Health Care Reform

Discussion in 'Miscellaneous' started by andypalmer, Jan 21, 2010.

  1. andypalmer

    andypalmer Active Member

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    Location:
    Baltimore, MD
    Starting a new thread to avoid cluttering up the MASS senatorial election result thread.

    Here's my collection or random thoughts on health care.

    There should be health maintenance plans. These plans require you to have x number of check-ups and tests per year, an annual (or more often, depending) full physical. Intent here is to catch major stuff early and take preventative steps and overall monitor health. Idea is that the longer you're in and following the plan, the cheaper it gets. Don't follow the instructions, your payments go up.

    Medical Malpractice doesn't belong in the courts. Doctors should pay into a fund managed by the state medical board. Any malpractice claims are brought before the state medical board who judge what happened and, if applicable, hand out financial rewards to the victim and penalties to the offending doctors (fines, suspension of license, etc.). Key thing is that medicine isn't a perfect science and as long as gross errors weren't made, if the doctor if following accepted practices, then if something bad happens, in most cases that's the risk that the doctor explained when you signed the consent form. As oversight, a state agency can act as an escalation point, with the ability to suspend and remove any "dishonest" members of the state medical review board.

    There should be a means for everyone to get urgent/emergency care without large out of pocket expenses. Whether it's a fund everyone pays into, whether its an interest-free/low interest medical loan thats available, or somesuch, no one should be forced to forego basic care because they can't afford it.

    People should not be able to be denied health insurance due to pre-existing conditions. Yes, their premium would be higher, but denial should not be permitted.

    Medical School cost should be subsidized by the goverment. This does away with the huge student loans that doctors are stuck with. In return, they must spend X number of years working in a government run medical facility. These hospitals and clinics will provide a core set of facilities around the country to help ensure everyone has access to medical care. These facilities will take all insurance, but the government will get to dictate the rates to insurance companies, to ensure costs are covered (which isn't always the case today). Private practices will be able to use the government rates or negotiate for their own. Doctors would be able to "buy themselves out" of their obligation, but at a premium (I'm thinking 150%-200% of cost).

    The duration of medical patents for medicine should be extended. This will allow companies to charge less as they'll be able to recupe their costs over a longer period of time before "generics" corner their market.
     
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  2. HatterDon

    HatterDon Moderator

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    I can't find a single point you've made that isn't well thought out, nor can I disagree with the logic behind any of them. I think all of these points, as well as all the point brought out by Congressional Democrats are worthy of bi-partisan consideration in writing the health care bills. Debate of those points and responses along the lines of "you have a good idea there, but have you considered this" from the other side of the aisle would have resulted in a better balance of what is needed and what can be afforded.

    It's a damn shame that Congressional Republicans chose NOT to make any contributions towards crafting the bill, nor did they show any interest in debating it. Governance is so difficult -- especially when one's nation is in a crisis [or 12] -- and it's so much easier to go on FoxNews and say "Socialist Obamacare wants to kill your granny!"

    Keep these up, ap. If you post something that I think is unrealistic or harmful, I'll say so. So far, though, I just want to buy you a beer.
     
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  3. stlouisbrad

    stlouisbrad Active Member

    Joined:
    Nov 24, 2007
    Andy, that was so well thought out and put together. Bravo! If only more of the discussions regarding politics and the issues on this website were as well constructed as that.
     
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  4. pettyfog

    pettyfog Well-Known Member

    Joined:
    Jan 4, 2005
    Ditto.. and I mean EXACTLY!

    but then....
    umm okay.. but WHAT exactly of the Dems 'additional points'?
    Especially easier when funding for abortions comes into play.. and when End of Life Advisory panels are mandated.
    And when any issue or change brought up in committee by Republicans is ignored. Gee, how did Don forget about that.. oh, yeah... that wasnt covered by MSDNC.
    Or maybe it was all that vernacular on the chambers floors about those evil insurance companies getting rich by denying treatment, ignoring the REAL facts that Medicare denies as much or more than the HMO's do... but hey, that's only Docs saying that.. whatta they know!
    Well, me too... and again, thanks for putting up what I think are the key points.

