Acceptable and Beneficial Health Care Reform

Now that the latest Health Care Reform blitzkrieg seems to have been staved off, it is time for a more comprehensive discussion and investigation into the actual problems and realistic solutions. Now that the exigency of defeating two poorly thought out bills is over, we should dispense with the rhetoric and begin to resolve the real issues. Now, the only way to ever bring together opposing sides of such a polarizing debate, is to, first, find some common ground and work outward, from there. Maybe, just maybe, Washington is actually learning they must listen to us. If so, we should not let the opportunity fade.

So, I hope this thread can become a repository of ideas. Again, without the rhetoric. Just recognition of specific problem areas and specific solutions. Here is my first offering:

It is widely accepted that a source of exploding health care costs, inadequate care and abuse of programs such as Medicaid / Medicare is the use of Emergency Rooms for primary care or non-emergencies.

9 Patients Account for Nearly 2,700 Emergency Room Visits, Study Finds

Local hospitals hurt by abuse of the emergency room system

A couple of reasons for this phenomena are the lack of a regular family practitioner / primary care physician and a belief that this is acceptable. The second is just a matter of education, accomplished through the elimination of the first.

While I have no knowledge of the situation in other states, we in Texas have locally administered County Health Departments. They are keyed toward the basics of health screening and disease prevention, such as vaccinations and inoculations. However, why should they be limited to these services? Why not expand their use to include providing primary care to the uninsured, under-insured and those Medicaid / Medicare recipients, who do not have a primary care physician?

In my rural county, with a population of around 38,000, there are about 50 physicians, including specialists. So, in order to staff the County Clinic for use in primary care, these physicians could provide services for a couple of days per month, in exchange for tax breaks and/or other benefits. Nursing staff could be arranged, similarly. Add in the utilization of interning students, from the local nursing and EMT schools and the additional costs are minimal.

Equipment, such as X-ray, etc., could be obtained from hospitals and private practices, who are upgrading or downsizing. Again, in exchange for tax breaks.

I always think looking at problems at the local level, gives a better perspective of solutions. I believe the expansion and use of the locally administered clinics would greatly increase the availability and quality of care for those without insurance.

What say you ATS?

reply to post by WTFover


Sounds good to me, at least it is an active solution and does not require a newly found Altruism on behalf of Corporate entities!

Bravo for dispatching the ol text book

where do I sign up?

BTW would this tax break for services be a state break or a federal one?

Either way I would go as far as say, completely eliminate ALL taxes for practitioners and staff members who participate, although I am not sure if that is constitutional.
I could go there, happily I might add...

S+F

Originally posted by Janky Red

Bravo for dispatching the ol text book

Some times I'm a little slow on the uptake. You lost me on this one

BTW would this tax break for services be a state break or a federal one?

Well, we don't have State Income Taxes, so I'd propose Federal and local.

Originally posted by WTFover

Originally posted by Janky Red

Bravo for dispatching the ol text book

Some times I'm a little slow on the uptake. You lost me on this one

BTW would this tax break for services be a state break or a federal one?

Well, we don't have State Income Taxes, so I'd propose Federal and local.

Don't worry, I still like the idea, I remembered to put my star and flag this time

I think you really need to look at the reasons why some of the articles in the legislation are the way they are. Specifically, we need to tackle the problems.

I think a major problem has been monopolization of healthcare by the health insurance companies. Living in a major metropolitan area, I'm hard pressed to actually find a private practitioner who doesn't work for a corporate owned hospital. A lot of issues have to do with cost, I'm amazed I can afford the coverage I have, yet for all that I pay I still have the ability to owe money.

Personal story: Wife had a mammogram after being recommended from the in-network doctor, went to the nearest hospital a few weeks later (appointment set up by the in-network office) and was treated by an out of network specialist, now I owe an additional $100. Is that ok? More and more I'm tempted to just drop my insurance alltogether to avoid these pitfalls.

If you live paycheck to paycheck, it's unlikely you'll afford insurance or the few hundred extra required because you get a persistent cough that isn't life threatening. If you do go to the emergency room you will be treated, but your debt will increase because you have a bill hanging over your head.

For a low-income household it's a vicious cycle, remain sick or suffer massive debt. There are millions in this country who can't afford to be healthy, I really believe that ideas like the public option were put there for them, not necessarily the millions who have insurance who are still paying exhorbitant amounts because those in-network hospitals still have to pay for those emergency room visits somehow.

Another problem, right off the top of my head, is the danger doctor's face if they make a mistake. No one should be allowed to sue for millions and millions of dollars, ever. I know there are horror stories of negligence (nobody wants a pair of scissors left in their torso), but there needs to be something done about protecting doctors from stupid patients that are trying to win their own little lottery.

This brings me to the idea that doctor's probably shouldn't be making more than six figures a year unless they really, really deserve it. That's just my idea though.

