Healthcare for all!

I have been thinking long and hard hard on the recent political football called the healthcare insurance crisis. And I do believe I have some ideas and a plan that could be workable. So here it is, in all its glory, for you, the ATS community, to peruse and disect. Please, let's keep this thread free of political sound-bites. This issue transcends politics.

A Redneck Health Care Plan ( I had to name it something)

The insurance industry is a recent addition to healthcare, and one that in itself does absolutely nothing to aid in the well-being or treatment of patients. It exists as a convenience for users of the system, to simplify payment and admissions, and for practitioners, to guarantee payment.

The single largest problem in the healthcare industry itself is in the area of cost. COBRA (the optional continuation of insurance after termination of employment) reflects this, with the cost commonly ranging between $1000 and $1500 per month for someone who is out of work. This high cost is not simply greed by the insurance compamies, but also reflects the high cost of operating as a healthcare professional and therefore the high cost to patients of healthcare.

What are the reasons for the high cost? High malpractice insurance costs to the doctors, a high standard of living for those doctors, expensive equipment that is frequently overused in order to avoid lawsuits or because early care is unobtainable, and the cost of treating those who cannot pay. This last cost is spread out among the bills of those who can pay, thereby raising costs.

My proposal has many parts. The first thing I would suggest is a pull away from the concept of spreading out costs for those who cannot pay. This could be accomplished by removing the middleman (insurance company) from the equation where cost makes healthcare prohibitive. I suggest a government-backed safety net for professionals who treat those who cannot or do not pay their medical bills. Simply stated, any doctor/hospital/lab who provides service for which they are not paid may make a claim with the Federal government. They would receive 50% of their bill up front as taxpayer-subsidized payment. The account would then be turned over to the most effective collection agency in the free world today - the IRS.

The IRS would attempt to collect the entire amount of the bill from the person who is responsible for it. The first collections would go to reimburse the Federal government for the payment already made, and the rest to the professional who rendered the service. Since the IRS is an agency of the Federal government, it would be a simple matter to specify income lines that would prevent collections from the truly indigent and allow collections from those who would abuse the system. Types of care provided could be weighed into the equation as well, placing harder collection on those who habitually use the emergency room rather than a doctor, thereby creating larger bills for the taxpayers.

At the same time, all healthcare professionals in the country could be required to provide care to anyone who requests it. This will not cause them undue hardship, because they now have a single collection agency that fronts a portion of the bill and attempts to collect it all, at their fingertips.

Step 2 involves the creation of a new arbitration body, specifically for the medical profession. All cases involving malpractice, illegal billing, even in-compassionate service by nurses or over-prescription of drugs, would be required to be brought before this panel. The panel would consist of doctors, hospital administrators, laymen, nurses, pharmacists, attorneys, and politicians. They would be required to hear any case that was brought forward, without benefit of attorneys on either side. Their decisions would be binding on the professionals only; patients who do not believe they recieved a fair hearing would still be free, after this step, to hire an attorney and enter the civil court system.

This in itself would reduce the amopunt of malpractice claims and leave doctors free to doctor without as much concern over legal turmoil. The risk of abuse would be small, since any panelists who attempt to 'help out' their peers would be subjecting them to the court system, which has lately been renowned for awarding ridiculously huge sums of money in malpractice cases. Check and balance.

This would also allow for a database of abuses by doctors. Many doctors have long records of making horrendous mistakes, yet they are allowed to continue practicing medicine. Under my system, any professional deemed responsible in three major or six minor hearings within two years would have their license to practice suspended for two years, and be placed on a probationary period for three more years. Any problems within that probationary period would result in complete loss of their license permanently.

Step 3 would apply to pharmaceutical companies and hospitals. It would consist of price controls that would tie services rendered to prevailing costs. For instance, it has been freely admitted that pharmaceutical companies sell their products to foreign countries for a tiny fractrion of what they charge Americans. I propose that any pharmaceutical company based in the US be prohibited from selling their drugs to Americans for any more than the lowest cost sold abroad. this would need an exception for humanitarian sales to third-world countries, but there is no reason to bilk the US population while subsidizing other countries, when the benefits of the US are used to do it.

Hospitals would be limited to charging no more than 200% of the lowest available retail cost for items that are available outside the hospital. They would not be prohibited from charging for service, but the very idea of a $20 aspirin should be infuriating to anyone with a conscience. Other cost controls could be implemented in a similar way, to force the price abuses to stop and reduce the overall cost of health care.

continued...

Step 4 would hopefully not be needed, but needs to be addressed: overall price controls on all aspects of healthcare. In the very possible event that health care remains unaffordable, restrictions could be placed on those administering the care. An example would be severe restrictions on the ability of pharmaceuticals to entice doctors into prescribing drugs via 'kickbacks'. This I see as a last resort, as the marketplace will generally correct itself if allowed to do so, but healthcare does not have full marketplace dynamics due to its nature of life and death.

