How would you fix the health care problem in the US?

[risktaker]

1. Tax sugar at a higher rate.
2. Tax foods high in fat at a higher rate
3. Reduce obesity by reducing free food to overweight "poor".
4. Add a "premium" for being overweight/obese.
5. Add a premium for any drug-related issue.
6. Encourage more activity in schools.
7. Tax fast food at a higher rate.
8. Tax sugary garbage soft drinks at a higher rate.

This country is SICK with overweight, butt UGLY shoppers!
Reduce consumption FAST & SOON!

Every time I come back from Europe & go to a Walmart/Target or some food stores I'm shocked & depressed by the lard attached to these women who just buy & consume shit and go see a doctor because they're sick.

 

[spinn]

Quote from risktaker:

1. Tax sugar at a higher rate.
2. Tax foods high in fat at a higher rate
3. Reduce obesity by reducing free food to overweight "poor".
4. Add a "premium" for being overweight/obese.
5. Add a premium for any drug-related issue.
6. Encourage more activity in schools.
7. Tax fast food at a higher rate.
8. Tax sugary garbage soft drinks at a higher rate.

This country is SICK with overweight, butt UGLY shoppers!
Reduce consumption FAST & SOON!

Every time I come back from Europe & go to a Walmart/Target or some food stores I'm shocked & depressed by the lard attached to these women who just buy & consume shit and go see a doctor because they're sick.

well said.....I will not even go into the Shoppers Food Warehouse near me beacause everyone in there looks like they are twoo weeks away from dieing.

My experience has been that it takes one or two months to escape the cravings of bad food the first time, then a week or so after that.

If the sheep knew how to be healthy maybe they would have the esteem to get mad at the lipitor pushing DRs.

 

[Dr. Zhivodka]

Just to correct what seems to be a general board misconception.

The AMA has absolutely ZERO to do with any licensing or certification a Dr. my have. The AMA is simply a trade organization and lobby group. And a very very weak one at that. Doctors are licensed by the State in which they practice. They also have a Federal DEA license with allows them to prescribe drugs.

Quote from Angrycat:

I don't mean we have to get rid of certification for doctors. I mean that the AMA should not be the monopoly on that certification.

The AMA doesn't actually control doctors and licensing by the AMA doesn't mean that the doctor is competent either. I've been to witch doctors more competent than some physicians. And in the end, I am very careful to choose a doctor because he is recommended than because the AMA licensed him because I know this is a problem.

With competing certifiers, each certifying body will have to prove that their certification is the most meaningful and that means they will have incentive to not just certify every buffoon who graduates medical school but to check his competency too.

The AMA's monopoly on licensing serves ONLY to limit the number of doctors and raise the cost to patients - as happens when supply is artificially limited.

 

[Angrycat]

Quote from wolfab82:

No offense sir, but this is dishonest logic and a bit simplistic. Free markets dont exist in America. Not in a world where Judges make their salary and twice that in bribes! Also, you are discounting the strength and power of the LOBBY in the US Govt. Lobbies intervene when market forces drive down the benefit of the rich and connected. (see Bailout, GM bailout, the subsidizing of failure is systematic and promoted!)

Insurance is a sheister business. Have you ever tried to collect on an honest claim? They dont have to pay on time, although you are hurt. Go ahead and DONT pay your insurance and see what happens to you!

Ask them to wait a while and see if they dont cancel your policy.

You cannot negotiate with thieves and liars!

You're right - but that is a function of overly powerful government and the regulation it writes for insurance.

The government should only be involved in enforcing contracts. That's it.

Competition should be interstate and the insurance providers have to provide customers a product they want at a price they are willing to pay.

Believe it or not, before WWII, this is how insurance worked. AND, btw, access, costs, medical care (when adjusted for the obviously not obsolete technology) was better. We know this will work because it worked before. Had government not interfered in the insurance market during WWII, we would be better off today.

There are examples of relatively free market health care systems that work - Singapore for instance. High quality care and cheaper.

 

[Angrycat]

Quote from Dr. Zhivodka:

Just to correct what seems to be a general board misconception.

The AMA has absolutely ZERO to do with any licensing or certification a Dr. my have. The AMA is simply a trade organization and lobby group. And a very very weak one at that. Doctors are licensed by the State in which they practice. They also have a Federal DEA license with allows them to prescribe drugs.

Not quite.

The AMA is a trade Union - the strongest in the nation. Like any trade union it seeks to increase the compensation of its members by restricting the number of members.

The essential control is at the point of admission into medical school - thereby controlling the number of doctors who graduate and become licensed. The AMA accomplishes this through the Council on Medical Education and Hospitals of the American Medical Association. The Council approves medical schools and suggest to them how many pupils they might admit. <i>suggests</i>. Of course, if you do not graduate from a Council approved program, you do not obtain a license to practice in the U.S.

