Health care in the U.S. - stop bickering and fix it
http://www.pamshouseblend.com/diary/12084/health-care-in-the-us-stop-bickering-and-fix-it (http://www.pamshouseblend.com/diary/12084/health-care-in-the-us-stop-bickering-and-fix-it)
Pam Spaulding
7/19/09
Q of the day: do you have a health care horror story to share? Was it denial of service or meds by your insurance, or hospital bureaucracy, or something even more onerous, like poor quality care?
I have to agree with this assertion over at Eschaton -- "The reality is if you get real sick, no matter if you're insured or not, you're probably financially ->-bleeped-<-ed." The partisan bickering over how much it is going to cost is ludicrous -- the cost is just one part of the problem, the fact that we have so many people uninsured and worse, under-insured, is the reality of too many Americans and to get everyone adequate care will likely cost trillions.
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According to this model, the 2007 report says, "The U.S. position above the trendline indicates that specialists are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more."
Mal practice is just that the practice pays it (overhead) before the doctor gets paid.
Mal practice also feeds many lawyers and makes doctors do unnecessary tests.
Typically one doctor makes over a million gross but the office costs eat most of it.
Remember these are average pay checks. If a young doctor starts out with a lot of debt for education and equipment etc. much of it the practice pays that first.
Post Merge: July 19, 2009, 11:57:13 AM
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You can not get more care without cutting some where. People that can not pay will reduce the care of those who can.
Post Merge: July 19, 2009, 12:59:58 PM
QuoteMichael's addiction was ultimately created by doctors," Chopra said.
Experts on doctor behavior said physicians often have a tough time saying no to requests from a patient -- even when the patient isn't a celebrity.
"There's constant pressure to say yes to things even when it's not in the patient's best interest," said Dr. Joseph Weiner, chief of consultation psychiatry at North Shore University Hospital in Manhasset, New York. "It's become an everyday dilemma."
The drug companies is another leg of the high cost of health.
Yes the advertisements, but then the ignorant public falls for marketing. But the real problem is the marketing done on doctors which include free classes and trips to seminars as well as rewards for prescribing. Then there is the research studies that create doubt about the harmful effects. Hire mercenary scientists and ghost writers for the papers.
Then we come to the Insurance companies. As the CEO's make from 10 to 30 million a year and their companies hundreds of millions each year as they lay off thousands.
Now how many of these problems does the national health care bills solve? Where are the savings?
The only proposal I have ever seen that has a prayer of retaining high quality care while ensuring maximum access is an MSA system and that is not only dead in the current political waters but what few experiments that do exists are targeted for elimination.
bicker or not bicker - nothing that has any chance of passing will do anything but make matters worse.
And I say this as a person who has NO health insurance on my wife or myself.
As was said above, if you do have a catastrophic illness, you are bankrupt (as things stand now) but the alternative is that, if the information I have seen routinely is at all correct, medical issues which are NOT catastrophic become major problems in a Euro-Canadian style system.
I don't profess to be an expert, and I sure can't say "X will definitely work" but the numbers on the current proposals don't add up.
It's better for folks like me to suffer the downside of being uninsured than for the entire country to bankrupt itself trying a system that can't possibly succeed.
Quote from: Laura Hope on July 19, 2009, 03:55:43 PM
It's better for folks like me to suffer the downside
I have to resepctfully disagree.
I'd bet Karl Marx is rolling over in his grave. He used to hold out hope for America, that ours was a nation that could achieve his vision without bloodshed. It is not better for you to suffer the downside of the current system, you are
just as important as everyone else. While the powers that be might have you convinced that being poor is your fault, barring deliberate action by you that's probably a lie. Our system needs poor people to function properly, and they/we are just as important as anyone else in the overall health of the nation. It is built on our backs.
We can have our cake and eat it too in when it comes to health care, I think the fear is nothing more than scare tactics. First of all, Americans won't tolerate the euro-canadian style system. Even if we went completely single payer (a pipe dream I know) we would endlessly take our representatives to task over it's flaws and expense. Lots of things were going to bankrupt the country at one point or another, and at the end of the day worked out fine. Our healthcare will eventually go the same way.
