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Author Topic: Are you a 1-Percenter?  (Read 4066 times)
jonzr
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« on: Jul 26, 2009 at 11:57 »

Didn't think so.  Write your congressman and tell him you want your universal health care, now.

http://informationclearinghouse.info/article23134.htm

You do deserve health care, don't ya?  I mean, all the health care we're already paying for w/out the morass of insurance company bureaucracy, etc. as the gate keeper?

This shouldn't be a bipartisan issue.  We're Americans, we should have the best, right?  Well, we don't.  We pay the most, yes?  But we're lagging well behind most of the developed world in health care.  That should not stand.

Write your senator.
Write your representative.
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vinman3
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« Reply #1 on: Jul 26, 2009 at 14:40 »

Yeah, cause the government does such a good job of administering other programs. And it is not just the top 1%, Obama has said himself, that the increase would be those making $250K or more (not me). That is NOT rich, sorry. Reform, yes. Government mandated and controlled health care. Absolutely not. Sorry Jonzr, have to disagree with your position here. I am sure I am the minority though Smiley
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« Reply #2 on: Jul 26, 2009 at 15:08 »

The status quo ain't cutting it though.  We need something different.  I know "government mandate" sounds bad, but if the government insists that you have health care, are you gonna argue?  My point is, we're paying for it already.  May as well have the money go towards the care than the pockets of the insurance fat cats and lobbyists and dirty politicians and pill-pushing-kickback-taking doctors, etc.

And what's wrong with asking the top 1% to carry their share of the load?  They've had their taxes slashed in recent years anyways. 

I can understand though vinman if you're one of those people hauling in a household income of $280K.  I'm sure you're already quite comfortable!  And those hauling in $280M probably don't worry about health care either. 

But for everyone else, the system stinks.  I've always had insurance either through my wife's job or mine.  Last year I spent 3 days in the hospital with an IV in my arm.  The bill was $15K and I had to pay my $1.5K portion of that.  WTF is that?  Yeah, 10% ain't bad.  But $15K for 3 days in the hospital?  Are you kidding me?  There were no expensive test with the machine that goes "ping" or anything, just an IV for the first 48 hrs + the antibiotics that were dripping.  Sorry, that's not 5 grand a day's worth of health care.  The system stinks.

Status quo ain't cutting it.  Write your congressman for your neighbor's sake if not yours.
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« Reply #3 on: Jul 27, 2009 at 08:35 »

"The nine most terrifying words in the English language are, 'I'm from the government and I'm here to help."
Ronald Reagan


Reform Yes, control no.
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« Reply #4 on: Jul 27, 2009 at 08:45 »

"Be thankful we're not getting all the government we're paying for."

- Will Rogers

I hear ya.  Still, the health care problem won't fix itself.  People have to let their senators and reps know that they'll be out of office if they don't bow to the will of The People rather than the will of The Dollar.

Of course, that would require us to actually vote them out of office.

And, of course, that'll never happen if we keep letting ourselves get distracted and divided by such silliness as partisan politicking.
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« Reply #5 on: Jul 27, 2009 at 14:35 »

I'm gonna have to disagree with you across the board on this one jonzr.  Any government involvement will only make it worse.  Medicare for everyone isn't going to work - we simply can't pay for it, no matter how much we squeeze the top 1% (by the way, they earn 18% of the income and currently pay 27% of the taxes while using fewer resources, so they're already pulling their weight).  And all countries with goverment funded care have major issues, no matter how the media portray how great it is.  Long waits for basic care, for example.

You want to limit drug company profits - two major issues with that.  First, they're a private business.  Is it fair to tell them what they can charge?  Not really a monopoly, since there are usually several competing products.  (BTW, government reguations make it a real problem for companies to reduce prices of drugs once they're set.  Basically, they'd have to pay back the difference to Medicare for previous prescriptions sold).

Second, if you limit profits, you also limit research on new drugs.  Those antibiotics you got in the hospital?  Without research it would have been pennicillin.  And probably the bacteria would have said "don't bring that weak s(tuff) in here!"

Pill-pushing-kickback-taking doctors?  Not even going to go there - wait, yeah I am. There are professions that make more money with less hassle and less on the line.  YOu want the best and brightest going into medicine?  Or do you want the guy working the night shift at Seven Eleven standing at your bedside with you or your family member's life hanging on his decision?  You want the smartest people willing to deal with all that goes into the job, don't begrudge them making a good living.