So, the AMA is really quite in direct control of how many doctors practice in the United States.

 

[Random.Capital]

How about this:

Step 1. Have the FDA (or whoever) define the basic coverage requirements for a health care insurance plan that would take care of most needs, most of the time. There are several state models that can be leveraged for this.

Step 2. Mandate that any insurance company can offer any insurance plan it likes, as long as it also offers the plan from Step 1 for a flat fee regardless of age or pre-existing conditions.

Step 3. Scrap Medicare, replace with means-tested vouchers for the standard insurance plan.

Everybody gets insured, everybody sees the cost of insurance, government isn't involved other than in setting standards and safety-netting the unfortunate (regardless of age), relatively straightforward to implement.

An even simpler alternative is to just open up the insurance plan given to Congress Critters and federal employees to all Americans, at the same price, regardless of age or pre-existing conditions.

 

[Angrycat]

Quote from Martinghoul:

I don't understand what all the endless back and forth is about. It's a simple choice of what you believe is a lesser of two evils:
1) Govt-administered universal healthcare. Potentially grossly inefficient and may introduce 'moral hazard' issues. On the other hand, if somehow you end up in circumstances where you or your family need the system, it's there and it's adequate. This is sort of the European model.

2) Private, mkt-oriented healthcare. Everyone buys their own. Probably very efficient, due to competition and incentives. On the other hand, if you can't afford it, you're dead, plain and simple. That's the mkt model.

Both have their pros and cons and people can argue interminably about which one is better. These arguments are a waste of time, IMHO. Might as well have a referendum, vote for one of the choices and just stick with it.

Again, my Z$2c...

1.) I lived in a country where single payer was the only option and I got very sick and was in and out of hospital for four years. You will not get anything that would remotely pass for "health care" by American standards. You may get to a hospital and a doctor, but you won't get care. It's not adequate and it costs a fortune because everyone has to go through the inefficient government meat grinder.

in Europe, you get access to really basic care - first aid type of stuff - reasonably quickly in most countries. But, more costly treatments are severely rationed or completely unavailable. And this is in countries that don't have America's obesity problem and that administer to 70MM people vs. 300MM and refuse care to illegals.

So, please, don't kid yourself - for your own sake. I'm not saying this out of some political position but because I've seen it first hand and my family has practiced as doctors in these systems. They all moved here. They couldn't take the patient suffering.


2.) Truely private market systems are both cheaper and cover more. Even our semi-private market screwed up quagmire delivers better care more efficiently than socialized care systems.

If we deregulate certain aspects of health insurance like the prohibition on interstate selling, there would be a competitive market in policies. Competitive markets have one great feature - they tend to bring products that consumers want at prices they are willing to pay.

For those who still can't afford it, there is a place for public assistance because I dare you to find one person in America who would stand by and watch someone die in the street. It doesn't happen here. So, there is a place for government, but it's a place of last resort. But, how can we say that health insurance is unaffordable when GOVERNMENT keeps loading it up with mandates and restricts competition?

 

[Mvic]

AMA and ACP are nothing like Trade Unions at least in the way a trade union is normally defined (terms come from the UK). AMA certainly advocates for a specialist rich system and the ACP is a better advocate for a PCP led system.

The only path to meaningful health care reform that I can see is through campaign finance reform. Without the later we don't get the former.

1. Tort reform where front line health care providers covered by EMTALA are considered Public employees and thus Federal government is liable so standard of care is not set by emotionally manipulated non medically trained juries. For non frontline practitioners caps on awards, an arbitartion process by medical tribunal with impartial medical and non medical arbitrators seated, payment from a federal fund with all providers paying in to it each year.

2. Federally standardized payment portal run by private company where contract comes up for renewal every 5 years and need to maintain certain payee satisfaction rating to retain contract. All payments for any health care nationally run through this portal.

3. Reimbursement must make medical home concept viable rather than PCP handing off to one specialist and essentially no longer having any input as patient gets bounced around form one specialist to another with no overview management of the patient's care. Research has conclusively shown that this medical home model vastly improves outcomes and reduces unnecesary surgery and other procedures and tests that specialsits and hospitals have a financial
incentive to perform. Easy enough for a specialsit to talk a patinet armed with little more than some info grabbed off the internet in to a procedure without potentially full disclosing all the rsiks. not so easy if the patiemt has a medically trained advocate for the whole care in thier PCP. Under the current system PCPs that try this type of advocacy are a) not compensated for it, and b) often seen as a pain by area specialists who don't want to take time to talk to the PCP about the patient's larger medical picture.