Single payer is the only system that is going to work in the US, and at that, its not going to work for all. But its the best choice of the options.
Quote from: tekla on July 19, 2009, 06:31:30 PM
Single payer is the only system that is going to work in the US, and at that, its not going to work for all. But its the best choice of the options.
You only have so many health care workers and facilities. Add 40% more work load to a system that has 95% capacity now and you are going to have people not getting care. If you add 40% more workers and facilities you add 40% more costs. Without cutting the middle men out and reducing the medical, insurance, legal and drug profits you will not save a dime to replace the computer systems already in place. You will only add more space for people to milk the system through fraud. The government does not have the staff to enforce any of the new paper crimes that will happen.
I see your point, lisa, but when people who typically had no health coverage stop using ER's as their general practitioner and start getting preventative & well-care, our current resources can be reallocated to shift to the needs of our new, insured public.
Quote from: Mister on July 20, 2009, 01:13:51 AM
I see your point, lisa, but when people who typically had no health coverage stop using ER's as their general practitioner and start getting preventative & well-care, our current resources can be reallocated to shift to the needs of our new, insured public.
But drug marketing and poor health lifestyles are just going to increase doctor visits. People are billed for ER visits. My brother died because of no health insurance.
Quote from: lisagurl on July 20, 2009, 09:38:27 AM
But drug marketing and poor health lifestyles are just going to increase doctor visits. People are billed for ER visits. My brother died because of no health insurance.
the only people who are billed or ER visits are those that don't have insurance and didn't qualify for low- or no-cost care based on their incomes. and, since medical bills are the #1 reason for home forclosures (or were 1.5 years ago, anyway) we know that not everyone who is billed by a hospital actually pays.
Quotewe know that not everyone who is billed by a hospital actually pays.
We know that not everyone who is billed by the IRS or anything else actually pays. That is why our system is failing.
Quote from: lisagurl on July 20, 2009, 11:45:38 AM
We know that not everyone who is billed by the IRS or anything else actually pays. That is why our system is failing.
Do you honestly think that tax non-payers who don't have a jillion loopholes to aid them are making the system fail, Lisa? I mean those lil ole tax-protesters out in Arkansas and Montana are bringing the American giant to its knees? :)
QuoteI mean those lil ole tax-protesters out in Arkansas and Montana are bringing the American giant to its knees?
It is not just tax protesters that is a drop in the bucket. It is those who buy more than they can afford such as mortgage holders, credit card deadbeats etc. But that too is small potatoes to the millions of businesses and tax payers that defeat the system designed by lawyers to give lawyers fist dibs on tax profiting scams that when enough discover them are closed as the lawyers through lobbyists create new ones. It is an unending game the is ethically unsound for a system to survive.
None of it really matters, it's all details and the mistake that's been made is to argue about it and not actually do anything. Just because it's going to be expensive and there will be a lot of fraud at first doesn't mean we shouldn't do it...we should, even if it takes a quarter of the GDP. There's like 50 million people with no healthcare, 10 million of them are kids, and that's just obscene.
QuoteJust because it's going to be expensive and there will be a lot of fraud at first doesn't mean we shouldn't do it...we should, even if it takes a quarter of the GDP. There's like 50 million people with no health care, 10 million of them are kids, and that's just obscene.
You can not spend more than you make. The only thing that keeps the U.S. solvent is faith in the system. Once other countries that are holding our debt think we can not pay, the U.S. will become a third world nation with little health care for anyone. We will not be able to buy the barest necessities. Remember we do not make most of what we need or use. We even import some of our food, most of our oil, copper, atomic fuel, electronic things, steel, drugs, etc. When the dollar is not valued we will not be able to buy any of it.
What is obscene is 5000 children die every day due to no clean water available to them. Start thinking that we take too much for granted.