One big help would be tort reform.  Significantly reduce liability, eliminate frivolous lawsuits, and two big cost savings occur.  Small one is that malpractice insurance goes down, decreasing cost of doing business.  Major cost savings is a significant reduction in extra tests being ordered/procedures performed because physicians won't feel like they have to protect themselves as much.

Biggest problem is the huge number of people, legal or not, that don't contribute yet utilize resources.  That doesn't change with government funding, since they don't pay taxes.

One issue to resolve, though one that may be unappetizing - everyone should have access to care, but should everyone get the same level of care?  Free clinics, hospitals with no bells and whistles, good medicines but not top of the line - is that reasonable for people without other options? 
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« Reply #6 on: Jul 27, 2009 at 15:47 »

I'm gonna have to disagree with you across the board on this one jonzr.  Any government involvement will only make it worse.  Medicare for everyone isn't going to work - we simply can't pay for it, no matter how much we squeeze the top 1% (by the way, they earn 18% of the income and currently pay 27% of the taxes while using fewer resources, so they're already pulling their weight).  And all countries with goverment funded care have major issues, no matter how the media portray how great it is.  Long waits for basic care, for example.
I just don't buy those numbers.  But if the 1% line is bothersome, make it .1%, whatever.  The rich have other sources of income that are taxed differently whether from investments or whatever.  So, a CEO who draws a $1 salary but pockets $250M in bonuses is paying the same proportion of taxes as me with my little sub $100K salary?  I highly doubt that.  If his accountant is worth his salt, he ain't paying anywhere near the my %.

I'm sure we already pour enough money into the system that it could be repaired to function properly w/out collecting more taxes.  But I'd still want to collect a fair share from those that aren't paying theirs.


You want to limit drug company profits - two major issues with that.  First, they're a private business.  Is it fair to tell them what they can charge?  Not really a monopoly, since there are usually several competing products.  (BTW, government reguations make it a real problem for companies to reduce prices of drugs once they're set.  Basically, they'd have to pay back the difference to Medicare for previous prescriptions sold).


Second, if you limit profits, you also limit research on new drugs.  Those antibiotics you got in the hospital?  Without research it would have been pennicillin.  And probably the bacteria would have said "don't bring that weak s(tuff) in here!"
I didn't say anything about limiting drug company profits.  I'm talking about reform of our health care system.  Drug companies are part of that, sure. 

Pill-pushing-kickback-taking doctors?  Not even going to go there - wait, yeah I am. There are professions that make more money with less hassle and less on the line.  YOu want the best and brightest going into medicine?  Or do you want the guy working the night shift at Seven Eleven standing at your bedside with you or your family member's life hanging on his decision?  You want the smartest people willing to deal with all that goes into the job, don't begrudge them making a good living.

If you weren't one of those then don't take offense.  But it's a simple fact that some medical doctors do accept kickbacks to push certain drugs on their patients.  This is part of the problem.

One big help would be tort reform.  Significantly reduce liability, eliminate frivolous lawsuits, and two big cost savings occur.  Small one is that malpractice insurance goes down, decreasing cost of doing business.  Major cost savings is a significant reduction in extra tests being ordered/procedures performed because physicians won't feel like they have to protect themselves as much.
True, but that will only be part of the solution.  The entire system needs to be torched and rebuilt from the ground up.

Biggest problem is the huge number of people, legal or not, that don't contribute yet utilize resources.  That doesn't change with government funding, since they don't pay taxes.

One issue to resolve, though one that may be unappetizing - everyone should have access to care, but should everyone get the same level of care?  Free clinics, hospitals with no bells and whistles, good medicines but not top of the line - is that reasonable for people without other options? 
I don't know, certainly don't have all the answers.  There will always be another level of care that people can purchase if they have the money.

Don't get me wrong here though.  I'm not all for "let's turn it over to the government" but at some point we need them to represent us and help establish a system that works for everyone, that provides care and in the case of a serious condition, doesn't bankrupt a family. 

Think of the troops and the children and our great nation. </palinism>
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« Reply #7 on: Jul 27, 2009 at 16:40 »

Quote
If you weren't one of those then don't take offense.  But it's a simple fact that some medical doctors do accept kickbacks to push certain drugs on their patients.  This is part of the problem.