In conclusion, look at what the legislation was and try and reason why it said that. If you can find a more reasonable way to provide health coverage to people on a state level, I implore you to do it.

well i thought the public option would be awsome but alas republicans said now and apparently us canadians have bad health care even tho i go see a specialist and get pills for free well i also am a afghan vet so but anyway i know non vets get same treatment

Originally posted by cdn_infanteer
well i thought the public option would be awsome but alas republicans said now and apparently us canadians have bad health care even tho i go see a specialist and get pills for free

well i also am a afghan vet so but anyway i know non vets get same treatment

I have to ask because I honestly don't know.

Is there a specific tax deduction from your paycheck for Canadian healthcare or is it lumped together with your regular federal(same in Canada?) tax? Also, when you get 'pills' do you just walk to a pharmacy, show your Canadian ID and walk out with antibiotics, or whatever you need?

reply to post by links234


Thanks for the reply. Believe me, I feel your pain. You did get me thinking about the advent of the whole HMO and PPO programs. It looks like we were sold a bill of goods, with those. I'll look into that and see if we can come up with a viable solution. I'll tell ya though, I tend to gravitate away from the "public option", looking for less federal government involvement.

I do have an idea for the malpractice problems, which I will post tonight.

For now, gotta go to work to pay the doctor bills and insurance!

Second solution: Tort reform that still protects the patient.

It is difficult to determine the true impact of medical malpractice insurance and lawsuit awards, on medical costs. According to the plaintiffs' lawyers side, it is minimal.

Malpractice insurance costs amount to only 3.2 percent of the average physician’s revenues...and...Few medical errors ever result in legal claims. Only one malpractice claim is made for every 7.6 hospital injuries, according to a Harvard study. Further, plaintiffs drop 10 times more claims than they pursue, according to Physician Insurer Association of America data.

www.medicalmalpractice.com...

According to the medical professionals it is significant.

Medical malpractice claims cost the health care industry more than $4.4 billion in 2006, not counting the accompanying increase in malpractice premiums...and...50.1% of all Texas physicians incurred claims during the period of 1989-2002

www.texmed.org...

As with most situations, the truth, probably, falls somewhere in the middle. So, is it a worthwhile endeavor to make some changes? I think so. Particularly if the changes are inexpensive, compared to the benefit.

Take a look at more information, from the first source.

Fewer than one-half of 1% of the nation’s doctors face any serious state sanctions each year. 2,696 total serious disciplinary actions a year, the number state medical boards took in 1999, is a pittance compared to the volume of injury and death of patients caused by negligence of doctors. A recent study by the Institute of Medicine of the National Academy of Sciences estimated that as many as 98,000 patients may be killed each year in hospitals alone as a result of medical errors.

Taking that information at face value, it is a problem. It tells me that the low number of disciplinary actions only invites negligence, and regardless of whether or not each case of negligence ends up as a malpractice claim, they are potential claims, which you know the insurance companies consider in risk assessment. I can, also, assume at least part of the problem is due to investigation backlogs.

My idea is to establish local peer / citizen review boards. Again, I am a strong advocate of localized solutions.

A person who believes they are the victim of medical negligence could present their complaint to a 6 or 8 person panel, composed of 4 or 5 citizens and 2 or 3 physicians. Larger counties would have several boards, probably assigned to individual precincts. The board would issue a recommendation to the complainant and the medical personnel. If a resolution is not achieved, the complaint would advance to mediation. The last resort would be advancement to the state review board and/or the court system.

I know this process would be challenged by the trial lawyers, but it ain't about them. It's about the patient, first, future patients, second, and reducing medical costs, last.

Any thoughts?

Once again I think that could work for me, sir...

My problem with Tort in the past has been that it is a proposal that can be used to bleed out an individual with less resources when trying to address a LEGITIMATE matter.
I understand that others consider the business first, but in reality both sides have a legit reason for concern in this matter.

I think this idea is great as it would mitigate the lawyering which harms plaintiff and defendants pocket in the long run. The best part IMO is that this would create an even platform and cut out the insiders who can easily manipulate an outcome either way.

In the big picture it would be hard to see either side of the aisle attack such measured and simple proposals. As I have said this would satisfy my "lefty" desires and greatly exceed my previous benchmark for any acceptable form of tort reform. (tongue twister)

WTF if you can keep all your solutions like this I'll vote for you

I'm curious about the malpractice lawsuits. Is it really a problem?

* The number of payouts doctors made for malpractice claims was 11,037 in 2008. That is the smallest amount since the NPDB began tracking data in 1990.
* The total value of those 11,037 awards? It was $3.6 billion. Modified for inflation, that is the second-lowest amount on record.

What is happening? Are hospitals suddenly much safer? Have doctors discovered a way to never make mistakes? If only the statistics were caused by such breakthroughs.