Overall, this would protect the professionals who administer health care, while allowing restrictions on cost to be safely implemented. It would not drop the technological level of healthcare, but would encourage more young professionals to enter the field. It would bring the high cost of care back to affordable levels, and would place final responsibility for payment on the user of the services, with compassion for those who are truly in need. And it would not cost anywhere near as much in the long run as the 'patches' I have been hearing from political pundits lately.

Comments? Come on, tell me whether I am a genius or an idiot! (I vote idiot )

TheRedneck

It sounds very plausible to me, and much better than the system we now have in place. Great post Redneck, now if you can only get it legislated into law.



[edit on 3/11/08 by LLoyd45]

reply to post by LLoyd45

Ah, if only. Here's an idea... if you like it, paste it into an email and send it to someone who can... a congressman! (feel free to remove the redneck part )

If enough members send enough of those emails, who knows? We just might get an actual working healthcare plan.

I love to dream...

TheRedneck

Sounds like a plan to me. I'll do it! Now whether they will pay attention to Joe Public who pays their salary is another matter all together.

Hopefully more board members will take the iniative as well. Affordable healthcare is something everyone has a right to regardless of their ability to pay.

Redneck your plan sounds just peachy except for the IRS as the collection agency.

IMO the IRS needs much less power than they have and its eventual abolishment is much desired. We have too much government control as it is.

I won't go into alternative tax plans on this thread as it would be way off topic.

I do agree that something has to be done concerning health care and it needs to be done expeditiously.

Dizzie

reply to post by dizziedame

Yeah, I didn't particularly like that part with the IRS either, but you have to admit, they are effective! And part of the idea is to prevent people from abusing the system. And just maybe they'll be so busy collecting health care payments, they'll have less time to harass taxpayers.

That said, any ideas on how payments should be collected from the deadbeats? I'm all ears.

TheRedneck



[edit on 11-3-2008 by TheRedneck]

I will have to agree with you that the IRS is, without a smidgen of a doubt, the most effective collection agency now in our economic system. They are working at peak efficiency now and I fear the agency may not be as productive if the matter of insurance collections is added to their already tremendous work load.

There is no doubt that a letter from the IRS brings extreme fear to the most brave of our citizenry. They have the power to take everything you own including your first born child.
Just kidding about the child.

Possibly a civilian collection agency with just a bit more power than they have at their disposal now would suffice.

This is the first year of my life that I do not have health insurance. Was approved for disability in July of 2007 and will be eligible for medicare 24 months from that date. I've stopped smoking, am excerising, and being most fastidious about my diet trying to stay well untill the medicare kicks in.

With my health history the monthly health insurance premiums went up to nearly $2,000.00. That was without prescription coverage. I cancelled the policy 3 months ago.

What is your opinion of the Canadian health care system?

Dizzie

reply to post by TheRedneck

I propose that any pharmaceutical company based in the US be prohibited from selling their drugs to Americans for any more than the lowest cost sold abroad.

In general, your proposal has much merit. One of the sticky points, though, is the above stipulation. Pharmaceutical companies charge the US more because we can pay more than 3rd world countries. According to them(and I'm certainly not an advocate of them), they need to charge what they do, to be able to recover research costs. I can just see them saying that if the above suggestion becomes law, they won't be able to do research on new drugs. Mind you, what you stated is TRUE, we are charged significantly more, but I'm playing the devil's advocate here, because I think that's what they would say.
If anyone has a workaround concerning this issue, it would be great.

BTW, nice job on the plan, in general. Tongue in cheek remark- if this becomes law, you realize that they'd have to quadruple the IRS. Do we really want that?

The reason foreign countries get such heavily discounted prices on our pharmaceuticals is basically they can break the patents and license generic manufacturers to manufacture the drugs.

Ok, so let's say that is the case. Any suggestions on how to solve the problem I posed, namely the research problem?

I have no solutions to that sticky wicket. It's all about profit, and they aren't going to give that up. Most of their new drugs seem to cause more problems than they resolve anymore. Take a look at the disclaimer for Paxil one of the most widely prescribed antidepressants:

In some children and teens, antidepressants increase suicidal thoughts or actions. You and your family should watch closely and call the doctor right away, if you have worsening depression, thoughts of suicide, or sudden or severe changes in mood or behavior (for example feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, hyperactive, overly excited, or not being able to sleep), especially at the beginning of treatment or after any change in dose.

