How SHOULD Health Care Work?

[Ani Ibi]

Originally Posted by vern humphrey

... if someone comes in with a sore finger, you don't put them up in a hospital room and feed them for the rest of their lives. There is a limit...

We had this problem up here in Canada for a bit. Folks with head colds were checking into emergency rooms and clogging up the system while folks with heart attacks were being forgotten in the corridors.

Now we have a phone-in service to a nurse practitioner who will then refer the caller to the emerg or simply tell the caller what to do at home until he or she can see the family doctor in the morning.

[emily47017]

vern, your idea to bill the state for ER services is one place to start... but that's the very least efficient use of your tax dollars. get everyone to a PCP early and we all save money in the end.

universal coverage doesn't mean people won't be able to make decisions about their own health care. it means that the immediate expense won't be such a looming factor in their decisionmaking. when you're living hand-to-mouth, it's hard to take the long view financially, even if you know perfectly well that preventive care is cheaper than emergency care.

[vern humphrey]

Originally Posted by emily47017

vern, your idea to bill the state for ER services is one place to start... but that's the very least efficient use of your tax dollars. get everyone to a PCP early and we all save money in the end.

Yep. Your mission, should you choose to accept it, is to round up all 12 million undocumented aliens for their checkups.

As always, should you or any member of your team be captured, the Secretariat will deny all knowledge.
[quote=emily47017;2435111
universal coverage doesn't mean people won't be able to make decisions about their own health care.[/quote]
Actually, it does -- as was pointed out in the case of Bill Clinton's heart surgery, if his wife's health care plan had passed (and if he had been an ordinary American), he would have been put on a waiting list and died before receiving surgery.
[quote=emily47017;2435111
it means that the immediate expense won't be a factor in their decisionmaking. when you're living hand-to-mouth, it's hard to take the long view financially, even if you know perfectly well that preventive care is cheaper than emergency care.[/QUOTE]
And how do you propose to change that? Have the poor who can't pay anything forced to have checkups? Who will pay for it? Congress has steadly resisted preventive checkups in most cases in virtually all government-run health plans.

[DrPiano]

Originally Posted by vern humphrey

Yep. Your mission, should you choose to accept it, is to round up all 12 million undocumented aliens for their checkups.

As always, should you or any member of your team be captured, the Secretariat will deny all knowledge.

Actually, it does -- as was pointed out in the case of Bill Clinton's heart surgery, if his wife's health care plan had passed (and if he had been an ordinary American), he would have been put on a waiting list and died before receiving surgery.

And how do you propose to change that? Have the poor who can't pay anything forced to have checkups? Who will pay for it? Congress has steadly resisted preventive checkups in most cases in virtually all government-run health plans.

Actually - universal coverage (everyone has health care) is NOT equivalent to a single-payer system (government or otherwise). If my memory serves me correctly (I was fairly young at the time) Hilary Clinton's idea was a single-payer system. Others here are suggesting universal coverage in a multipayer, market-driven system.

Sick people footing the bill for their expenses actually does seem just and right to me. They are the ones using the services. When I get sick and use the emergency department (or any medical services for that matter), I pay for them.

FYI - I'm in favor of tightening security at our borders and deporting illegal immigrants. I'm all in favor of legal immigration - obey our laws (including on how to enter our country), respect us, and do your best to integrate into our society if you want to live here.

Don't make an incentive to use emergency services. If the government pays for everyone to use the ED then what would be the incentive for ANYONE to use a primary care physician. Paying for the ED is one way to use tax dollars - but is it the wisest way? Does it give us the best return on investment? I respectfully submit that it does not. Helping people get health plans that cover ED visits might be better... And I agree with emily47017 - the wisest return on our investment would be to figure out a way to encourage people to get plans that pay for preventive care - and that pay for keeping chronic illnesses under control. Am I advocating forcing people to have these plans? NO. But I would suggest that perhaps a middle ground - such having at least a minimum insurance that would pay for things like ED visits- might be a wiser investment of US Tax Dollars.

[vern humphrey]

Originally Posted by DrPiano

Actually - universal coverage (everyone has health care) is NOT equivalent to a single-payer system (government or otherwise). If my memory serves me correctly (I was fairly young at the time) Hilary Clinton's idea was a single-payer system. Others here are suggesting universal coverage in a multipayer, market-driven system.

All such systems founder on the same rock -- "Why shouldn't I go to the doctor for my hangnail? I pay the premiums, don't I?"

That drives costs up. The counter to that is regulation -- which generates paperwork, which drives costs up. It also sets prices -- as one doctor said to me, "If I know the insurance company will pay $100 for a particular treatment, why would I ever charge $95?"

MSAs work by motivating people to bargain for health care and to avoid over-consumption.

