Healthcare Reform: what should be done

farm

Thu, May 25 2017, 3:42 pm

1. If healthcare is a business and not a moral requirement of a government to bestow on its people, it needs to be run in a way that it will be profitable. This means limits, exclusions, and deniability. Free market. Insurance company competition. Higher prices for older and or sicker people, etc.
2. If healthcare is a social program offered to all citizens and funded by the government (ie taxes), it will be a costly and long term money losing public service that will be difficult to sustain, like social security. But should be done nonetheless, for the public good.

Agree?

Amarante

Thu, May 25 2017, 3:45 pm

Greater regulation of drug prices. Government should be allowed to negotiate rates for drugs for Medicare and America id likectjry do for services and like the VA does. There is no reason US Prices should be so much higher than anyplace else.

By the way, this also includes the price of all kinds of medical stuff. The same hip replacement mechanism costs four times as much in the US as in Europe. That's the exact device sold by the same company.

There needs to be some way to help people so that they don't completely lose help with subsidies at certain income levels. Certainly the solution isn't to permit older people and people with pre existing conditions to be charged unaffordable premiums.

The issue really is the private insurance market versus those who get insurance through large corporations as you need a large pool for insurance to work. Seems to be simplest to have a single payer option or at least let people in the private market purchase the same insurance that Federal employees can buy in their state.

chaiz

Thu, May 25 2017, 4:54 pm

Fox wrote:

1. Tort reform

I feel like for some reason doctors are the only profession that need to be protected from accountability. You can go on and on about personal injury lawyers, but I think there is a certain level of arrogance allowed with doctors and that is what is driving up costs. Studies show that when doctors/hospitals apologize for their mistakes there is much less cost in terms of suits and settlements.

Amarante

Thu, May 25 2017, 4:59 pm

Fox wrote:

1. Tort reform
2. Allow insurance to be sold through organizations and non-profits
3. No minimum mandated services
4. Allow insurance to be sold across state lines
5. Create subsidized high-risk pools for those with pre-existing conditions

Insurance can be sold across state lines. However, insurance companies don't do it because it's logistically impossible to set up networks of health care providers.

High risk pools have almost universally been an utter disaster. They are underfunded and premiums are unaffordable. What is needed is to have a wide insurance pool with everyone into the pool. The funding in Trumpcare wouldn't cover the estimated cost of high risk pools.

No mandate services mean that insurance for women would once again become more costly than for men and coverage for pregnancy would become prohibitively expensive on the private market.

At one time insurance was sold through organizations and non profits as a sort of pool. All of these got out of the business because the premium became too high since the insurance was being purchased only by middle aged or older people. I know this because I bought insurance in the private market and eventually there were no organizations one could join to get a larger pool.

Amarante

Thu, May 25 2017, 5:08 pm

chaiz wrote:

I'm not sure what your point is all professionals carry malpractice insurance including doctors, architect, engineers. Other businesses carry all kinds of insurance as well. Insurance isn't being protected from accountability any more than having auto insurance protects you from accountability.

I do agree that studies show that a simple apology seems to be helpful.

SixOfWands

Thu, May 25 2017, 5:25 pm

Fox wrote:

3. No minimum mandated services

I'm just going to pick on this one while waiting for a call.

Its nice in theory. People can buy what services they choose.

But that leaves us with the question of what we do if they choose wrong.

Susie is a single 30 year old woman whose employer does not provide health insurance. She is generally healthy. So Susie does her risk analysis, and doesn't buy insurance, or buys a minimal policy.

Oops. Susie (who is not an Orthodox Jew) gets pregnant. Its high risk, requiring a lot of intervention that isn't covered, and she cannot afford. Do we let the baby die?

Susie's baby is born, but with the same heart problem as Jimmy Kimmel's son. No insurance. Do we let the baby die?

Susie lives under a dark cloud. She just developed cancer. Its treatable, but the costs greatly exceed the limits of her insurance. Should we allow Susie to die?

That's the problem, IME. People want to allow for uninsured, and for minimal insurance. But no one wants to allow those who guess wrong to die. Its universal health care. Sort of. And freedom. Sort of. And none of it works.

More questions than answers from me, though.

SixOfWands

Thu, May 25 2017, 5:36 pm

Destroy the stranglehold that the AMA has on the medical profession.

About 18,500 people graduate from medical schools in the US each year. But we face a 90,000 doctor shortage by 2025. And its worse in some places than others. Sure, there are plenty of doctors in NYC (and for Fox, in Chicago). But not in rural America.

And the AMA likes keeping this shortage, to keep salaries high.

I want to see more doctors, and doctors encouraged to practice in under-served areas by conditioning financial grants to being in places with needs for 10 years after residency.

youngishbear

Thu, May 25 2017, 5:43 pm

SixOfWands wrote:

I agree with you, but I also understand why this doesn't resonate with libertarians and others who don't believe it's the job of government to save us from ourselves.

It smacks of elitism if you will... Though as I said in a previous thread, not trusting the masses is an integral component of our Constitution.

