.

Now they should be expanded to the general population.

Not against this however it introduces it own problems, as I noted above you bring in an element that can dictate prices and fees and remove the ability of the system to push back. The VA is badly underfunded and lacks a lot of cutting edge systems that are considered important and are available in private systems.

Quoting flyingturtle (Reply 14):
Yes. At my university, you can study medicine for 1500 $ a year. That's the only fee the university demands. The Harvard Medical School's tuition comes in at 50'000 $.

If your fee requires that you serve something after school then I can support it but if your fee does not actually cover the cost of training you and you can go where ever you want then I do not think I would be in favor of it.

Quoting wingman (Reply 17):
The only thing ideological in this debate is the inability of some Americans (or Portuguese) to ever see the positives in anything done by other countries. We should run this country like a business, and part of that means continuously examining and evaluating the "competition" for better ways of doing things.

Agreed. And the USA can do it "It's own way" whether that be with profit, or subsidized medical education, a tax on food, whatever. No matter what it will be our own "American" solution just kike every other nation has their own ultimately unique solution.

Tugg



I don’t know that I am unafraid to be myself, but it is hard to be somebody else. -W. Shatner
25 AirframeAS : The one thing that really bites me is the flexible healthcare spending accounts (the use it or lose it deal). In ways to make health care so much chea
26 Mir : Credit cards are not a need item, they're a want item - you can get by just fine without them. Health care is a need item - you can't get by without
27 flyingturtle : I can't see how this is bad, because free market is already failing in efficiently providing healthcare. That the VA is underfunded is not VA's probl
28 FlyPNS1 : Four words for you: End Of Life Planning. Too much cost is incurred by people vainly trying to fight the inevitable. People need to accept that life w
29 pu : This is a huge issue that could alone alleviate the entitlement spending binge. Any average nursing home has about 80% of the patients in Alzheimers,
30 garnetpalmetto : The problem is, when those four words get used, alarmists start spouting the death panel nonsense. Look at what happened when the VA put out that end
31 Post contains images Ken777 : And that is because the states want to retain control of what health insurance is in their borders. Not a bad idea as some states don't have bad fait
32 DocLightning : That is odd. Lincomycin isn't really used anymore. Lincomycin is a lincosamide antibiotic. We use clindamycin in this country. Lincomycin is still us
33 Ken777 : Had to smile at this. The neurosurgeon who has done both of my cervical discectomy & fusion (20 years apart) was complaining about the NPs &
34 DocLightning : It's not just that, it's just that they view themselves as test orderers and antibiotic dispensers. It's true, you need to come up with a differentia
35 seb146 : Yes and no. For-profit health care has a lot of money going toward advertising, board of director bonuses, offices in posh locales. Medicare does not
36 Pyrex : We've noticed. So what? Are New Yorkers so different than people from SD that they can't live with the same health plan the people from SD live with?
37 Post contains images ajd1992 : Greed is bad in the sense that people who can't afford it simply cannot visit a doctor because they can't afford it. I couldn't imagine living in a s
38 Mir : Maybe, maybe not. But why should we let one or two states decide the healthcare laws for the whole country (and hence, the cost structure)? Whatever
39 flyingturtle : I'll use a quote from Oscar Wilde to answer this... What are followers of the free market ideology? People who know the price of everything and the v
40 NoUFO : Yes, and at the same time such a database would raise questions concerning privacy rights and its possible abuses. Same here according to Wikipedia.d
41 Ken777 : To change it you first need to fight the state rights groups as they are the ones that want to keep it at a state level. Local politicians wanting to
42 NoUFO : We have a so called "elektronische Gesundheitskarte" (along the line of "electronic health insurance card") here, where the encoded data is stored on
43 Ken777 : While I'll agree with you that a patient should have the final word I really like the idea of a central file that doctors can access for critical inf
44 NoUFO : But wouldn't you have to grant the personnel permission to access your file by entering a pin or giving them sort of a key-card? Else a doctor or nur
45 Post contains images AirframeAS : Disagree. When the costs of Heath care are so damn high with greedy doctors and insurance companies who limit what you are allowed types of care, it
46 blueflyer : Since you're like... a doctor... and stuff (what stuff), let me ask you a question on a topic you didn't broach. I read/hear often that one way to cu
47 pvjin : Yeah sure not if you compare to poor developing countries, but from all countries with similar amount of wealth sure it has.
48 PPVRA : Wait, you mean health care costs are under control in Europe? You've got to be kidding me! Let me remind you of the thread title: Suggesting a system
49 DeltaMD90 : I don't get it. I know this has to do with American healthcare, but wouldn't listening to Europeans (which for the most part, have good healthcare) b
50 Ken777 : WHy? If I'm out of it I still want them to get the information they need. Hey, why not use fingerprints as identifying which file to look at? I'm hap
51 HOMsAR : I'm just curious, since it hasn't been mentioned in this thread at all. To what extent does our lifestyle have any contribution to health care costs?
52 PPVRA : And so do Americans. Studies have shown Europeans spend more out of pocket than Americans on healthcare. On the other side of the pond, government ru
53 AirframeAS : If we did have good healthcare the Obamacare wouldn't have existed. We do need to overhaul healthcare from top to bottom. But portions of Obamacare i
54 DocLightning : show them.
55 Post contains images zippyjet : Make shopping for health insurance more competitive. Meaning I live in Maryland but if I find a better sweeter deal for a health insurer from say Dela
56 Pyrex : Whatever happened to the idea of individual rights? If my state or county makes fireworks illegal I can still drive across the border and buy them, w
57 mt99 : Wrong. "Price" is what someone pays for something. Its just a number. I think that the word you are looking for is "value". And mess with the the Sta
58 Mir : If your state makes fireworks illegal, then you can't use them in that state. In order to use them, you'd have to move to another state. Likewise, if
59 Rara : I didn't sketch health care in Europe. In fact most of what I wrote would be a good idea to implement in Europe as well. I'm quite convinced it would
60 Ken777 : A really big extent IMO. A lot of people in this country (including me) drive a lot because there isn't the centralized business district that people
61 zhiao : Only Belgium and Swtz spend more OOP than USA according to OECD data.
62 PPVRA : OECD: xhttp://www.oecd-ilibrary.org/docserver/download/fulltext/8107051e.pdf?expires=1352670778&id=id&accname=guest&checksum=B5733AB0EFAD
63 Post contains links PPVRA : Here's an interesting infographic I have run across: http://www.chcf.org/publications/2012/08/data-viz-hcc-national
64 Post contains links NoUFO : Couldn't open it (cookie session expired), but I found this: http://www.oecd-ilibrary.org/social-...alth-key-tables-from-oecd_20758480 "Out-of-pocket
65 pu : That is only logical if you believe the MARKET economy can or does always determine what is (your term) "superior." The market works well in many cas
66 Pyrex : It is pretty easy to put two health plans together and compare which one is best for your specific circumstances. Considering most health plans get s
67 pu : If that was the end of the story I might halfway agree with you. BUT Insurance companies sell polcies fully intending to refuse a certain percentage
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