Originally Posted by DrPiano

Sick people footing the bill for their expenses actually does seem just and right to me. They are the ones using the services. When I get sick and use the emergency department (or any medical services for that matter), I pay for them.

I agree -- I don't expect the hospital to pay for my car, laundry, rent and so on!! I pay that myself.

Originally Posted by DrPiano

FYI - I'm in favor of tightening security at our borders and deporting illegal immigrants. I'm all in favor of legal immigration - obey our laws (including on how to enter our country), respect us, and do your best to integrate into our society if you want to live here.

And I agree -- except for one thing:

How many 40-passenger busses would it take to deport 12 millino people. Allowing 60 feet per bus, and 100 feet between busses, how long would the column be? At 55 mph, how long would it take for that column to pass an intersection?

Originally Posted by DrPiano

Don't make an incentive to use emergency services. If the government pays for everyone to use the ED then what would be the incentive for ANYONE to use a primary care physician. Paying for the ED is one way to use tax dollars - but is it the wisest way? Does it give us the best return on investment? I respectfully submit that it does not. Helping people get health plans that cover ED visits might be better... And I agree with emily47017 - the wisest return on our investment would be to figure out a way to encourage people to get plans that pay for preventive care - and that pay for keeping chronic illnesses under control. Am I advocating forcing people to have these plans? NO. But I would suggest that perhaps a middle ground - such having at least a minimum insurance that would pay for things like ED visits- might be a wiser investment of US Tax Dollars.

The problem is looking for a solution where it isn't -- like the drunk looking for his car keys under the lamp post because that's where the light is.

How will you care for the indigent? What do you propose for the illegal who comes into the emergency room with a fractured leg?

The current answer is, "The other patients must pay for it." Is there a better answer?

[emily47017]

Originally Posted by vern humphrey

And how do you propose to change that? Have the poor who can't pay anything forced to have checkups?

you missed my point. most people want to make responsible decisions about their health care. if checkups, routine tests, management of chronic illnesses and early detection of progressive illnesses are all available free or at low cost, that's going to save us all boatloads of money in unnecessary ER visits.

as it is, if i have $15 to spare this month, i'm more likely to spend it on milk, peanut butter and a couple pounds of vegetables than on the copay for a doctor's appointment to check out that shortness of breath i've been having... maybe i'm just allergic to something and it'll go away on its own. or maybe it'll turn out to be congestive heart failure. the best investment for taxpayers is to help me do both: buy food and get that symptom checked out before it sends me to the ER.

[vern humphrey]

Originally Posted by emily47017

you missed my point. most people want to make responsible decisions about their health care. if checkups, routine tests, management of chronic illnesses and early detection of progressive illnesses are all available free or at low cost, that's going to save us all boatloads of money in unnecessary ER visits.

Oh, I don't miss the point at all.

I ask, "Who's going to pay for it?" And how?

Originally Posted by emily47017

as it is, if i have $15 to spare this month, i'm more likely to spend it on milk, peanut butter and a couple pounds of vegetables than on the copay for a doctor's appointment to check out that shortness of breath i've been having... maybe i'm just allergic to something and it'll go away on its own. or maybe it'll turn out to be congestive heart failure. the best investment for taxpayers is to help me do both: buy food and get that symptom checked out before it sends me to the ER.

And how will you change that?

[emily47017]

see my first post on this thread.

[vern humphrey]

Originally Posted by emily47017

see my first post on this thread.

Okay:
eliminating the health insurance industry means implementing one of two existing solutions: a government run system (a la britain), [/quote]
We talked about this -- if Hillary's plan had been implemented, and Bill had been an ordinary citizen, he'd have died on the waiting list for heart surgery.

Government run systems neither hold down costs, nor do they provide better care.

Originally Posted by emily47017

or a single-payer insurance system (where there are copays, premiums and whatnot, but it's all funneled through one not-for-profit organization).

Kind of like the Post Office.

Let's see the hands of everyone who wants to turn his healthcare over to the Post Office.
[quote=emily47017;2435395]
the outrageous cost of health care in the US can be mitigated by:
cutting out the middle man![/quote
That's essentially what MSAs do.

Originally Posted by emily47017

digitizing medical records and making them available to providers anywhere in the country

That would be a violation of HIPPA (the Health Insurance Portability and Privacy Act) as written. And I really don't see any great cost savings there -- help me out. Where do the savings come in?

Originally Posted by emily47017

promoting a cultural shift within the health care community away from new/shiny and toward tried/true, AKA evidence-based practice

Or as they say in Canada, "Our government provides us with the best medical technology available in the 1970s."

