Seriously thoughtful American Health Care

[nanotube]

Originally Posted by formerroadie

Thanks for the link. I will have a listen. Anyway, in terms of debate, our system wouldn't be the same. Part of that has to do with the idea of a central database. That is the main issue there. For example: a person comes to a doc with flu symptoms. That doc says you have the flu. That persons goes for a second opinion. Then they go for a third. They don't have a way to track how many doctors people have gone to (I sat with a Canadian doctor on a plane to BC once and asked him what he thought was most problematic about the system. That was his answer.). This can be remedied by a central computer system that allows doctors anywhere to access your data (as long as there are strict security measures and it is not hooked up to the internet. It needs to be self-contained) or you charge a small co-pay, which would hinder a lot of people form going doc to doc. I think we, as Americans, can do that .

Not sure if I'm misunderstanding your idea. I'm not sure having a central database is doable at all. I work at a non profit healthcare company and we constantly struggle with putting different sets of data together from different physician offices. To be honest its just impossible. And mind you, this is just ONE healthcare group. Imagine when you want to expand it throughout the country....crazy/wrong/useless healthcare data will be flowing around the "database".

Of course, I agree that having such a database would help a lot, at least we wont have 10 sets of data from the same freaking patient. There are too many electronic health records in the US that its just impossible to implement such a central database idea.

[brecklundin]

Originally Posted by Halk

As I understand things in the USA there is very basic healthcare for all. On top of that anyone can purchase a separate plan, although most people buy into corporate schemes which are significantly cheaper.

In a word...no.

I cannot obtain health insurance period no matter what the price. Well, there is a program (actually a very limited lottery type program) in each state where people in my situation can obtain rather expensive coverage that ends up costing as much or more than the treatments needed for me to simply function daily. Or about $12,000/yr out of my pocket minimum...for something I was born with and for which no cure exists. And any current meds which might potentially (tried over a dozen so far in my life and none have done anything, this is not unusual for my situation) help are far more dangerous than living with the 24/7/365 pain.

And consider this, my disease was Dx'd at 9yrs old (41yrs ago) and prevents me from being able to work for someone else for multiple reasons, not the least of which is I do not know from hour to hour, let alone day-day if I will be able to work or even get out of bed. So, I work as a consultant instead. But, even that is getting harder to do every day. So, no shot at group coverage via some AmeriCorp anyway...

I had a longer answer, but you know what? It matters not at all...

[formerroadie]

Originally Posted by nanotube

Not sure if I'm misunderstanding your idea. I'm not sure having a central database is doable at all. I work at a non profit healthcare company and we constantly struggle with putting different sets of data together from different physician offices. To be honest its just impossible. And mind you, this is just ONE healthcare group. Imagine when you want to expand it throughout the country....crazy/wrong/useless healthcare data will be flowing around the "database".

Of course, I agree that having such a database would help a lot, at least we wont have 10 sets of data from the same freaking patient. There are too many electronic health records in the US that its just impossible to implement such a central database idea.

It is actually part of what Obama wants to do. Electronic medical files. I have a feeling there will be a proprietary database with a proprietary set of software that each office has.

[formerroadie]

Sorry Breck! This is a major reason I'm fighting my heart out for health care reform. Stories like yours kill me because, in the richest country in the world, your story should never happen.....

Originally Posted by brecklundin

In a word...no.

I cannot obtain health insurance period no matter what the price. Well, there is a program (actually a very limited lottery type program) in each state where people in my situation can obtain rather expensive coverage that ends up costing as much or more than the treatments needed for me to simply function daily. Or about $12,000/yr out of my pocket minimum...for something I was born with and for which no cure exists. And any current meds which might potentially (tried over a dozen so far in my life and none have done anything, this is not unusual for my situation) help are far more dangerous than living with the 24/7/365 pain.

And consider this, my disease was Dx'd at 9yrs old (41yrs ago) and prevents me from being able to work for someone else for multiple reasons, not the least of which is I do not know from hour to hour, let alone day-day if I will be able to work or even get out of bed. So, I work as a consultant instead. But, even that is getting harder to do every day. So, no shot at group coverage via some AmeriCorp anyway...

I had a longer answer, but you know what? It matters not at all...

[nanotube]

Originally Posted by formerroadie

It is actually part of what Obama wants to do. Electronic medical files. I have a feeling there will be a proprietary database with a proprietary set of software that each office has.