    Continuing coverage is key! I think your wellness programs are a little unrealistic at the moment, but we arent far from the point where actual real Screening using blood and fluid analysis goes a helluva long way toward early finding of cancers, to say the least ...and tech ought to be able to soon find heart and lung disorders without needing a million dollar machine to do it.
    - - - -- - - -- - - -- - - -- - - - -
    Oh, by the way... you DO know that immediate treatment for urgent problems, regardless of ability to pay, has been available for sometime, right?
     
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  5. andypalmer

    andypalmer Active Member

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    Treatment's not the issue; it's when you get the bill in the mail...it then goes to collections, destroys your credit rating, etc. etc. For some people (I was one of those in my early 20s), even a $100 doctor's visit fee is more than you can afford so, since you don't want to get a knock on your credit rating, you just "self-treat."

    On the current health care mess in the capital, I think blame belongs on both sides of the aisle. The Dems thought their majority could force through their agenda and the GOP were generally happy to watch the President's major platform fall flat on its face. Those members of both parties who tried to honestly reach a good agreement were in the minority.

    Also - thanks for the kind words from all. The fact that both Don and 'fog think its a good idea is a pretty good political litmus test :)
     
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  6. Clevelandmo

    Clevelandmo Active Member

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    Sep 13, 2007
    Nice thread AndyP. Here are my thoughts:

    We should provide basic healthcare coverage for everyone, but a budget, bare-bones version. No joint replacements, no dermatologist visits for normal acne, no psychiatry visits for people who are sad but functioning fine in daily life, no tests for rare diseases to cover the doctors' asses, no abortions, no cushy hospitals, etc. The world-class, cadillac healthcare that many Americans have become accustom to is simply too expensive to cover all Americans. If people want those "optional" things, they can buy supplemental healthcare insurance - themselves or their employer can provide them – or pay out of pocket.

    The above means that there would be a huge demand for general and family practice physicians. We already have a shortage of these so I like ideas like AndyP’s for medical school to be subsidized in return for service. I also would favor paying certain specialists a general physicians salary to take a year or two off to get board certified in internal medicine or general pediatrics. I’m assuming there would be an excess of specialists so this would address that and the need for general internists.

    One exam/year unless there is a necessary medical reason for more or for a specialist exam. I don’t agree with Andy’s idea of penalties for not getting annual preventative exams. I think the benefit of preventative exams and care in terms of health care cost reduction is overrated for two reasons. 1) some people will never comply with the doctors orders so you can spend the money to make them go but it doesn’t mean it will do any good. 2) studies have shown that over the lifetime of a patient, it is actually the healthy people that end up costing the most. This is because these people live longer and end-of-life care is the most expensive. If people want to overeat, neglect exercise, smoke, over drink, avoid the doctor, then let them. Their penalty is bad health and chances are they will cost less over the course of their lifetime.

    We need electronic medical records for everyone. A doctor or healthcare worker should be able to access the record of any patient they are treating from any place in the country. This will lower medical costs by eliminating duplicate testing, enabling quicker and more accurate diagnoses, and reduce the number of medical accidents. It will also allow doctors to identify things like drug addiction. The data (data only; no identities) from these records should be accessible by medical researchers; this would be invaluable for improving treatments and finding new cures. It is the equivalent of the barcode for consumer and retail businesses.

    I totally agree with Andy’s idea about medical malpractice suits other than I think it might be better to have the courts determine the damages awarded to victims in the event the Medical Board has found a doctor guilty of malpractice. However, the board should make all decisions regarding a doctor’s license.

    The exception to my bare-bones coverage for all is people in the military, police officers, firefighters and others who serve in a similar capacity to protect the rest of us. They would receive a higher class of medical coverage, especially for things that would allow them to continue to serve. I would consider putting teachers in that category also.