I don't take any offense, but I think that problem is an exceedingly small percentage that doesn't significantly impact the bottom line.

Quote
I didn't say anything about limiting drug company profits.

My mistake, misread it.  Insurance is a big issue I admit.  However, more control governmnet has, more money for fat-cat politicians to "reappropriate."

Even many Democrats say reform won't happen without more money/increasing deficit.  If more revenue is needed, I tend to favor what I call "optional" taxes.  Two examples:  raise cigarette tax - let those who smoke pay more for increased costs due to smoking related illnesses.  Don't want to pay - quit smoking and your health care costs will likely go down also.  Second, if you want more taxes from wealthiest group, is a luxury tax.  Add 5% to cost of vehicles over 50K, boats, high end TVs, etc.  If you don't want to pay, don't buy the item.

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« Reply #8 on: Jul 27, 2009 at 16:52 »

Kinda surprised as I thought jonzr was a libertarian.  Though I'm not sure how they view this.

I manage two medical practices and a department of medicine at a local hospital.  I probably won't wade in deep to this discussion, as I realize the pain caused by high prices and seemingly scarce care.

You mentioned the $15K bill.  Was the $15K the charge or payment?  My experience with patients and my own family healthcare bills is that the hospital charges a certain amount, the insurance company pays about 36% of the bill and the patient is responsible for any applicable co-pay or deductible (also in v. out-network).  

Not projecting this to jonzr's comments but M'care is a terrible model for a national plan.  M'care denies so much coverage that private companies don't.  M'care is usually a year+ behind covering medications and procedures that the private insurers pay for.  My guess is that to make a national plan work, and to really save $$$, the plan would drastically reduce what is covered while increasing denials (which mean the payment falls on the patient, if the medical office has the patient sign an Advanced Beneficiary Notice per M'care guidelines).  

To msdmnr's comments about the best and brightest, I actually read an article recently that there is a push to dumb down the requirements to get into med. school.  The idea is to bring in students from rural areas that have difficulties attracting and retaining PCPs.  I guess it's better than no doc but it certainly creates two health care systems.  

And that lends itself to msdmnr's point of various levels of care.  I guess kind of like car insurance plans.  Whatever the state minimum is and then tiers above that (ie, silver, gold and platinum package).  Patients w/ low tiered care still go into debt or are placed on a long waiting list for treatment in free clinics.  

I don't know if msdmnr faces this already but insurances, M'care, M'caid and private, are moving to a quality-based payor system.  PQRI is already available from M'care and Carefirst has some similar program out.  Ideally, for example, wrong-site surgeries and infectious disease #s go down on the inpt. units.  Very great end benefits.  What likely will occur as well is denied days in the hospital increase as the ins. companies use quality indices to minimize the days they have to pay.  Hospitals will push to get these non-paying patients out of the hospital ASAP.

Healthcare is an uncomfortable topic, as we expect everyone who gets sick to have the opportunity to get better.  

I put a lot of responsibilities on the patient for preventative care.  Many of the patients seen in my practices do not use insurance-covered or free education programs re: their conditions. So many patients are non-compliant with medications and life-style changes.  They don't enjoy eating differently, exercising, etc., but come back every few months with abnormal lab values and general unhappiness with their condition.  

More than I wanted to say.  I live in the DC corridor, which is thick with pro-national healthcare talk.  Some valid reasons on that side of the aisle to move things in a different direction.  Problem is, the way to reduce cost is to cut the # of available physicians, NPs, PAs, etc., reduce medications and procedures covered, and run the country further in to debt or having an already burdened middle class take on more and more taxes to pay for the new system.

Okay, I dove in instead of wading in.  Not a very academic or thougthful discussion on my part.  Just a view from the other side.
« Last Edit: Jul 27, 2009 at 16:55 by SCacalaki » Logged

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« Reply #9 on: Jul 27, 2009 at 17:07 »

I like the idea of single payer: take out the conflict of interest between profiteering and health decisions.  Public financing, private delivery.  We talk about how inefficient Medicare is, but over 30% of our healthcare dollar goes to paperwork, admin costs, bottom line profits and CEO wallets.  I just don't buy that we can't streamline the paperwork and bureaucracy -- Obama's ideas on getting us into the 20th century of information exchange ring true here -- and do better than 70% efficiency.  