Amarante

Thu, May 25 2017, 5:55 pm

youngishbear wrote:

As they say, there are no atheists in foxholes so the problem is that me way or another we pay the costs since the cost for all those uninsured people is passed along in the form of increased hospital fees so premiums go up. It's just passed along in a different way

I don't understand why mandated insurance is an issue. We mandate insurance for people who drive. Of course one could argue that one can just not have a car but for even the most libertarian soul still clinging to the adolescent thrall of Ayn Randy, that doesn't happen.

Most of us pay insurance for autos and homes we never use. The whole concept of insurance is that the risk is spread to a large enough pool so that the cost for any one person is manageable. That's the idea of the mandate which creates the pool which enables the marketplace to stabilize.

MagentaYenta

Thu, May 25 2017, 8:37 pm

SixOfWands wrote:

A lot of this was covered in the PPACA. Folks never paid attention to it because they didn't look behind the dog whistle subjects.

Things like loan forgiveness for practicing in underserved areas increased. Federal supports for local housing programs that help recruit doctors to geographic areas increased.

Financial supports for mobile medicine units were also to be increased. Unfortunately those programs are now in jeopardy due to Republican threats against the PPACA and cut backs in programs under the proposed Republican budget.

I live in an area of the country were the expansion of these programs is vital to our rural population.

Amarante

Thu, May 25 2017, 9:15 pm

PinkFridge wrote:

It's hard to dial back entitlements once they're part of the picture, e.g. kids stay on till 26.
I would like to see some true "if you like your doctor you can keep your doctor," if at all possible.

In fairness, the issue of networks is because of what insurance companies are willing to negotiate. Even with corporate insurance policies, doctors in the network can change especially for people who choose either HMO or preferred provider networks. When I got insurance through a company, my network could change every year and every time I changed jobs.

Ironically the only people I know who don't worry about networks are people on Medicare because almost every doctor takes Medicare except gynecologists and pediatricians. It would be difficult to have a practice and exclude elderly people. Ironically, Medicare is single payer and is probably the insurance plan people I know are most happy with. They don't worry about deductibles and copayments and almost without exception can use the best hospitals and whatever doctors they choose withiut worrying or looking up beforehand to see if they are in the network.

amother

Rose

Thu, May 25 2017, 9:45 pm

I was actually thinking about this and wrote down my thoughts yesterday. I am talking about holistic and integrative care being more available to people:

Healthcare has become an economic leech on society. The idea that everyone should be entitled to healthcare seems about right. No one should be left without care when they are in need. So we all pay into a system and have healthcare rationed out so that we can all get a piece.
Is there a shortage of healthcare?
America has the biggest healthcare industry in the world, worth about 17.8% of the GDP. It is also sorely lagging behind other developed nations in health, with the highest rate in infant mortality, chronic and degenerative illness in the developed world. But there are appointments going on, prescriptions being filled, symptoms being treated. So why the discrepancy?
I think everyone should have coverage for emergency care. Routine care, however is another matter. Routine care is about maintaining a state of health. When people are responsible to choose how to care for their health, they may actually start to think about it. They may weigh their choices based on merits rather than mandates.
When an industry forces their services on you, you wonder whether the services you are entitled to are the services you want. If you were buying a car, you would look into several models, look over your choices and try to choose the best option that suites the needs of your family. However, this is not the case when you receive the mandated care that you are entitled to. You probably wont even get to choose your doctor.
People take care of things that they pay for because they have a personal investment in it. In this convoluted healthcare system, you pay in, but you don’t get what you pay for. And you will have no idea what you are paying for.
So, to answer the above question, there is no shortage in the healthcare industry. But there is a shortage of healthcare. If Americans choose to continue in this system can we at least rename it? A name is supposed to express what it is. So lets call it symptom management and maintenance.
Now an investment in your wellbeing; that should be called healthcare.

youngishbear

Thu, May 25 2017, 10:34 pm

Amother rose, I have seen it written before, that Western healthcare is actually "sick-care".

To be honest, before I worry about whether my insurance covers my chiropractor of choice, I'd appreciate it if whatever harebrained scheme politicians cook up can pass the Jimmy Kimmel test.

As a people we value human life enough to raise half a million dollars to save ONE young woman. I think taking care of the sick should remain our #1 priority.

MagentaYenta

Thu, May 25 2017, 10:53 pm

Amarante wrote:

...Ironically, Medicare is single payer and is probably the insurance plan people I know are most happy with. They don't worry about deductibles and copayments and almost without exception can use the best hospitals and whatever doctors they choose withiut worrying or looking up beforehand to see if they are in the network.

Actually when you are on medicare you do worry about copays and networks and covered services. These fees and rules are all dependent on the supplemental plans you purchase and the carrier. The feds contract with a variety of carriers to cover parts A, B, C, and D. It's incredibly burdensome and confusing with vast amts of paper work.

I was briefly on Medicaid expansion in my state before turning 65 it was a bit easier to navigate but still a pain.