Universal Healthcare? YES, we CAN!

originally posted by: Phoenix
a reply to: carewemust

That's valid issue,

Short term even were congress to pass anything putting system changes into practice would probably take longer than September and it hard to imagine even by January.

You're right, many will be left in a lurch.

I myself have been in lurch for sometime now.

Suggestions?

Freeze it in position till congress acts via E.O or something similar?

I hear you loud and clear as I'm forced to wing it and hope nothing happens health wise as this mess works way slowly through spaghetti grinder that is our congress.

With McConnell now delaying a vote on the ObamaCare replacement bill indefinitely, I'm too disgusted to even talk about it anymore. My anger at Republican leadership overshadows rational thought at this moment!

a reply to: DontTreadOnMe

I gotta problem with that if I am understanding your position.

There are no standards or guidelines?
So, I need stitches.
Urgent care #1 charges $75.00
My doctor charges $50.00
My neighbor's doctor charges $35.00
Urgent care #2 charges $45.00....but if you pay at the time of service, it is $32.00
The ER charges $85.00

And on it goes.
You cannot shop around every time you want medical care.

Consider this: who sets the prices in your local convenience store? The owner. There is no law that says he can't price a 50 cent can of vienna sausages for $5.00. But he doesn't. Why not?

Because, while he might sell one or two if someone with money was hungry enough, he wouldn't sell enough to make a profit. People would quickly learn that the store overcharges and he'll be out of customers in short order.

Health care works the same way. People tend to chose a doctor and stick with them, so they learn quickly how expensive he is. They can then decide whether to stay with him or go somewhere else. If I had the money, I would pay a little extra for a doctor I could understand and who has a good bedside manner than for one who speaks broken English and acts like I'm a head of cattle.

Price controls are dangerous economically. Set them too low, and doctors who provide good care can't afford to stay in business. Price them too high and people can't afford to pay them. There is a middle ground that economics alone will seek out.

I also have to ask: who should set the prices for procedures if not the doctors performing them? Insurance companies? They have proved over a long period of time that they care nothing about people, only money. That's a lot of why the costs are skyrocketing now. Insurance companies set the rates they will pay.

TheRedneck

a reply to: DBCowboy

I fear though that giving this to congress would be like giving a tank of slime eels the Declaration of independence and expecting them to form a coherent government.

I think you're disrespecting slime eels in that comparison...

TheRedneck

a reply to: veracity

I take it you approve? That was my intention.

TheRedneck

a reply to: TheRedneck

Too late at night for me to dig into your writings, so I'll do it tomorrow. Instead, since I can't yet comment on what you've wrote, I'll tell you about the plan going through my head.

We make a hybrid single payer system.
Equipment is purchased from the companies by the feds.
Medicine is purchased from the companies by the states.
Procedures are purchased from towns.

So, if we need MRI machines, the feds purchase 5000 in a year from relevant vendors and distribute them.

The states need drugs? They purchase those and deliver to hospitals.

The hospitals need a procedure done? The town pays for that.

All negotiated with local/state/fed governments as the sole buyers, and any provider as a seller.

a reply to: TheRedneck

The scam goes like this... you lobby to get a drug classified as Orphan. Even if it is a 10 dollar a month drug that has been on the market for 40 years. Once it is classified as Orphan, they get a monopoly on it for at least 7 years and can charge insane amounts of money for it.



Drugs For Rare Diseases Have Become Uncommonly Rich Monopolies

www.npr.org...

www.washingtonpost.com... 1c14fb8c8_story.html?utm_term=.daef3fea5a43


You may have heard about these 2 in particular in recent news: 5,000% and a 6,000% price increase.

www.forbes.com...

5,000% price increase on a drug for a rare infection that made Martin Shkreli, then chief executive of Turing Pharmaceuticals, “the most hated man on the Internet.” But Shkreli’s was an incremental innovation in price gouging. Before that, we had the case of Makena, used to prevent pre-term birth. It was launched in 2011 at a price of $1,500 when a similar drug was previously available, from compounding pharmacies, for $20. The strategy basically worked: AMAG Pharmaceuticals, which now owns Makena, booked sales of $93 million in the third quarter of last year.

Why does this keep happening? Well, with the exception of Shkreli, enabled by a thicket of market inefficiencies, because it’s the law. And that’s very much the case for Marathon and Emflaza.

A similar example with epipens.

www.forbes.com...
Why Did Mylan Hike EpiPen Prices 400%? Because They Could

UPDATED 08/22/2016, including a statement from Mylan at the end] Mylan MYL +0.40% pharmaceutical company has a virtual monopoly on EpiPens after a voluntary recall felled their only competitor*, Sanofi’s Auvi-Q, over possible dosage miscalibrations. It’s not the drug being delivered that brings the bucks, though—epinephrine’s a cheap generic. The cost trickery is in the delivery system, the Mylan EpiPen.

