ABC News is running a special on health care this week and they asked two bloggers to stick in our 2c. I’m up asking Why Is Fixing American Health Care So Difficult? David Williams from The Health Business Blog pens an article about IT and transparency that is slightly more optimistic.
Feel free to come back here and comment.
Almost all the problems with the American
health care system boil down to two questions. How do we create a
system that ensures that all citizens, and perhaps residents, have
access to health insurance? And how do we contain the huge cost
increases?Of course, behind these questions lies the question of how to reform
the nation’s largest industry that serves and richly rewards many
powerful interests. Continue.
Categories: Uncategorized
Everything in healthcare is changing almost daily. very few people knows what is happening behind the scene.
The best bet is to go to uncle sam & use his websites. I am sure that it would give us the most authentic info.
here is one to start with – https://www.healthcare.gov
Check it out before anything else. I think all the content stems from this one.
Marie
Another good resource for uptodate health insurance info is http://www.qqbenefits.com. I highly recommend it and then speak with your health insurance adviser.
Mark
Hello,
My name is Jake Waring and I am an acting student and Central School of Speech and Drama in London, England.
We are devising a piece of theatre based on the American Healthcare System.
I am researching this and would like to hear real people’s stories and experiences about the system. No matter how insignificant things may seem, everything is very valuable to my research, as actual human encounters give me a better view than simply reading facts and figures on the internet.
It would be greatly appreciated if you could email me even the smallest details or stories you have, whether it be good or bad experiences with hospitals, insurance companies etc.
I am also looking to get actual interviews over the phone/Skype so if you feel you have more you would like to tell me or just to have a chat that would be amazing.
My email address is jake.waring@cssd.ac.uk
Facebook: Jake Bare Tiffin Waring
Skype: jake waring
Thank you for your time,
Jake
Here’s a company doing something constructive about the healthcare crisis. They offer what is called medical tourism. It’s overseas surgery at about 1/5th the cost.
Terrific blog — thanks very much for it!
I am troubled by some of the word choices, though, especially since I see them so often in discussions such as these. You write: “How do we create a system that ensures that all citizens… have access to health insurance?” This wording conflates the insurance with the health care. It isn’t the insurance we need, it’s the health care. So the question ought to be: “How do we create a system that ensures that all citizens have health care?”
Let’s not build-in the assumption that these expensive middlemen are necessarily part of the package… They’re not!
Thanks again for a great blog.
— Dan Keller
You know I just watched a video of what the right wing idiots are doing and saying about kids and there health care. Ya know its sad when a single man who doesnt make enough to afford health care cant even get Medicaid but when they start attacking kids thats absolutely freakin rediculous. They wanna send death threats to these children and there families? Who in there right mind couldnt threaten a child? That is just plain sick. If they wanna start threatening people let them threaten someone who doesnt give a rats a** about what they think. They have already screwed up our lives enough the worst they can do is throw us in jail. They have already made our lives miserable and allowed us to have a astronomical medical debt. Which when looked at by companies that do credit check to see if your worth the money to give a real job to doesnt look all that well so we are left to working for someone who doesnt pay worth a damn and has no medical benefits. You say your all for your country but I say no your all for as much money and as much pain as you can cause the little guy just for your pure enjoyment. People wonder why Americans are starting to leave this great country and move else where. Well when you have a government that cant get its head out of its own butt long enough to see we need to to quit worrying about whats goin on with our neighbors and worry about our own people first it stands to reason why they leave. We need to get a government in office that is gonna care about us and not just what is going to line there own pockets. They dont understand that what they are slowly starting is going to end up as a war on our own soil and it will be there own fault.
I recently left a job and got the COBRA letter from my employer. I was in a state of shock so I started doing some research.
If you have ever left a job where you had group health insurance, you probably have been asked if you want to continue your COBRA benefits. A common reaction in this situation is to take a look at the price of the plan, and balk because it is so expensive. Many people seek out individual and short term health insurance quotes but end up wasting a lot of time online looking around for affordable health insurance to fit their needs.
Before you look for health insurance quotes, take a look at this resource about COBRA and COBRA alternatives. It can help you understand if you should continue your COBRA benefits. It details in what situations it might be a good idea to consider keeping your COBRA coverage.
If you’ve been chronically ill, or you take expensive medications, a COBRA alternative may not be right for you. You might be very happy with your benefits and want to keep them. Or you may have been declined for insurance recently. All of these factors might make you decide to keep your COBRA coverage.
Why is fixing American HealthCare so difficult? Perhaps becasue the powers that be are composed of Pharmaceutical Company interest, like the FDA, the AMA and all our paid off politicians who are asleep or controlled at the wheel. Pharmaceitucal Industry’s political control is far sweeping as in an intigral part of the WTO and those who would have a NWO.