I know, it's really worrisome. Look also at the hormone replacement drugs that they gave to post-menopausal women for years, before they determined that they increased a women's chance of breast cancer, heart attacks, and strokes. A new study indicates, that although the increased risk of heart disease and stroke disappear once the women stopped, the risk of breast cancer remains at 27% higher for women who did take the drug. My wife is in that boat, and we're concerned. Her doctor has her getting mamograms every 6 months, and we're concerned with the risk from excessive radiation. We just don't know what to do anymore, all because of something the drug companies CAUSED.

reply to post by ProfEmeritus
My Mother-in-Law recently died of ovarian cancer, and one of her oncologists said it was most likely caused by the hormone replacement therapy she received by her GP. Naturally he refused to put his opinion in writing for fear of professional reprisals. They also precribed her Fossomax which really caused her serious side effects until they took it off her treatment regimen.

I'm sorry to hear about your wife, and I hope she's one of the lucky ones that suffer no ill effects from her treatments. My prayers are with you guys. If you're not religious (which is fine by me), then accept my best wishes.

Thank you. I appreciate your prayers. We pray every day that our children and grandchildren will be ok, given what is going on in the world today. It was so much simpler growing up in the 1950's. Two television stations, which went off the air at 10pm or so, howdy doodie, Milton Burl, Show of Shows,I Love Lucy, no sex/violence/ terrorists/ on tv, a unique time in the history of our country.

reply to post by dizziedame

There is no doubt that a letter from the IRS brings extreme fear to the most brave of our citizenry. They have the power to take everything you own including your first born child.
Just kidding about the child.

Yeah, we have DHS for that.

I'm truly sorry to hear about your battles. I do hope things will work out OK. My coverage has been off and on for some time now, since in my field of work company change is fairly frequent. I would estimate I have had some type of insurance about 60% of the time over the last few years.

As to the Canadian system, I can't say much on it except for what I have heard. I understand health care is free for all taxpayers, but I also understand that the overall tax rates are extremely high, even compared to ours. I have also heard that they often have long waits for certain types of care.

In the end, someone has to pay the bills, and if there is not profit in the industry, it will be hard to find talented people to do the work. No one works long for free, nor should they have to. And when I am seeing someone about a condition that could so drasticly affect my life, I want it to be the best trained, most talented, most intelligent person possible. I'm sure everyone does.

So the question becomes, who pays, and how? I thought up this plan because the opnes I see being batted around between the politicians all concern themselves with insurance, not medical care. Insurance companies add nothing to the profession, rather, they tend to raise the cost of it and restrict access to their own coverage policies. These are not based on any helth-related situation, but on a profit margin. Should insurance become mandatory, there will be a massive price increase in insurance rates. Why? Because there will no longer be the market pressure of buyers opting not to buy due to expense, and if coverage is required to include pre-existing conditions, then rates will have to go up to cover the additional expense.

Bottom line: insurance companies manage funds, they do not pay out of pocket for health care. They make a profit from it. Think about that $2000/month premium you cancelled. The present political push would have made that illegal. That's why I prefer a system based on cunsumer-driven rather than government-mandated care.

TheRedneck

reply to post by ProfEmeritus

In general, your proposal has much merit. One of the sticky points, though, is the above stipulation. Pharmaceutical companies charge the US more because we can pay more than 3rd world countries. According to them(and I'm certainly not an advocate of them), they need to charge what they do, to be able to recover research costs. I can just see them saying that if the above suggestion becomes law, they won't be able to do research on new drugs. Mind you, what you stated is TRUE, we are charged significantly more, but I'm playing the devil's advocate here, because I think that's what they would say.

Thank you for the kind words!

As to the pharmaceutical companies, have you noticed a trend of the last 7 years? I have. New medicines are now regularly advertised on TV, many without even mentioning what they are for! I knew about the 'little purple pill called Nexium' long long before I even knew what it was intended to treat, and this is doubly ironic because it treats a condition I have lived with all my adult life.

I have watched medicinal cost soar, and people I have known for years become financially strapped with 'forever' prescriptions, some many times over. True, these people have aged over that time period, but it is a trend that one cautious prognosis from a doctor has in each case led to the high number of prescriptions, and in people who are not tremendously aged. In some cases, I have seen medicines prescribed literally to treat side effects of other medications.

In short, the problem with our current administration is not limited to Big Oil. It also includes Big Insurance and Big Drugs. All are getting a pass. My proposal is simply to pull in the reins on an industry that is choking the very life out of health care and the people who rely on it.

And research went on long before you could find out all the glorious details of Bob's sex life on a 30 minute commercial. Despite claims to the contrary, I think research into new drugs will continue long after Bob has a stroke from lack of blood available to his brain (er, wait, you see his grin? That may have already happened... ). It's a bluff, and a poor one at that. In any case, I personally reject the idea that somehow I should pay for drugs for the rest of the world when I can't have any myself, simply because I don't have enough money.

