Sponsor Message:
Non Aviation Forum
My Starred Topics | Profile | New Topic | Forum Index | Help | Search 
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 4 hours 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 5 days 2 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 onlineRara From Germany, joined Jan 2007, 2136 posts, RR: 2
Reply 2, posted (2 years 2 weeks 5 days 1 hour 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 5 days 1 hour 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 5 days 1 hour 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 5 days 1 hour 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 5 days ago) and read 1823 times:
Support Airliners.net - become a First Class Member!

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 5 days 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 5 days 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 23 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 23 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 23 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 23 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 20 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 20 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 20 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 20 hours ago) and read 1822 times:
Support Airliners.net - become a First Class Member!

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 20 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 18 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 17 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 17 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 17 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 17 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 17 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 16 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
User currently offlineAirframeAS From United States of America, joined Feb 2004, 14150 posts, RR: 24
Reply 25, posted (2 years 2 weeks 4 days 16 hours ago) and read 1863 times:

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 cheaper is to allow the funds to roll over indefinitely and eliminate the use it or lose it crap. That's YOUR money. And tossing out that rule alone, IMO, would make health care cheaper.

I angers me that once Dec 31st rolls around, and you have $500 on that account, you lose that money the next day. That should be illegal and it's thievery. This is exactly why I don't use a flexible health care spending account.



A Safe Flight Begins With Quality Maintenance On The Ground.
User currently offlineMir From United States of America, joined Jan 2004, 21803 posts, RR: 55
Reply 26, posted (2 years 2 weeks 4 days 16 hours ago) and read 1864 times:

Quoting tugger (Reply 24):
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.

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 it (at least not without passing on the cost of the care you'll inevitably need to society). So the economics have to be different, and you don't want to push up the cost of a good for those who most need that good.

Quoting tugger (Reply 24):
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

I'd be fine with that too, but that's not very much different from what we have now.

-Mir



7 billion, one nation, imagination...it's a beautiful day
User currently offlineflyingturtle From Switzerland, joined Oct 2011, 2456 posts, RR: 14
Reply 27, posted (2 years 2 weeks 4 days 16 hours ago) and read 1884 times:

Quoting tugger (Reply 24):
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

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 problem, but the one of the Congress.

Quoting tugger (Reply 24):
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.

I acknowledge that Harvard Medical School is privately run. But doctors are already required to pay more in taxes if they earn more than I as a biologist. The same applies to the law, the business management and the art student. And as a institution funded by the state, it does not have to cover its costs anyway. Our policy is that academic education should be affordable for all. (I've studied on a budget that would have made me eligible for social welfare.)

You can also turn the question around: Lower tuition fees encourage students from lower socioeconomic to take up studies in medicine, thus increasing competition among the students, and thus improving the academic quality of the MDs. If the education costs 100'000 a year, the university will miss many bright minds.


David



Keeping calm is terrorism against those who want to live in fear.
User currently offlineFlyPNS1 From United States of America, joined Nov 1999, 6694 posts, RR: 24
Reply 28, posted (2 years 2 weeks 4 days 15 hours ago) and read 1887 times:

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 will end and spending your last years as a senile, vegetable in a nursing home isn't really living anyway...not to mention that it costs a ton.


User currently offlinepu From Sweden, joined Dec 2011, 748 posts, RR: 13
Reply 29, posted (2 years 2 weeks 4 days 13 hours ago) and read 1881 times:

Quoting FlyPNS1 (Reply 28):

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 will end and spending your last years as a senile, vegetable in a nursing home isn't really living anyway...not to mention that it costs a ton.

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, dementia or various other states considerably less than what most of us would call alert, and many of those are only alive physically having lost all apparent mental function. Each of them is costing about $2500 a month to Medicare, for years and years on end.

....no one wants to make the call to cut off grandpa, but maybe grandpa should have the right to choose while still cognizant that perhaps he would exchange free college tuition for his grandkids (or whatever) in lieu of perpetual long term care?

SOMEHOW this massive misallocation of resources to people who probably wouldn't even want it for themselves (if able to choose) has to be addressed.

Pu


User currently offlinegarnetpalmetto From United States of America, joined Oct 2003, 5423 posts, RR: 52
Reply 30, posted (2 years 2 weeks 4 days 13 hours ago) and read 1884 times:

Quoting FlyPNS1 (Reply 28):
Four words for you: End Of Life Planning.

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 of life planning pamphlet "Your Life, Your Choices" - Michael Steele claimed it was a pamphlet encouraging veterans to commit suicide.



South Carolina - too small to be its own country, too big to be a mental asylum.
User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 31, posted (2 years 2 weeks 4 days 12 hours ago) and read 1887 times:

Quoting Pyrex (Thread starter):
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.

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 faith laws. That could lead to a nasty situation for patients, unless we establish some very protective laws at the federal level.

Quoting Pyrex (Thread starter):
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.

The insurance companies have done a pretty good job splitting up the country (market). The more you move to a national wide system the more you diminish their ability to play games.

Quoting Pyrex (Thread starter):
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

Until there are some very protective federal laws you really don't want to go there. Health insurance is a state level only industry and can't be moved nationally without laws & regulations at a national level.

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.

That isn't going to make a difference - Texas has brought in tort reform and there were no reductions in health care costs. All that happened there was patients got the shaft. But it was a really good way to attract doctors from all over the country - especially the ones that had been sued a LOT.

Quoting Pyrex (Thread starter):
If that is not constitutional, for some reason, eliminate the ability of lawyers being awarded a portion of the winnings

That would probably be unconstitutional as well. Even the Defense Lawyers would be supporting the Trial Lawyers. Without active Trial Lawyers the Defense Lawyers would see some very unacceptable cuts in their own income.

Quoting Pyrex (Thread starter):
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.