Harmonization – a political philosophy coming to a government near you soon! That will regulate your healthcare options especially in your choices in Dietary Supplements. The pharmaceutical industry wants full control of dietary supplements. Soon you will be seeing telivision advertisements for a wide variety of supplements produced by pharmaceutical industry as they work to put small manufactures out of business and to require supplements to have a prescription from a medical doctor, their controlled and paid drug pushers.
weblink:www.stopthenorthamericanunion.com/videos/EuropeanUnion.html weblink:www.youtube.com/watch?v=3tg8suvwS3o&mode=related&search=
Although the above video is about the European Union I strongly recommend that you watch it and when you are done click on “About the NAU” in the left hand column. This website and video was recently brought to my attention. It draws together a number of historical incidents and puts it into a very distrubing light. I am not saying that everything here is absolutely correct but it certainly is food for thought.
The biggest question is – Is the United States going by way that England did? Is our fate to loose jurisdiction of our nation and our own back yard. Will we too loose civil liberties under Codex Harmonization and International rule through the WTO? This information will tell you exactly why our supplements are in jeopardy, what it has to do with NAFTA and CAFTA and the WTO.
I’m not going to get into bickering about the specific issues on this forum. I’m just posting it because I think in large part much of it is true. Do your own edification, make your own judgements. And when you see the reality coming down the pike perhaps you will remember that you were warned of things to come.
Do I think that there is anything we can do to stop it? I don’t know. I do think that our next election will be of paramount importance. And no I’m not for Hillary. We must seek out a strong Constitutionalist that will stand up against legistation that will suck us into the NWO through international trade agreements or that intends to dissolve international borders.
weblink:www.stopthenorthamericanunion.com/TreasonAbounds.html
Jim… here is your statement:
“The problem is that the cost of health care is so high that we cannot afford it on a “pay as you go” basis – like we do with every other basic human need (food, housing, clothing, transportation, etc.)”
If designer jeans cost over $100, 6 CD’s cost over $100, if an auto repair bill runs over $200, a vet bill for FiFi runs over $150, Dinner for 4 runs over $100, one ticket to a major league sporting event w/parking & snacks cost over $100, 2 concert tickets cost over $150, a DVD player costs over $100, one months rent costs over $600….
When a physician gets paid $50 (including your copay)from your health insurance company or Medicare, for an office visit – which must be split to pay for the building, utililities, staff salaries & benefits, medications and supplies, phones & computers w/electronic medical records, malpractice and other insurance, taxes, loan payments, equipment lease payments…
AND a person goes only once or twice a year… Even at List Price, that’s only $200 a year. How much do you spend on CD’s? The movies? Your social life? Snacks?
What about healthcare is unaffordable? You can’t stand the doctor getting paid between $4 and $8 a visit???
Not to mention, the doctor having to work 6-7 days a week and pull Call Duty.
It’s probably less than YOU make on a per hour basis – and significantly more work.
“Profit” is what a doctor calls his paycheck, to feed his family. Oh… maybe we aren’t supposed to have one of those either.
Why keep trying to come up with a rational model healthcare model supporting irrational values?
Attempting to defeat nature’s design and intentions through massive $100,000 healthcare subsidies at the end of life stage is ultimately futile & a waste of money.
Spending the same $ 100,000 investing in our society, including the future of young children and young adults will generate far greater rewards to a vibrant society.
Assuming the “education” of a largly uninformed and illiterate public that prefers watching the Jerry Springer Show and Maury Povich’s “Who’s my Daddy?” expose’s rather than critical reading and debate is an exercise in wishful thinking.
“things may have to get worse before the public demands to be educated and heard, especially since the general public is unaware how bad things are.” Perhaps because, in general, for most people – things are pretty good – especially their health care.
What people are worried about, and businesses are worried about is the cost of their health insurance-not the cost of healthcare.
These are TWO DIFFERENT ISSUES. Offer affordable Major Medical policies with Chronic Condition Coverage and specific disease riders (based upon family history) and discard the bloated, overly expensive, “We Cover Everything, kind of, sort of, with pre approval, minus certain conditions” that is being sold today
– and the problem is solved. The golden question:
WHAT IS AFFORDABLE HEALTH INSURANCE?
Bankruptcy has been the only recourse of a fair number of people without health insurance and having a major hospital stay or dealing with a chronic health condition, such as renal failure.
The goal should be $200 a month insurance per person policy. The pricing should encourage LONG TERM HOLDING, like 20 year term insurance or a 30 year mortgage to make it viable to the health insurance industry. Why?