    The basic coverage for all could be paid for by the government through insurance companies that are contracted by each health care institution. That way each healthcare provider only has to deal with a few systems of billing. Right now, many healthcare systems need 2 billing specialists for every three doctors. Supplemental insurance would be chosen and purchased by individuals or employers, but a universal coding and billing system would be standardized and simplified. Medicare and Medicaid would be able to compete with the insurance companies for all this business. If they are good they will get some of it (if they are not, they become obsolete) especially since most healthcare organizations are familiar with them. The VA stays in its current form.

    No more advertising by drug companies. They can have drug reps/experts that only educate healthcare professionals. I don’t know if this will bring drug costs down but at least I wont have to sit through Viagara commercials anymore.

    50% tax on cosmetic surgery and cosmetic treatments. If you look at doctor’s income, plastic surgeon incomes are almost always among the highest even though many of their procedures are not covered by insurance.

    Award each individual a one-time free elective procedure if they sign-up to be an organ donor. Similarly, you could institute a health care credit system where people with low medical costs can donate credits or save them up for an uncovered procedure.

    The FDA and the European regulatory agency should combine into a single body for drug and medical device approval and regulation. This would lower the cost and time to bring new medical treatments to patients in the US.
     
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  7. andypalmer

    andypalmer Active Member

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    Location:
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    Mo.

    - I agree on the basic coverage point. Everyone should have access to basic coverage - how to pay for it and who pays for it are the open items.

    - regarding the extra health care cost of healthy people, my counter argument is that healthy people pay more INTO the health care system than non-healthy people, at a proportional rate that more than compensates for their more expensive late-life care. Those with medical issues miss more work and their condition often impacts their ability to advance their career. From my "liberal" economic view perspective, healthier citizens are more productive members of society than non-healthy ones. Also, I wouldn't want Health Maintenance to be the only plan, just another option, alongside Health Insurance. The point being is that those who follow the doctor's orders should be rewarded.

    - I like the better/cheaper coverage for emergency services and military employees.

    - While I dislike the viagra and cialis commercials as much as the next guy, I don't see that as sufficient justification to limit the free market. Plus some of the advertising by other medicines are actually good consumer education. I would add, though, that I don't consider treatment for ED to be "basic care" so if basic insurance didn't cover the prescription cost, I wouldn't lose any sleep.

    - My only caution about taxing cosmetic surgery is that sometimes, it's not necessarily what I would call "elective" - i.e., burn victims, assault victims, birth defects. While I'm OK with a surcharge on elective cosmetic surgery (the money should go to the overall public health care funding), there would need to be defined exceptions.

    - I would rather award *healthy* organ donors with reduced health care costs or tax breaks; any other benefits runs of risk of running into the "selling organs" business (i.e., if I become an organ donor, you'll give my wife the surgery she needs).

    - I like the FDA/EU combined effort idea. Having an international body handle this would be good all around.
     
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  8. andypalmer

    andypalmer Active Member

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    A couple I missed

    - electronic records - good idea.

    - courts handle awards after board rules malpractice - I'd be ok with a Judge doing it, but not with a Jury; imo the award of financial recompense should be an objective decision, not a subjective one.
     
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  9. HatterDon

    HatterDon Moderator

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    My only comment on Mo's ideas are how does one determine whether there is a real need for psychiatric care or of the person is "just sad." And does "just sad" include clinical depression? Post-partum depression? How DOES a doctor diagnose "just sad?"

    Good stuff from everyone so far. I'd vote for a significant amount of each set of ideas I've seen.

    More please!!!!
     
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  10. Clevelandmo

    Clevelandmo Active Member

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    Sep 13, 2007
    I know from first hand experience that the Brits can do what I suggested with post partum depression. They are ranked as one of the best in the world at treating post partum. The midwives there see plenty of cases, but they only treat the ones in which the depression is preventing the mother from taking care of herself and her infant. Of course, this is easier for them to do effectively because their post natal visits are in the mother's home so they can see things first hand. In the US they have a questionaire for post partum. Pretty much any woman who has just had a baby is going to fail that questionaire at some point.