The Pharma Industry controls pricing in the US. They basically wrote the Medicare Prescription Program for W. No imports of medicine, no price negotiations by Medicare, etc.

Reality is that the industry has the money to influence politicians and will fight hard to protect their profits. Don't look for too much help there

Quoting Pyrex (Thread starter):
In many countries, a medical degree is something you obtain after 5 or 6 years of study straight out of high school

That was the system in Australia when my wife went through 3 years of PT training right out of high school. Far more intense than what US students are getting today and just as effective. You need to remember, though, that this approach requires improvements to the high school programs. Students on a professional (or university) path need to handle a lot of the work in high schools. That means investing more in the public school system.

Quoting ajd1992 (Reply 1):
Twenty-one THOUSAND Dollars. That's insane.

That's the US Way. It could have been far higher.  
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?"

We all know the answer: people in this country who cannot afford to go to a doctor go to the ER when they get sick.

Quoting NoUFO (Reply 3):
Let them do something to minimize "doctor hopping",

National databases can resolve that problem to a significant degree. Just like a Rx database can reduce prescription abuses.

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.

Health care costs are directly related to WHO pays for it, You cannot have significant cost reductions without addressing that one factor. Make smart changes there and the other issues can fall into place.

Quoting Pyrex (Reply 7):
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.

The difference is that patients don't go cost shopping for a surgeon if they have a major problem with appendicitis. They could care less about price shopping - they just want to get taken care of ASAP

And there are other factors outside of the patient's control. It someone told them that Dr. Smith is the best bone surgeon they might find that he is not on call when you break your leg. He might be enjoying the weekend at the lake and one of the other doctors in his practice is the one you get.

Quoting ajd1992 (Reply 9):
I don't think it's free - it's paid for via tax regardless if you use it or not.
Quoting Pyrex (Reply 10):
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.

Look at the infrastructure we have today. We need 50 different state department to operate Medicaid. And there is not consistent care delivered for the federal dollar provided - no equal protection under the law.

You want efficiency? Move Medicaid to the federal level, operate one Department and end those 50 unnecessary state level departments. A good start - especially if you fold it into Medicare departments, systems, and policies.

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

Of course there is, starting with a profit motive. Insurance companies will work hard to see what they an get away with.

Quoting ajd1992 (Reply 11):
You asked how to make it cheaper, the easiest way is regulate the prices they can charge (which are borderline criminal, IMHO

Start price administrations for health care and there will be no reasons to limit price controls to health care.

Of course, you were going to understand that these price controls will basically limit health care over time (smart high school students obviously will avoid a medical system with price control) and it will reduce research.

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.

Bingo.

Quoting flyingturtle (Reply 14):
Do they train better doctors? I wouldn't say so.

Reality is that there are no more bones or muscles in the human body when you study at Harvard. You don't get more medical conditions in the medical conditions textbook. You have the same range of drugs in the PDR and the same basic tools, like a blood pressure cuff.

Quoting pu (Reply 15):
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....

That's another Bingo.

Step one to reduce health costs is a federal program covering health care based on tax revenues for payment, and inclusion of a private insurance system for those who want to pay. In Australia the private insurance was a fifth of the US policies because this extra cost of of covering those who can't pay. So private insurance is 5 times the cost as it is in Australia because we can't see the facts right in front of our face.


User currently offlineDocLightning From United States of America, joined Nov 2005, 20246 posts, RR: 59
Reply 32, posted (2 years 2 weeks 4 days 10 hours ago) and read 1884 times:

Quoting NoUFO (Reply 22):
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.

That is odd. Lincomycin isn't really used anymore. Lincomycin is a lincosamide antibiotic. We use clindamycin in this country. Lincomycin is still used in Pakistan (I just learned from Wikipedia). Why they use it and nobody else...I have no idea. It has poor oral absorption and apparently bad side-effects. Clindamycin has a very similar antimicrobial spectrum, has excellent oral bioavailability, and a favorable side-effect profile.


User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 33, posted (2 years 2 weeks 4 days 8 hours ago) and read 1882 times:

Quoting DocLightning (Reply 18):
It's incompetent physicians, NP's, and PA's.

Had to smile at this. The neurosurgeon who has done both of my cervical discectomy & fusion (20 years apart) was complaining about the NPs & PAs the last time I saw them. His biggest complaint was that they have no clue about differential diagnosis and he is sent patients who should not have been referred.

I've heard that from "she who must be obeyed" - but my better half did her PT studies in Australia 40+ years ago and differential diagnosis was an important factor in her training.

Quoting AeroWesty (Reply 19):
1) Assign social workers to manage the care of the highest-cost patients.

Hell no. Social workers are not sufficiently trained to make decisions on patients with complex problems. They probably think they are, but no chance would I trust them.

Quoting AeroWesty (Reply 19):
2) Educate patients and caregivers about when to head to urgent care rather than the emergency room.

Establish a medical care system where people at the lower economic levels can afford urgent care - or even preventive care.

Quoting AeroWesty (Reply 19):
Reign in the cost of medications.

That won't happen as long as the industry can continually make big political contributions.

Quoting pu (Reply 29):
....no one wants to make the call to cut off grandpa, but maybe grandpa should have the right to choose while still cognizant that perhaps he would exchange free college tuition for his grandkids (or whatever) in lieu of perpetual long term care?

Whoa there, fella. I'm a grandpa. I'm aware that I'll not last to 100. I'm lucky my body has lasted 68 years - many in my high school graduation class (50 years ago) haven't been as fortunate. Don't know how long I'll last, but looking at my parents causes of death I'll probably go with a stroke or cancer. My wife is well aware of my desires on pulling the plug, just as I am of her desires.

Maybe what we need for the elderly is continual research on conditions that result in such high costs. Mental conditions are a key area of research.