Flipping policies every year or two makes health insurance a game of roulette. Get the money now and pass the cost to someone else tomorrow. Long term commitments makes each client more valuable and lest risky. Like term insurance, the cost will increase over time – because as we age, we need more health services, and the type of care we need gets more expensive.
What will should it buy? Make the health insurance battle over the quality of their service and product offerings. Define a minimum and let the insurance industry, to differentiate and sell their product, add their own extras and incentives to make a better product.
Keep it simple people and it will work. It will be understandable. Identify AFFORDABLE and don’t confuse the effort with one size fits all vision of EQUALITY to force some realignment of society to conform to some utopian ideal…
It doesn’t work.
People need different coverage options, because we each have our own biochemical & genetic makeup, and our own personal health practices – which will affect the policy that we purchase for ourselves and our families.
Just as importantly, just because the solution is in place, don’t assume that people will voluntarily spend their money on affordable health insurance. Car insurance is already MANDATORY – and ignored on a large scale. That’s why You & I have Uninsured Motorist Coverage. There has to be a better enforcement mechanism. (While you are at it – solve the motorist w/no insurance problem too!!!)
The Problem is simply the high cost of health insurance. The rest of the health care industry will adjust accordingly to the new reality.
Pick a base amount and allow the flexibility of options. Mandate the availability of the coverage by all insurance companies in all 50 states and DC. Each state needs to be involved to tailor the policy costs to tailer them to their Cost of Living situation – a New York policy will cost more than a South Dakota policy, because the cost of living in NY is higher than SD.
Remember that insurance is designed to protect against catastrophic loss – NOT expected and usual expenses.
The example is the auto industry – insurance pays if the vehicle is stolen or damaged by a storm or auto accident. It does not pay for maintenance repairs, new tires, or your subscription to satellite radio. IT keeps Auto premiums LOW.
Costs go down dramatically when the probability of expense (loss to insurance company) goes down. Period.
Give people a GOOD alternative and they will support it.
Per Tony:
“If we choose to live in a society then we are by definition a part of that society. If we are part of that society and we are free and equal, then we are equally responsible for everything that happens in that society. No society is perfect so we can expect some members to be disenfranchised.
Do we have a responsibility to these individuals? If we are part of that society and reaping its advantages, of course we do. ”
A corresponding thought which we NEVER hear from the Universal Healthcare advocates – and those of the Leftist Persuasion – but is absolutely vital to the success of any society…
=== What is the responsibility of ALL members to contribute to the benefit of society ????
Why are portions of our society consistantly and falsely portrayed as victims with no accountability for their prior actions and corresponding circumstances – and therefore no responsibility to make a positive social and/or financial contribution to the success of that society??? E.g. we hear of RIGHTS, but no corresponding RESPONSIBILITIES. The responsibilities always seem to belong to someone else. The sacrifice must be made by someone else. WHY?
If there is to be a discussion of free and equal, then that discussion must include equal, personal responsibility.
Interestingly enough, in this anniversary of the Jamestown landing, the Jamestown colony was origionally established as a holding in common, where everyone received an equal share of the bounty.
Jamestown’s colonists were starving, susceptible to disease, and vulnerable to attacks from native american tribes.
To save the colony, the holding in common economic model was changed – due to the lazy, indolent, and slothful behavior of others, not planting and producing enough food or their FAIR SHARE of the work. To force ALL colonists to contribute, colonists were given individual plots of land to tend. Put another way, some worked and contributed to the survival of Jamestown. Others wanted a free ride – a parasitic relationship to society.
By changing the rules, and enforcing all members of society to produce and protect the interest of society, Jamestown survived.
The same could be said for healthcare and many of the ills bedeviling our society today.
The Victimized, Excuse Society has to come to an end.
To quote an American icon, Robert F. Kennedy, “Ask not what your country can do for you, but what YOU can do for your country”.
I have just finished reading the excellent article by Matt, and the extensive comments.
I would offer some reflections:
As a retired Family Practice Physician I can attest to the statement that 1/3rd to 2/3rds of all medical care is unecessary or without benefit.
I spent the last 10 years working in an Urgent Care clinic. Mamy patients presented with self limited problems, such as viral respiratory infections, etc.
Competition among insurance companies makes them offer great benefits in order to attract patients and generate large amounts of revenue. It is too easy for a patient to go to an Urgent Care clinic and pay $5.00 rather than explore options to self treat or make them aware of what point in the llness requires an evaluation by a physician. Even then, they may not accept that their illness is self limited, can be treated with simple solutions, but will often demand an antibiotic pill or injection to “nip the problem in the bud”.