Quote from: lisagurl on July 20, 2009, 07:58:51 PM
What is obscene is 5000 children die every day due to no clean water available to them
This is stupid, I agree, but it doesn't have anything to do with the health care system. The torture policy is/was obscene, the funding level of public schools is sad, not to mention the lgbt rights or lack thereof situation. What would you suggest for healthcare then, just leaving it be? Nearly every other industrialized nation in the world has managed passable healthcare for it's citizens and not gone bankrupt, why will the world end if America does? Give us a soultion instead of just criticisms of flawed but workable ideas.
America has a long history of taking what we need if we can't buy it or talk our way into it. I'm not worried about a lack of faith in our system, the rest of the world is probably more concerned about a desperate, hungry, bankrupt superpower with a chip on her shoulder than with collecting their interest. For that matter, we haven't always been broke, and we won't always be. This hard time will eventually pass. This is a good time to put a healthcare system in place while people are feeling vulnerable and greed is being scorned rather than celebrated.
The US isn't in danger of a financial meltdown if health care is reformed and by reformed I mean re-invented. Will a health care for all program send the US spiraling out of control into an abyss of debt and chaos? Of course not..sure there will be problems and lot's of them but that's part of the process not a harbinger of failure. The US has three major obstacles in the way of proper health care.
1. Insurance Companies-Since the inception of HMO's the system was designed for profit and greed while being sold/marketed to America as a feel good hug to soothe the soul and protect the working mans wallet. Since that time they have mastered the art of profit over health. They hire the best lobbyists and hand out campaign 'donations' and massive perks of various types to ensure that politicians will support their companies. They don't want a government option for insurance because they know that such a policy would be free of all the trip wires and booby traps they use to deny coverage and increase profit. They will fight it to the death and the GOP and some of the Dems will be their army.
2. Pharmaceutical Companies-The second leg of the evil giant. Unimaginable practices of holding drugs until they are more profitable to release. Releasing unsafe drugs for profit knowing full well that there is very little chance they will be held financially responsible should the drug be deemed unsafe and pulled (the fines they pay are minute in comparison to the profit they made releasing the drug to begin with). Charging obscene amounts for drugs that have no competitive brands and claiming that the cost is a direct result of the expense of development (yeah..the dog ate my homework too).
3. Politicians-Why? Because, regardless of how much they like to talk about their roots, they have no concept of what middle and lower class Americans want or need. They understand money and they understand power...they can get both by supporting insurance and pharmaceutical companies. Very few, if any, of these men and women have ever had to just deal with the consequences of a health problem because they couldn't afford to see a doctor. They've never had to decide that electric bills and groceries have to come their health. They don't worry about having an insurance company revoking payment for a surgery or major medical bill causing immediate financial ruin because the insurance companies are very careful to make sure that those in power never experience these things. Instead they get they held and caressed while the insurance companies whisper sweet things in their ears and happily give them the best coverage possible.
They will not be defeated easily. There's a lot of power and a lot of money at stake and these guys aren't going to play nice. They are going to look us right in the eye and tell us it can't be done despite countries with bigger problems than ours having managed to create real working health care systems and not suffered economic meltdowns or disasters. We like to say in America that our system might not be perfect but it's the best there is and that could certainly be applied to many things but not our health care. It's disgusting how we treat our own citizens...and it's disgusting how we allow it to continue. Those with insurance (who aren't in power) fight constant increases in copayments, denials of coverage and the always frightening revocation of past paid bills. Those without insurance..well they just go without or flood the ER's for medical care and statistically die much earlier. Sometimes it can't just be about the money..sometimes it has to be about doing the right thing. The insurance companies have already started a massive TV campaign to convince the people that this reform will cause grief and woe of biblical proportions..the sad thing is that, as Prop 8 proved, they will probably believe it.
Sorry..I'm rambling..I'm tired, I'm in pain, I'm angry and all I can think about is how I'm going to lose my health insurance next month and how there will be no way for me to have the next surgery (non TG related) I'm scheduled for. I'm not even sure the doctor will continue to prescribe medication since I won't be able to afford office visits. :(
Personal opinion here. The biggest reason for high costs is malpractice insurance. When people can get "free" money by suing , they do. When a lawyer says I can get you a million even tho you only lost in wages, medical, care of children while in hospital, etc legit costs are only 100k, many people do it. They need to cap the costs of "pain and suffering" as opposed to actual costs of what happened.
