Health Care Policy

[Beavah]

I do not want to end up with universal (socialized) health care.

 

Yah, da health care thing is a bit of an awful beast, eh?

 

I honestly don't know what I want.

 

I think health care is a limited resource, eh? So in the end, there needs to be some way to allocate that resource.

 

I firmly believe that markets do a much better job of allocating resources than governments. It is a fundamental aspect of liberty to allow people to choose their own priorities and expenditures, eh?

 

At the same time, I recognize that havin' 800 different billing mechanisms for health insurance is ridiculous overhead, especially for hospitals that typically run on somethin' like 0.5% margin.

 

I also recognize that insurance is meant as a way of sharin' risk. A few variable charges for personal choices (like smokin') are OK, perhaps. But how far do we go? Variable pricin' for obesity? For high cholesterol? For prior history of problems? For havin' bad genetics? The more we allow insurers to subdivide and skim the cream, leavin' the rest of the population on the ER and da taxpayer, the less we achieve.

 

I also recognize that sayin' "no" to health services is often just not possible, eh? Yah, sure, not havin' health insurance or havin' crappy coverage might be dumb. Which one of us is goin' to stand at the hospital entrance and not allow a 12-year-old Boy Scout to be treated because his parents couldn't afford coverage, or chose cheap coverage?

 

Then there's employers, eh? Private health care costs are bankruptin' businesses.

 

It's nice to be with scouts on international trips, where yeh honestly don't have to worry about insurance cards or permission-to-treat or HIPAA or whatnot. At da same time, if a lad ever had anything serious, I'd want him back in the U.S. because he just might die before his turn for advanced treatment comes in those countries. Unless he didn't have insurance here.

 

Maybe we need a single billing system and tight regulation to reduce overhead and prevent insurers from just skimmin' the cream. Maybe we need universal baseline care. Maybe care for those under 40 who are more likely to contribute long-term to society should be cheaper or provided, and then old folks like me should have to pay full freight for our extra drugs and services, or die off if we can't afford 'em. Lots of health care dollars these days are spent on the "walkin' wounded."

 

I confess it's complimicated enough that I'm not sure what I want.

 

Beavah

 

 

[baschram645]

If an overhaul is done to the system I believe that every member of the House and Senate as well as every government worker including congressional staffers should be required by Law to partake. Even when they leave government service.

[vol_scouter]

baschram645 has a good idea that will never happen. Ted Kennedy had the best medical community in the world in Boston but went to neurosurgeon at Duke considered to be the best in the world to resect high grade astrocytomae. Do you really believe that kind of option would be available to the rest of us. Do you think that senator Kerry would stoop to going to a clinic with 'us'. The Kerry who told the press that he understood the average person while he was skiing on his private ski slope, complete with lift, on his private mountain.

 

Beavah,

 

The health care system is badly broken. The primary reason is that the free market has no role. Insurance companies set their rates based on medicare rates (often ~1.3 times medicare). There is no negotiation with medicare and little with insurance companies. So health care providers (physicians and hospitals) cannot set prices based on their cost of doing business. Medicine is already heavily socialized - that is why it is failing.

 

The Massachusetts Medical Society studied the costs of defensive medicine. Their conclusion was considered a very conservative estimate at $1.4 billion dollars for Massachusetts alone and that the actual figure is likely considerably higher. There must be some sort of reform that does not prevent a patient harmed by true negligence to be justly compensated. That said. The system must be reformed so that physicians can feel that they do not have to prove every diagnosis beyond any doubt. Patients have to be responsible for their own health issues. For example, in many states a patient told that they should have some test done does not have the responsibility to get the test done. The ordering physician has the responsibility to be sure that the test is done. That adds much cost.

 

In the 1960's, medicine was paternalistic with physicians making decisions for their patients. That was wrong but now physicians have no real ability to use their knowledge and experience in order to provide appropriate care. Patients who are elderly and/or quite ill should not be resuscitated if they suffer a cardiac or respiratory arrest. Physicians should be able to make some of those decisions. Families want 'everything' done because they have no financial burden (in fact they may be spending much the elderly person's social security checks).

 

Insurance covers your car for large losses but not routine maintenance. Your homeowner's does not cover painting your house but does if it burns down. Health insurance should not cover 'routine maintenance' of our bodies. The policies should have rather large deductibles and cover serious illnesses and not more minor problems.

 

The system is breaking due to reporting requirements. Hospitals have RNs who do nothing but check charts to see if mandated documentation is done on a daily basis. Nurses and physicians spend less time with their patients because of ever increasing reporting requirements. These requirements are not improving safety and outcomes as they are claimed to do.