Part of the solution to improving health care in this country involves much improved patient education. I am not sure how to best accomplish this, but this must be part of the answer to this complex problem.
The article by Matt talks about involving patients in the process of improving patient care. When I was in training, one topic discussed frequently was “how does a patient select a personal physician”?
Patients generally select a physician based on the 3As. The first A stands for availability. How easy is it for the patient to be seen quickly by the physician, the most important factor. A number 2 is affability. How do I and the physician get along. Is he pleasant, kind, caring, attentive to me or distant, disinterested, rude, etc. The factor of least importance is Ability. Patients most often do not have access to information that allows them to judge the ability of a physician. I realize this is a simplification, and that the internet now allows access to information regarding success rates of surgery, rate of infection in hospitals, etc. But most patients don’t want to spend the time exploring the info, they just want ready, easy access to a physician of their choice. This is becoming harder and harder to find. Many patients are going to the system of finding a physician, paying a fixed amount of money per month and having that physician be available to them 24 hours a day. Physicians are also finding this a less stressful way of practicing, with the headaches of dealing with any insurance paperwork. I don’t think this is the answer to our health care crisis, but it is one approach.
It does not matter what type of plan we come up with, there are some simple facts. 80% of the health care dollars are spent on 20% of the patients. Poor, elderly, those at high risk because of their lifestyle, i.e., obese, smokers, alcohol and drug abuse, etc. This will never change. Is their a way to work this into the equation? I do not have the answer. So do we accept a socialistic appoach and say that the have’s must take care of the have nots?
Let us talk about single payer healthcare. We already have an example of that system in the multiple HMO’s and medicare advantage plans created by our government. These plans, as they relate to Medicare patients, function in this manner. They hire recruiters during the open enrollment period of Oct to Dec. These recruiters flood the nursing homes, retirement homes, senior centers and sponser seminars to explain their plans and to try to recuit as many new subscribers or converts from other plans as they can. Each new subscriber results in the medicare withholding of $98.50, plus an amount up to 5 or 6 hundred dollars from the government for each patient.
These plans are often over-loaded with patients to the point of long waits for appointments, or more commonly, long waits for tests or procedures such as hip replacement, cataract surgery, diagnostic testing such as ultrasounds or CT scans or MRIs. There may be withholding of procedures such as colon cancer screening. There may be lack of time in the busy schedule of the physician to adequately explain the risk and benefit of certain procedures. The elderly patient with hearing or mental problems may not truly receive “Informed Consent” regarding the need to do a procedure.
These HMO’s receive large amounts of money. If there is a surplus left over at the end of the year, there may be some sort of “bonus” paid to phsicians. In some cases this may give them an incentive to withhold care or testing.
A single payer system could result in most people, not our Congressmen and Senators of course, into this type of HMO. Limited resources could result in withholding of care from many people.
Asking patients to decide what constitutes a good system does not make sense. There are many experts out there who could address the problems, once they are defined. This in itself is a huge problem. Deciding how to correct the system is also a hard decision. We could throw money at the problem, and eventually we would be in the same boat as social security. Not enough people paying into the system to suppost those who are taking money out of the system.
If you drop a piece of fine china and it shatters into a million pieces you don’t run for the glue to get your piece of china back. American health care is that broke.(no pun intended)
We need to start over. Our premises have been wrong from the beginning. The concept “Lets base our system on the free market economy” is easily the worst possible methodology for a health care system.
Under this concept, we charge people who want to be healers a fortune to learn the craft, whether it is a community or private educational center. Yes teaching Medicine is expensive but future healers should not bear these costs.
Of course if it has cost a fortune to get your education you may feel that legitimizes you charging a “fortune” for your services. The snobbery that comes from the idea that “I paid a lot for my education” also seems to
support the idea that I can charge more (Lawyers are another example, by the way) Of course, your community may not be willing to pay you what you think you deserve so you will choose to provide less than excellent care and make it up in “volume” “I will lower my charges and just see more patients” Rarely, it appears, is the option to make less money. (I see absolutely no physicians driving an average car and living in an apartment despite their “high calling”). However I hear many, if not most, physicians espouse how their goals are altruistic and and their thoughts pure.
Our society has never said lets provide an inexpensive education to healers and insist they take care of our people at a reasonable price. Why? because somehow another we have decided that limits freedom. Whose freedom? Certainly not the healer’s freedom but definitely the freedom of everyone else. Shouldn’t good health should be everyones right?. (One of those unalienable rights, I think, that our leaders espouse?)
Of course physicians are not the only problem.
