Our Healthcare System

Something that has been troubling me lately is the overall state of our healthcare system. On one hand we have the best in the world if you have insurance and one the other hand you have big problems when it comes to people without money and insurance. If our healthcare issues were left up the CPF to solve then what would be your solution. I in NO way want to turn this into a political debate but would rather keep this to what's fare and reasonable for our country.

Hear is a short list of issues. (maybe you can add to this list)

The price of our health insurance keeps going up.
The uninsured are often charged extortionate amounts.
Unnecessary bankruptcy for many.
The legal issues and law suites.


Some suggest that the government completely socialize health care and others suggest market-based solutions but both seem to have problems. If it's socialized then do you put limits on what you spend on an individual to keep that person alive? What's the life of an indefinitely hospitalized 85 year old man needing 800 dollars of medication a month worth? Is that too much and should society just let him pass? What do you think should change? Should healthcare be a right? Again please do not turn this into some kind of political debate.

Insurance and drug companies are of the most profitable businesses in the USA. They both give some of the largest donations to politicians and have the most expensive lobbyists. Healthcare is COMPLETELY politicized. The terms healthcare and justice systems are oxymorons.

Healthcare problems are this nations #1 security threat. The money spent on the Iraq war may have been enough to cure cancer or a host of other diseases. Today, healthcare in the USA = politics; they MUST be separated before costs can be contained.

Healthcare cannot be addressed WITHOUT a political debate.

Re: Our healthcare System

As a pharmacist I can tell you what is wrong with system from my point of view. INSURANCE COMPANIES. A very simple explanation. One of my customers called in one day with a refill for his Pravachol 80mg. Knowing his insurance was expired I processed it as cash- I believe the price if I remember it correctly was $498.50. Now if I brought that rx to counter and said "that will be $498.50"- where would you tell me to go. But he gives me his new card and pays $20 for it.

You have removed any price to benefit ratio that ever existed. An easy way to explain the situation in a retail pharmacy: when a drugs sales goes down- the price goes up. Where else do you see a manufacturer raise prices when their sales go down?

Would people get rid of their insurance cards- no way. So it will continue this way.

Look at this from a pharmacist's point of view. Supposedly you "negotiate" with insurers for a fee. In reality you must take what they offer or they will go to a store that does. Pharmacists are in short supply and they will remain that way- who wants to go to school for 6 years to make ~80,000 with no upwards path, work weekends, work without overtime, sometimes without lunch breaks, supper breaks. Stress levels will only continue to get worse as insurers regulate everything; half my time is spent just talking or arguing with insurance companies.

Re: Our healthcare System

Well I think (my opinion, I don't have research to back it up) that regulation, and much like ronrph said, a lack of a "sense of value" in the medical insurance consumer. People complain about outlandish drug costs, and how much they pay for lobbyists, and profits, but stop and consider for a second that in the US most new drugs are a result of private research (again I think so anyway). Private research takes money, in order to get more people to invest money you really need to show returns so yes they are profitable, and yes they lobby in their favor who doesn't? But the drug industry in the US is also HEAVILY regulated, the FDA requirements for gettting a new drug to market are extremely rigorous, this provides "safety" per consumer demand but in the process you drive up the price of anything that must undergo that process. So do you want safe or less expensive? In a slightly different direction with all of the lawsuits over mistakes, and I don't deny that those mistakes cost people their lives and or quality of life in many circumstances, but the lawsuits have driven the costs of many medical related services and products up due to the need for insurance. So again, you can have "safe" or you can have less expensive.
The second point is that consumers don't see the value in what they are "buying". We are victims of our own wants, we wanted lower more managed payments in the form of insurance plans, but as we get lower prices we consume more, then prices have to go up because insurance is based on probabilities, much like a bookie, sure they get a cut but they aren't making profits anything like the markup in jewelry. So as consumers, consume more, insurance companies need to collect higher premiums etc.. to cover the costs. So here you have the dilemma of do you want more predictable spread out costs? or control your own spending and perhaps spend less if you don't use services as often or more if you really need services. I personally know of several cases where doctors charge much less for someone without insurance largely because they don't have to deal with all the paper work and rules etc... (My parents don't have insurance)
One last point, some increase is natural, it's all part of inflation. (I know I know, healthcare costs are going up much more than inflation, but let's just keep some of that in mind)
I'm not so sure the system needs real change other than the consumers being more educated about how things really work. But if I had to do something I think I would look at reducing the regulations and doing something to limit the liabilities some in order to give companies/providers a chance to lower their prices.