Point two:
Sad money when it comes to schools? Come on, when my taxes pay for a high school to have a better weight room, showers, sauna etc then Most adults in the area can even pay a health club for, the schools are not lacking in money but in sound budgeting.
I would much rather have control of where my money goes than letting the government control it. They can't balance a budget (obviously) and I don't think they should be the ones who decide if I can get a procedure or not. It is my body and my choice, I see no need to have to share my medical records or money with any governmental body. Since when does any one have the right to judge whether my situation is better or worse than someone else's based on age or probable length of life among other strange criteria of which you may or may not have access to.
There is no perfect system, so looking for a health care system without any disadvantages is a futile exercise.
As a UK citizen, with many US friends who've been here and experienced our socialized medicine (the NHS, National Health Service), I have to say that I'm glad we have it. Getting the right funding & resources isn't easy and waiting lists can be long for non-urgent surgeries. Some of the hospitals aren't as shiny new as the private ones.
That aside, it works well enough for most people - not all, but most. My eldest daughter has a severe congenital glaucoma and has been treated by some of the best opthalmic surgeons in Europe since she was born...for free. (Well yes, I make a contribution to the NHS via deductions from my pay packet but of all the things I may contribute to, this is one I think is worthwhile).
Just my tuppenceworth... :)
QuoteWhat would you suggest for health care then, just leaving it be?
No but they need to address the problems first.
1. Pay for performance. In other words you pay only if the doctor helps your problem.
2. Have a rating of doctors so the public can choose one that has good odds of not doing malpractice.
3. Make insurance non profit like electric coops.
4. Fix the FDA, as it stands now they work for the drug companies.
5. Do away with Medicare and Medicaid replace them with non profit coops funded with the same FICA money.
6. Take the power away from the AMA to control medical schools.
7. Control the pay of specialists to the same level as general practitioners.
8. Get the lawyers and legal system out of the medical business. Let a judging panel decide disability payments for people injured by doctors.
9. Limit the drug companies spending on marketing, lobbying and doctor rewards. Fix the drug research testing problems, require all raw data and let public scientists analyze it.
10. Support well care and charge people for poor health practices. Smoking, over weight, drugs, etc.
Remember money does not come from the thin air . Every penny put in a persons pocket comes from another person's pocket.
Quote from: lisagurl on July 21, 2009, 08:23:11 AM
1. Pay for performance. In other words you pay only if the doctor helps your problem.
I like this idea, although I'd break it out into a bit more detailed performance related pay system. The biggest problem I have with doctors is poor and sloppy diagnosis skills. Successful diagnosis would be one metric, I'd say. As long as we don't measure them on "througput" (number of people helped), as that's too easy to play and drives the wrong behaviour. "Take two pills and call me in the morning, +1 on my numbers, next!"
Quote
2. Have a rating of doctors so the public can choose one that has good odds of not doing malpractice.
If, following complaint and investigation, a doctor is found guilty of malpractice, they should be struck off the medical register (although for minor infractions that may not be necessary). I agree with the intent here, though.
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8. Get the lawyers and legal system out of the medical business. Let a judging panel decide disability payments for people injured by doctors.
Hear, hear! This both feeds the compensation culture and thrives from it.
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9. Limit the drug companies spending on marketing, lobbying and doctor rewards. Fix the drug research testing problems, require all raw data and let public scientists analyze it.
Impartial, objective analysis is not consistently performed - agree!
Quote
10. Support well care and charge people for poor health practices. Smoking, over weight, drugs, etc.
Yes I agree here too (with provisions for edge cases which are not really the individual's fault).
Quote from: lisagurl on July 21, 2009, 08:23:11 AM
... Remember money does not come from the thin air . ...
