How would YOU fix healthcare?

I'd take all the money we spend on the military and shift it towards a universal coverage plan for everyone.  

I'd leave the specifics up to the experts but maybe something like the current states' CHIP would be a start.   

Jorf...just a question, what would universal health care do to research? Would it affect it in any way? I would like to see universal care also, a pay according to your income maybe. I'm not sure how it would be structered.

I would regulate the individual market more. If you have a problem and aren't in an employer group it can be very difficult to get or switch coverage. It makes it hard for the self-employed.

I don't remember what paper I read this in this weekend but it was a comparison of the prices of various procedures in the US and in India, Thailand and somewhere else I don't remember.  The procedures were things like joint replacement, cardiac bypass and several other things that were needed, but not critical.  The differences in price were substantial.  I wonder if medical tourism will affect US health care.  It would be easy to write these things off as substandard, US insurers do that to everything they don't collect from, but the differential is exagerated.

It will be interesting.

I'd get rid of all the medical professionals whose talents are obviously more suited to being prison guards or IRS agents.

I know that's a flip answer, but I also mean it with all my heart!  Then there's the nurses I've encountered who might be hard pressed to find their way out of a paper bag.  And these are just in reference to the medical care providers themselves.  

In the bigger picture, I think the insurance companies are eroding the fabric of our society.  Truly, it is MORE than enough for a doctor to learn what a doctor needs to know just to be a doctor.  Yet, they have to be aware and sensitive to the ins and outs of insurance coverage.  And that's on a good day.  I hate to think how much time, energy and talent is wasted over insurance disputes.  

I'd also like to see the end of these astronomical price tags!  I remember a thread ions ago where people compared what their paperwork said was the price of neulasta.   Mine said $6,000 a pop.  And I have crappy insurance.  Maybe one in a hundred cancer patients have insurance that would pay that much for it, but is that any reason to charge everyone in that facility that much??  The range reported by people right here in these forums started at $2,000 and went all the way up to $7,000+.  Each!  What's up with that?  It really seems to me like the pricetags are snatched out of greedy peoples' wishful thinking.  

I think early detection and screening for all manner of conditions and diseases should be more commonplace.   It's reprehensible for people to 'suck it up' until the emergency room is the only avenue for treatment of any kind of condition.  We need more early detection, more proactive care, more common sense, and reasonable prices.  

editing to add my biggest pet peeve:  how could I have forgotten this one??  I think it is such a ripoff and an unconscionable practice for insurance companies to deny coverage to those with pre-existing conditions.  Just think back to the 60s and the Title VII act that made discrimination illegal.  The doom and gloom critics predicted it was the opening of the litigation floodgates and our most prosperous companies would go out of business.  Don't you know the same doom and gloom critics would say the same thing about insurance coverage being available to people who are *sharp intake of breath* ALREADY sick!  Armeggedon would surely follow on the heels of such a radical concept.  You know, and maybe that's true.  But what would we really lose if the insurance companies went under as a result of their practices?  It's industry which denies coverage and treatments to people who need it, and it employs how many thousands of people have that distasteful task for their jobs.  What we have is broken.  It's based on a model that requires a pool of enough healthy people to pay for the smaller minority who have claims at any given time.  That demographic is clearly changing with all the obesity and diabetes affecting people from childhood.  But more offensive to me than the flawed model is the fact that our insurance companies can discriminate based on qualities very often outside our invididual ability to control, and that's just not right.   They should've been included in the Title whatever that passed in the 60s which outlawed discrimination based on qualities beyond our control.   

Hi BB et al,

A good question....and lots of good responses.  

The support of any distribution of resource requires some decisions first.... decide the purpose for the system and the priorities within the purpose....

e.g. to care for the public health and safety?  to develop improved methods of care and thus longevity?  to teach and educate? to make profit? 

All systems are interdependent on the other...just like our body systems....tweak one and the other reacts.  The first level to think of is that Health-care is part of the federal and state budgets.  Then the next level to think of is within the industry itself.

This is what happened in the late 80's when they moved the system into a consumer market to raise capital to support the demands of the baby boomers coming to the age when people access the greatest percentage of services--we got old.

So to produce bigger, better, faster health care using the free market system, the price of delivery also rose with it....