We decided from the beginning of our history that health care is a business. If you have a health care problem you have to pay to get it fixed. (Even if the problem is related to your communities poor ability to solve its other problems: bad air. bad water, poor working conditions, accidents etc).
So, the physical ills living in this society place on us are not the societies responsibility as a whole but only our personal responsibility (because we are so free?)
Maybe the largest problem we have is HEALTHY people. It appears that healthy people don’t want to pay in anyway for health care for unhealthy people in this society. The elderly and the poor are frequently the most unhealthy and it seems healthy people feel they have no responsibility in this society for providing any part of the unhealthy’s HEALTH care. Even if these people are in their employ, are members of their socieity, relatives, victims of disasters or whatever.
“They are not my responsibility they are someone else’s.
If the premise is that healthy people think this, then obviously only the unhealthy are responsible for the unhealthy.
Of course many of the healthy are the wealthy or it least, “unpoor”. Most of the “unpoor” (the wealthy included) are involved in disenfranchisement of the poor.
Whether you pay an “illegal” to mow your yard because he works cheap, or you employ skilled labor but pay them inadequately because you can, you are disenfranchising people who then have a greater chance of becoming unhealthy without any ability to pay for their health care.
Its hard to imagine that disenfranchising such people gives you permission not to take some responsibility for their health care.
If we choose to live in a society then we are by definition a part of that society. If we are part of that society and we are free and equal, then we are equally responsible for everything that happens in that society. No society is perfect so we can expect some members to be disenfranchised.
Do we have a responsibility to these individuals? If we are part of that society and reaping its advantages, of course we do.
Where am I going? If this society is responsible for all of is members then our health care system has to provide for all. If we make that premise then we need to start over, and create health care for everyone.
Let’s level the playing field from the top to the bottom.
Physicians get cheap excellent education and are required to see limited number of patients and charge reasonable rates. Profits from developing medical equipment, new drugs, advanced procedures are all limited, (not great for our great free economy but great for our people) If big business is frustrated with their limited profits,they should develop MORE medical advances. Instead of a lot of profit for a few ideas how bout a little profit for each of a LOT of ideas. (Yes this is backward, but reasonable thinking) I am assuming all stock holders have all ready have health insurance.
Hospitals are required to treat everyone and charge exactly the same rates to everyone for every service despite their financial status, insurance or no insurance, wealthy or poor.
Who they charge might be up for grabs. Charge the government, the insurance company the employer the patient but NEVER anyone who has no ability to pay.
Of course this WILL NEVER HAPPEN, but what will probably happen if this is explored is a dialog that may result in a national health insurance program. Would that work? You betcha, but only if everyone in the society exercises their responsibilities as a member of a society to take care of all its members. Martha stated above that health care in Canada is a political scam. I do not know. What I do know is that if it is, it is because of special interests or lack of interest not because it will not work. Society has always solved every problem it ever completely invested in. Polio, Small Pox TB are slowly disappearing. Slavery is an anathema, Women’s suffrage is evaporating in the free world. We have created technological advances that have changed the entire world. All of these things have required great ambition, energy and most of all, dedication.
Health care for everyone is entirely possible but everyone has to want it and take the responsibility as a member of society to assure it. As soon as this society will elect leaders and support a move in this direction it will appear. We may spend decades refining it but as long as we put the needs of society before our own selfish needs it will work. Only then are we truly free and equal.
I know many comments in this blog are more realistic and are related to improving the existing system. Forget it
We need a clean slate, fresh chalk, and a desire to rise above ourselves and create a new paradigm.
T
FIRST OF ALL, TO THE PERSON WHO STILL HAS THEIR CANADIAN CITIZENSHIP – YOU CAN’T LEGALLY USE THE SYSTEM IN CANADA UNLESS YOU MOVE BACK HERE AND ARE A RESIDENT
– SO IF YOU COME TO CANADA FOR HEALTH CARE YOU’RE NO BETTER THAN ILLEGAL ALIENS GOING TO THE USA FOR HEALTH CARE.