The EpiPen’s been around since 1977, but Mylan acquired the autoinjector—which precisely calibrates the epinephrine dosage—in 2007. The patient now pays about 400% more for this advantage to receive a dollar’s worth of the lifesaving drug: EpiPens were about $57 when Mylan acquired it. Today, it can empty pockets of $500 or more in the U.S. (European nations take a different approach to these things).

Bottom line, whenever one of these scum companies get a monopoly on production / distribution of a drug, they don't just raise the price, they open GOUGE beyond reason. (They don't even pretend to feed you a bs explanation anymore.)

a reply to: TheRedneck

So, you cannot do crap with healthcare until you break up the AMA monopoly (explained below) since they wield the control and will never willingly give it up.

You have to "un-corrupt" the entire medical establishment just as you have to un-corrupt the Pharmaceutical companies. A freeking Trade Union controls our entire supply, standards, accrediting, etc. (You have to gut this, re-write the requirements on what is needed to become a licensed physician and open up residency controls which are artificially restricted.



Who or what controls the number of medical doctors in the U.S.?

Government licensing, regulations, and funding are the greatest controls on the number and types of medical doctors, with those policies effectively being set by trade unions, most notably the AMA (American Medical Association).

Trade unions like the AMA and the AAMC (Association of American Medical Colleges) are not only powerful lobbyists and influence their members to conform, but they also appoint the members of accrediting agencies (e.g. LCME, ACGME), as well as members of task forces and advisory councils (e.g. RUC which sets prices).

While they have not set an explicit quota for the number of doctors (wink wink), their policies create shortages.

For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

To give a flavor of the specific controls, here's an overview of the requirements for becoming a medical doctor (based on A Primer on Medical Education):

(1) A 4 year pre-med college degree, then register with AMCAS (American Medical College Application Service) and take the MCAT (Medical College Admissions Test) which is designed by the AAMC.

(2) Graduate from 4 years at an LCME (Liaison Committee on Medical Education) accredited medical school. Note that, according to the LCME directory of the 141 programs currently in the US, there were no programs accredited between 1982 and 2002.

(3) Pass the USMLEs (US Medical Licensing Examinations) during medical school which are designed by the NBME (National Board of Medical Examiners) and the FSMB (Federation of State Medical Boards of the US). There are per-specialty national board examinations after residency as well.

(4) Up to 5 years of hospital residency (and then possibly a fellowship) accredited by the ACGME (Accrediting Commission on Graduate Medical Education) which is controlled by the trade unions.

In practice, residency is also largely limited by government funding:

Residencies are funded through hospitals. Through Centers for Medicine and Medicaid Services (CMS), the federal government pays hospitals for each resident (known as direct medical education funding, or DME). Hospitals with residents also receive slightly more reimbursement from Medicare for their patients (indirect medical education funding or IME). In most cases, CMS will only pay for a limited number of residents per hospital. States may also contribute to residency education, often through Medicaid programs that are partially funded by CMS.

How Medicare Subsidizes Doctor Training:

This means hospitals used to have incentives to create new residency slots ad infinitum so they could keep on getting higher and higher payment rates from Medicare. Congress decided (perhaps understandably) that this was financially unsustainable; there was also some concern about creating an “oversupply” of doctors in the 1990s. So in 1997, Congress capped the number of positions that Medicare would underwrite, freezing the total at what it was the year before.


(5) Earn a living through payment for services which is controlled by a market that is heavily distorted by government regulations, including those favoring insurance and price fixing via the AMA RUC's (Specialty Society Relative Value Scale Update Committee) recommendations to CMS (Centers for Medicare & Medicaid Services) that favors specialists.

See also:
- Does the AMA limit the number of doctors to increase current doctors' salaries? (Skeptics StackExchange, 2011)
- Warnings of doctor shortage go unheeded (Seattle Post Globe, 2011)
- Solving the Shortage in Primary Care Doctors (NY Times, 2013)
- The Shortage of Medical Residency Spots: A Failure of Government Control (Forbes, 2013)

- Special Deal: The shadowy cartel of doctors that controls Medicare. (Washington Monthly, 2013)
- How the AMA’s Price Fixing Distorts Health Care Delivery and Pricing (Naked Capitalism, 2014)

- The Case Against Medical Licensing (Dr. Wilson, 2014)
- Capitalism and Freedom: Chapter IX: Occupational Licensure (Milton Friedman, 1962)
- The AMA and Price Discrimination in Medical Care (Thayer Watkins)
- Antitrust Enforcement in the Medical Services Industry: What Does It All Mean? (Havighurst, 2005)

www.quora.com...