4. State wide health insurance exchanges where everyone from a doctor's group (Drs have to be exempted from the current anti trust restrictions so that they can compete with HMOs to offer patient's insurance directly) to private health insurance companies can offer the public insurance. Maybe some sort of reverse auction software could be involved where insurers compete for your business. This insurance is essentially to cover well patient care and short stay hospitalization and procedures with a maximum cap (maybe $20K). Mandatory coverage for all and only individuals and families can buy, no business provided insurance any longer. If a business wants to provide their employees with insurance they can give them a voucher and the employee can use it when they choose their insurer on the exchange. Premiums would be very low with this model, maybe 10-15% of what they are today for health insurance and people currently paying premiums Medicaid and medicare patients would also have to participate under a voucher system.

5. A portion of everyone's premium would go toward paying in to a national catastrophic and chronic care pool that would take up payment of expenses where the above policy ends (at the 20K limit). Each such case would have a medical manager review care once every 6 months to insure that it was a) working toward an improvement in patient's health with the patient also having to make an effort to improve health such as losing weight, reducing smoking though with good support programs available etc with financial penalties for lack of progress (or put another way bearing more of the cost of their own care due to their current choices), b) most efficient and least expensive treatment for chronic condition, c) rationing care where further care would not result in significant benefit according to impartial medical tribunal (patients PCP and case worker who does the 6 month review would have to advocate for the additional aggressive/experimental treatment).

The cost savings in the system would come from allowing real competition for patients to occur with max liability for any insurer from a doc's group to a traditional HMO having a max liability of $20K per patient. Patient's would be able to switch coverage every year so if customer service was not good they would be able to vote with their feet. Patient satisfaction and wellness metrics would be published annually for each insurer so you would see them on the health insurance exchange.

Now health care providers can focus on care instead of defensive medicine and paperwork. They have a financial incentive to keep a patient well and off medication as much as possible, no unnecessary tests and procedures as they eat in to the bottom line and do it all with good customer service. In this system whoever takes on the liability of the patient's care has a direct financial incentive to provide that care as bet as they can but for as little as possible. By shattering the current monopsony of the big health insurance cartels costs will fall dramatically especially when huge barriers to entry for the small groups are removed like the malpractice insurance and the paperwork nightmare that only large groups can either purchase affordably or cover the administrative overhead.

Patient freedom to choose is maintained and now the choice is real as it is an apples to apples choice as each insurer has to offer the exact same benefits up to the cap. Patients get their card when they sign up and just show it to registration when they show up for their appointment, no co pay. If doctor's group is the insurer then other than billing the patient for the monthly premium no bills to submit, no administrative headaches. More time to spend with patient and incentive to do so to keep patient happy, incentive to keep patient well, advocating for patient with specialists., prescribing cheapest drugs. Only the most efficient and quality of care conscious insurers/providers would survive such a health care model. the benefits would be enormous in terms of having a healthier nation, cost of health care as a % of GDP would fall at least a couple of %, and would be a boon for corporate America's competitiveness as the health care monkey would finally be off their back. The true stakeholders, namely the patient and the providers, would finally be calling the shots and have major skin in the game.

 

[aceofbase]

ban malpractice lawsuits. doctors can't even afford malpractice insurance. the insurance cost is pass to clients.

insurance is waste of money and most of insurance cost is from insurance fraud.

car insurance is a rip off too ...so much insurancd fraud. getting into a n accident at no fault is like winning a jackpot...so many people getting $30,000 payment for minor crashes. scratch.

malpractice and motor vehicle lawsuits is where lawyers make the most money from. a lawyer can get as much mony from plaintiff as she/he agree on like 50% and no payment until claim paid. A lawyer only needs 5 cases claims of $500,000 and he/she can make a good living . Easiest cases as insurane companies sell fear just pay rather than cost of legitigate and insurance companies always lose in these cases.

Quote from Eliot Hosewater:

I see a lot of well deserved criticism of Obama's plan(s), but not a lot of constructive alternatives. Almost everyone agrees that the current system is broken and unsustainable, with insurance costs rising so fast, deductibles increasing, etc.

What would you offer as a solution?

I think allowing states to implement single-payer plans, and/or promoting health care cooperatives might help. There was a doctor in NYC in the news a few months ago who wanted to offer a direct payment plan for his patients, for something like $100 per month he said he could treat most people for most problems. I believe the state health insurance-oriented laws put a stop to that. The health insurance companies couldn't stand the competition. Also, I heard about a coop in the northeast that has been in operation for decades and offers care at a reasonable cost. Why are there not more of those?

 

[obama-lama]

Quote from TraderZones:

The concept it will save 10s of billions has been debunked. I have seen this in several different sources. Do some homework, before parroting something you read.

Something I've read?!
You are a fucking idiot.

I won't give you the honor of a link to ANYTHING I consider worthwhile on this topic, but you can start a search of topic relevant, current news here
http://news.google.com/news?hl=en&q=health billing fraud&um=1&ie=UTF-8&sa=N&tab=wn
you stupid bird-brained person.