The charges reflect the market costs...the reimbursement of those charges reflects the contract terms with the insurance companies, employers and individuals who pay for health care.  In my experience the reimbursement rate was less than 50%.  Why charge you may ask?  Because if you don't calculate the charge, there is no data to substantiate IRS, HCFA, etc.....or to make decisions for expansion and contraction.

Health care has never been 100% social or 100% market.  It is on a scale that shifts from one side to the other as market cycles change.  This is true in any country.  The US is the richest economy in the world...thus the prices reflect that reality. 

But price does not equate to quality...this is where watchdogs such as the World Health Organization and national regulatory environments step in....a healthy US Attorney General helps a lot too.

So we didn't get the biggest bang for the buck if we measure quality.

I'd start there in the budget process.  What will produce quality as measured by outcomes.  What will really impact and what will only add costs.  Support systems and services that support quality.  If this can be successfully identified, we will happily observe health professionals and research scientists rally around that tree...and they are the people we need to support here....the people who spend their lives to learn and understand what it is that we ask of them to do for us.  They aren't the bad guys in black hats.

I'd also look at existing resources and redistribute services so not to loose well trained people.  Would you work without incentive?  

We can't wipe out ALL private medical practice...or ALL insurance companies ... or ALL pharmaceuticals ... or ALL publicly traded businesses with profit incentive.  If we do the cost only shifts on the scale.

Do we need hospitals that look like five star hotels?  We need clean facilities that control infection.

Do we need advertising budgets and TV ads?  We do need public service announcements again...FCC rules.

Do we need malpractice lawyers soliciting on TV?  We do need malpractice lawyers to control abuses of the system.

When they tried to contract services that were considered redundant .... more than needed to support a community within a response time radius....competition raised it's head and said.."but not in my back yard".  So we created superstar cannibals at the cost of other communities in need. 

Even insurance companies originally organized as non profits morphed, created for profit subsidiaries, shifted buyers to those products, increased rates, decreased coverage and even went off shore with funds from US premiums to find profits.

Health care services expanded considerably in the for profit model.  It's an efficient model to raise capital and expand growth.....it's simply time to balance the scales....salvage the benefits and reduce the excess.   

I'm not pointing fingers....this is natural behavior in a capitalistic society.  This society is what supported unprecedented growth and power in only 300 years time....it has good purpose as well.

So I wouldn't throw the baby out with the bath water. 

There is no single answer...life is not linear, it's systemic...so these are a few of my thoughts and opinions. 

Iodine...I second that...speaking for the pc....t's not about tax write offs...it's about calculating the cost of services delivered...the market price.  There is no financial benefit derived from the margin.  Only information to provide to the people who set the value of reimbursement...insurance companies and the government...a very small percentage was ever paid directly from the patients....at least 7 years ago.

Medical malpractice is out of control.  The story goes like this....how much does it cost to settle the case vs litigate the case.  If we are in court for years...doctors in court rooms instead of operating rooms...there is a cost...and that is too high...so they settle.  It's not about right or wrong...it's about money and the value of time....always has been.  So the lawyers took advantage with the sentiments of people and stirred up cases that would settle.  Malpractice premiums are based on actual occurances...so the price climbs with the occurrence...not with whether or not there was a real problem.  Actually, I wanted to counter sue for lost wages when doctors needed to go to court to defend themselves against non valid cases.

I agree that there is a tremendous cost associated with the maintenance of records...much for legal protection...see where the circle leads...

There is medical malpractice here too...but the patient is more responsible for their medical information than the doctors.  We carry our reports and films with us to our appointments...we are our own storage.  Computerized records would be even more expensive.  They would facilitate information to the doctors, but I would hope that clinicians would not rely on computers only for their source of information.

You can not imagine how many patients withhold information about themselves for so many different reasons.  It only takes one piece of information missing to the puzzle pieces to cause an event...an incident...that can trigger a complication.  

The more you delegate responsibility to someone else for your work, the more you loose control of the outcomes, eventually.  You can't do it alone, but there needs to be a clear delineation of responsibility along the line...and not only to make lawyers and patients rich. 

If they can tackle this question, they can free up the legal community to go after the real problems....talk about energy conservation.