The best part of that research is that all the young ones today will (hopefully) reach that point where they will benefit.


User currently offlineDocLightning From United States of America, joined Nov 2005, 20246 posts, RR: 59
Reply 34, posted (2 years 2 weeks 4 days 8 hours ago) and read 1878 times:

Quoting Ken777 (Reply 33):
Had to smile at this. The neurosurgeon who has done both of my cervical discectomy & fusion (20 years apart) was complaining about the NPs & PAs the last time I saw them. His biggest complaint was that they have no clue about differential diagnosis and he is sent patients who should not have been referred.

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 differential. That's how you figure out what tests to order and what treatment to prescribe. But you actually have to CARE about what you are doing and use your brain.

Frankly, a lot of what I see is carelessness or simple "I don't know what I'm doing so I'm gonna do everything." There's this website called UpToDate that most hospitals have a subscription to (I have my own). It's really good and it contains literature reviews on most of the issues your typical primary care physician is likely to encounter in practice.

If people would take five minutes and actually read it from time to time, the quality of care would be much better.


User currently offlineseb146 From United States of America, joined Nov 1999, 11768 posts, RR: 15
Reply 35, posted (2 years 2 weeks 4 days 7 hours ago) and read 1871 times:

Quoting tugger (Reply 24):
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.

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 do the same, which is why there is a huge difference between the two.



Life in the wall is a drag.
User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Reply 36, posted (2 years 2 weeks 4 days 5 hours ago) and read 1871 times:

Quoting ajd1992 (Reply 11):
I lack the intelligence

We've noticed.

Quoting Mir (Reply 13):
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

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? If I live in New York, I can drive over to New Jersey to buy cheaper cigarettes or order something on-line that is not available in my state and have UPS deliver it but I cannot sign a simple insurance policy, that requires no physical travel whatsoever. That is ridiculous.

Quoting Mir (Reply 13):
You could mitigate that somewhat by creating some federal standards for coverage sold across state lines,

Obamacare does just that. Ridiculous standards, in many cases, which eliminated perfectly good plans, but it does.

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 $.

Do they train better doctors? I wouldn't say so.

Again, you are (perhaps deliberately) mixing things up. At your university you PAY $1,500 a year - that is not what it costs. If you are going to be intellectually honest don't compare Apples with Oregano.

Quoting pu (Reply 15):
proftis

Again, that word... in the U.S. there are hundreds of for-profit health insurance providers, and there are probably just as many non-profit health plans (plus of course, there are the for-loss plans, i.e., the government-ran ones). If you believe that profit somehow is evil you can go to Kaiser Permanente, Blue Cross Blue Shield, etc. If indeed not making a profit was as superior as you (and others here) claim it to be, logically these guys would have driven the for-profit operators out of the market by now. The fact that they didn't is a sign they are not. As someone who works a lot with mutual life insurers (same not-for-profit motivation and structure) I can tell you that any so-called benefits from the removal of the profit motive are often more than counter-balanced by the reduced incentives for efficiency caused by the lack of need to generate a profit. Heck, just look at the U.S. university system for an example of "not-for-profit" at work (i.e., institutions run by faculty and staff for the benefit of faculty and staff) - my university increased tuition by 27% in the past three years alone and still bugs me for donations.

BTW, one thing I don't understand is why healthcare seems to suffer the brunt of the attacks denouncing profits. People need food and shelter far more than they need healthcare, and yet I don't see people attacking Gordon Ramsey for making a profit selling food, or a contractor for making a profit building and repairing people's homes.

Quoting pu (Reply 15):
This is the evidence from Europe

Maybe in your part of Europe... the evidence from Portugal is, you pay a 70% marginal tax rate that supposedly gets you free healthcare but if you become sick you better have health insurance or be prepared to wait a long time...

Quoting wingman (Reply 17):
and have the shittiest healthcare system

The U.S. doesn't have anywhere near the shittiest healthcare system.

Quoting wingman (Reply 17):
It's not only economically stupid (see per capita spend chart)

Sure will. Please point me to the chart where it shows countries with a similar legal system as the one in the U.S.

Quoting DocLightning (Reply 18):
It's incompetent physicians, NP's, and PA's.

Maybe, but is that really a U.S. phenomenon?

BTW - examples like that happen in reverse as well. My dad had a really bad sprained muscle in his upper thigh when he came to visit me in the U.S. one day. He could barely walk and was in a lot of pain so we took him to the hospital (although we kind of suspected it was just a sprain). Since the pain happened suddenly for no apparent reason (was walking into cold water at the beach), he had a history of high cholesterol and blood pressure (as well as strokes in the family) and had just recently disembarked from a long-distance flight, they decided to do a sonogram to rule out deep-vein thrombosis. Ultimately it was just a (really bad) sprain but I was kind of glad they did it - the treatment ended up being the same as they would have given him in Europe (some ice-packs and an Aleve) but the difference is in Europe they probably would have sent him home straight away without spending more than 5 minutes with him.

Quoting AeroWesty (Reply 19):
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);

Some insurance companies already try to do that, as they recognize it will ultimately lead to lower costs, but of course if a nurse employed by an insurance company calls up someone to make sure they are taking their insulin (or doing their physical therapy, or whatever the case might be) all hell breaks lose.

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.

That is a big one. It never ceases to surprise me how often someone ends up in a hospital emergency room with nothing but a bad cold due to the lack of much simpler walk-in clinics.

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.

The problem with that is, how exactly do you know it is the last month or two of someone's life? If someone gets into a bad accident and might not make it, how do you tell the trauma surgeon to stop operating? What is the cut-off threshold for survival odds, and who makes that call?

Quoting AeroWesty (Reply 19):
6) Publish a list of how much medical services cost.

Agreed, and proposed that earlier. Increasing price transparency is key.