Doctors With Borders: How the U.S. Shuts Out Foreign Physicians
MDs trained overseas must go through an often prohibitively difficult, time-consuming process
www.theatlantic.com...

American Medical Association President Robert Wah recognizes this residency bottleneck. “U.S. residency program positions have not increased at an adequate rate to accommodate the expanding number of U.S. medical graduates and the current IMG [International Medical Group] applicant pool,” he said in an email.

Even if the AMA were to magically produce a few thousand more residency slots, it would barely make a dent in 91,500 projected doctor shortage.

Whittling down the shortage will likely take a combination of measures.

A third fear is that loosening regulations would negatively affect U.S. medical schools. If coming back to the U.S. were easier, Americans might be more likely to study in places like England and Israel because becoming a doctor would be both cheaper and faster overseas.

Further, an influx of doctors could impact a more sensitive matter—with an increased doctor supply, salaries among America’s white-coats would almost certainly go down.

“Nobody wants to share their pie,” Alomran says. “This is the same everywhere and is not unique to medicine, in my opinion.”

a reply to: infolurker


And these "gouge" practices are custom made for President Trump to show that he is indeed on the side of the consumer..the little guy.

I already understand why Congress turns a blind eye to sick Americans being hurt by pharmaceutical price gouging. But Donald Trump can rise above their criminality, and force the prices lower... just like he did for some airplane contract earlier in the year.

How bout just the US for a change. I dont think my tax money should (or can) fund the entire Universe

a reply to: infolurker

That's a lot of information! Thank you!

Gonna take some time to sort through it all, but I will start today. I may or may not have enough time to address all of those problems in my plan, but it sounds like a second bill aimed primarily at pharmaceuticals, and a third aimed primarily at medical training could be useful.

TheRedneck

originally posted by: carewemust
a reply to: infolurker


And these "gouge" practices are custom made for President Trump to show that he is indeed on the side of the consumer..the little guy.

I already understand why Congress turns a blind eye to sick Americans being hurt by pharmaceutical price gouging. But Donald Trump can rise above their criminality, and force the prices lower... just like he did for some airplane contract earlier in the year.

giving tax breaks to millionaires and stealing the from the poorest is helping the little guy how exactly?

originally posted by: TheRedneck
a reply to: infolurker

That's a lot of information! Thank you!

Gonna take some time to sort through it all, but I will start today. I may or may not have enough time to address all of those problems in my plan, but it sounds like a second bill aimed primarily at pharmaceuticals, and a third aimed primarily at medical training could be useful.
TheRedneck

The below article from Harvard Business Review is a "must read" to really dig into cost savings and innovation. If I were writing a plan, this information would be crucial to understand and utilize the vocabulary or jargon of this particular subject. This is crucial for any plan to ever increase quality and lower costs.


If you have ever read any of my older posts on the subject, I usually use the example of LASIK surgery as an example of how care and technology get better and better and the price also keeps going lower. (Posted Pricing and Bundled payments are 2 of the reasons).

Again, this is crucial information.

Bundled payments have existed in health care for some time in isolated fields such as organ transplantation. They are also common for services that patients pay for directly, such as Lasik eye surgery, plastic surgery, and in vitro fertilization.

Bundled payments will be the catalyst that finally motivates provider teams to work together to understand the actual costs of each step in the entire care process, learn how to do things better, and get care right the first time. By encouraging competition for the treatment of individual conditions on the basis of quality and price, bundled payments also reward providers for standardizing care pathways, eliminating services and therapies that fail to improve outcomes, better utilizing staff to the top of their skills, and providing care in the right facilities. If providers use ineffective or unnecessary therapies or services, they will bear the cost, making bundled payments a check against overtreatment.

The result will be not just a downward “bend” in the cost curve—that is, a slower increase—but actual cost reduction. Our research suggests that savings of 20% to 30% are feasible in many conditions. And, because bundled payments are contingent on good outcomes, the right kind of cost reduction will take place, not cost cutting at the expense of quality.

This article from Harvard Business Review will explain why we need to change the way base funding and payouts to providers work as well. Instead of Capitation based funding, look at Bundling. I think Rand Paul has mentioned something similar on bundling insurance but nobody will listen to him since you know, he is an actual doctor.....

Bundled payments will empower providers to coordinate and integrate care

hbr.org...

