Healthcare Reform: what should be done

chaiz

Fri, May 26 2017, 3:45 am

Amarante 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.

It is a republican talking point that doctors get sued too often and too hard, thus driving up malpractice insurance costs which are passed on to the patients one way or another. The solution to the problem is tort reform, according to republicans. I understand that all professionals carry some sort of liability insurance. But for some reason no one really hears about it and for some reason the costs are understood to be part of the cost of doing business. Yet, for doctors, it seems that malpractice insurance is too much for them and it is often blamed for high medical costs. I am saying it is because doctors seems to be the one profession where we allow and and find acceptable arrogance on part of the doctors. And it is the one profession where we seem to limit how accountable doctors can be, via suing them.

saw50st8

Fri, May 26 2017, 6:56 am

There are a lot of problems that compound each other.

Doctors are afraid of lawsuits so they order every test under the sun.

Doctors have no idea about the various costs of things so a slightly similar test/procedure/drug could be a fraction of the cost but there's no clear information for doctors to look at cost.

Until recently, consumers paid a small copay and had no clue what things cost. Americans are only getting upset now (meaning the last ten years or so) because co-insurance and high deductible plans are more common. Now consumers are realizing how expensive all those little things are.

Medicaid isn't great for adults. There are very few specialists and it can be hard to get appointments depending on where you live.

Americans have a terrible lifestyle that drives up costs. We definitely do sick care in America and a lot of our own issues are caused by the American diet and lack of exercise. Poor places are even worse.

Doctors go to medical school for a long time, invest a lot of money and expect to be compensated accordingly, as they should be. Right now doctors are being squeezed more and more (which passes on to the consumer).

I think everyone in the country needs some version of catastrophic care. I think other items are optional. I do think that every woman who hits puberty needs to have maternity coverage (not optional).

As a country, we need to decide if we want to provide everyone with health care or not. It's not a "right" like some people are touting it as.

saw50st8

Fri, May 26 2017, 7:00 am

chaiz wrote:

Doctor malpractice is really high. 10 years ago, my OBGYN told me that her malpractice insurance was around $150,000/year. My insurance company paid her $8,000 for pregnancy, deliver and care after birth. She has to deliver roughly 20 babies before her malpractice is covered and that doesn't even cover anything else (office space, secretary, supplies, phone etc).

chaiz

Fri, May 26 2017, 8:49 am

saw50st8 wrote:

I understand that. But maybe the issue is that the quality of doctors or medical education is lacking. I keep hearing about defensive medicine, yet the US's life expectancy rates are not on par with the rest of the developed world. And the maternal mortality rates are one of the highest in the developed world.

saw50st8

Fri, May 26 2017, 9:03 am

chaiz wrote:

I don't think it's quality of doctors specifically. I think there are a lot of cultural issues that go into this:

1) Health of American - American culture leans towards big macs, soda and sedentary lifestyles. Those all contribute drastically to poor health.

2) We are a sue happy population which seems to have driven up the c-section rate because doctors were practicing more defensive medicine. It's really hard to find OBGYNs who will or have experience in delivering breech babies. C-sections are inherently more dangerous for all parties involved except the doctor.

3) In order for doctors to get enough out of their practice, they often have to practice assembly line/fast paced medical care. Health insurance pays based on visits, not on time. It's really hard for a doctor to sit and spend an hour with you if it's not an emergency even if they can gain a lot of information from the patient that way. They can't afford to do that.

4) Interventions in the US are extremely common - outside of the US, you will find a lot more women who opt out of pain medication for labor. Epidurals and other forms of pain medication can have negative results on the labor, delivery and recovery. Every intervention leads to increased risk.

I'm sure there are plenty of other reasons people can point out. I think these are all chicken and egg items. I think the reason it's so hard to solve health care in the US is that our existing policies create a hodgepodge of other issues. I don't have a solution though :-)

LittleDucky

Fri, May 26 2017, 10:43 am

amother wrote:

I work in healthcare and I've come to the conclusion that we need to get big business out of health care. We need single payer. This would be far more efficient and would be less costly with a lot more benefit in the long run.

We pay more for worse health results under our current system and our pre-PPACA system.

This topic showed up on my news feed earlier in the week.
It won't be cheaper... CA government just did a study on implementing single payer (run by democrats almost entirely so this is no propaganda or fear tactics. These are politicians that WANT single payer) It will not only cost more than the current cost for medical care in the state--- it will cost more than double the ENTIRE budget combined. Now imagine if the whole country did it...

"The annual price tag for single payer health care in the Golden State would be a whopping $400 billion.
The total amount of money allocated for the California state budget for the coming fiscal year is $179.5 billion" (CNBC article listed below).

http://reason.com/blog/2017/05.....-cost

http://www.cnbc.com/2017/05/24......html

Oh, and this is the state that rarely ever meets the projected cost. That bullet train is now costing that state HOW much more than they estimated?

amother

Purple

Fri, May 26 2017, 1:57 pm

saw50st8 wrote:

Totally OT, but when we discuss things like this I am always happy that my midwife isn't a doctor. I understand why doctors do what they do, but at the end of the day, they have themselves in mind and dont necessarily act or advise me in the way that's best for me or my baby. I wish people would understand this when choosing a doctor, and getting maternity care.

jkl

Fri, May 26 2017, 2:43 pm

Amarante 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.