The real causes behind the drop in medical malpractice payments? Changes to the medical liability laws, making it more difficult to bring a case. Another culprit: limits on the number of malpractice lawsuits. These hindrances mask the actual state of health care in the country. Trying to control or correct the outcome doesn’t change the root of the problem.

www.zifflaw.com...

What should we compare this 3.6 Billion dollars to? The total spent on healthcare, the total spent on malpractice lawsuit insurance or what?

reply to post by jam321


Who knows what the reality is? But, most of that $3.6B is an expense of the malpractice insurance companies, not the physicians and hospitals and probably shouldn't even be considered a direct increase in health care costs.

I do think you have to include the cost of malpractice insurance premiums and, more significantly, attorneys' fees.

Good thinking and thanks for bringing that to my attention.

reply to post by jam321


It's not the rewards or frequency of rewards in malpractice cases that is the problem. It's all the duplicate and/or unnecessary tests and procedures that doctors order to cover their butts that is the problem. Instead of the one or two tests that are needed a doctor will order five just in case you're the one person who decides to sue for malpractice this year. It's the unnecessary extra tests thrown in that causes health care costs to go up. Not to mention the amount doctors get charged for malpractice insurance which are then passed on to us.

The goal of tort reform is to get it to where doctors aren't as worried about being sued and do their jobs more efficiently. That's my understanding of it, at any rate. The trick is to accomplish that without preventing people who truly have been harmed from seeking and obtaining compensation for the doctor's negligence since obviously there are some doctors out there who really shouldn't be practicing medicine. No, I take that back. They do need to practice, just not on living things.

WTFover, you've had some superb ideas there so far.

I would like to see an expansion of "minute clinics" where a person could have simple problems, say an ear infection or strep throat, treated by a Physician's Assistant for a reasonable fee. I understand most charge between $35-$65.

I believe that some sort of catastrophic health insurance should be available to just about everyone for purchase. I had the darndest time getting health insurance for my son because he has autism. Healthy as a horse except for that. And all I wanted was catastrophic so that if something big happened we were covered. Didn't mind paying his prescriptions out of pocket and for minor doctor visits.

Prescription costs are a bear as well, since any legislation so far (medicare prescription coverage anyone?) has included a no-negotiate clause. Stop the darn commercials, I don't need to ask my doc about every new pill out there, save the advertising $ and lower the prices.

reply to post by Mountainmeg


I have a catastrophic policy, because I really just never get sick enough to go to a doctor. When I do, averaging less than twice a year, I only pay $35 for the office visit. This is much cheaper than paying the higher premiums for a comprehensive policy, with which I would still pay a $30 or $35 co-pay.

I absolutely agree that that there should be no pre-existing condition restriction. Not sure where you live, but, here in Texas, there is a State administered "high-risk pool", from which everyone can purchase insurance, without denial.

What is your opinion of state mandates and the impact they have on healthcare?

Studies estimate that mandated benefits currently increase the cost of basic health insurance coverage from as little as 20% to as much as 50% depending on the state and the mandate.

www.examiner.com...

I would guess you have never sat in a county health dept. for 6 hours for a regular flu shot. Only two people in line in front of you. This is a good example of the government health care system we DON"T need.

reply to post by alttracks


You are correct, I have not experienced that kind of wait time, although I do live in a rural area. I've, always, been able to get m kids right in, for vaccinations / inoculations.

Please don't consider this as doubting your claim. However, don't you consider the local government administration of such, as a much preferred alternative to federal control? Don't you feel the people have more control of the local government and could influence positive changes, more easily?

Originally posted by jam321

What is your opinion of state mandates and the impact they have on healthcare?

Wow, I will probably get myself in trouble here, but here goes.

I guess my simple answer is, absolutely, no mandates for anything considered to be elective. From your source and this one

www.cahi.org...

I can see several that should be excluded. (Here's where I expect to be slammed) Massage therapy? Alcohol/substance abuse? Family/Marriage therapy?

I think the best option, in place of state mandates, is for the application of an ala carte method of purchasing health insurance. There is no "one size fits all" policy. I think mandated coverages make some policies cost prohibitive, preventing some families from necessary and, possibly, affordable coverages. Also, the removal of such mandates and ala carte purchasing, could offset the increased premiums of covering pre-existing conditions.

What do you think?

Here's one I don't understand: why does an insurance company pay a reduced rate for a hospital bed but the guy without insurance is charged full-price? There should be one fee - if there was one fee, then more people might feel that they could pay for their own medical needs.

Also, I have a "healthcare spending account" - but I can't roll any of the money over from one year to the next - I have to spend it all before the end of the year or lose it...why can't they just cap it so that I can't accumulate more then $10K or whatever number they pick...but to force me to use it or lose it is BS.

[edit on 30-1-2010 by bowlbyville]