Actually, Lisa ... it does "come from thin air." The central banks establish "money," and they establish it out of thin air. Go read a bit about the Emperor Norton who passed out his own "money" for exchange in SF in the 1800s. He may have been thought of as delusional and crazy, but his "tender" was accepted and he was able to buy goods with it.
The same principle works for "money." It's ephemeral and is based on the belief in it by the population that uses it.
How did that $1 trillion + get doled out by the Fed to the banking/insurance system recently? The Fed "made the money out of thin air."
QuoteHow did that $1 trillion + get doled out by the Fed to the banking/insurance system recently? The Fed "made the money out of thin air."
It relies on faith in the system. Faith only goes so far and the future generations will be responsible for the debt, be it inflation, taxes or reduced lifestyle but requiring more work. Plenty of products are sitting in the trash heap and unpaid credit cards bills as the national debt climbs. Now the Chinese are working their asses off in the promise that they will get paid later. When later never comes they just might try to take it. Nothing is free.
QuoteMr. Wessel says, all "had a gut sense that the U.S. economy was overdue for a financial crisis of some sort" before the catastrophic events of last fall, but "no one at the Fed" rang "the gong and warned investors, lenders, business executives, and consumers that years of easy credit even for risky borrowers, placid markets, and shared optimism were unsustainable."
Ir's rather ironic that so many of the "capitalist fat cats that exploit the workers" are Chinese business people. In fact, there is a rapidly swelling divide between the ever wealthier middle class and the working class.
Power and money; probably the two most corrupting influences there are.
Just curious. How are "It's ephemeral and is based on the belief in it by the population that uses it." and "It relies on faith in the system" different from each other?
Exactly! They are not. Money=fantasy. But a fantasy that has a rather hard edge to it since practically everyone believes it's there.
Quote from: Nichole on July 21, 2009, 10:50:38 AM
Just curious. How are "It's ephemeral and is based on the belief in it by the population that uses it." and "It relies on faith in the system" different from each other?
Exactly! They are not. Money=fantasy. But a fantasy that has a rather hard edge to it since practically everyone believes it's there.
QuoteMr. Wessel says, all "had a gut sense that the U.S. economy was overdue for a financial crisis of some sort" before the catastrophic events of last fall, but "no one at the Fed" rang "the gong and warned investors, lenders, business executives, and consumers that years of easy credit even for risky borrowers, placid markets, and shared optimism were unsustainable."
Quote from: Nichole on July 21, 2009, 10:50:38 AM
Just curious. How are "It's ephemeral and is based on the belief in it by the population that uses it." and "It relies on faith in the system" different from each other?
Exactly! They are not. Money=fantasy. But a fantasy that has a rather hard edge to it since practically everyone believes it's there.
QuoteMr. Wessel says, all "had a gut sense that the U.S. economy was overdue for a financial crisis of some sort" before the catastrophic events of last fall, but "no one at the Fed" rang "the gong and warned investors, lenders, business executives, and consumers that years of easy credit even for risky borrowers, placid markets, and shared optimism were unsustainable."
And your point, other than just placing Mr. Wessel (Horst?) further down the page than before is what?
Mr. Wessel appears to be saying exactly what you and I have said: that belief is the bedrock of money.
Beliefs only last as long as they are not challenged. Shared optimism as a fantasy is not lasting. Even In ECO 101 the professor held up a reserve note. The students rather have the silver certificate. The population (especially the wealthy) has a lot of doubt about the value of American currency. Many are diversified around the world and there are countries like China and India calling for a new world standard as our credibility is falling. Some of the highest power brokers in the world are calling for a new world order. Both you and I have lived through periods of high inflation. I do not keep paper or any money in my mattress. When the majority has nothing to lose then you will see a revolution. All ready places like France, Greece, China, India, etc. are dealing with unrest due to losing belief in the governments.
Post Merge: July 21, 2009, 07:58:31 PM
QuoteNew York state and New York City have agreed to pay a total of more than a half billion dollars to settle federal allegations that they knowingly submitted false Medicaid claims for more than 10 years, the Justice Department announced Tuesday.
The states are committing fraud on the federal medical program just think what a free for all it will be with a national system.