.

If you can keep a mandate fair and equitable perhaps it wouldn't be an issue. A mandate is where everyone pays, not one subsidizes the others. Obamacare's mandate definitely wasn't that. It provided free plans for people under poverty, but more than doubled (or tripled in some cases) the cost for the middle class, while adding on high deductibles. With the auto insurance mandate, no one in subsidizing someone else's plan and cost is based on your situation not on everyone else's around you.

Not having a mandate opens the debate about is healthcare a right or not. With so many variables, I don't think there can ever be a perfect solution, but we should try for the best one possible. If anyone can figure out something that works for all - they deserve a noble peace prize.

Some things to consider:

1 - Single payer systems have been proven to offer subpar care and dreadfully long waits for life-saving or necessary treatments.

2 - Demanding lower cost for meds will affect new discoveries and new drugs. If the profit incentive is lost what will drive the years of research?

3 - Lowering doctors reimbursements will increase doctor shortages - as Obamacare has proven. The rate of retirements in the last few years has gone up drastically

4 - Tort reform is a must. Strict criteria must be set for lawsuits and outrageous rewards should be limited (with exceptions of course). As a previous poster mentioned, its one of the biggest factors of medical costs. Doctors order every single test under the sun to protect themselves, (because of the ease of which lawsuits are filed), and a simple hospital visit ends up costing thousands. Malpractice insurance have skyrocketed the last couple of years., just check up on the statistics as to how many OB/gyns have dropped the OB part of their services recently.

Bottom line - Do we offer the best medical care for those who can afford it, or do we create a system with lower standards? Both ways people die. The difference is that with offering the best medical care, the poor people will be affected. With lowering our standards or care - the poor and middle class will be affected. (The rich will always have the cash on hand or the means to get the best medical care around.)

So can the imamothers post their opinions on this debate? - And before anyone states that offering a single payer system with the best medical care is an option, it is NOT. The cost would be so astronomical, it would drain every available resource from everything else.

farm

Fri, May 26 2017, 3:44 pm

The car insurance example is food for thought. The whole reason it works is because actuaries assess the risk of each insured so that each person is charged enough to cover for possible payouts and for the insurer to make a nice living. So younger male drivers in Brooklyn have to pay more than middle aged female drivers in Waterbury. But when health insurance companies try the same, everyone is up in arms and lobbying against charging more based on age, gender, weight, smoking status, etc. Maybe if we actually modeled premiums for healthcare along the lines of auto insurance, the numbers would work? Plus people have incentives to improve their health. Like those defensive driving courses that lower your car insurance premiums and make you a better driver too.

jkl

Fri, May 26 2017, 3:47 pm

farm wrote:

Another reason it works, is because EVERYONE pays. No one subsidizes someone else's auto insurance.

SixOfWands

Fri, May 26 2017, 4:05 pm

jkl wrote:

Another reason it works, is because EVERYONE pays. No one subsidizes someone else's auto insurance.

Insurance is inherently based on subsidizing others, so that they will subsidize us in the future.

If we take a group of 100 people, we know that their health care costs over the next year are likely to be $100,000. (I'm just making the numbers up.) That's because some people will never go to the doctor, while others will have catastrophic health care needs. You pay your $1000 and gamble. Maybe you'll "lose" by not needing it. Or maybe you'll wind up in the hospital, and everyone else will be paying for you.

Just a random google. "Among patients who received trastuzumab [for breast cancer], the median insurance payment was $160,590." We ALL pay for that, through our insurance premiums.

Now, granted, there are no government subsidized auto insurance premiums, if that's what you mean. That's because as a society, we don't believe that cars are a necessity. If you can't afford insurance, you don't drive. But health insurance is different.

Maybe you don't think it should be different. But I certainly haven't seen that here. When women say "What OB takes Medicaid," I've never seen anyone say "if you can't afford health insurance, have that baby on your own; I recommend lots of clean sheets." And when someone couples a mention of Medicaid with reference to a sick child (chas v'shalom), I've yet to see anyone say, "look, you can't afford a doctor, let the kid die." Thank Gd I've never seen it. But when people say that we shouldn't subsidize health care, that's what they mean.

youngishbear

Fri, May 26 2017, 4:05 pm

farm wrote:

I hear you. Life insurance works that way, too.

The only thing is, a car is a luxury.

Cardiac care for a child born with heart problems is not. It is cruel to punish those with the greatest need.

Sigh.

jkl

Fri, May 26 2017, 4:14 pm

SixOfWands wrote:

I wasn't pointing out that we should adopt an equal system for health care. I was merely pointing out why the auto insurance mandate is not a fair comparison. With auto insurance, any participant is a payer and not subsidized, so this allows for a healthy market. With medical insurance, where some participants are required to pay for themselves plus others and some don't pay at all, it does not allow for a healthy market hence all the problems.