In fact, we're spending two, three times what other Western nations are for healthcare.  For every person who says Canadian, French, Brit, etc. healthcare involves long waits and substandard care, there are plenty of others who say that's nonsense.  IMO, it's moot: we already HAVE the healthcare providers in place AND we're spending the money.  What we're not getting is ROI in terms of life expectancy (and other metrics) for health dollar spent.  We should be able to maintain (or improve) care, not increase per capita spend, and expand coverage for what we pay right now.  

My big disappointment is that Obama has removed SP from the discussion entirely.  We wouldn't want to disrupt the for-profit healthcare providers, after all: that's our bottom line, isn't it?  

All the arguments against government ANYTHING fall flat for me, too.  Believe me, I've seen government inefficiency firsthand, but there are successes as well.  I'll take the US Army over Blackwater any day, and we do just fine with socialized notions as firefighters and police forces.  There are certainly arguments against using Medicare as the model for a SP system, and I agree that we can reduce costs looking at tort reform, and getting provider input for a SP model.  But I don't think SP is coming any time soon.

http://www.pnhp.org/

I think I'm in over my head with posters here who know more about this subject than I do, but this is one area where I think free market absolutely fails the needs of consumers.
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« Reply #10 on: Jul 27, 2009 at 17:38 »

Also, Medicaid and Medicare are getting the dregs of the system, so to speak.  The healthcare companies get the cream of the crop, or at least until those people get too sick. 

http://www.pnhp.org/facts/why_the_us_needs_a_single_payer_health_system.php

Quote
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« Reply #11 on: Jul 27, 2009 at 19:25 »

In fact, we're spending two, three times what other Western nations are for healthcare.  For every person who says Canadian, French, Brit, etc. healthcare involves long waits and substandard care, there are plenty of others who say that's nonsense.  IMO, it's moot: we already HAVE the healthcare providers in place AND we're spending the money.  What we're not getting is ROI in terms of life expectancy (and other metrics) for health dollar spent.  We should be able to maintain (or improve) care, not increase per capita spend, and expand coverage for what we pay right now.  

That's where I'm coming from, well said.

And Scac, yeah, more often than not I fall in with libertarian ideas, but I'm not gonna cut off my nose to spite my face.  Health care for all?  I'm there, let's do it - it makes sense.  We're already spending the money, let's get the service corrected.

From what I understand, we haven't even taken advantage of learning the ups and downs from countries who are doing more with less.  WTF is that?  It's where we should have started.
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« Reply #12 on: Jul 27, 2009 at 19:28 »

And after health care is fixed, let's tear down and rebuild the education system from K-12, college and beyond.  We are falling waaaay behind the rest of the civilized world.  It's shameful, really.

But that's for later.  Gotta get those bastards in DC to do what's right for the people.  That's us.
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« Reply #13 on: Jul 27, 2009 at 22:04 »

While there certainly are pros to a national system, I guarantee you that you don't want to see it model M'care.  

Guaranfuckintee you.

Patient Rx doughnut holes, non-coverage of FDA-approved medications (osteoporosis medications for the elderly being one I have seen often), minimum coverage standards for education (medical nutrition therapy is only covered for those with dx of diabetes and renal failure....high cholesterol, obesity, hypertension, and hyperlipidemia are not covered by Medicare; Carefirst and BC/BS cover for these dx), and a black/white policy of approving procedures.  

Not to mention they pay a fraction of what private insurers pay.  About $30 on a $100 charge for outpatient services.  And that is to cover a 45 minute visit with a physician, who has front desk and medical assistant help.  Overhead.  Billing.  Malpractice insurance.  Rent.  Medical benefits.  Retirement benefits.

I'm telling you, we ain't breaking even.   Not close.

And we're on the EHR now.

One key to keeping down costs is to keep patients out of the ER and inpt. side and have preventative care promoted on the outpt. side.  ER is killer on the pocketbook.  This is where patient responsibility comes in...not waiting until the condition is beyond outpatient treatment, if possible.  Diabetes is a perfect example.  Patients not taking medication (insulin), not attending diabetes education classes (not knowing carb counting or meal portioning), and not having annual eye and foot checks.  I hear my dept. physicians complain often about patient non-compliance, yet the same patient(s) come back month after month with A1C values at 10+ complaining about how poorly they feel.  Diabetes (DM II) can be managed through proper diet, exercise and sometimes medication.   The patients who make the leap to lifestyle changes are the ones who are seen less often, reducing the cost to the hospital and insurer.