Re: Our healthcare System

man...don't even get me started. I must say I completely agree with all of the above posts. To live in the greatest country and have such a crippled healthcare system....unspeakable. As an insured employee of a company, I would rate my insurance pretty good. But that is simply based on what healthcare used to offer. It seems every year our premiums increase and our coverage decreases. Now I pretty much have to ask the insurance company what type of service or treatment I need because it seems as though they disregard what my doctor says because its not within their guidelines.

A couple of years ago, my wife and I went through infertility. The process was somewhat cut short because of insurance. We figured we could pay for it ourselves. I went to purchase a 5 day supply of medicine for my wife. The pharmacist said"that will be four thousand five hundred dollars!!!! "For a five day supply?" "Yes". I walked out and haven't considered fertility since. And those numbers didn't even include the process itself, that was just the meds.

I've noticed in Florida many doctors are now going without malpractice insurance. Althoug this is extreme, I applaude them for making a stand. Until we get insurance out of the medical field, prices will continue to skyrocket, We will simply loose more doctors and healthcare will continue to take a downward spiral.

Re: Our healthcare System

US taxpayers heavily fund drug research. Much of the expense comes from advertising, buying political advantage and double digit profits.

Re: Our healthcare System

pays to try and stay healthy

Re: Our healthcare System

I think some major problems are:

1) Malpractice insurance premiums are sky high and driving up medical care costs, this is driven by too many lawyers and patients looking to strike it rich with huge malpractice settlements. We would all benefit from reform in this area.

2) The insurance companies administering the health care plans are creating a huge overhead expense on the system. We have to pay to support the legions of these administrators and the health care providers have to bring on a lot of extra staff to fight with the insurance company administrators. We pay for that also. These administrators also have too much control over who gets what care. They are making medical decisions without medical degrees. I am very reluctant to ever say that the government should take over the administration of any private sector activity because they usually can't do it as efficiently, but in this case, they couldn't possibly do it worse. We need some reform in this area.

3) Many individual consumers of medical care tend to overconsume because there is little direct cost out of their pocket for each individual service. An ideal system would retain the incentive for consumers to evaluate the value of a service vs. its cost. This can only be done if people have to reach into their own pockets to pay for stuff rather than paying for it all up-front in huge insurance premiums (remember that less than half of the premiums are spent on actual medical care, the rest is wasted in administration). To do this, you would have large deductables and the insurance would mostly be for catastrophic expenses. To a great extent this will lower premium costs, allowing people to have more money available to them to pay for these greater out-of-pocket expenses and this accomplishes two important things: 1. it encourages consumers to really evaluate the cost vs. the benefit of the care and 2. it removes insurance administrators from handling that portion of health care expenditures, reducing the huge overhead cost of their participation.

4) Clearly, the fact that many people are uninsured and insurance is hard to afford is a big problem. A national system would take care of that, or some other good reform.

5) Costs are going to go up if medical capabilities are always going up. That is just math. There is always some new, expensive procedure that is being introduced, and paying for the use of it requires new money that was not needed before it's introduction. As long as there is a benefit to the new procedure that justifies it's cost, this is a good thing on the whole.

6) Yes, we waste money on hopeless cases. We keep people alive for long periods of time who have no real medical hope of recovery. We perform expensive surgeries such as transplants on people so old and medically fragile that even the patient realizes they will never recover from the procedure. I have heard that we spend more than half of our healthcare dollars during the last year of a patient's life. There are some difficult ethical and moral problems to solving this one, but if you compare the US to any other country in the world, you will see huge differences. Maybe we can learn how to improve this by looking over our boarders.

7) Our healthcare mentality is geared more to the heroic salvation of critically ill patients rather than to preventing disease and keeping people healthy in the first place. It is cheaper to advise a low-fat diet and exercise to a 20-year old than to give him a heart transplant at 50. We need to focus more of our resources on the prevention and less on heroic procedures. Our current insurance system rarely pays for prevention.

8) The health care industry lobby is the most powerful lobby in Washington. There are actually more health care lobbiests than there are Senators and Representatives. It is as if every member of congress has his own personal full-time health care lobbiest. That, combined with the enormous campaign contributions means that health care is one special interest that carries a lot of clout.

If you consider how these problems are creating huge problems in our healthcare, but also all have possible solutions, you can see that real potential exists for improvement. What we need is leadership.

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jayflash said:
Insurance and drug companies are of the most profitable businesses in the USA. They both give some of the largest donations to politicians and have the most expensive lobbyists. Healthcare is COMPLETELY politicized. The terms healthcare and justice systems are oxymorons.


Healthcare problems are this nations #1 security threat. The money spent on the Iraq war may have been enough to cure cancer or a host of other diseases.