SECOND, THE HEALTH CARE SYSTEM IN CANADA IS SO BAD IT’S BEYOND REPAIR. THEY DENY CARE HERE BUT DO IT BY NOT HAVING ENOUGH DOCTORS, THEN IF YOU GO TO AN ER OR URGENT CARE THEY BERATE YOU FOR NOT HAVING A DOCTOR. I KNOW HOW BAD IT IS BECAUSE I’M A REGISTERED NURSE IN ONTARIO. WORKED IN CALIFORNIA FOR 15 YEARS AND THE U.S. SYSTEM IS VASTLY SUPERIOR. ONTARIO IS AT LEAST 10 TO 15 YEARS BEHIND THE U.S. IN EVERYTHING. ALSO, I HAVE TO PAY INTO THE SYSTEM BECAUSE OF MY INCOME, WHEREAS OTHERS WHO USE THE SYSTEM ALL THE TIME (I STAY AWAY FROM IT) DON’T HAVE TO PAY BECAUSE THEY DON’T MAKE “ENOUGH” MONEY. I’D RATHER HAVE A MEDICAL SAVINGS ACCOUNT THAN THIS CRAP. ALSO, I FIND IT AMAZING HOW MANY PEOPLE WHO CAN’T AND WON’T PAY FOR ANY PART OF THEIR HEALTH CARE BUT WILL BRAG ABOUT OWNING A HUNDRED PAIRS OF SHOES, OR NEVER MISS GOING ON A CARIBBEAN VACATION EVERY YEAR – IT’S ABOUT PRIORITIES. IF PEOPLE THINK SPENDING MONEY ON LUXURIES IS A PRIORITY, THEN SO BE IT. IF I DECIDE I WANT TO SPEND MONEY ON HEALTH CARE I DON’T HAVE THAT CHOICE IN CANADA. STAY AWAY FROM SOCIALIZED MEDICINE, IT’S A POLITICAL SCAM.
The problem is not the lack of or cost of health insurance. The problem is that the cost of health care is so high that we cannot afford it on a “pay as you go” basis – like we do with every other basic human need (food, housing, clothing, transportation, etc.) First and foremost, we have to decide health care is a basic “right” for our citizens and to what level of quality that right extends. If we decide that health care is a basic right, like a public education, then all bets are off with respect to our current system of delivering health care. You cannot have a workable system of government subsidizing or sponsoring health care without a balanced regulation of the health care industry. That means, regulating (limiting) physicians fees, drug costs, etc. and eliminating profit from the system.
If we truly wish to make health care available and affordable then perhaps the government should get into the health care business directly – just as it address the national defense, law enforcement, and most other governmental services. Establish a national health service, with medical clinics, hospitals, etc. in every community where we have a post office. Pay the costs of medical education, physician training, etc. in exchange for 5 years service in the National Health Service (such as we do for Military officers in ROTC). A national health service would provide competition to the health care industry, as well. In most communities there is little, if any, choice in hospitals or specialized health services. The health care consumer cannot “shop” for even the most basic health care needs. This alone drives the high costs inherent in our current system of high demand, low supply.
If we are determined to use the taxpayers money in an effort to provide quality health care to all Americans, then lets go all the way…a basic level of care, paid for by our tax dollars, free to every citizen – just as we get our police & fire protection, national defense, etc. Those who want more or better quality health care than the system provides can pay for it themselves.
I must be nuts. This blog starts with the notion that we must decide or answer “How do we create a system that ensures that all citizens, and perhaps residents, have access to health insurance? And how do we contain the huge cost increases?”
Says who? Believe it or not, I don’t want any individual or collective “you” deciding how I gain access to either insurance or health care. And, I have no desire to accept individual or collective responsibility for how anyone else accesses either insurance or healthcare. It seems to me the first questions ought to be whether freedom or control should be presumed.
If you take just a glance at the U.S. system, you notice that the feds control:
1) nearly every step in the process of becoming a doctor or pharmacist;
2) nearly every step in the process of obtaining insurance, whether through your employer or even purchasing it individually;
3) nearly every step in the pharmaceutical delivery process; and,
4) through the silly income tax system, the feds disguise and distort the consequences of many healthcare choices made either individually or by one’s employer.
Clearly, there’s not been a “free market” in the healthcare system for a long time, at least not in the U.S. Am I to blithely presume then that there must be some good reason to let politicians control it all?
Can anyone tell me three things politicians, especially at the federal level do well?
I see nothing that suggests coerced collective solutions to this (or any) problem work better than solutions reached by individuals left free to decide where, when and how much property ($$) they want to exchange for someone else’s services (Drs.) or products (drugs).
The “starting point” set out above burdens me to prove I’m entitled to my individual freedoms, when those of you who want to rob me of my freedom should have the burden of proof.
I’ll ask again – what evidence suggests that the politicians in D.C. are wise enough to control any aspect of the healthcare system? And, for those of you who say “but look at Canada” or any other collective system, I ask you to tell me how many pharmaceuticals have been developed in Canada?
Mr Lohman says that meds “should be developed by the NIH. Breathtaking idea. Please, tell me what prevents the NIH from doing just that? And, what/who allows those “detestable” pharmaceuticals” to make those “rip offs?” Duh, the very same politicians you expect to save you?