My brother, insurance consultant to the stars (corporations, that is), says here is the way to pay for universal health care without bankrupting the country.  Of couse, he doesn't discuss all the other changes we need beyond paying for care, which in my view is only half the battle.  But if anyone is interested:

www.apttax.com  

Oh, Dotti, that was just toooooo sad.  I'm going to try to post the link.  Thanks for bringing this to our attention.

http://www.nytimes.com/2008/02/21/world/europe/21britain.html?pagewanted=1&_r=1&sq=Paying%20Patients%20Test%20British%20Health%20Care%20System&st=nyt&scp=1

Thanks Beesie for that information. Very few Americans have lived in countries with universal health care and many are worried that their health care may be substandard if universal health care is introduced here.   Perhaps that's why a critical article, such as the one cited earlier, receives so much attention. Understandable, I think. 

I'm always surprised though when England is used as a model, as it has one of the worse systems in the EU, certainly not the best. When we were living in Italy, there were articles every day about the English having to send their emergency patients to France for surgery.  Infection rates in English hospitals are well above average, and there were many other problems. I think when Margaret Thacher came into office, she tried to get rid of national health care, couldn't, and made no effort to improve a very old and flawed system. As you say, things change and systems need upgrading, even health care systems.  

I think Sicko should have focussed on the French system, which although not perfect, is far better than what they have in England.  Perhaps Moore didn't because of the language barrier.  I know in Italy, where we lived, many Italians would purchase private health insurance to supplement the public, much like people do here who are on Medicare.  The cost, though, was so much less than here. I also know that Herceptin was approved for adjuvant care in Italy before it was approved here.  There are flaws in the Italian system as well, but we were quite happy with it. And as Marilyn mentions in her post, there are a lot of excesses here that frankly are not necessary to good health. 

Just saw this on Google from Associated Press!  Hooray!

A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer was awarded more than $9 million Friday in a case against one of California's largest health insurers.

Patsy Bates, a hairdresser from Gardena, had been left with more than $129,000 in unpaid medical bills when Health Net canceled her policy in 2004.

Arbitration judge Sam Cianchetti ordered Health Net to repay that amount, along with $8.4 million in punitive damages and $750,000 for emotional distress.

Health Net said in a statement it would immediately halt canceling policies without them first being reviewed by a third-party panel. The company also promised a comprehensive review of its practices.

Marilyn,

I think that the currently-described Clinton and Edwards plans try to combine what we presently have while introducing mandates and ways to pay for adding the uninsured.  I doubt if either of their plans, as now written, will be what we wind up with in the long term, but they were both wise in acknowledging that the American system is different from most of those in the EU and that it is impossible to replace one with the other.  I was sure that if Clinton got the nomination, it would take her at least two terms to make any real changes to our health care system, but that her experience in this area and her primary emphasis on health care in her domestic platform would insure that, in the end, she would achieve the necessary changes.  Obama's approach suggests to me that he doesn't understand the problem and won't seriously tackle it, certainly not with everything else he proposes to do on the domestic side.

I agree with you (and so apparently does Clinton) that you can't unplug one and plug in another.  To extend your analogy, it's probably a matter of gradual steps, perhaps changing fuse boxes to circuit breakers first. But for sure, we have to start soon, and somewhere, before our current system completely breaks us. Mandating health care for everyone and then working out how we can deliver it seems a good place to start.

And isn't it amazing what it costs to go to a doctor in Italy.  I still shake my head over a visit that I made to a pulmonologist in New York in the late 1990's.  I called the office before visiting and asked the cost. I was told it was $300; I was in the office 45 minutes and later received a bill for $1800.  I had excellent coverage at the time but called my carrier and asked it not to pay the bill.  They didn't and I got dunned for years, never paid, and never will.  I sent him a check for $300, which was still far too costly for the services rendered.  My uninsured husband's visit to a proctologist in Italy in 2005, including x-rays and other tests, was $75.00.  His colonoscopy was free.  When he asked the doctor who performed it what he owed, the doctor said, laughing, "Nothing, it was a pleasure looking at your colon," and then, seriously, added:  "Italians don't pay and I don't see why you should." 

And when a tooth that we paid some $5,000 to save in New York fell out one night in Italy, and he needed to get a bridge, the entire cost for the bridge was $125.00. It looked easily as good, and was as comfortable, as anything he would have gotten in New York for probably $2,000.  I really don't understand why we put up with it!