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So, since Healthcare is completely politicized, and the money was spent on Iraq, are you saying that the healthcare lobbyists brought about the money being spent on Iraq instead of being given to them to research cancer cures???

I wouldn't dispute that healthcare is politicized, of course it is, by its high quality nature (which we demand) its a high capital product. ANYthing that has that much money at stake, and the emotional boot of sick children to be pulled out and used when necessary is going to have a lot of people pushing to have it go their way. Nothing conspiratorial or sinister about it.

My solution is one that I personally would find quite painful. Healthcare has been allowed to rise to the level of cost that it has because for a majority of people, someone else has been paying it ie. insurance, medicare/medicade, government research grants. Since we've been insulated from the cost there's been no market force to check rising costs. Since the bills have been handled by professional payers (insurance companies etc.), entities whose price tolerance far exceeds that of individual consumers, prices have risen beyond what the consumer can handle without a professional payer. Meanwhile, individual consumers with such benefits have enjoyed the illusion that healthcare is cost free and have demanded more and more frequent services, and better drugs and technology.

The "problem" (such as it is) is that a lot of good has come from this unfettered money flow. As stated above, our medical care is the best in the world, miraculous by standards as recent as fifty years ago. And we've become used to this level of care and technology, some even consider it a constitutional right...

Professional payers took care of and hid the inevitable cost of such healthcare for as long as it could but now costs are rising beyond what they can handle and there is no "super-professional payer" to pick up like the insurance companies did for the individual consumer decades ago. So obviously the rise of the cost of healthcare has to be checked.

Government provided coverage would only exacerbate the disassociation between cost and demand, and add a level of bureaucracy that would make current insurance companies look streamlined. Legislative mandates capping costs will only serve to drive the resulting unprofitable companies from the market, without addressing the other half of the problem, consumer demand. The only solution to address both must be market based. This solution is happening to a degree already, start returning some of the cost to the consumer through higher co-pays,paycheck contributions to health insurance, and medical savings account plans. This has the effect of easing the judgement of the consumer back into the equation.

Will it solve the problem in the next five years? No, it took us decades of having someone else pay our bills to get us into this pickle, any solution that doesn't break the country will take nearly as long. We've had it good for a very long time, and we've benefitted through miraculous advances in science and improvements in quality of life, but we have to acknowledge the reality of what this costs.

good replies.

one thing that i disagree with is the idea that somebody else is paying for my insurance.

I am paying for my insurance. it is a benefit, and i take a lower pay scale so i can have it (we pay less as a large group). therefore, i am paying for it (though my employer contributes as well).

i would be making 160% of what i make now if i did not take benefits.

just an FYI.

Bob

Personally, I like what the Aussies have done with their systems. Sure the taxes may be high, but I think it pays for itself. It would be interesting to hear from some of them on this topic.

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pedalinbob said:
good replies.

one thing that i disagree with is the idea that somebody else is paying for my insurance.

I am paying for my insurance. it is a benefit, and i take a lower pay scale so i can have it (we pay less as a large group). therefore, i am paying for it (though my employer contributes as well).

i would be making 160% of what i make now if i did not take benefits.


Bob

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Yes, but that is only because you are in effect in a quasi-pyramid scheme. You aren't paying what it actually costs. You may be paying what it cost for you right now if you're a healthy young male with reasonably good luck. But if you're a sixty year old cancer patient, your care including bloodwork, MRI's, physician and nurse care and expert consultation, chemo, hospital room space, prescriptions etc etc. can cost actually many many thousands of dollars a year more than you ever actually paid through your benefits. That cost is only able to be paid because there are a bunch of healthy people elsewhere in the system paying more in than they are currently using. IOW, your payments don't go into an account with your name on it for later use, they're being used to pay a portion of a more expensive person's bill. The system works if enough of the young people die before they start costing more money than they contribute. Nothing sinister in that, its a perfectly legitimate method of paying for care that's more expensive than a single person could otherwise pay. However it also effectively hides the actual cost of medical care from us because by the time we're getting the expensive stuff, we're not paying the hundred thousand dollars it costs, a bunch of younger healthy people entering the system are.

The "problem" is that these dang sick people are living longer and they're consequently requiring more of the expensive care seniors need, thereby reducing the ratio of younger contributing workers to older healthcare consumers. Actually its a good problem to have, societal quality of life-wise, but it still disguises actual healthcare costs from the consumer, thereby systemically encouraging its inflation.