Now, I have heard many stories of families not being able to pay their health care bills.  Many are well-to-do middle class families who recently lost a job and had a major health emergency or who are small-to-medium business owners with no health insurance, amongst other scenarios.  I think these scenarios of financial ruin best illustrate some of the problems with the current health care system.  For the impoverished, there are free clinics and sliding fee scales (what my office uses for those who make certain annual incomes v. # of people in the household).  Those two opportunities are not available to middle class America.  

Re: European systems, I'll look into the malpractice and negligence lawsuits in those countries against physicians and hospitals.  My guess is the % is much higher here in the US than Europe but that's just my reflection on U.S. society in general and nothing based in fact right now.
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« Reply #14 on: Jul 27, 2009 at 22:24 »

Re: European systems, I'll look into the malpractice and negligence lawsuits in those countries against physicians and hospitals.  My guess is the % is much higher here in the US than Europe but that's just my reflection on U.S. society in general and nothing based in fact right now.

I think your instinct is correct on that one.
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« Reply #15 on: Jul 27, 2009 at 23:52 »

To back up Scac's assessment - Medicare simply doesn't work as a health care system, and that's what we'll have.  Either that or the V.A. system, which if you've experienced it, probably won't sit too well with the general public either.  I can tell you with no doubt - when I was in practice, if my payor mix was 100% Medicare/Medicaid, I would not be able to keep the doors open.  Every single year Congress voted to cut Medicare reimbursement, and every single year, after much wrangling, agreed to put it back where it was and acted like they were doing doctors a favor.  Well, rent, slaries, insurance, office supplies, etc, don't stay the same - they go up.  If your income is flat, and your expenses continue to increase, doesn't take long for those lines to cross.

YOu think there's a physician shortage now?  Wait till there's a national system with no tort reform in exchange.  Then the real health care crisis will hit.

As far as quality based care goes, on the surface it makes a lot of sense.  Unfortunately, it will lead to difficulties for the sickest patients to get the care they need.  Physicians will shy away from the people with six chronic health problems who can't/won't follow treatment regimens; surgeons won't want to operate on high risk patients, etc., because those patients will make your numbers look worse.

 An important thing to remember is that while health care costs are high, and many people suffer high bills without insurance (or with it in some cases), the vast majority of those people can still get care.  The medical field is probably the least aggressive in regards to collections.  Most of the time (not all, I realize) if the patient is making an effort to at least pay something on a regular basis, doctors won't refuse to see them.  And emergency rooms legally cannot refuse to see anyone on the basis of an unpaid bill.  So while the bills aren't fun to recieve every month, people can still usually get the care they need.  Usually - I know it doesn't always work that way.

FYI, I agree that the government does some things well - Post Office as another example to add to Finny's list.  To this point I haven't seen any evidence that they can manage health care.

I'm not a big fan of private insurance by the way, in case it sounds like I am.  At least not in its current form.  What I'd like to see is a system that turns back the clock.  In our current system, we expect insurance to pay for office visits, medicines, and basically everything related to our health.  As an example, think about how much auto insurance would be if it also covered your gas, oil changes, and basic maintenance.  Or if you use your homeowner's to pay for electricity, gas, water, paint, light bulbs, etc.  So why do we expect our health insurance to cover everything?

I would like to see everyone go to policies that cover major medical only - ER visits and hospitalizations.  Cost would be significantly less.  Then, people could take the difference and have medical savings accounts to cover office visits, medicines, etc.  Then patients have much more input into the cost of their care.  If your medicines are too expensive, discuss with your doctor if there are less expensive options.  Maybe they'd be more inclined to follow treatment plans and/or make lifestyle changes to improve health and decrease their cost.  Also hopefully premiums would be lower so more people could afford them, decreasing the number of uninsured. 

