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njlauren -> RE: What is the solution? (11/17/2013 5:41:20 PM)
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quote:
ORIGINAL: igor2003
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Okay, I haven't read all the way through this. In fact I've only read the first half-dozen posts, so I don't know what has been said or not said. I don't have much time this morning, so I'm just going to throw my 2 cents in and let them fall where they may.
About 3 months ago my mother fell and broke her hip. $1200 just for the 15 minute ambulance ride to the hospital. Health care costs in all areas is outrageous. She had to stay in a nursing home/rehab facility for about 3 weeks. Her co-pay alone was $50 per day.
For years, the American people have wanted something to be done about the rising cost of health care. My own feeling is that they did not want "forced" insurance. They wanted AFFORDABLE health care. Now, personally, I don't like Obamacare, but I'm glad that someone has finally tried to do something. I wish it had been a bipartisan project. I think that the give and take in negotiations would have ended with a better bill. I wish they would have consulted more with the American people to find out what they really want and what would really work for them before drafting this monstrosity. Hopefully, over the next few years changes can be made to the bill to make it more people friendly.
Now, what is the solution? Unfortunately, there are no easy answers, but I think the health care system needs overhauled from the ground up. Today's health care isn't driven by any desire to actually heal people. Health care professionals and pharmaceutical companies make more money treating symptoms rather than actually fixing problems.
I have no idea whether the following is true or not, but it does make sense. I heard that there are at least some outlying villages in China where the village doctor is paid by healthy people. They pay him a certain amount each month as long as they are healthy. If they fall ill or break a limb or something, they STOP paying him until they are healed and back in good health. To me, THAT is good health care. It benefits the doctors to actually heal people. He has a vested interest in keeping them healthy.
I know that exact system would not work here. But if our health professionals started making more profit from healthy people instead of sick people I can't help but feel that our entire health care system, including the costs, would probably benefit.
Igor, the problem is the republicans didn't want to negotiate, the tea party morons party line was that the answer is to do nothing, and if people fall sick and so forth, or don't have insurance, no big deal. They are like that idiot Santorum, who too much communion wine and wafers rotted what little brain he has, when he said if people don't have insurance they should go to emergency rooms, which is what a lot of tea party morons believe (worse, a lot of tea party types are old people on medicare, who are complete hypocritical assholes..want to get rid of socialized medicine? Then get your ass of medicare and pay for your health care). The republicans make noise about the market solving it, but it hasn't, for a lot of reasons (among other things, it is very very difficult to have an open market with health insurance, too few companies have the resources for it). I debated this crap in high school almost 35 years ago, and nothing has solved the problem. Insurance across state lines? Going to fail because doctors are local, a plan in Arkansas is cheaper because doctors and such make less there, not to mention everyone would locate their plan in Arkansas who would promptly tell them "locate here, I'll make sure you don't have to pay for anything' to try and get jobs). There is simply no competition on health insurance, and won't be, small businesses can't get into it. 35 years ago HMO's were supposed to cure all the ills, they failed, in part because to make money, doctors and providers found ways to game the system, PPO's have failed, it just hasn't worked. We are told medicare is efficient, but that is only because the cost of medicare is in effect shifted on other people's insurance, medicare pays 40 bucks for a 200 buck procedure, doctor overcharges other people.
Some have argued the answer is high deductible medical insurance, with HSA's (health savings accounts) to cover the deductibles, but they have gotten expensive, too, because health insurers play all kinds of games with what they are supposed to pay out in the non deductible region, they claim costs are too high, and often leave the patient stuck with it.
The other problem as Desideri puts it is the health industry itself. Doctors do things like invest in MRI clinics, so when a patient comes in with a sprained ankle, they send them for a MRI, which is ridiculous, because they make more money off it. Pharm companies run ads touting their latest meds (which should be outlawed IMO, those ads for crap to regulate urination, etc), and they get ma and pa coming in wanting the 'miracle' arthritis drug that will allow them to run like teenagers, rather than a generic that would probably work just as well. There is just too much incentive to load on costs.......
There are no magic answers, but here are some of my thoughts:
-We should be regulating our food supply better. First of all, thanks to the corn lobby, a lot of the food out there is subsidized shit, and I am tired of hearing how we have 'freedom to eat what we want'...the problem is, we don't even know what is in food out there. Crap that is the main component of silly putty is allowed in many processed foods and cheap corn that makes Iowa bible thumping, dumbass farmers rich, has contaminated everything with HFC to who the hell knows what (the guy who wrote the "Omnivore's dilema" said that studies of food shows that something like 40% of what people eat has corn in it, which isn't healthy). Meat is loaded with antibiotics and hormones, foods are loaded with pesticides, many of which have not been fully tested (and the antibiotics in meat is one of the reasons antibiotics are failing to work with some bugs). We allow shit in food that isn't even on the label, and even organic food allows compounds like Carageen, that is a known irritant that can cause all kinds of issues. One of the downsides of all this is people getting obese, the kind of food they are producing is a disaster, the meat is fatty and unhealthy, baked products have all kinds of sugar and crap in it, and that is costing us.