Re: Our healthcare System

Excellent points, Lurker. You pretty much wrote exactly what I would have about this problem. I'll just elaborate on two points you made:

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3) Many individual consumers of medical care tend to overconsume because there is little direct cost out of their pocket for each individual service. An ideal system would retain the incentive for consumers to evaluate the value of a service vs. its cost. This can only be done if people have to reach into their own pockets to pay for stuff rather than paying for it all up-front in huge insurance premiums (remember that less than half of the premiums are spent on actual medical care, the rest is wasted in administration.


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I might add that this would also encourage people to take better care of themselves since much of the medication and treatments insurance pays for are for entirely preventable conditions.

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7) Our healthcare mentality is geared more to the heroic salvation of critically ill patients rather than to preventing disease and keeping people healthy in the first place. It is cheaper to advise a low-fat diet and exercise to a 20-year old than to give him a heart transplant at 50. We need to focus more of our resources on the prevention and less on heroic procedures. Our current insurance system rarely pays for prevention.


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I blame the insurance system for not paying for prevention but at the same time I also blame a lifestyle that results in larger numbers of people becoming unhealthy. I would say the automobile beyond anything else is to blame for our health woes. First, it promotes a largely sedentary lifestyle since it offers door to door transportation. Second, air pollution from automobiles creates a whole host of health problems, including causing many cancers, asthma, and other health problems. Poor air quality also causes people to spend less time outdoors exercising. Third, injuries and deaths from automobile accidents cost a huge amount in medical costs.

After automobiles I would say diet is another big cause of health problems. Overeating and eating the wrong foods contribute to a national obesity epidemic along with all the associated health problems that brings. Even worse, we now have children starting their lives overweight. Unless something is done this will eventually incur enormous costs.

Ultimately, I think a solution is to have health insurance accounts rather than the current system of employer and individually paid insurance. There are no administrative costs since you simply take money from the account when you're sick. You have an incentive to remain healthy and avoid unnecessary procedures because of the finite money in the account. You can use some of the funds in the account to buy catastrophic insurance coverage but other than that it would be entirely a user pays system. This would ultimately bring down the costs for most common medical procedures. It would also end the enormous numbers of malpractice payments since there would no longer be enough money in the system to cover those.

In the absence of what I suggested, it might be a good idea for insurance companies to refuse payment for illnesses caused by preventable conditions such as obesity, or for diseases like AIDS which are 100% preventable by avoiding certain types of risky behavoir. If a person is overweight, give them a reasonable amount of time to lose the weight, and refuse to cover them if they don't lose it by the end of the grace period.

One thing is clear-the current system doesn't work. As a nation the US spends more per capita on health care than any other country yet has large numbers of people in very poor health.

Re: Our healthcare System

jtr1962, I agree with your comments and I would generalize them even further by observing that relative to the majority of the world's population, Americans are very wealthy and that wealth gives us the luxury of leading sedentary lifestyles with an abundance of food always at our fingertips. This has obvious health consequences. And as you observed, almost everyone gets a car and that has a host of health consequences, as does unlimited access to cigarettes, alcohol, drugs, etc.

The wealth also gives us access to world-class health care and the combination of the two (unhealthy lifestyles & ability to pay for healthcare) means that we are going to consume a lot of helathcare and therefore pay a lot for it. Finally, the better the helathcare, the more we are able to live very long lives in relatively poor health, thus creating even more demand for healthcare.

In a sense, it is American wealth itsself that is driving the problem at a very basic level.

Of course this comment is more about lifestyle than it is about our healthcare system, and it is more realistic to improve a system than to change a culture. But is is important to know that improving a system is harder when you are working against the current of cultural forces.

Re: Our healthcare System

Here's my spin on all of this as a healthcare worker: The American idea of healthcare is mainly an after-the-fact fix for a problem.

With all the super surgeries and the like, we've become experts at putting out fires--in reality, we should have just kept the greasy rags away from the fire in the first place! We need to involve people in health maintenance. We need to prevent illness. Improving diet and exercise can go a huge way in preventing many common chronic illnesses! The saying is still true--an ounce of prevention is worth a pound of cure.

I'm actually having a bit of a problem adjusting to my new position in a civillian hospital. When I worked for the government, care was provided for our patients, and we did what was best for the patient at the time. For the most part, I wasn't concerned with dollars and cents beyond what we were budgeted because I knew that the people I was taking care of were getting what they needed.

Now, in the civillian sector, I'm working with many people who I know will have trouble paying for their care. I know that they will be billed for huge amounts of money for everything that I recieve orders for. I know many of the people I'm sending home with prescriptions will be making decisions about whether to buy their medicine or to buy more nutritious food. All the good I did throught their stay will be ruined because of financial difficulty. Even with gvt. and case worker assistance, many of these people will end up back in the hospital weeks later for the exact same thing.