SixOfWands

Fri, May 26 2017, 4:23 pm

farm wrote:

But the ACA does allow higher costs for certain things. Eg,

Quote:

Penalizing employees for pounds is perfectly legal. Under provisions in the Affordable Care Act, 2014, employers can charge employees an extra 30 percent of the total cost (employer and employee portions) of individual or family health benefits coverage if they don’t meet specific wellness goals, including body mass index (BMI).

http://observer.com/2015/09/un.....yees/

nylon

Fri, May 26 2017, 5:58 pm

It's not really possible for health insurance to do all that work. That involves nutrition, poverty, all kinds of things. Not covering basic services means thst people don't go to the doctor regularly and chronic conditions go untreated. There isn't really any evidence that higher deductibles improve outcomes.

The problem with letting people buy what they want is that people who are health buy skimpy insurance. Then when they get sick they want better coverage. Same with birth: if only people who think they might get pregnant buy it it becomes impossible to obtain. This is why every other country, regardless of exactly how they do health care coverage, makes everyone get a comprehensive level of basic coverage. The government isn't looking at it solely from a consumer point of view but from a public health point of view. Looked at from a population wide basis, ensuring good prenatal and maternity care pays off in healthier mothers and babies.

Health insurance and car insurance aren't really comparable because a great deal of health is beyond your control. Everyone needs health care. Health is better thought of as a shared risk scheme.

Amarante

Fri, May 26 2017, 6:05 pm

Auto insurance is not a perfect example because much of health is really based on genetics or luck. Not to mention that there are conditions that are easily treatable inexpensively like minor blood pressure or cholesterol which would be helped with preventative care which can't be given unless health insurance covers stiff like that and the ER isn't used as a last resort by the poor.

Also only some of one's autho insurance is based on personal habits and quite a bit is based on stuff like zip code in which one is thrown into a larger pool. Even though I have a spotless driving record with no accidents, I still pay significantly higher rates than someone who lives in a different zip code.

But really the bottom line is that for people with any kind of moral conscience, health care is not a privilege but a right. You have to be treated by a hospital which pee Obamacare resulted in the crazy expensive health system where those withiut insurance went to emergency rooms and often they had conditions that could have been treated relatively inexpensively if they had access to treatment. And that's just the economic argument and not the moral argument that treating someone with diabetes or high blood pressure so that they don't go blind, lose a leg or stroke out is humane.

LittleDucky

Fri, May 26 2017, 7:17 pm

amother wrote:

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?
SNIP.

This statistic has been mentioned as to why we need to go to socialized health care. However, each country reports infant mortality differently. Each country follows different rules as to what counts as "live"- whether they must be able to breathe independently, weigh a certain amount, be above a certain gestational age, or various other criteria (some require more than one). Some only count the child as "alive" if they live past 1 day or even 7 days. Otherwise it is seen as a "still birth". The USA follows the strictest protocol of "heartbeat or breathing independently or voluntary muscle movement". If we all get to define the criteria differently, it makes it quite hard to compare by the numbers!!

We also try to save babies born as young as 22 weeks gestation when other countries will see them as "still births".

Another major issue is that the USA has a much more diverse population, with different cultures. We have different ideas on health, seeing doctors, eating habits, smoking, drinking, and other risky behaviors. Do we do home births or hospital births? Medicated births? All of these play a role in the general health of our country and, while not saying one way is better or worse, it does have an impact.

Statistics have shown that African American infants have a much higher infant mortality rate than Caucasian or Hispanic infants-- the reason for that isn't exactly known yet but a country with a much more unified population would have a much easier time decreasing their mortality rates. We need to help our entire population and figure out why there is such a discrepancy and it is only mentioned here to show a possible reason (But interesting to note that many of the countries ranked higher on the list do not have such diverse populations or many Black individuals living there...)

nylon

Sat, May 27 2017, 11:57 pm

It is not true that single payer systems all have long waiting lists and subpar results. Americans like to use single payer as if it were synonymous with universal healthcare. There are many models. Never mind that it's a myth that you don't wait here either. America is not equally served by physicians.

US maternal and neonatal mortality rates are poor not because doctors practice bad medicine in the sense of any individual decision. C section rates don't correspond well at all to mortality in western countries. Our statistics are poor because while part of our population gets excellent health care, another part gets too little. We spend relatively little on poverty reduction. We give women Medicaid when they get pregnant and then kick them off it three months after they give birth. This means chronic health conditions are not well managed prior to pregnancy. You have women coming in with uncontrolled diabetes or hypertension. And there are racial disparities we don't fully understand that persist even when the statistics are corrected for other issues like insurance or socioeconomic class.

WHO has tried to standardize reporting of births (there is a strict definition for perinatal mortality for example). The gaps persist in a lot of categories. It can't all be explained by differences in reporting. Infant mortality, where the US lags, is all deaths to one year. That is not because of stillbirths. The US does pretty well in perinatal mortality; we do poorly in neonatal and infant.