The bottom line is that capitation is the wrong way to pay for health care. It is a top-down approach that achieves some cost savings by targeting low-hanging fruit such as readmission rates, expensive drugs, and better management of post-acute care. But it does not really change health care delivery, nor does it hold providers accountable for efficiency and outcomes where they matter to patients—in the treatment of their particular condition. Capitation’s savings also come at the high cost of restricting patient choice and inhibiting provider competition.

Let’s consider the alternative.

Paying for Value: Bundled Payments

For virtually all types of products and services, customers pay a single price for the whole package that meets their needs. When purchasing a car, for example, consumers don’t buy the motor from one supplier, the brakes from another, and so on; they buy the complete product from a single entity. It makes just as little sense for patients to buy their diagnostic tests from one provider, surgical services from another, and post-acute care from yet another. Bundled payments may sound complicated, but in setting a single price for all the care required to treat a patient’s particular medical condition, they actually draw on the approach long used in virtually every other industry.

Bundled payments have existed in health care for some time in isolated fields such as organ transplantation. They are also common for services that patients pay for directly, such as Lasik eye surgery, plastic surgery, and in vitro fertilization.

To maximize value for the patient, a bundled payment must meet five conditions:

Long article but worth the read if you really want to improve the entire system. As you can tell, I am kind of into solving this particular issue as well.

Do you think that medical coops should be addressed? It seems that there are some that are working quite well. They provide all normal services for a set monthly fee. You only pay the fee and the only charges at a visit are if you need a prescription or something that is outside normal office care. The coop buys the drugs and fills the prescriptions on site so cost is greatly reduced. I believe the one that is being touted as an example is in Kansas.
atlas.md....
I believe one of the issues is that currently they aren't allowed everywhere.

Even $50 a month for a coop would save me personally about $500 a month. That should easily cover a cat policy. I think something should be included to allow this model in all states.

a reply to: TheRedneck

I am still reading, but wow ... you really put some effort and thinking into this. I had never read any proposal for so-called 'universal' healthcare that I liked before, until maybe this one. There is a lot in here to like, even for a healthcare cynic like myself hah

a reply to: TheRedneck

Here are some "must see" videos as well. You will be shocked! 2nd video mentions the CON law.. again, you will be shocked.

Direct Care Information, Direct Posted Pricing "Price honesty" (first one is really, really good)













www.nbcnews.com...

Skip the first 5 mins of news babble on this one. At around the 9 minute mark, This one explains Insurance Company "claims repricing" that insurance companies do to actually want you to go to places that charge more!

At the 16 min mark, why people who have socialized medicine in their own country, go to Oklahoma for medical treatment.

a reply to: infolurker

On the subject of financial 'buydowns'... i.e. insurers making prorated deals with certain doctors and requifring the insured to use them... III(A)-3 specifically disallows doctor networks. That in itself should put enough pressure on insurers to not use such practices, and actually should level the playing field for doctors to enter the market. More doctors = better choice and lower prices = better care.

TheRedneck

a reply to: TXTriker

I actually like that idea, but I prefer to go by the rule of thumb that regulations should be as little as possible. There is nothing in my plan that would prevent such a system, so considering the level playing field for doctors to enter the marketplace, this is an idea which should take off on its own. Especially if there are examples of it working in some areas where it has been tried.

Since any prohibitions are at the local/state level, I don't particularly like the idea of bringing such power to the Federal level. It would be nice if Obamacare hadn't brought any power to the Federal level, but it is what it is.

TheRedneck

originally posted by: TheRedneck
a reply to: TXTriker

I actually like that idea, but I prefer to go by the rule of thumb that regulations should be as little as possible. There is nothing in my plan that would prevent such a system, so considering the level playing field for doctors to enter the marketplace, this is an idea which should take off on its own. Especially if there are examples of it working in some areas where it has been tried.

Since any prohibitions are at the local/state level, I don't particularly like the idea of bringing such power to the Federal level. It would be nice if Obamacare hadn't brought any power to the Federal level, but it is what it is.

TheRedneck

I'm not fond of regulation either but sometimes a positive regulation is needed to prevent the creation of negative regulations. I know that some state have regs that prevent lower level governments from overriding state law. Perhaps something that prevents the denial of any type care model. Let the marketplace decide if the model works rather than having the govt say this model is not viable.

a reply to: Fowlerstoad

Thank you! Now, if we can just get someone to listen... this is the kind of thing that will need grassroots support to have any chance at all.

TheRedneck

1. I don't see anything in there about people who choose not to purchase insurance.

2. The fact that insurance companies cannot deny benefits (no pre-existing conditions) means that the insurance companies' financial exposure is unlimited. We'll end up with the same problem we have now: sky-high premiums.

3. I see nothing in there allowing a doctor to stop accepting new patients when his workload gets too high.