This system sucks. It's depressing. Big changes are needed, and government intervention may not be the cure, but it can't get any worse. Just have the govt. compensate the hospitals for what is done and let people recieve the care they need.

Re: Our healthcare System

Well here are my two pennies worth.

I agree that the system needs repair but it saddens Me and flat out scares Me when I see people getting on high horses talking about denying healthcare to people that suffer from conditions that the person on the high horse do not suffer from. How much is some one's life worth? regardless of age or condition could you walk up to some one and tell them they will get no care because you belive their life is not worth the expense? Even if that said person was 85 and drying from cancer but wished to fight to the end could you pull the plug against his/her will? There are other things to concider above monetary cost. These are people! not hunks of equipment that have a crossing point to where it's no longer worth the cost of maintance. I personally fear and would fight against a system that would deny treatment baised on an arbatary age or if some ellitist in an office far away belived that your "problem" could have been prevented. There are other ways to fix our system and still have the level of care that we are known for with out going down this road.
I do tend to sway to a type of tort reform to help ease the insane amounts people are awarded for malpractice lawsuits. sure there may still be some that demand that level of pay out but it's my belief that most don't.
One thing that I do my self that might help if more did this was to buy your own medication if a over the counter
one works just as well. I have bad heart burn(go figure a dragon with heart burn)and was on Nexium for treatment, I discovered that one bottle was 90+ bucks. I paid 20, the inshurance paid the rest. I now use Prilosec OTC and pay for that my self at a slightly higher cost but that removes a bit of load thats not passed on to other people.
Anyway thats My 2 pennies for now.

My name is Draco Americanus and I approve this message.

Re: Our healthcare System

The decline of our healthcare system will be sheilded by rationalization after rationalization. In the thirties, if visitors to Moscow asked why so few of the citizens wore glasses they were invariably told that the Russian diet was so superior to that of the rest of the world that fewer of their citizens NEEDED glasses.

The socialization/democratization of healthcare in the States is unstoppable. It cannot be turned around. The only positive thing is that as more time passes fewer will remember that it was once much better.

Re: Our healthcare System

right now, i'm pretty lucky. when i moved out and went to school, i qualified for Maine State Insurance. i have an absolute zero copay for prescriptions and appointments. when i was still on my mother's insurance it was a $20 copay.

i haven't had any surgery/rehab, etc since i've been on the state insurance, so i'm not sure how smoothly it will pay out. time will tell.

but i'm dreading the day my credentials disqualify me for the state insurance and i'll have to seek out a plan.

on the old Blue Cross/Blue Shield plan, i was perplexed by the costs of my tonsilectomy and wisdom teeth removal. not to mention when my asthma would get bad and the ER-then appointments-then follow up appointments chain would start and things got very expensive (can i live???!!?).

right now @ 20 years old, i'm mostly in the dark about insurance and the like. i only know enough to comprehend how inferior our system is to say, Europe's, or even Canada's.

it's that whole "you're not a patient, you're a customer" thing.

Re: Our healthcare System

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BlindedByTheLite said:

right now @ 20 years old, i'm mostly in the dark about insurance and the like. i only know enough to comprehend how inferior our system is to say, Europe's, or even Canada's.

it's that whole "you're not a patient, you're a customer" thing.

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I would not be so fast to say that and would also disagree.
As many problems our system has I would still take it over what they have in canada and europe. I have family in canada and they compliane endlessly about the wait to see any one and the crappy care when they do get to see some one.
There system does have some good points that I belive We should addopt here but to say it's better I belive that to not be true.
One thing that I have been hearing about is Europe may have some realy bad problems paying for their health care system due to the aging workforce and smaller younger workforce that needs to pay for it all, along with a low birthrate. Just like our welfare and ss system thier needs to be a min amount of working people to pay for it all.

Re: Our healthcare System

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Draco_Americanus said:
...and they compliane endlessly (in Canada) about the wait to see any one and the crappy care when they do get to see some one.

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I have standard health insurance and even I have to wait weeks to get an appointment /ubbthreads/images/graemlins/jpshakehead.gif

As an example, in the military healthcare system, I could go on sick call in the morning and be seen by a Primary Care Provider within hours. I can leave that afternoon with a folow-up appointment scheduled with a specialist and my medication and it wouldn't cost me a dime.

Granted, that's a big difference and it's not an expectation of what a federal system would be like, but it's an example of what I've seen.

The funniest thing I see out of this is that curently I would need to go through my insurance company to schedule and approve an appointment weeks in advance with a physician that I work with on a daily basis. /ubbthreads/images/graemlins/icon6.gif