Oh, I see. Then they are probably going to ask physicians to submit structured data files to some central database. I am very supportive of this idea but it's a looooooooooooooooooooooooooong way to go.

I like the concept of healthcare reform...however I'm not sure if there's a way to reduce cost when every single entity involves in healthcare wants MAX $$$ in a limited pool of funds.

[JohnClif]

...and healthcare 'reform' (as opposed to true reform).

Here in the USA we have government-run healthcare programs: Medicare, Medicaid, and the Veterans' Administration (VA) for military and ex-military who are retired. Medicare and Medicaid are going broke. The VA has an unfortunately well-deserved reputation for delivering substandard medical care... and it's going broke, too. The less said about the pathetic government-provided health care on Indian ('native American') reservations, the better.

In short, the government hasn't proved that it can run ANY health care system. Accordingly, many people (like me) are very reluctant to let them control a functional, working (albeit problematic) health care system that does provide excellent health care for the majority of Americans. Congress agrees, and will exempt itself from any health care bill passed.

A second issue is pragmatism. You can either have universal health care, or you can have top-notch health care, but you can't have both. Why not? Because universal top-notch health care is unaffordable. Other countries handle the cost issue by rationing, e.g., the UK. Given the choice between a government bureaucracy deciding who can get treatment, or being able to decide based on ability to pay (the market), I'll go with the market.

As several people have mentioned, the indigent get free health care. The rich and the insured get health care. Those people in the middle, the working class without insurance, face financial disaster if they get a debilitating disease or get severely injured. But even then they get treated. I recently read about a 23-year-old person without insurance who got leukemia. He was treated and cured (remission for more than 5 years), and the hospital waived the bill because they knew he wouldn't be able to pay. This is one reason why health care is so expensive in America; we really do treat everyone and raise the bills on the people who can pay (or their insurance companies) to keep the hospitals solvent. I dated a pharmacist who told me why a single Tylenol tablet is $70... the few tablets that are paid for cover the costs of the numbers that are dispensed for free.

I, and I believe most Americans, would support health care reform that included letting insurance companies compete across state lines (they can't do this currently), include tort reform that caps damages to real damages only (no pain and suffering), and I would even support a subsidized catastrophic health care option for everyone (a policy with $2k deductible, paid for by a $50 per taxpayer per year tax regardless of income, but that covers everything else, so if you get in an accident or get cancer you're covered). This eliminates much of the costs associated with the current health care system... people going to hospital emergency rooms for non-emergency treatment because they don't have insurance... yet covering everyone against the cost of catastrophic illness. I'm sure the insurance companies would step up to fill the gap between 0 and $2k. To me, this is about the best we can hope for. The government also needs to streamline Medicare and Medicaid paperwork because the overhead adds considerably to the price of a patient visit ($30 or more just to process the paperwork per visit).

The reason why I'm against the public option is that the government will price this so low as to kill private insurance even though the government will be losing money... and then private insurance won't be available AND the program will go broke leaving none of us with insurance. We see symptoms of this with Medicare and Medicaid today, where doctors aren't being reimbursed at a high enough amount to cover their costs... and so many doctors have stopped accepting patients covered by these programs.

Many talk about health care and how it should be considered as a right that everyone is entitled to. The problem with this is that, unlike the negative rights that are guaranteed in our Constitution, positive rights like the right to health care and the right to employment put a financial burden on others. Is it right to forcibly confiscate money (which really represents a portion of our lives, the time we spent earning that money) from one person and give its value to another? After all, taxes aren't voluntary. If you don't pay them, the IRS comes to collect, with guns... and they will shoot you if you resist. Sounds more like robbery than charity, doesn't it? And, if health care is a right, then what about food and water? We all MUST have sustenance daily or we will die. Why aren't these free? The answer is, a need does not create a right, and redistributing wealth even for a good cause is unconstitutional. This is the principled reason why many are against government-run health care; the ends do not justify the means.

I hope this gives some insight into the health care debate here in America. There's no bad guy... no evil insurance companies, or hospitals, or greedy doctors. One side sees the good in providing health care to everyone at government expense, the other side wants to know how on Earth we can afford to pay for it.