Originally Posted by emily47017

providing the best preventive care possible (this has to go way beyond the yearly physical -- smoking cessation, weight loss, vaccination, proper management of chronic conditions, early detection of acute conditions, etc.), which means, i'm sorry to say, providing it for free.

Nothing is free. Someone must pay. Who do you see paying for this?

[emily47017]

Originally Posted by vern humphrey

Kind of like the Post Office.

no, the post office is government run and more analagous to my first option.

That's essentially what MSAs do.

it's not. the financial agency managing the MSA is a middle man. also, you've said yourself that MSAs wouldn't be sufficient for catastrophic situations, and we would need private insurance for that.

MSAs don't alleviate the problem of avoiding preventive care; if you're rolling leftovers into an IRA, you'd even be able to rationalize by saying "i'm saving for retirement!"

Where do the savings come in?

in eliminating wasted time (in getting information to deal with whatever ailment is presenting) and man-hours (in processing the same paperwork a thousand times in a thousand different doctor's offices).

[vern humphrey]

Originally Posted by emily47017

no, the post office is government run and more analagous to my first option.

Not any more -- it's a non-profit chartered public corporation.

Originally Posted by emily47017

it's not. the financial agency managing the MSA is a middle man.

No more than a bank -- and it isn't a middle man in the medical field -- it doesn't make any rules about what I can do with my MSA.

Originally Posted by emily47017

also, you've said yourself that MSAs wouldn't be sufficient for catastrophic situations, and we would need private insurance for that.

Yep -- but that would reduce the insurance impact on costs by over 90%

Originally Posted by emily47017

MSAs don't alleviate the problem of avoiding preventive care; if you're rolling leftovers into an IRA, you'd even be able to rationalize by saying "i'm saving for retirement!"

MSAs won't prevent a comet from hitting the earth, reverse global warming, or raise the average mileage of the auto fleet.

But they will go a looooong way to controlling costs in the medical industry.

Originally Posted by emily47017

in eliminating wasted time (in getting information to deal with whatever ailment is presenting) and man-hours (in processing the same paperwork a thousand times in a thousand different doctor's offices).

I haven't seen a thousand doctors in my whole life.

Nor does every doctor see the same patient for the same complaint -- so the same paperwork has to be done in every doctor's office anyway -- for each patient, for each visit.

Now if we keep our present insurance-ridden system, or go to a government-paid system, then I can see some advantage. Insurance claims can be transmitted electronically. But we already do that.

[emily47017]

vern, it sounds to me like you're brand new to the concept of single-payer insurance. perhaps you would find the answers to your questions at the physicians for a national health program website: http://www.pnhp.org/facts/singlepayer_faq.php

[vern humphrey]

Originally Posted by emily47017

vern, it sounds to me like you're brand new to the concept of single-payer insurance. perhaps you would find the answers to your questions at the physicians for a national health program website: http://www.pnhp.org/facts/singlepayer_faq.php

Quite the contrary. I am well aware of the theory -- and the pitfalls -- of single-payer insurance.

[manualman]

I really like the Canadian joke. It actually illustrates emily's point. Why NOT do like I originally proposed and have a BASIC universal health care system modeled on Canada's for preventative and routine care, tab picked up by the taxpayer.

BUT, don't take it to the extreme they have. Retain a modified version of our current private health care system (modified to use MSAs and proportionate copays) for the hospital stuff? Yup, the rich still get the very best care, but they also finance the ADVANCE of medical science. In 30 years, perhaps Clinton's procedure will be routine and the rich folks will have funded the discovery of an even BETTER form of treatment only available to them-for a while.

P.S. Don't kid yourself. If Hillary had gotten her way, well-connected guys like Bill would STILL find ways to butt in line in front of us peasants!

[vern humphrey]

Originally Posted by manualman

I really like the Canadian joke. It actually illustrates emily's point. Why NOT do like I originally proposed and have a BASIC universal health care system modeled on Canada's for preventative and routine care, tab picked up by the taxpayer.

How would we do this?

Originally Posted by manualman

BUT, don't take it to the extreme they have. Retain a modified version of our current private health care system (modified to use MSAs and proportionate copays) for the hospital stuff? Yup, the rich still get the very best care, but they also finance the ADVANCE of medical science. In 30 years, perhaps Clinton's procedure will be routine and the rich folks will have funded the discovery of an even BETTER form of treatment only available to them-for a while.

I'm still unclear of that the government will pay for, and who will benefit.

Originally Posted by manualman

P.S. Don't kid yourself. If Hillary had gotten her way, well-connected guys like Bill would STILL find ways to butt in line in front of us peasants!

That is my point, exactly. As I said, if Bill were an ordinary citizen, he'd die on the waiting list.

When you starve with a tiger, the tiger starves last.