What are the suggestionsn on healthcare?

[dblack]

Hmm... I'm not sure if that's supposed to answer my question or not.

In any case, I agree that health care providers should be working on better 'systems' that provide a lower-cost, higher-value service. The principal problem is that they have no incentive to do so. We've allowed the entire health care industry to regulate itself out of all sane market pressures.

We've created a 'system' that insulates patients from financial concerns. For the most part, you either don't have insurance and you can't afford the inflated costs at all, or you do have insurance and you don't really care what the doctor is charging - because you're not paying.

That's what I find most disturbing about your perspective. The preoccupation with 'payers' seems to rest on the assumption that there are only two ways to pay for heath care - insurance or government. That is THE problem in my view, and fixing it entails removing the aspects of the 'system' propping this up.

The missing piece in all of this (and why there is no meaningful incentive for providers to implement the kinds of reforms you suggest) is a motivated health care consumer. As it is, patients have virtually no incentive to look for bargains, and doctors have virtually no incentive to provide them. This calls for two reforms that I don't see in your list. First, we need to remove all the tax and regulatory policies propping up employer-provided, low-deductible, group health insurance. It's a failed model and is only hanging on because of the privileges afforded it by state intervention. Second, we need to remove the regulatory cruft preventing people from seeking better alternatives.

This is fundamentally different than the systemic approach (as you've defined it). It is based on the notion that, left to their own devices, people are rational. Ultimately, we can't afford what we can't afford, and health care providers - if they want to stay in business - will find a way to provide health care at prices people can afford. But only if we let them, and only if the people getting health care are the ones paying for it.

 

[lizzie]

My suggestion on health care is a repeal of the HMO legislation of the mid-70's, and require people to pay for their own physician office visits and prescriptions. Use insurance only for catastrophic and hospitalization coverage. This would bring more of the free market into the equation and help reduce costs.

 

[Greenbeard]

That's what I find most disturbing about your perspective. The preoccupation with 'payers' seems to rest on the assumption that there are only two ways to pay for heath care - insurance or government. That is THE problem in my view, and fixing it entails removing the aspects of the 'system' propping this up.

Third party payers are not going away. As has been pointed out many, many times, health spending is incredibly skewed: less than a fifth of Americans spend more than ~$5,000 on health services in a given year (i.e. amounts that would certainly put one over the deductible in a high-deductible plan, at which point relatively comprehensive insurance coverage kicks in), yet they account for nearly three-quarters of national health expenditures.

That said, what you're talking and what I'm talking about are not mutually exclusive. Indeed, a melding of the concepts--a system of "smarter cost sharing" that seeks to harness both the advantages of managed care by a payer and those of consumer direction--is increasingly viewed in some corners as the direction of the future. Two good articles espousing the view are "Reviving Managed Care with Health Savings Accounts" and "Consumer-Driven Health Care: Promise and Performance."

The conclusion of the latter article in particular is worth quoting here:

Health care should be consumer driven for reasons of both efficiency and ethics. When in possession of adequate information and faced with appropriate incentives, consumers make better choices for their own health than does any third party, be that third party motivated by the most praiseworthy of intentions. Moreover, as a matter of ethics, it is the patient and consumer, not the physician or insurer or employer or regulator, who should be vested with the right to make tradeoffs in the emotionally and sometimes spiritually charged domain of health care.

That said, one must acknowledge that consumers often need support if their choices are to promote their well-being and constraint when they are spending other people’s money. Health care is complex at best and not infrequently rife with nontransparent, anticompetitive, and even fraudulent behavior on the part of the many self-interested agents. Individual consumers can benefit from some of the efforts by governmental and employer sponsors, health insurance plans, provider organizations, and medical management programs. Consumers need others to create meaningful products and processes from which they can choose—bundles of products and services that can be measured, priced, purchased, and used not only by the highly educated and motivated individual but by those who are sick and scared, of only modest means and financial sophistication.

The blind spot in the consumer-driven analysis of market performance concerns the importance of coordination in insurance, delivery, and sponsorship. The obdurate insistence on á la carte choice and retail purchasing pushed the theorists of consumerism into positing organizational and market dynamics that have not been observed in the real world. The important issue is not, however, the current status and structure of health care and health insurance but the trend into the future. It seems safe to say that insurance product design will continue to move toward consumer-driven elements and that managed care elements will be recrafted into forms in which consumers choose but are subject to incentives structured by insurers. Enrollees will have more information but also more financial responsibility at the time of receiving care. Products will continue to proliferate and differentiate to accommodate the preferences and purses of potential enrollees. Health plans will specialize in data collection, aggregation, and analysis that can be used not only to support patient choice but also to evaluate provider and product performance through registries, observational studies, and clinical epidemiology.

As it moves further along the consumer pathway, health insurance is likely to strengthen rather than weaken some vestiges of its managed care heritage, especially the development of programs seeking to improve the care of enrollees along the spectrum from full health to dire illness. These include preventive and wellness programs for healthy enrollees, service coordination for patients needing acute care, disease management for enrollees with chronic conditions, and intensive case management for enrollees with severe conditions. These likely will be presented as options rather than mandates, consistent with the consumer-driven ethos, although perhaps with higher cost sharing for those who are eligible but choose not to participate. What is unclear, over the long term, is the extent to which more choice for consumers will prevent health insurers from being able to continue to offer the steep discounts they currently wrest from their provider networks.

The market is no more stuck on first-generation high-deductible insurance products and individually purchased coverage than it was stuck on HMO products and employment-based sponsorship models under managed care. The market continues to pioneer hybrid forms that incorporate elements of both managed care and of health care consumerism. We can name the emerging system “managed consumerism” or “facilitated consumerism,” or we can find some more felicitous phrase.30 The important point is that for choice to be meaningful, it has to be choice among meaningful options, and meaningful options need to be designed, built, and managed.

 

[peterson121]

For me, that is to provide jobs for the unemployed citizens so that they can afford the hospital bills.

 

[Euro]

State ran health care. From

Want to see the per capita costs of health care decrease drastically in this country? There's a pretty simple solution. TAKE CARE OF YOURSELF. Many of our health care costs are the direct result of things people voluntarily do to themselves. They smoke, they don't exericise, they're over weight, they don't eat right.

Government can stimulate this through consumption taxes. E.g.aggressive taxing on cigarettes,fat food,candy,chips etc. Tax cuts on healthy food like fish,vegetables,fruit etc.

 

[dblack]

According to me the health care is very important for us.We have to take some steps for the health care first of all we have to take the health insurance.Allow insurance companies to compete state line. More competition = lower prices.Lower medical malpractice insurance costs, and dished out 99% of medical malpractice litigation. Fucks surgeon is not to blame, because the customers know the risk.

What's the deal with not putting spaces after sentences? The 'very large brain' guy who started posting a couple of days ago was doing the same thing. Is this the common practice on your planet?

 

[mskafka]

derp...

1. Allow insurance companies to compete over state lines. more competition = lower prices.
2. Lower malpractice insurance costs for doctors and throw out 99% of malpractice lawsuits. A doctor that fucks up a surgery is not to blame because the customer knew the risks.

Medicine should be like any other business. Doctors should compete and insurance companies should compete.

Problem. Solved.

Okay, while I'll agree that there needs to be tort reform, we also don't want a lot of incompetent providers walking the halls of hospitals. I've seen more than one patient killed from incompetent providers...at every level. Now the amount of litigation that we have at the moment is ridiculous; but do you want a doctor of questionable knowledge and skill getting ready to cut you open?