Quoting DocLightning (Reply 18):
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

Again, same issue with the social workers - some insurance companies do just that, and try to assign doctor ratings to the providers in their networks based partly on efficiency, but it never seems we can have an adult discussion about effectiveness of treatment without resorting to "they want to tell me what to do / save money at the expense of patients" rhetoric.

Quoting garnetpalmetto (Reply 20):
States that have enacted tort reform measures, like Texas, have seen no corresponding drop in med mal insurance premiums

I don't know about Texas, but I do know about Missouri. The state passed tort reform and the insurance companies were very clear publicly at the time that they would not start cutting rate until that law had withstood legal scrutiny. Of course as soon as the law got passed the ambulance-chasers started challenging it in court until, several years later, the law was struck down by the Missouri Supreme Court on some technicalities, Good thing the insurance companies didn't start cutting rate immediately.

Quoting garnetpalmetto (Reply 20):
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?

I work with insurance companies, and every day - every single day - I see examples of insurance markets where favorable underwriting conditions lead to increased competition and entrance of new players, which leads to a reduction in rate (often too high of a reduction). Insurance companies are the most rational, numbers-driven businesses there are - if they see an opportunity to earn their cost of equity in an area that fits their strategic appetite they will. Right now most insurance companies are sitting on a ton of excess capital they are looking to put to work, and will do so to the extent it makes sense.

Quoting garnetpalmetto (Reply 20):
The sort of system your advocating is one in which only wealthy plaintiffs could even think of filing a med mal claim.

No, the system I am advocating is one in which only the cases of truly egregious negligence (the kind that should get your license revoked) are taken, not every time you don't like an outcome.

Quoting tugger (Reply 24):
I know many might think taxing food is dangerous

The problem with that is you wouldn't be taxing food to pay for healthcare, you would just be taxing food. Politicians love supposedly targeted taxes because it gives them a reason to use misguided ire against whatever is the target of the day to come up with another (hidden) way to raise revenue for themselves, as well as employ a few hundred friends administering it. If you want more revenue just ask for higher income taxes, don't try to hide it in something else - don't give politicians that power.

Quoting tugger (Reply 24):
and I would think an escrow account being required to cover such services to prevent lapses and problem due to bankruptcy

That is what statutory surplus (i.e., capital) is for... the notion that you need to have surplus in all jurisdictions you operate in is unworkable.

Quoting Ken777 (Reply 31):
Reality is that the industry has the money to influence politicians and will fight hard to protect their profits. Don't look for too much help there

I am fine with them having the same amount of revenue they have now - something needs to pay for that research - just distribute the revenue more evenly. Stop subsidizing developed countries.

Quoting Ken777 (Reply 31):
You need to remember, though, that this approach requires improvements to the high school programs. Students on a professional (or university) path need to handle a lot of the work in high schools

Not really. It would be ideal, of course, but looking at freshmen classes in colleges today I am sure you could come up with a few thousand people a year that had the knowledge, inclination and maturity to go to this program.

Quoting Ken777 (Reply 31):
The difference is that patients don't go cost shopping for a surgeon if they have a major problem with appendicitis. They could care less about price shopping - they just want to get taken care of ASAP

Most medical treatments and procedures don't need to be done ASAP, and I opened an exception for those.



Read this very carefully, I shall write this only once!
User currently offlineajd1992 From , joined Dec 1969, posts, RR:
Reply 37, posted (2 years 2 weeks 4 days ago) and read 1866 times:

Quoting tugger (Reply 24):
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.

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 society where that was the case. I call the doctors, book an appointment, and then go to it. No money changes hands, and I'm on my way with a prescription (which to be fair, are expensive in England. 7.40 for a prescription! Not in Wales, Scotland or N. Ireland though.....)

Quoting tugger (Reply 24):
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.

I'm not paying for it but then so are quite a few people in the UK. We have something like 2 point something million unemployed in the UK (and that's not counting the people under the age of 18 so maybe add another 5-7 million to that for those who don't pay) and there is no logical way to tax people who don't earn. Benefits are the exception but here you actually get MORE healthcare benefits as you get free glasses, prescriptions, eye tests and some other stuff.

Not only that I'm a student anyway so I'm not exactly a drain on society. I am working towards something which a lot of people on benefits here just stay signed on and then go down the pub.

Quoting Ken777 (Reply 31):
That's the US Way. It could have been far higher.  

I know, I dread to think - thankfully he had thought to take out insurance beforehand, which he'd never done before!

Quoting Ken777 (Reply 31):
Look at the infrastructure we have today. We need 50 different state department to operate Medicaid. And there is not consistent care delivered for the federal dollar provided - no equal protection under the law.

You want efficiency? Move Medicaid to the federal level, operate one Department and end those 50 unnecessary state level departments. A good start - especially if you fold it into Medicare departments, systems, and policies.

That's insane - surely making it Federal from the start was the better idea as it benefited people countrywide, rather than letting states run their own?

Quoting Pyrex (Reply 36):
We've noticed.

  Don't be a dick about it. No need for personal insults. I'm not stupid, I'm just not clever enough to be a doctor.


User currently offlineMir From United States of America, joined Jan 2004, 21803 posts, RR: 55
Reply 38, posted (2 years 2 weeks 3 days 23 hours ago) and read 1864 times:

Quoting Pyrex (Reply 36):
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?

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 happened to the idea of state's rights?

And that's before the fact that selling insurance across state lines will increase costs on the sick, which should make the whole idea a non-starter (at least in the form in which it has been proposed).

-Mir



7 billion, one nation, imagination...it's a beautiful day
User currently offlineflyingturtle From Switzerland, joined Oct 2011, 2456 posts, RR: 14
Reply 39, posted (2 years 2 weeks 3 days 22 hours ago) and read 1864 times:

Quoting Pyrex (Reply 36):
Again, you are (perhaps deliberately) mixing things up. At your university you PAY $1,500 a year - that is not what it costs. If you are going to be intellectually honest don't compare Apples with Oregano.