It seems to me that if you would enslave me, YOU (individually and collectively) should first have the burden of proving a principled reason, and that I shouldn’t be burdened with proving that I am entitled to my freedoms. Again, if I’m not free to chose when, where and how much of my own property I’m willing to exchange with someone else for their property or services, then I am little more than a slave, as my freedoms then depend solely on someone/something else telling just how much or little freedom I am to have. What a sorry notion. And for so little in return.
On top of it we are allowing the pharmaceutical industry to contibue its massive rip-off of the public. Meds should be developed by the NIH and licensed out to multiple manufacturers. THAT would be a true free market! But follow the money. It will never happen.
We are victims of our own free market economy. Standards of care are being driven though the marketing relationships of biomedical companies and providers. Hospitals and physicians do not sit in strategic planning meetings and discuss a vision of healing all who are directed to the facility. Like most businesses, they focus on how to achieve a profit, which in all other industry sectors is important. Therefore, the discussion in the meeting is how to differentiate the enterprise from its competitors in order to grow market share. This is primarily achieved through offering the most cutting edge arsenal of medical services. The downside is that these services are always more expensive to the consumer and the medical outcomes and benefits may not be any better. Patient convenience seems to be the primary measure, not cure. That fact of the matter is we need to establish a national benefit plan which spells out the benfits that will be paid, period.
FYI – I summarized this conversation on another blog focused on finding ways to get the public involved in transforming our healthcare system at the grass-roots level and, at the same time, helping the elderly, handicapped, infirmed, and their families and care-givers deal with daunting challenges imposed by the complex, fractured system we have today. The conversation evolved into an exploration of patient advocacy.
Anyone interested in getting involved with us at the ground-level as we discuss, openly and honestly, how to accomplish these goals through creation and activities of a community-based not-for-profit organization.
Please join us here.
America’s healthcare system operates in definace of fundamental good business practices and basic economics, not to mention common sense.
The antiquated and broken system can never be fixed without efficiency, for starters. Infomatics administrators and physicians are at loggerheads. IT systems can’t be implemented unless there are universal standards. We don’t even have universal billing codes, much less diagnosis, treatments, anything. No resources go into prevention or efficiency, it’s all going into research and education.
It’s a problem with a solution, but there are too many that profit from the current status quo. Until the consumers in America finally demand improvements, they’re not going to come. It’s going to take a consumer uprising.
We are not going to have a universal “medicare for all” system here in the United States, at least not in my lifetime.
The root cause of the REAL problem is slowly being fixed, and all the while the “experts” are predicting… forecasting… even giving into… socialized medicine.
I don’t see it happening. Everyone needs to wake up, see the problem for what it is, and take charge.
As I sit typing this, the lsrgest carrier in the U.S. is on the hook for anti-trust, price fixing, collusion, and restraint of trade. They’ve been caught redhanded and are going to go down, along with all the brokers who followed suit. The carriers and large brokers have all bilked the consumers out of trillions of dollars collectively, and it’s going to stop. It has to stop. It will stop. Well informed consumers understand this, and are looking at all their options, many of which they have been told aren’t really available to them, which is criminal.
The only crisis is that people have been ripped off for so long, they are just accustomed to it. Now, everyone is starting to reach a point where “business as usual” just isn’t an affordable option, much less a wise business decision.
I agree 100% with “simple,” and the simplest is Medicare-for-all. But even Medicare needs some fine-tuning to eliminate waste.
We are going to have a universal system in 10 years. The only thing standing in the way are the moneyed interests trying to make it 20 years. But they surely must see the handwriting on the wall, but whatever delay they can inject adds to their bottom line.
R.Oakley – Are you saying (as I paraphrase you post) that (a) key to solving our healthcare problems are clinical models fostering patients and their providers to promote wellness (keep well and make well safely, effectively, and efficiently) and (b) our economic models, which focus on how the care is paid and profits accrued, are a big part of the problem because they interfere with the promotion of wellness?
I must drop in my $.02.
1) Patients see healthcare as something to be “delivered.” They’ve been taught to expect this by…
2) An insurance industry looking for efficiencies and cost-cutting beyond muscle and deep into bone, taking a page out of MacDonald’s book by treating healthcare as a fungible “product,” while
3) Free-marketers insist that the problem is with patients who refuse to take “personal responsibility” for their health – as though their children never fall off a bicycle
I sensed a spindly thread in somewhere in here that says we go back to the basics. Patient. Doctor.
Now we add on: Outside testing facilities. Hospital for accute care.
Ok. How much would this cost?
How much of our problem is an industry bent on taking premiums and investing them to keep a company’s books looking fat and happy and not actually producing the “product” we’re expecting? How much of this is just a perverse form of speculative banking?