-Doctors are pretty decent at treating diseases caused by bacteria, or things like getting a bad cut or a broken bone, but when it comes to preventing disease they stink. Last I just read doctors are going to start treating people with Statin drugs to prevent cholesterol issues on a much larger scale, treating 10's of millions more...yet no study has shown that doing so is particularly effective in treating heart disease.
And on nutrition doctors are still in the dark ages. They preach the whole 'red meat' is bad mantra, which is crap, and promote eating grains a la the FDA food pyramid, which is crap, too. In the food pyramid grains are at the bottom, it should be vegetables, and meat and saturated fats in moderation are not bad for you, but doctors tell the 'thou shalt not eat red meat', and that is not backed by science. They still promote the idea of dietary cholesterol causing heart disease, when cholesterol comes from the liver, and cholesterol itself is not evil per se (it is why they tell people to take folic acid, it prevents cholesterol from sticking)....yet they are putting people on statins, that reduce the liver's ability to produce cholesterol (which also reduces coq10, which the heart needs, and can cause muscle damage). Doctors nutrition and exercise advice is quite frankly a joke (if you want to get healthy, doing cardio alone is pretty much useless, and if you don't change diet you might lose weight, but you won't be healthier).
We spend a tend of money on treating disease, but little on preventing it.Among other things, the good industry has been allowed to operate almost unregulated, and then to top it off government subsidies (that the tea party scream cannot be cut) for farm programs make our food less healthy, not more. If we made a serious effort to fix our food supply, stop allowing the kind of thing where the 'low fat' products doctors tell people is more healthy to be loaded with sugar and chemicals, if we got rid of the corn subsidies that turn out cheap but crappy food like McDonalds, we probably could bring down health care costs, especially in old people where a lifetime of bad eating gets you. And oh, yeah, get rid of crop subsidies for tobacco while they are at it, and try to find a way to eventually make tobacco illegal (somewhere between 50 and 100,000 people are year die from tobacco related issues, all of which are expensive to treat).
The chinese idea of paying a doctor when you are healthy and not paying when you are sick was sort of the basis for HMO's, in the sense that they had an impetus in 'keeping people healthy'. The problem is that in the end they didn't, they just did what traditional medicine did.
In the end I suspect the only solution that might work is some sort of single payer system, whether it is pure governmental or some sort of private/industry hybrid. United Healthcare might not be happy, but given that the health insurers are a big part of the reason health costs have skyrocketed (take a look at their profits, and you will see why premiums went up). One of the reasons for a single payer of some sort is that they have the ability to make prices transparent, since doctors all over would have to use them. A woman on NPR was talking about how she asked her health insurer to find out how much a procedure would cost from various doctors and hospitals, and it took them 6 weeks to get back to her with what it will cost her, which is ridiculous. Doctors get away with not saying, because it is all so fragmented now, but if they all had to report what they charge cause it is all one provider, then maybe people could figure out the best place to go. Maybe the single payer would be underwritten by health insurers in a pool but run by a not for profit group whose prime interest, rather than making money, would be to make sure that care was given efficiently and transparently, but I think to get a pool where the healthy subsidize the ill is going to take that route. Medicare is a disaster in the send that it has a pool that is almost entirely high risk and high cost, the elderly, medicare for all citizens would have a pool of the young and old, sick and healthy, which should drop the cost.
We also need to figure out the doctor office end of things. For one thing, we need to break the AMA's hold on things.Sorry, but you don't need an md when you need stitches, have athletes foot or a sore throat, or routine treatment like that. Nurse practicioners and trained med techs could do that just as easily, and it is a lot cheaper than a doctor, especially these days when it often is a specialist doing basic stuff.
Too, maybe the government could take over a significant portion of doctors costs. Doctors argue the cost of medical school and coming out with several hundred thousand in debt, maybe kind of like the military, doctors would work in government clinics serving those in need of medical care for 7 years, and once done, their debt is over. This way there would be a pool of doctors handling ill served rural and poor areas. Same with malpractice insurance (which is one of the biggest rip off's in terms of insurance; the rates have skyrocketed because insurers are making a ton of money), a government pool would be a lot cheaper for doctors then the greed mongers in the private insurance racket.
We also need to regulate things like doctors owning labs, mri clinics and the like, then seeing patients and sending them there, it is just a reason to order unnecessary tests.
Desidiri is right, the problem with Obama care or any solution is that it doesn't cover the whole spectrum of health care, you can't just look at insurance, the whole thing needs to be changed. The AMA and the health insurance companies aren't going to be happy,but it is the whole thing that needs changing.
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