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 value of nothing.

I'll digress a bit to show you something.

Markets are a wonderful tool to agree on prices. There is demand, and there is supply. And together they'll work out prices. But the value of something isn't tied to the price. Markets know absolutely nothing about what is a fair and just price that would reflect the value of something. Markets do not anwer what is... RIGHT.

Markets could put price tags on human life (and they already do so in the case of expensive drugs). Markets could agree on the fee you have to pay to get a legal abortion, at any time of the pregnancy. Pro-lifers would offer you money in order you don't get an abortion, and if your money and that donated by pro-choice people outweighs that of the pro-lifers, you're free to do an abortion.

In short, everything can be solved by putting a price tag on it.

But if everybody stubbornly insisted on cost transparency, little advancement would have happened for the human race. Cost transparency is a vital tool, however, to solve other problems - like the external costs of car driving. Nobody paying the true costs of pollution.

The value of medical training is huge, but a huge price can and should be avoided. Social mobility is one reason, giving lower (and now also middle) class boys and girls a chance to be doctors. They can't travel back in time and ask their parents to work harder in order that they can study at Harvard.

To sum it up, I find it intellectually dishonest to only look at costs and prices.


David

[Edited 2012-11-10 06:32:37]

[Edited 2012-11-10 06:33:32]


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 40, posted (2 years 2 weeks 3 days 19 hours ago) and read 1859 times:

Quoting Ken777 (Reply 31):
National databases can resolve that problem to a significant degree.

Yes, and at the same time such a database would raise questions concerning privacy rights and its possible abuses.

Quoting DocLightning (Reply 32):
That is odd. Lincomycin isn't really used anymore. Lincomycin is a lincosamide antibiotic. We use clindamycin in this country.

Same here according to Wikipedia.de, but K. told me this perhaps a decade ago, and we don't know when the patient was prescribed lincomycin.

[Edited 2012-11-10 10:14:36]


I support the right to arm bears
User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 41, posted (2 years 2 weeks 3 days 18 hours ago) and read 1858 times:

Quoting Pyrex (Reply 36):
but I cannot sign a simple insurance policy, that requires no physical travel whatsoever. That is ridiculous.

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 ensure they get their "political contributions"?

Quoting Pyrex (Reply 36):
The U.S. doesn't have anywhere near the shittiest healthcare system.

We have the most expensive medical care in the world, but without corresponding outcomes.

Quoting NoUFO (Reply 40):
Yes, and at the same time such a database would raise questions concerning privacy rights and it possible abuses.

Privacy & abuses are one issue, immediate availability of patient information for a treating doctor is another. The great thing about the VA system is that you could goto any VA clinic in the country and the doctor seeing you will have immediate access to your files.

In reality there needs to be a very strong law against pre-existing conditions in all states before it is safe for many people to have this level of information integrated in a national system.


User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 42, posted (2 years 2 weeks 3 days 18 hours ago) and read 1857 times:

Quoting Ken777 (Reply 41):
Privacy & abuses are one issue, immediate availability of patient information for a treating doctor is another. The great thing about the VA system is that you could goto any VA clinic in the country and the doctor seeing you will have immediate access to your files.

We have a so called "elektronische Gesundheitskarte" (along the line of "electronic health insurance card") here, where the encoded data is stored on the card rather than on a distant server. Right now it is just some personal data such as name and address, but soon the card will also store information on prescriptions, allergies, blood type, and your medical history - if the patient agrees. So you, the patient, can say: blood type, rhesus factor and allergies are okay, but I do not wish my medical history to be on a card I could lose; I'll just bring my physical files to my doctor if need be.

I like the idea of information stored on millions of individual cards better than one centrally organized register with millions of entries, and the individual should have the last word.



I support the right to arm bears
User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 43, posted (2 years 2 weeks 3 days 17 hours ago) and read 1855 times:

Quoting NoUFO (Reply 42):
I like the idea of information stored on millions of individual cards better than one centrally organized register with millions of entries, and the individual should have the last word.

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 information.

In my case the No 1 issue is the fact that I have 3 cervical vertebrae fused (C 5-6-7). In an emergency I want an anesthesiologist to be aware of that when putting me under for emergency surgery. OSA and the range for an autopap would also be nice to have available if I'm not able to tell them.

Basically the information you want medical personnel to know if you are unable to tell them - that is the first step for me.


User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 44, posted (2 years 2 weeks 3 days 16 hours ago) and read 1852 times:

Quoting Ken777 (Reply 43):
Basically the information you want medical personnel to know if you are unable to tell them - that is the first step for me.
Quoting Ken777 (Reply 43):
I really like the idea of a central file that doctors can access for critical information.

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 nurse who knows you could read your file without your consent. And if it's going to be a card, why not store your data on the card? This way you would not have to rely on a stable, secured line and a well-functioning giant server.



I support the right to arm bears
User currently offlineAirframeAS From United States of America, joined Feb 2004, 14150 posts, RR: 24
Reply 45, posted (2 years 2 weeks 3 days 13 hours ago) and read 1851 times:

Quoting Pyrex (Reply 36):
The U.S. doesn't have anywhere near the shittiest healthcare system.

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 still ranks as the shittiest system.

Quoting Ken777 (Reply 41):
We have the most expensive medical care in the world, but without corresponding outcomes.

  



A Safe Flight Begins With Quality Maintenance On The Ground.
User currently offlineblueflyer From United States of America, joined Jan 2006, 4126 posts, RR: 2
Reply 46, posted (2 years 2 weeks 3 days 11 hours ago) and read 1852 times:
Support Airliners.net - become a First Class Member!