I know this is simplistic, but I’m an IT guy. I like simple. Simple doesn’t break. Simple may not be the flashiest, but it is unbeatable at producing the core result: Broken people who get fixed. Non-broken people who stay that way. The end.
“If the Congressional Budget Office can be set up as a totally nonpartisan agency, why can’t we establish one for health care.”
And the answer?
“Elect Democrats”
Goodbye, Jack.
Elect Democrats, because it is a 100% political issue and the Republicans are in the pocket of the health care industry (and I say that as a lifelong Republican that voted for Bush twice).
“If the Congressional Budget Office can be set up as a totally nonpartisan agency, why can’t we establish one for health care.”
Good question! How would you answer it?
If the Congressional Budget Office can be set up as a totally nonpartisan agency, why can’t we establish one for health care. Actually, I’d like all of them set up that way, or follow the model of the federal reserve board where members serve 10 year terms.
I believe most people would accept control by governmental agencies – or at least a coordinating role — if trustworthy, non-partisan watchdog groups monitor their activities.
As far as innovation goes, having putting every healthcare invention in the public domain will probably stifle creativity in a capitalistic economy. An alternative is to “share” intellectual property through licensing or building it into products for sale. This isn’t free sharing, of course, but it does get the innovation into the hands of anyone willing to pay for it, pays for the inventers’ work and investments, and encourages more innovations.
“Do you believe our government has the ability and integrity to do this devoid of politically-influenced hidden agendas? Do you think our government would embrace and support valid, unbiased science that conflicts with the economic motives of powerful special interests?”
Oh, yeah, probably – as much as I trust any other federal health-related organizations such as CDC, or the public health service or Medicare or the National Center for Health Statistics Research (I think its name has changed – you know the organzation) etc. Anyway, the alternative is to have those very private-sector companies and interests you mention control the research. I think it’s a push. And universities are not exactly pristine either.
An important factor has to be the answer to this question: what happens to breakthroughs? In the private sector there will be innovations but they will not be shared. In the public sector innovations will be shared – provided there are any.
Pick yer poison.
“Wouldn’t it make more sense to designate one federal agency to collect and analyze national health care data and be responsible for policy recommendations based on the analyses?”
Hmmm. Healthcare researcher in many universities and other non-government institutions are funded by government grants. So, in a sense, some of that’s being done. Going one step further, and giving the Feds the responsibility for transforming the research results into evolving evidence-based guidelines that are disseminated nation-wide is an interesting possibility that could help promote better healthcare. Do you believe our government has the ability and integrity to do this devoid of politically-influenced hidden agendas? Do you think our government would embrace and support valid, unbiased science that conflicts with the economic motives of powerful special interests?
“We do need standardization, at least one area: A universal data set”
Wouldn’t it make more sense to designate one federal agency to collect and analyze national health care data and be responsible for policy recommendations based on the analyses? This would require that finally there be agreement on a uniform data set & that would be mostly for the good.
You make good points, Jack. If there weren’t already dozens of EHRs/EMRs being used in many places, if VistA has the flexibility to be transformed into something that addresses the needs of all practitioners (from PCP to surgeon to oncologist to chiropractor to psychotherapist to nutritionist to acupuncturist, etc.), and/or if having a mish-mash of different products made nation-wide data sharing (interoperability) too difficult, then I’d agree whole-heartedly. Even though this is not the care as I see it, I do agree with you about several things:
1. VistA ought to be seriously considered by any appropriate provider who lacks an EHR or who wants to switch to a different one.
2. We do need standardization, at least one area: A universal data set that includes every possible piece of data related to every possible: (a) diagnostic factor (including genetics, demographics, concomitant conditions, as well as biological, psychological, and mind-body symptoms); (b) treatment method/procedure/technique/process/guideline/protocol/regimen; (c) prevention/wellness strategy; (d) side-effect and complication; and (e) clinical and financial outcomes.
We’ve also addressed the need for a “universal translator” that takes any piece of data from any software system or any technical term in any message, which is being sent from a provider to other providers or patients, and translates that data so it can easily be stored in the recipients’ databases, or translates those terms so the message can be easily understood by the people receiving it.
Steve, VistA software is only an example I gave to demonstrate that it is already paid for by the public, is open source, and is an excellent starting point. It can be expanded to do all of the things it does not yet do, but I’d rather see that than 10 other parallel efforts and a mish-mash of efforts. This single-source doesn’t have to stifle innovation, like open-source Linux outside companies can still have input and make their money on support services.
Jack – VistA software is good, but as far as I know, all EHR systems have their own strengths and weaknesses. For example, does VistA accommodate the needs of all primary care physicians and specialists in independe