BTW, nice job on the plan, in general. Tongue in cheek remark- if this becomes law, you realize that they'd have to quadruple the IRS. Do we really want that?

Nah, we'll just raise their workload so much they won't have time to deal with the working-class taxpayers anymore. Who knows? They might just simplify the tax code to speed things up.

Did I just say that? See what happens when you can't afford drugs?

TheRedneck

I have seen medicines prescribed literally to treat side effects of other medications.

Isn't that the truth. The last year of my mother's life, that is exactly what they did to her. They gave her fosamax to minimize bone loss, as her bone density was not good. After a few months, she developed esophageal reflux disease. (When the fosamax first came out, they apparently didn't know it caused this- or at least they didn't tell anyone about it), so then they started giving her prilosec. Things started to go downhill quickly, she started bleeding through the bowels. They did a colonoscopy (she was 82 at the time and only weighed 85 pounds. They did not find any cancer or polyps, but the colonoscopy was brutal on her. Her intestinal bleeding increased, they gave her a transfusion and 2 weeks later, they said she needed another one, but that they felt it would only delay the inevitable. She died one month later. They said she just "bled out". The doctors said that was common in older people, but the point was, that until they gave her fosamax, she never had any stomach problems. I believe to this day that the fosamax is what killed her.

reply to post by ProfEmeritus

I'm so sorry to hear about your trials with your mother. Mine is at that stage now, taking 8 different drugs at last count. One is Plavix, a blood thinner. I went shopping with her last Christmas and she got a tiny scratch on her hand from a cardboard box. When I first looked at it, it didn't even seem to have broken the skin, but within 5 minutes, blood was pouring from her hand. My wife took her into the bathroom to stop the bleeding. It was so bad, we had several store employees wanting to call 911. Thankfully we got the bleeding stopped. Why she is on it, I'm not sure, as she has never had problems with blood clots.

I have an aunt who was recently on her deathbed, literally. The family was actually talking about her funeral. She was in a zombie-like state, could barely walk with a walker, and did not even seem to recognize anyone anymore. She fell, hurt her hip, and went to the hospital. Luckily, she saw an older doctor there, who took her off 7 different medications before sending her home. She is now vibrant, can walk unassisted, and is talkative and alert.

Perhaps one of the toughest and strongest men I ever knew was one of my uncles. His experience started when a team of mules and a wagon ran over him. I don't mean they knocked him down as they went past; they spooked while he was holding them, and literally ran over him!. He went home and decided he was hurting too much, so he went to the hospital. They operated for some torn muscles, and sent him home. He died a couple of months later, a weak and confused shadow of the man who got up from the accident.

I have learned from these experiences. With the exception of federally-mandated two-year physicals (where I think I do a good job of ignoring the doctor's advice), I have not been to a doctor in over 15 years. The last medicine I bought was a 2-pack of Goody's aspirin about 5 years ago for a headache. I threw one of the packs away a year ago.

TheRedneck

That's amazing about your aunt. I think the drug companies push so many drugs that aren't needed, and in fact, in many cases, do harm. If any of your family members have ever been in a doctor's office, waiting to get seen, they've probably seen a drug rep walk right up to the desk, and next thing you know, they're in the doc's office. Probably, when the patient does finally get into the doc's office, you know there's going to be a brand new medicine prescribed for whatever you have (or don't have).
I don't know what goes on behind the scenes with drug reps and docs, but let me tell you about what goes on between book publisher sales reps and college professors.(BTW, this didn't apply to me, because the first time a book rep came to my office, I threw them out, and told them NEVER to come back to my office again- They got the picture.)
They come in, with a complete list of courses and subjects you are teaching. They get them from the online course schedules and catalogs. They show you a list of books that supposedly apply to your courses, and try to convince you to adopt them. Some of my colleagues would really play the game. They would act hesitant. Next thing you know, the reps are offering to send them to Florida or Arizona(winter months, of course), at their expense, to go to a book fair. Alternatively, they would suggest a round of golf to discuss their book needs, or a nice dinner at a very expensive restaurant to discuss their "book needs". Of course, the colleagues would also manage to get two copies of the books(one for the office and one for home-of course!).
At the end of the semester, one of the "book hawks" would come around and
buy the books back from the professor(Understand that they got them for free). Many of the professors would even ask the reps to send them some texts that they had no intention of ever using, with the guise of "I'd like to take a look at this text, I may adopt it next semester. Then at the end of the semester, they'd sell the books back to the book hawks.

Drugs are a huge business in this country. I wholeheartedly agree with you, Redneck, that MANY of these drugs are being prescribed when they are not needed.

My prayers go out to you, with respect to your mother. I hope things go well for her and you and your family.