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.
Quoting DocLightning (Reply 18):
I'm like...a doctor...and stuff.

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 curb medical costs is to pay providers per outcome instead of per performance. Thoughts?

Quoting tugger (Reply 24):
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.

In practice, I suspect most such requirements would run afoul of interstate commerce laws.

Quoting Ken777 (Reply 33):
Social workers are not sufficiently trained to make decisions on patients with complex problems.

Nor should they make medical decisions, but they can certainly push patients to follow a disease/treatment appropriate lifestyle, such as diet, exercise, etc...

Quoting Pyrex (Reply 36):
So what?

So maybe you're ok with all health insurance companies setting up shop in the one state that allows them to screw their customers the most, but I am not, not even if I supposedly get a little bit more competition out of it.

Do you know why credit card issuers set up shop in a handful of states as opposed to any other? Because the others had limits on interest rates, the ones the issuers chose do not...



I've got $h*t to do
User currently offlinepvjin From Finland, joined Mar 2012, 1366 posts, RR: 0
Reply 47, posted (2 years 2 weeks 3 days 11 hours ago) and read 1849 times:

Quoting Pyrex (Reply 36):
The U.S. doesn't have anywhere near the shittiest healthcare system.

Yeah sure not if you compare to poor developing countries, but from all countries with similar amount of wealth sure it has.



"A rational army would run away"
User currently offlinePPVRA From Brazil, joined Nov 2004, 8971 posts, RR: 39
Reply 48, posted (2 years 2 weeks 3 days 11 hours ago) and read 1847 times:

Quoting Rara (Reply 2):
Socialize it.

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:

Quoting Pyrex (Thread starter):
Solutions To Reduce Healthcare Costs In The U.S.  

Suggesting a system that has failed to keep costs under control elsewhere as an alternative is no solution at all.



"If goods do not cross borders, soldiers will" - Frederic Bastiat
User currently offlineDeltaMD90 From United States of America, joined Apr 2008, 7972 posts, RR: 51
Reply 49, posted (2 years 2 weeks 3 days 10 hours ago) and read 1844 times:

Quoting PPVRA (Reply 48):

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) be beneficial? I won't lie, media in the US made me think it wasn't fine and dandy over the pond, but listening to a bunch of real Europeans, their system seems a lot better, even if it's not 100% perfect (ours ain't either and I think even the Republicans, with their different approach on healthcare, can take some good things from Europeans.) It isn't a big d*** measuring contest, sometimes the US will have better things/ideas, sometimes the Europeans (or other nations) will have better ideas



Ironically I have never flown a Delta MD-90 :)
User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 50, posted (2 years 2 weeks 3 days 10 hours ago) and read 1843 times:

Quoting NoUFO (Reply 44):
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?

WHy? If I'm out of it I still want them to get the information they need.

Quoting NoUFO (Reply 44):
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?

Hey, why not use fingerprints as identifying which file to look at? I'm happy with that.

Quoting NoUFO (Reply 44):
Else a doctor or nurse who knows you could read your file without your consent

Why should I care if someone wants to peek? So they discover that I don't have a prostate or gallbladder. They might be able to guess that looking at the scars. The scar from the removal of the parotid gland is also pretty obvious.

Reality is that I don't care if they look. At 68 what have I got to hide? What interest me is ensuring that they have access to every bit of information they need.


User currently offlineHOMsAR From United States of America, joined Jan 2010, 1203 posts, RR: 0
Reply 51, posted (2 years 2 weeks 3 days 9 hours ago) and read 1840 times:

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?

I'm thinking about the drive-everywhere/walk-nowhere, sit-on-the-couch-eating-potato-chips, eat-at-McDonalds-every-day-for-lunch lifestyle? Or the work-people-until-they-drop-with-no-time-off lifestyle?

Do those factors contribute to a higher propensity for people becoming sick? I'm assuming the answer to that question is yes, but is it significant enough to have an impact in reducing overall costs?



I was raised by a cup of coffee.
User currently offlinePPVRA From Brazil, joined Nov 2004, 8971 posts, RR: 39
Reply 52, posted (2 years 2 weeks 3 days 9 hours ago) and read 1846 times:

Quoting DeltaMD90 (Reply 49):
which for the most part, have good healthcare

And so do Americans.

Quoting DeltaMD90 (Reply 49):
but listening to a bunch of real Europeans

Studies have shown Europeans spend more out of pocket than Americans on healthcare. On the other side of the pond, government runs less but, through rule making, make Americans less sensitive to prices. Who has a more market-based system here? Who is more socialized? It's definitely not clear.

Quoting DeltaMD90 (Reply 49):
their system seems a lot better, even if it's not 100% perfect

Their system is just as broken and is bankrupting them. The only difference is that their system is less sensitive to people being out of coverage, but now with ObamaCare this difference will slowly go away. Both systems, however, will remain broken on both sides of the pond. And costs will continue to climb.



"If goods do not cross borders, soldiers will" - Frederic Bastiat
User currently offlineAirframeAS From United States of America, joined Feb 2004, 14150 posts, RR: 24
Reply 53, posted (2 years 2 weeks 3 days 7 hours ago) and read 1843 times:

Quoting PPVRA (Reply 52):
And so do Americans

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 is not the answer. The mandate needs to be thrown out. It makes no sense with the unemployment rate where it currently stands.

[Edited 2012-11-10 21:40:33]


A Safe Flight Begins With Quality Maintenance On The Ground.
User currently offlineDocLightning From United States of America, joined Nov 2005, 20246 posts, RR: 59
Reply 54, posted (2 years 2 weeks 3 days 7 hours ago) and read 1848 times:

Quoting PPVRA (Reply 52):
Studies have shown

show them.