[ahammer]

also I would like to bring up like all new tech.. along with lots of new medical procedure start out at a really high cost. r and d needs to be paid off also as time goes buy we find better lower cost ways of doing things we have done before.

cost comes down over time. this is done in steps so that as the companys will get more customers but each one is paying less.
starts out with only the really rich being able to have it.. then the modrly rich.. then the low end rich. high middle class so on.

so things right now that are only for a rich in 10 to 20 years becomes somthing for the masses.

with gov care there is a clift where the price you can sell it at drop off.
this could lead to company holding of on this tech to just privet care till the point they can get the cost down to the lowest price point possible .

not sure if that is really clear.. may try to reword that tomorrow.

[ggareau]

A second issue is pragmatism. You can either have universal health care, or you can have top-notch health care, but you can't have both. Why not? Because universal top-notch health care is unaffordable. Other countries handle the cost issue by rationing, e.g., the UK. Given the choice between a government bureaucracy deciding who can get treatment, or being able to decide based on ability to pay (the market), I'll go with the market.

Honest question. Since I'm Canadian, I've been following the US healthcare thing fairly closely (because you really can't get away from the american media here) and for the life of me, I can't figure out the whole "rationing" concept. Using the textbook definition of "rationing," Canada doesn't ration, and has a "top-notch" system depending on how you view it.

So, in short, what do you (Americans using the word in this debate) mean by rationing? I honestly cannot figure it out.

[GeoffC]

Originally Posted by brecklundin

And consider this, my disease was Dx'd at 9yrs old (41yrs ago) ...

One reason why the UK's National Heath Service is good (sometimes), it'll continue to look after you .... at least most of the healthcare is free.....

[Angst]

Originally Posted by ggareau

Honest question. Since I'm Canadian, I've been following the US healthcare thing fairly closely (because you really can't get away from the american media here) and for the life of me, I can't figure out the whole "rationing" concept. Using the textbook definition of "rationing," Canada doesn't ration, and has a "top-notch" system depending on how you view it.

So, in short, what do you (Americans using the word in this debate) mean by rationing? I honestly cannot figure it out.

As close as I can tell, they are referring to long waiting lists for some procedures. The procedures, (I think MRIs are given as an example), are not available "on demand." When your position on a waiting list corresponds to your need for the procedure, rather than your ability to pay for the procedure, this constitutes rationing.

It's political spin mostly.

[Nate the great]

http://www.slate.com/id/2227082/?from=rss

[Mycropht]

I believe one of results of the present health care system in the US is general insecurity among a large part of the population. If we view a society as an organism, and even if we don't, that is quite a bad thing not only for health of an individual but also for health of the society. E.g., it is simply wrong to give people financial option of getting a basic dental health care or not (e.g. I will have my tooth taken out because I can't afford to have it saved). The government is damaging health of the nation by allowing that. How big would be direct costs of providing basic dental treatments for everyone? How big are indirect costs of not providing it?

On the other hand you are running the world's most powerful military machine in existence. Can you really afford it? Does that make you feel more secure than a better health care system would? A half of your present military costs would probably be enough to keep you equally secure as today. Since you would have to cut some (shady) global policemen adventures maybe it would also cut the percentage of people hating your guts. For a quarter of your military costs (saved in the previous step) you could have the best public health care system in the world. The remaining quarter would be enough for making USA the best place on this planet and for a few manned trips to Mars. Since this is a Mobile Read forum we should not forget free e-book readers for everyone.

[ggareau]

Originally Posted by Angst

As close as I can tell, they are referring to long waiting lists for some procedures. The procedures, (I think MRIs are given as an example), are not available "on demand." When your position on a waiting list corresponds to your need for the procedure, rather than your ability to pay for the procedure, this constitutes rationing.

It's political spin mostly.

See, that's what I thought. That's a huge misrepresentation.

[ggareau]

Originally Posted by Nate the great

http://www.slate.com/id/2227082/?from=rss

That's how the Canadian system works, actually. And it works just fine.

[PKFFW]

Originally Posted by Nate the great

http://www.slate.com/id/2227082/?from=rss

I'm not sure how a flawed "pricing system"(for want of a better term) indicates that a single payer system wouldn't work?(by single payer I'm assuming you mean public health care system?)

It seems to me that the only change required would be to look more closely at how we value services and act accordingly. Of course that would require the people within the system actually putting the needs of the patient first, which is highly unlikely if do so is going to affect their hip pocket.

Cheers,
PKFFW