I know this is all over the place, but one more thing.  One reason we aren't seeing the benefit of increased cost of care in life expectancy or however you want to measure it is that we are battling against an ever-worsening lifestyle.  We eat more, eat worse food, and exercise less than most other countries.  I think the fact that we're in the ballpark with those nations is a testament to a pretty good health care system.  We live longer than previous generations despite a less healthy lifestyle.  Why?  Better health care.
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« Reply #16 on: Jul 28, 2009 at 09:01 »

To back up Scac's assessment - Medicare simply doesn't work as a health care system, and that's what we'll have.  Either that or the V.A. system, which if you've experienced it, probably won't sit too well with the general public either.  I can tell you with no doubt - when I was in practice, if my payor mix was 100% Medicare/Medicaid, I would not be able to keep the doors open.  Every single year Congress voted to cut Medicare reimbursement, and every single year, after much wrangling, agreed to put it back where it was and acted like they were doing doctors a favor.  Well, rent, slaries, insurance, office supplies, etc, don't stay the same - they go up.  If your income is flat, and your expenses continue to increase, doesn't take long for those lines to cross.

Ok, ok, ok - no Medicare! 

An important thing to remember is that while health care costs are high, and many people suffer high bills without insurance (or with it in some cases), the vast majority of those people can still get care.  The medical field is probably the least aggressive in regards to collections.  Most of the time (not all, I realize) if the patient is making an effort to at least pay something on a regular basis, doctors won't refuse to see them.  And emergency rooms legally cannot refuse to see anyone on the basis of an unpaid bill.  So while the bills aren't fun to recieve every month, people can still usually get the care they need.  Usually - I know it doesn't always work that way.

From personal experience, that $15K bill mentioned earlier and the $1.5K portion that was mine to pay - that happened between the layoff, contract work and where I am now, regularly employed, benefits, etc.  So, I was making a good faith effort to pay that debt at a rate of $100 per month.  After about 6 mths the hospital turned it over to a collections agency b/c I couldn't pay the balance.  Gee, thanks.  That's for a patient who had good insurance, paid the copay, paid the first $300 up front for the bed, paid for all the incidentals like extra fees for catscan and x-rays, etc.

That's utter bullshit.

I know this is all over the place, but one more thing.  One reason we aren't seeing the benefit of increased cost of care in life expectancy or however you want to measure it is that we are battling against an ever-worsening lifestyle.  We eat more, eat worse food, and exercise less than most other countries.  I think the fact that we're in the ballpark with those nations is a testament to a pretty good health care system.  We live longer than previous generations despite a less healthy lifestyle.  Why?  Better health care.

One can only blame the patient so much.  Yeah, they are 100% responsible for their lifestyle and their parents are 100% responsible for their genetics.  People can live what would be considered a perfectly healthy lifestyle and still get sick.  And with our current system, if it's a major illness, BAM!, they are fucked, their family is fucked, little Joe-Bob ain't going to college, retirement is down the drain, etc.

But people do like their unhealthy food.  Hey, everyone really likes piling on the cigarette tax.  Fuck it, let's tack on a 50% McDonald's tax and at the grocery store, a 50% beef tax and a 50% butter tax and a 50% high fructose corn syrup and sugar tax.  Oh shit!  Some things are getting through the cracks - 50% deep fry tax, 50% partially hydrogenated-anything tax.  And frankly, I don't like all the genetically-modified crap.  A tomato plant started growing out my back last month but the insurance wouldn't cover treatment plus my doctor is afraid I'll sue him if he removes it.  But the tomatoes do taste better since I quit smoking, so there's that.

I'm looking into a botany insurance plan.
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« Reply #17 on: Jul 28, 2009 at 09:09 »

Forgot about the emergency room issue.  I believe Scac mentioned that much of the money gets wasted there.  But isn't that a catch-22 situation?  Why do the people go to the emergency room first?  I'm assuming it's b/c they won't get turned away for not having insurance. 

Isn't that a problem that will instantly go away if there's coverage for everyone?  Then when people show up at the emergency room with a chest cold, the doctor or nurse can tell them to fuck off and go to their primary care physician.  Win-win.
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« Reply #18 on: Jul 28, 2009 at 11:14 »

I think we're all in agreement that some sort of reform is needed.  Where we differ is what type of reform.

To answer your question jonzr re: the ER, yes and no.  IMO, if a national system comes out, it needs to push preventative care and education.  Let the PCP and specialists treat the problem prior to the condition getting so poor that an ER visit is the answer.  So yeah, I think you're right to emphasize alternatives to the ER as a way to reduce costs.