User currently offlinezippyjet From United States of America, joined Sep 2001, 5501 posts, RR: 13
Reply 55, posted (2 years 2 weeks 3 days 7 hours ago) and read 1843 times:

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 Delaware or Florida I should be able to buy/sign up for that. Enable us to deduct from taxes for alternative, holistic medicine if the big money big pharma and big insurance want to block this alternative. Make trial lawyers pay an insurance premium for all the paperwork and legal sue happy stuff they create. This may balance things out.
  



I'm Zippyjet & I approve of this message!
User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Reply 56, posted (2 years 2 weeks 2 days 20 hours ago) and read 1843 times:

Quoting Mir (Reply 38):
Whatever happened to the idea of state's rights?

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, why should insurance be any different?

Quoting flyingturtle (Reply 39):

People who know the price of everything and the value of nothing.

The price of something is how much something is worth, to the people doing the transaction. But nice attempt at trying to compare Apples and Grapefruit.

Quoting flyingturtle (Reply 39):
Markets could agree on the fee you have to pay to get a legal abortion, at any time of the pregnancy.

There is another thread going on right now on abortion, and you can see my position on the topic there. Let's not de-rail this one any further.

Quoting Ken777 (Reply 41):
We have the most expensive medical care in the world, but without corresponding outcomes.

And what I am trying to do is reduce costs, and end subsidies to other countries.

Quoting blueflyer (Reply 46):
Do you know why credit card issuers set up shop in a handful of states as opposed to any other? Because the others had limits on interest rates, the ones the issuers chose do not...

You mean a bunch of people who otherwise would have gotten loans from a pawn shop or Vinnie the Shark were able to find cheaper credit?



Read this very carefully, I shall write this only once!
User currently offlinemt99 From United States of America, joined May 1999, 6649 posts, RR: 6
Reply 57, posted (2 years 2 weeks 2 days 20 hours ago) and read 1842 times:
Support Airliners.net - become a First Class Member!

Quoting Pyrex (Reply 56):
The price of something is how much something is worth, to the people doing the transaction

Wrong. "Price" is what someone pays for something. Its just a number. I think that the word you are looking for is "value".

Quoting Pyrex (Reply 56):
If my state or county makes fireworks illegal I can still drive across the border and buy them, why should insurance be any different?

And mess with the the State Rights? Don't be such a communist...

[Edited 2012-11-11 08:08:10]


Step into my office, baby
User currently offlineMir From United States of America, joined Jan 2004, 21803 posts, RR: 55
Reply 58, posted (2 years 2 weeks 2 days 20 hours ago) and read 1843 times:

Quoting Pyrex (Reply 56):
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, why should insurance be any different?

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 you don't like the insurance rules for your state, you can move to a different state.

-Mir



7 billion, one nation, imagination...it's a beautiful day
User currently onlineRara From Germany, joined Jan 2007, 2136 posts, RR: 2
Reply 59, posted (2 years 2 weeks 2 days 20 hours ago) and read 1844 times:

Quoting PPVRA (Reply 48):
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:

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 bring health care costs down while maintaning good medical services. It would, however, make health care much less interesting as a profit-making enterprise.



Samson was a biblical tough guy, but his dad Samsonite was even more of a hard case.
User currently offlineKen777 From United States of America, joined Mar 2004, 8436 posts, RR: 9
Reply 60, posted (2 years 2 weeks 2 days 18 hours ago) and read 1841 times:

Quoting HOMsAR (Reply 51):
To what extent does our lifestyle have any contribution to health care costs?

A really big extent IMO.

Quoting HOMsAR (Reply 51):
I'm thinking about the drive-everywhere/walk-nowhere, sit-on-the-couch-eating-potato-chips, eat-at-McDonalds-every-day-for-lunch lifestyle? Or the work-people-until-they-drop-with-no-time-off lifestyle?

A lot of people in this country (including me) drive a lot because there isn't the centralized business district that people in other countries can buy from. My late mother-in-law used to do a fast shop after work & before catching the bus home. She worked in the CBD in Perth and that was a logical approach for many. In Tulsa more and more people work outside of the downtown area, cutting bus revenues (and service) making cars far more important. Same with shopping. I take a car to Sam's for bulk shopping and the wife stops at grocery stores for the other stuff. Walking to the shops here is not a realistic option.

Our shift to processed foods and fast food has hurt. I was in high school when we got our first McDonalds (about 1960) and young people were significantly thinner than today. But we also had gym classes and got a bit of exercise in every day.

This isn't just a US problem - we have been pretty good at exporting our fast food chains.

Quoting PPVRA (Reply 52):
Studies have shown Europeans spend more out of pocket than Americans on healthcare

Is that counting the employer costs? For many this is the vast majority of medical spending - and it's not them spending the money.

Quoting Pyrex (Reply 56):
If my state or county makes fireworks illegal I can still drive across the border and buy them, why should insurance be any different?

Fireworks don't present near the challenge that medical insurance does. As there is no current federal law that will protect patients & their families from abuse by the industry. Your "need" to set off some fireworks doesn't start to relate to your need for, say, some high priced chemo drugs.

Quoting Pyrex (Reply 56):
And what I am trying to do is reduce costs, and end subsidies to other countries.

You are not going to get meaningful reductions in costs until you have universal care at the core level. That doesn't mean that private insurance companies cannot be profitable - they can be very profitable, even when charging a fifth of what they charge today. Especially if the Fed is allowed to offer a competing product,


User currently offlinezhiao From United States of America, joined Jan 2011, 407 posts, RR: 0
Reply 61, posted (2 years 2 weeks 2 days 16 hours ago) and read 1836 times:
Support Airliners.net - become a First Class Member!

Quoting PPVRA (Reply 52):
Studies have shown Europeans spend more out of pocket than Americans on healthcare. On the other side of the pond, government runs less but, through rule making, make Americans less sensitive to prices. Who has a more market-based system here? Who is more socialized? It's definitely not clear.