 

Hospitals are for sick people, not hotels with gourmet coffee and being waited on hand and foot.

 

Society must decide if everyone deserves to be saved or to have all treatments. We transplant organs in patients whose disease process will cause the new organ to fail in the same way as their own failed. That does not make good sense but the system is told that it must be blind to the reason for organ failure. So an IV drug abuser with heart failure gets the same chance for a transplant of an organ that failed because of his actions as an innocent teenager born with a defective heart. Society must decide what to do. Much of the medical dollar is spent treating very pre-mature infants alive and the elderly. Many times, professionals know that the outcome for an elderly patient will be death but are forced to keep them alive for weeks or months before they die as expected. They could be kept comfortable and allowed to die with some dignity.

 

Get the government out of health care!!!! Ban all groups health plans!!! Require everyone to have individual health insurance that allows only small variations in premiums based upon health issues. Change them back to indemnity plans that pay so much for a given procedure or illness. For many things then the market comes bcak into play and will adjust costs.

 

Allow hospitals to charge what it costs to have a hospital room for a day. Insurance companies keep room rates low so that hospitals have to charge inordinate amounts for other items. People can understand that most hospital rooms cost more than $1,000 per day with all of the skilled employees and equipment. The insurance companies realize that forcing hospitals to cost shift makes the public unhappy with the hospitals instead of other aspects of the health care system.

 

Most do not realize that the US and Japan (I believe) are the only countries that allow the pharmaceutical companies to make a profit. Canada and European countries have laws requiring the pharmaceutical companies to sell medications at cost. So we have to pay for the profits. All other countries should allow profits as well which would dramatically lower our costs (that is why drugs are cheaper in Canada). Before you say that we should do the same thing, remember that companies are in business to make a profit. When they no longer can make a profit, they cease to be in business. We need new drugs especially antibiotics.

 

The FDA can require pharmaceutical companies to perform expensive clinical trials until the FDA is satisfied that the drug can be released. All the while the patent clock is ticking often resulting in a very few years to recoup the development costs of the drug, to make a profit, and fund new drug development. Almost no one else has the same hurdle. I would propose that the patent clock ceases while the drug is in clinical trials so that the companies will have a longer time to cover those expenses etc.

 

I could go on and on. The one thing that I am certain of is that following Obama into more socialized medical system will make things worse - not better. Take the word of a 22 year professional who is leaving the profession because it is increasingly difficult tocare for my patients.

[vol_scouter]

Almost forgot, get rid of the report cards and ratings of hospitals and physicians. Many of the hospitals who advertise 'Top 100' such and so paid to be on the list. Many of the lists have to do with profitability and not quality measures that are poor measures at best.

 

 

Some examples: Occasionally after a myocardial infarction (heart attack), the muscles that keep the mitral valve from being pushed back into the left atrium by the left ventricle can be involved. If those muscles, the chordiae tendinae, are involved, they can rupture leading to sudden flail mitral valve. Without emergency surgery, the death rate is essentially 100%. With emergency surgery, ~20% will survive. However, the report card will show a high mortality rate for those who save that 20% of patients. More and more cardiothoracic surgeons are no longer doing the procedure so that now the 20% who would have lived will die.

 

Another example, a patient goes from a good medical community to a world renowned hospital to get a valve replacement. The valve is replaced with problems and a few days later the patient goes home. The patient develops a fever after returning home and goes to the local good medical center that also does valve replacements. They determine that the valve is infected, a condition called endocarditis. The local hospital calls the world renowned center that will routinely refuse the transfer because the local hospital can handle the infection which likely occurred at the time of surgery. The patient may require another valve replacement at the local hospital in a much more difficult procedure with a higher morbidity and mortality than the first valve replacement. So guess what, the endocarditis will be attributed to the local thoracic surgeon even though they had no involvement. If the valve has to be redone, the higher morbidity and mortality will also be attributed to the local surgeon who inherited the problem. Results: the local surgeon and hospital get a worse report card. The world renowned center does not have its own problems count against them and they will lecture the 'inferior outlying hospitals' about how to do a better job.

 

No I am not a surgeon of any kind.

 

Also, nothing in the previous posts is presented as medical advise or standard of care. The representations are as I understand from other professionals relating their personal experiences.

 

 

Even in posts for scouting, we are paranoid of lawsuits.