A national system that pays for "all" won't solve the ER issue.  That's because there are many illegal immigrants that use ERs for primary care services.  And I have to assume this would continue as they would be covered by a national system. 

So the ER system might not be as overloaded with a national insurance system, but there would still be many patients not covered for ER services.

Again, I realize there are valid points on both sides.  For me, healthcare is my profession...my livelihood, like it or not.  So my perspective is different.
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« Reply #19 on: Jul 28, 2009 at 11:29 »

jonzr, sorry to hear your experience re: the bill and collections.  I can understand where you're coming from.

For me, if a patient reaches out to me re: an outstanding bill, I work with the patient and billing office to set up a payment plan.  Also look into sliding fee scales should a patient be eligible.  Various pt. assistant programs available from pharm. companies.

At the same time, I have patients who complain or flat-out refuse to pay their $5-$25 co-pays.  I have no sympathy.

Re: your response to taxes, your liberatian roots finally show! Smiley  But taxes would have to be raised, on everyone, to cover everyone in the US.  There just aren't enough 1% to cover the coming baby-boomer generation.  Heck, as it stands, M'care will have a tough time surviving.

What I can see is some type of national system with private "plus" plans.  Medicare already has them with Bravo Healthcare and CareImprovementPlus being the two I see often (though, I heard CareImprovementPlus is heading towards bankruptcy).  This would allow patients to pay extra for extra coverage, increased medicine coverage/availability, etc.  

I like msdmnr's idea re: major medical only...but I see a bigger problem for ERs under that system.  What is the incentive for the patient to use/pay for PCP when they can put off their condition long enough to warrant free ER service?  I would expect many patients would rather not pay $88 for a level 4 f/u with their endo if they could wait until their blood sugar was in the 300 range and have their insulin taken care of in the ER/inpt. for free.  
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« Reply #20 on: Jul 28, 2009 at 11:44 »

It's just a big 'ol cluster f*ck. 
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« Reply #21 on: Jul 28, 2009 at 11:54 »

It's tough.  And so there is the model story that you have of your own experience that suggests things aren't currently working.

I've seen M'care in action and it isn't something to model.  M'caid takes forever to obtain eligibility for.  And patients suffer during this waiting period, as they are unable to obtain the care they need.

msdmnr mentioned the cons of quality-based pay.  And I think he's correct and it piggy-backs onto physicians' fear of lawsuits from high-risk cases.  Plenty of stories of OBs turning away women with high-risk pregnancies.
Alas, I think every payor is moving to a quality-based pay system.  So that's where we're headed.

My guess is that there is an answer, but not a perfect answer.  Some people will still not get the care they need.  Some will continue to pay more for care than others.  Physicians will choose other fields, reduce hours/availability, or follow the boutique care system (already prevelant in many areas).  The number of hospitals will be reduced as funding becomes even more scarce. 
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« Reply #22 on: Jul 28, 2009 at 12:15 »

I'm appreciative of all the input but now less hopeful than in my relative greater ignorance.  Sigh.
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« Reply #23 on: Jul 29, 2009 at 08:29 »

Well, I don't think anyone sees Medicare as the optimal model.  I don't know what the proposed Obama model is, since it appears he's having Congress do the heavy lifting.  All I know is, I think the system in place currently should be scrapped in toto.  And that's from someone with damned good insurance, co-pays, etc.  I think we can do better, more patient- and physician-friendly, more economically sound, etc., but I think we're slouching towards halfassdom.

Quote
I know this is all over the place, but one more thing.  One reason we aren't seeing the benefit of increased cost of care in life expectancy or however you want to measure it is that we are battling against an ever-worsening lifestyle.  We eat more, eat worse food, and exercise less than most other countries.  I think the fact that we're in the ballpark with those nations is a testament to a pretty good health care system.  We live longer than previous generations despite a less healthy lifestyle.  Why?  Better health care.

I know I've been on this soapbox for quite a while, but if you get a chance, see Food, Inc.  It's a nice summation of my basic polemic on the American industrialized food system.  DVD out in November. 



Msdmnr, what is your current job, if I may ask?
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« Reply #24 on: Jul 29, 2009 at 14:09 »

Love the charts at this site...

Single payer is not at the table in this discussion, and is not the same as the proposed public option...