Only Belgium and Swtz spend more OOP than USA according to OECD data.


User currently offlinePPVRA From Brazil, joined Nov 2004, 8971 posts, RR: 39
Reply 62, posted (2 years 2 weeks 2 days 14 hours ago) and read 1835 times:

Quoting DocLightning (Reply 54):
Quoting PPVRA (Reply 52):
Studies have shown

show them.

OECD: xhttp://www.oecd-ilibrary.org/docserver/download/fulltext/8107051e.pdf?expires=1352670778&id=id&accname=guest&checksum=B5733AB0EFADA9901B21BF140E5594A0

(page 95, figure 5.5.3)

Quoting Ken777 (Reply 60):
Is that counting the employer costs? For many this is the vast majority of medical spending - and it's not them spending the money.

No, just out of your own pocket. The whole idea here is giving you greater control over costs.

Quoting zhiao (Reply 61):
Only Belgium and Swtz spend more OOP than USA according to OECD data.

Quite a few more do, as the link above show.

[Edited 2012-11-11 13:59:05]


"If goods do not cross borders, soldiers will" - Frederic Bastiat
User currently offlinePPVRA From Brazil, joined Nov 2004, 8971 posts, RR: 39
Reply 63, posted (2 years 2 weeks 2 days 14 hours ago) and read 1835 times:

Here's an interesting infographic I have run across:

http://www.chcf.org/publications/2012/08/data-viz-hcc-national



"If goods do not cross borders, soldiers will" - Frederic Bastiat
User currently offlineNoUFO From Germany, joined Apr 2001, 7965 posts, RR: 12
Reply 64, posted (2 years 2 weeks 2 days 14 hours ago) and read 1836 times:

Quoting PPVRA (Reply 62):
OECD: xhttp://www.oecd-ilibrary.org/docserver/download/fulltext/8107051e.pdf?expires=1352670778&id=id&accname=guest&checksum=B5733AB0EFADA9901B21BF140E5594A0

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 expenditure on health" is indeed lower for the U.S.; however, if you take a look at "Out-of-pocket expenditure on health per capita" then the U.S. ranks pretty high (3rd actually).

I am not sure how OECD came to the conclusion, how Germans would pay 13.2 percent of their total expenditure on health out of their pockets. 571 EUR per anno? Does this include glasses and complementary or alternative medicine the insurance companies refuse to cover? Then perhaps, yes ...



I support the right to arm bears
User currently offlinepu From Sweden, joined Dec 2011, 748 posts, RR: 13
Reply 65, posted (2 years 2 weeks 2 days 13 hours ago) and read 1839 times:

Quoting Pyrex (Reply 36):

. If indeed not making a profit was as superior as you (and others here) claim it to be, logically these guys would have driven the for-profit operators out of the market by now

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 cases, especially where it is in society's interest to have the strongest come out on top. But it fails elsewhere. Education is free at the point of delivery because even educating dumb kids helps society. Roads are free to use even to the poor slobs who don't pay taxes because efficient transportation serves us well.

Admitting the market does NOT work in every case is an important part of self honesty.



Pu


User currently offlinePyrex From Portugal, joined Aug 2005, 4040 posts, RR: 28
Reply 66, posted (2 years 2 weeks 2 days 7 hours ago) and read 1835 times:

Quoting pu (Reply 65):
That is only logical if you believe the MARKET economy can or does always determine what is (your term) "superior."

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 sold into the Group channel, where combined premiums for a whole company can easily be at least several tens of thousands of dollars at the low end and well into several millions at the high end, whoever is the benefits manager for that company better be making an informed decision or they are not doing their jobs properly.



Read this very carefully, I shall write this only once!
User currently offlinepu From Sweden, joined Dec 2011, 748 posts, RR: 13
Reply 67, posted (2 years 2 weeks 2 days 7 hours ago) and read 1837 times:

Quoting Pyrex (Reply 66):

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 of claims regardless of their validity.

...which is one of the biggest reasons Obamacare has support. In other words, if insurance companies actually paid without the need of litigation (80% of ALL US court cases are against insurers attempting to enforce policy provisions), Obamacare probaly would not have passed into law.

Because insurance companies believe they have a way to increase PROFITS by denying legitimate claims, they deny claims in bad faith because only a smaller percentage of policyholders will sue.

The insurers are factoring in their own dishonesty to produce profits!


Pu

[Edited 2012-11-11 21:21:28]

Top Of Page
Forum Index

This topic is archived and can not be replied to any more.

Printer friendly format

Similar topics:More similar topics...
Woolworth's To Close All Stores In The UK posted Wed Dec 17 2008 07:27:50 by EWRCabincrew
Russia Is To Deploy New Missiles In The Baltic posted Wed Nov 5 2008 16:24:38 by Mortyman
Best Way To Find Strategy Jobs In The UK? posted Thu Jul 17 2008 07:54:32 by 22right
How To Get A Notarised Copy In The UK? posted Tue Feb 20 2007 00:42:50 by Runway23
Things To See And Do In The Rockies? posted Tue Oct 26 2004 13:47:34 by TupolevTu154
Need To Get To San Jose At 3 In The Morning. posted Thu Sep 12 2002 18:50:03 by AerLingus
How To Post Photos Not In The Database posted Fri Mar 1 2002 03:53:01 by UAL1837
Atempted To Smugle 44 Birds In The Pants posted Wed Dec 5 2001 10:13:56 by Thom@s
Gary McKinnon To Stay In The UK posted Tue Oct 16 2012 08:00:29 by flipdewaf
Groups In The Pentergon Considered To Nuke Mecca posted Fri May 11 2012 01:09:20 by oldeuropean