[frankj]

Well, I am honored. After posting off and on over the years, a declarative sentence extracted from one of my posts ends up being spun into a thread.

 

Health care, and more specifically, the government provision thereof, has the potential to bankrupt this nation. Don't take my word for it. Read this column by George Will:

 

http://www.jewishworldreview.com/cols/will010109.php3

 

I don't have the answers but here is what I do know, not in order of importance.

 

1) The public and private employers cannot continue to bear the burden of insurance for their own employees, and indirectly subsidize the uninsured.

2) Health care seems to be one of the only things in this modern world of the USA where the consumers cannot shop for services and make price comparisons.

3) It is my belief that people, in general, do not accurately place a value on goods or services that they deem are "free," as in the case of employer-paid-for medical costs.

4) When the government gets into the business of paying for health care, costs will go UP, not down.

5) When the government gets into the business of paying for health care, they will draw up a list of what conditions are covered and what conditions are not. And, the list of covered conditions will grow shorter, the longer government is involved.

5) When the government gets involved in direct payments for health care, using public money, that is taxpayer money, groups and organizations seeking a place at the trough will expand: use your imagination on this one.

 

An overhaul of the system should include these items, in my opinion:

 

1) Portability -- a person's medical coverage should not be tied to their job.

2) A large deductible (how large, I don't know) but it should be big enough to discourage people from abusing insurance coverage.

3) Catastrophic coverage that is available to purchase -- the purchase of which should be encouraged. Don't ask me what do we do with someone who doesn't purchase it, or can't afford it and they have a big problem -- if I knew the answer to that, I wouldn't be sitting here, I'd be in Washington DC making policy.

4) Get the routine stuff out of hospital emergency rooms and into clinics. This is a place where some taxpayer money might be well spent -- maybe some deal where doctors etc. agree to work for a while if gov't pays some of their education costs.

5) There will always be some element of "free" government health care needed for the destitute. This, in my opinion, should only be extended to the legal citizens of this country. Period.

 

In closing, in my opinion this is one of the most difficult problems we face as a nation. Regardless of which party is in power, in the White House or in Congress, this is going to be difficult to solve in a manner that does not bankrupt this country.

 

 

[Novice_Cubmaster]

Vol,

 

I agree with 99% of what you said - except for:

 

"... We transplant organs in patients whose disease process will cause the new organ to fail in the same way as their own failed. That does not make good sense but the system is told that it must be blind to the reason for organ failure. So an IV drug abuser with heart failure gets the same chance for a transplant of an organ that failed because of his actions as an innocent teenager born with a defective heart. Society must decide what to do. ..."

 

My son is a heart transplant recipient, and as a result, my family has been part of the "transplant community" since 2000. UNOS (United Network for Organ Sharing) sets the rules for how organs get allocated - not society or the government. Part of evaluating a potential organ recipient is lifestyle and compliance - in other words, will they take good care of their new organ and follow the rules to insure it lasts as long as it can. The rules for determining who gets hearts and lungs are pretty stiff. There's more leeway with livers and kidneys (hence Larry Hagman & David Crosby). From the recipients we know, UNOS has done an incredibly fair job in allocating organs.

 

I'd rather have a medical board set the rules and determine who should receive a new organ than society or the government. Unfortunately, there are too many "medical" shows on TV filling peoples heads with nonsense about organ transplants - having society set the rules would be a disaster. As for the government, I sure as *** don't want politics involved in determining who should get an organ. (Remember, Society + Government brought us Welfare, Medicaid, Food Stamps and other well-meaning bungles)

 

Sorry about getting on the soapbox, but misinformation about transplant rules and organ allocation can cause people to decide against being donors, or donating the organs of a loved one. Having seen the lives that have been saved by a transplant, and a few that were lost while waiting - I had to say something.

 

NC(This message has been edited by novice_cubmaster)

[scoutldr]

During the campaign, and being a reasonably smart guy, I always wondered how the Obama administration and Democrat congress were going to pay for "universal health care". In a recent edition of the Wall Street Journal (which, I assume 99% of the voters don't read), the details are emerging. It's "health care redistribution". In a nutshell, the proposal, hidden in the $825B stimulus bill, will allocate $1.1B for studies to determine the relative "cost-effectiveness" of various drugs and medical devices, with an eye toward limiting their use to save money. The bill says that the "more expensive" medical products will no longer be prescribed.