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« Reply #25 on: Jul 29, 2009 at 14:31 »

Love the charts at this site...

Single payer is not at the table in this discussion, and is not the same as the proposed public option...



There you go, highest cost system, 37th in quality.  I'm expecting our sens and reps to act in a bipartisan manner, for the good of the people instead of their own (or party) interest, for once, and deliver a system that's a reasonable top 10 and do it for LESS MONEY THAN WE'RE SPENDING NOW.  Why less?  Because there's already too much waste.  Streamline the system, cut out the greed at the administrative level and BAM!

We need American Healthcare 2.0 sooner than later.

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« Reply #26 on: Jul 29, 2009 at 14:39 »

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Msdmnr, what is your current job, if I may ask?

Teaching college full time now.  Anatomy and physiology mainly.
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« Reply #27 on: Jul 29, 2009 at 14:52 »

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Msdmnr, what is your current job, if I may ask?

Teaching college full time now.  Anatomy and physiology mainly.

I'm hoping you don't get the amount of Engrish that Pens does...

BTW, when I die, I'll have 'em send you my liver.  Great for show and tell.

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« Reply #28 on: Jul 29, 2009 at 15:46 »

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BTW, when I die, I'll have 'em send you my liver.  Great for show and tell.

Cool, we've got a pig liver in the freezer.  It'll be a good lab to compare.

Hopefully the pig liver hasn't been pickled with Nyquiltinis.
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« Reply #29 on: Sep 17, 2009 at 05:08 »

If government health care reform passes, put Pittsburgh right back on the "dying cities" list.

Besides, if the federal government can't even execute "cash for clunkers" properly, then why the hell would we want them playing around with a chunk of our gross national product?
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« Reply #30 on: Sep 17, 2009 at 15:40 »

Forgot about the emergency room issue.  I believe Scac mentioned that much of the money gets wasted there.  But isn't that a catch-22 situation?  Why do the people go to the emergency room first?  I'm assuming it's b/c they won't get turned away for not having insurance.  

Isn't that a problem that will instantly go away if there's coverage for everyone?  Then when people show up at the emergency room with a chest cold, the doctor or nurse can tell them to fuck off and go to their primary care physician.  Win-win.


It should infuriate you to know how your tax dollars get wasted in the ER.  First, it's not just the uninsured that use the ER as a primary care clinic...it's the medicaid and medicare population.  On most days, if you come into our ER...I will have you out the door in less than 40 minutes if we don't run tests.  Our closest pediatrician is about 30 miles away (yes we are very rural).  So, the medicaid population uses our ER as a pediatric clinic because they don't want to drive...and they don't want to wait (2 hour wait times at the pediatrician).  We can't turn them away.  So, Joe taxpayer pays a $500 visit instead of a $75 visit for a simple sore throat.  $500 for pharyngitis?  That's nuts and so wasteful.  We have no recourse...there is no motivation for these people to change their habits.  

The ER is a haven for those who like to seek narcotics and are looking for a jackpot judgement.  We must practice defensive medicine...and that raises costs.

Make people accountable for how they use the ER, pass tort reform, require health insurance and health spending accounts for everyone, and eliminate primary care clinic coverage.
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« Reply #31 on: Sep 17, 2009 at 15:53 »

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If you weren't one of those then don't take offense.  But it's a simple fact that some medical doctors do accept kickbacks to push certain drugs on their patients.  This is part of the problem.

I don't take any offense, but I think that problem is an exceedingly small percentage that doesn't significantly impact the bottom line.

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I didn't say anything about limiting drug company profits.

My mistake, misread it.  Insurance is a big issue I admit.  However, more control governmnet has, more money for fat-cat politicians to "reappropriate."

Even many Democrats say reform won't happen without more money/increasing deficit.  If more revenue is needed, I tend to favor what I call "optional" taxes.  Two examples:  raise cigarette tax - let those who smoke pay more for increased costs due to smoking related illnesses.  Don't want to pay - quit smoking and your health care costs will likely go down also.  Second, if you want more taxes from wealthiest group, is a luxury tax.  Add 5% to cost of vehicles over 50K, boats, high end TVs, etc.  If you don't want to pay, don't buy the item.



Exactly, how many physicians are willing to risk prison and loss of license for a few bucks?  It has to be an extremely small percentage.  I can't imagine that being a huge problem.
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