    I think psychiatrists, for their own benefit, have taken advantage of a social movement in this country to take mental illness more seriously and to remove the stigma. They are over treating and over diagnosing common disorders like depression and ADHD. Both of these conditions have been around since the beginning of man. They are a normal and natural part of life and they can often be managed with time and lifestyle changes (and in the case of ADHD vigilant parenting). But in our instant gratification society, we want to reach for a pill to make anything disagreeable go away, rather than face reality.

    For a universal healtcare system, I think we should treat depression like a fever or poison ivy rash - only the severe cases require special treatments. Psychiatrists should spend their time on the serious and truly debilitating conditions like bipolar disorder, schizophrenia, addiction and severe depression.

    Don, pretty much everything I suggested is a slippery slope, but if you are going to cover everyone, you can either bankrupt the country or cover everyone imperfectly - IMHO.
     
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  11. pettyfog

    pettyfog Well-Known Member

    Joined:
    Jan 4, 2005
    Well, to answer Don, first:

    Know anyone doesnt exhibit some signs of 'depression'?
    I don't. In fact I suffer from it, too. But sometimes the best treatment is nothing more than knowing you got it. And in the mid nineties I finally realized we all do.
    For instance one doc put me on Paxil, then another when I disclosed the classic side effects of that drug decided I was bi-polar and wanted to put me on lithium.

    I gave the guy a five minute verbal middle finger -because I had actually DONE my homework on Paxil, and he hadnt- and walked out, then started to wean myself off it. I felt much better.

    That doesnt exactly answer Don's concerns but I think it puts a little light on the problem.
    - - - - -- - -
    I, too, think that tort malpractice should stay in the courts, Cant just cut loose all those 'John Edwardses' on an unsuspecting public they'll only find another scam system.
    Limit damages awards to 3X costs, as discerned by judges.
    - - - - - -- -
    Much as I advocate states rights, a lot of insurer costs are related to having to offer plans based on state requirements. There certainly is some cost associated. Find a way to create base plans that are available nationwide.
     
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  12. Clevelandmo

    Clevelandmo Active Member

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    Sep 13, 2007
    I'll concede to your wisdom on the first point.

    On the second point no - please make the couple sitting in separate bathtubs holding hands on a hilltop go away.

    On the third point, I agree. Burns, accidents, serious birth defects would not be considered cosmetic and would not be taxed. I am only talking about taxing procedures that are completely cosmetic such as injections, face-lifts, breast implants, etc.
     
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  13. andypalmer

    andypalmer Active Member

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    If we had national standards for health insurance, then I'd be ok with national plans, but I am strongly opposed to insurance companies being able to "sell over state lines" (it's one of the major reasons I didn't vote for McCain) - that would just lead to all insurance companies moving to the state with the least consumer protections and we'd just all get screwed.

    I do agree that we're over prescribing psych meds. That said, it's not safe for my wife to go without her anti-depression meds for as long as 4 days.
     
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  14. HatterDon

    HatterDon Moderator

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    Mo, I agree. You don't need psychiatrists diagnosing post-partum depression if you have mid-wives doing post-natal home visits. A mid-wife would certainly be able to recognize this problem quicker than a psychiatrist or a GP -- even a "family doctor." If we had this, I'd be very happy with it.

    In this country, however, I don't think we have a lot of mid-wife visits. As a matter of fact, the last I heard the AMA was trying to stamp out midwifery in this country altogether. Also, I'm not sure that the majority of health care plans call for home visits of any kind.

    I must say that while I'm very happy with my government-run health care, I have no idea about how they deal with PPD, ADA, or clinical depression. We have no kids, and I'm a pretty happy guy.
     
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  15. pettyfog

    pettyfog Well-Known Member

    Joined:
    Jan 4, 2005
    Health Prem Costs to go up

    Evidently the Science is Settled:
    Mandated Mental Health Parity

    That'll mesh nicely with a House Proposal to repeal Insurer's Antitrust exemption

    Sure.. that sounds good. After all when it was enacted, the biggest player by far was Blue Cross. Now there's many more companies offering health insurance. What could possibly go wrong?

    Hint: Listen to the insurance commercials closely.. 'not offered in all states'.
     
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