 

"The bill gives incoming Health Secretary Tom Daschle wide discretion to set priorities, and he's long advocated a US approach based on the British agency, the National Institute for Health and Clinical Excellence (NICE). Mr. Daschle argues that the only way to reduce spending is to allocate medical products based on "cost effectiveness. He's also called for a "Federal Health Board", modeled on the Federal Reserve to rate medical products and create central controls on access."

 

Article written by Dr. Scott Gottlieb of the American Enterprise Institute.

 

PS: The article was sent to me as a .pdf file, so I can't post the link. If anyone's interested, I'll forward the file by e-mail if you PM me.(This message has been edited by scoutldr)

[vol_scouter]

NC,

 

You are correct about the transplant list. I am glad that you son received his heart transplant and is doing well. Transplants are paid for eventually by the public either through higher insurance premiums or by government paid plans. So the public in essence has decided that UNOS should provide the framework. It is a good program but in my view there are still some issues. The recipients must change their habits for a period of tie to qualify - 6 months I believe. However, the long term recidivism rate is high for many addictions. Also, should I be given similar opportunities to have a transplant if the reason is due to my habits (even things like not controlling obesity related hypertension and diabetes) versus a disease or condition that the patient in not way caused? That to me is a societal issue. Society could ask UNOS to change the selection criteria to reflect societal values. I am not saying that it must or should be changed, only that society pays and should through some process set some of the general standards or adopt the current ones.

 

Transplants are expensive initially and the recipient will usually be costly to the healthcare system in the long term as well. I fear that our rush to socialism will ultimately result in the loss of the option of transplants as simply too expensive - that would be wrong and a tragedy.

 

Socialism has never really worked. Return medicine to the free market and the costs will decrease.

[Hal_Crawford]

Here is a link to the article cited in the previous post:

 

http://online.wsj.com/article/SB123241385775896265.html

 

As it is an op-ed piece it is heavy on opinion and (possibly selective) analysis so it should be taken with a grain of salt. Looking at other articles from the same author I see he generally writes from a conservative perspective and seems to be tied to the pharmaceutical industry. WSJ has always had a conservative tilt (big business is their market) but I have less respect for them since their purchase by Rupert Murdoch. Also American Enterprise Institute is a conservative think tank with strong ties to the neocon movement. None of this means that the analysis is wrong but I will need to see more before I get too concerned that the sky is falling.

[TheScout]

Doesn't seem constitutional to me. It should be a state issue. There doesn't have to be a national contoversy. Let the people decide through their legislatures in each state according to their customs, traditions, and values.

[GernBlansten]

The only thing universal about our health care system, is that everyone universally agrees its messed up in its current state.

 

I hear solutions being presented from the Dems, but nothing from the Republicans. Only arguments against the Dem plans. Now would be a great time for the Republicans to present a working solution.

 

Single payer seems like the best compromise. It ain't socialized medicine. Its one giant health insurance plan. Medical providers are still private enterprises. Spread the risk across 300 million. Release private business from the burden of paying for medical insurance of their employees. Eliminate the profit motive on medical procedure approvals. Simplify the billing and rate structure. No more Bill McGuires making $1.1 Billion bonuses.

 

True free market health care would lower costs for those who can pay, but are Americans really ready to step over the dying poor and elderly in the streets?

[vol_scouter]

Hal,

 

I am a physician who has practiced for 22 years and is leaving well before retirement because of the worsening mess that makes it more and more difficult to care for patients. I have lived in Denmark and worked at a VA for a short time thus seeing socialized medicine up close - it is not a good system. I got the article from a professional email and went to the Massacusetts Medical Society website. It is as good a study as one is likely to get on such a topic. I have no relationship to the pharmaceutical industry except I prescribe.

 

Gern,

 

We already have in essence a single payor. A true single payor would hopefully eliminate some paper work but all of the other problems remain. The republicans di not have the courage to recommend returning the system to the free market. No other country has made this work, we will not either.

[GernBlansten]

A totally free market health care system would be purely driven by profit, not patient care. Un-regulated, we could have the same greed and corruption that took down our banking system.

 

Just because no country has tried a pure free market system, doesn't mean that it will work.

[scottteng]

A claim that free market practices brought down the banking system is spurious. It is well established that government regulations requiring loans be made without considering ability to repay is what damaged the banking system. The chances of a return to free market medicine are fairly slim. The best solution would be to remove the union aspect of medicine. If we open medical colleges with two year practical doctor programs and graduate several thousand doctors per year the inflated costs will disappear. Look at the price of chiropractic treatment which is not as regulated as medical treatment and which is not generally covered by insurance.

[TheScout]

True, it was the monetary policies of the federal government.