"Fixing" our healthcare system...

[Firethorn]

NPR is currently doing a piece on health care insurance and such, and going quite a bit into France's healthcare system.

Per NPR, France seems to get twice the healthcare at half the cost.  On the other hand, a deficit of 9B doesn't seem like a good thing to me, especially for a country with a fifth of the population.  Especially when private supplimental healthcare insurance is specifically mentioned.  They mention that the sicker you are - the more France covers.  Sounds a bit like 'insurer of last resort'.  They spend a lot of time covering the difficulty pregnant women have getting healthcare insurance(in this context, women who move BACK to the USA after spending time in France).  The words 'You don't write a policy on a burning building' come up.

How would YOU fix our healthcare system?  Does it even need to be fixed?

Things I'd consider:
Prefered fix:
Healthcare savings plans; allow deductions for obtaining private healthcare insurance.  Look into ways to encourage individuals to obtain private healthcare insurance, seperated from their work.  Ways to reduce the paperwork and payment collection costs.  Ways to encourage people to pay for their own healthcare without involving insurance(except for extreme cases).  Ways to encourage private healthcare insurance/plan providers to offer affordable individual insurance/plans.  Clear out any rules/laws disallowing government healthcare plans from negotiating drug rates.  Ways to encourage people to live healthy - such as offering healthier choices in school lunches.*

Optional tweaks, not necessarily libertarian, but then I call myself a libertarian because it's the closest match, not a perfect one:

Disallow 'pre-existing conditions' like pregnancy from being a disallowing factor.  Especially if they are currently or were recently covered by another plan.  In this case, covered by France would count.  To help make it up to the business, I would allow a long term contract to be required - being forced to cover a pregnant woman isn't so bad if she's going to be with you for the next couple years, at least.  Note:  You can lock in the contract, but by the same token, the rate and service level would be locked in.

Disability level healthcare - where the condition is either permanent or will result in an extended inability to work, can be covered by the government.  Yes, it's essentially required insurance, but as we're socially unwilling to let them suffer due to their poor choices, it shouldn't be much different than the mandatory unemployment insurance schemes most states have.  Everybody pays a tax on a portion of their income to cover the truly disabled**.  Some are born disabled, some are born unknowing with a genetic condition that later manifests, some are caused by injury, disease, or poison.  My uncle is on disability for a combination of genetic factors and agent orange exposure.  My grandfather has been on disability for years for a combination of damage from polio and an accident caused when a piece of equipment failed*** from when he worked as a mechanic.

Welfare stuff - I firmly believe that people should be better off working than depending on government aid.  I generally oppose hard benefit cut lines.  As part of my philosophy in this regard, providing subsidized healthcare to low income families and individuals who would be better off not working due to the cost of healthcare is reasonable.  It's cheaper to provide the healthcare than to have them quit in order to qualify.

* On another article from france - they had a piece where school lunches were the equivalent of $2 cheaper, but prepared by a three star chef rather than a 'cook'.  By utilizing fresh, mostly locally grown food, reducing waste, etc...  He's able to produce healthy, tasty food for less than the cheap, palatible only due to large amounts of fat/suger, preprocessed junk.
**As always, I know fraud, waste, and abuse will exist.  I just support effective measures to surpress it.
***Back before equipment and safety procedures were quite as developed as they are now.
edit:  later review found spelling errors.

[Manedwolf]

If our healthcare system is so "broken", why the hell does everyone from every other country fly HERE for the world's best specialists in care?

[grampster]

The president of France came to America to see how our system works because he doesn't think his does.

I'd like to see non taxed health dollars continue to come from employers, if they choose, as part of one's pay/benefit package.  Those dollars should not be taxed at the employer level or the employee level.

That does still give an employer a leg up in hiring good people.  Health insurance should be purchased like auto or homeowner insurance in a competitive market, choosing the coverages one wants above and beyond some baseline coverages that are compulsory for everyone, like no-fault auto is.  There could be token surcharges for pre-existing conditions for a stated period of time, and could be treated as a partial tax credit at the fed and state level.  Health insurance premiums could be generally deductible on fed and state income taxes even though they are not taxed as income.  Group discounts should be eliminated.  If an employer does not offer health insurance dollars, the worker could get a partial tax credit in addition to deductibility.  Let the market sort out the employers that can't afford to use health insurance dollars as a job benefit.  Some folks might rather have the tax credit because they might like a particular field of work.  The less dollars going to government and staying in the market place makes for a stronger economy and reduces government waste and control.

I continue to believe that the market works better than government.  Letting government do it makes everyone lazy and lets the system decay because there is no accountability.  A government bureaucrat does not get fired for paying too much for stuff, he gets promoted.  Let a buyer make the same error in private business, he is terminated.  Why do a lot of people seem to believe that elected people and bureaucrats somehow have a better grasp of a thing than people to actually do a thing??

[cassandra and sara's daddy]

how do they do a school luch 2 bucks cheaper? i was under impression they only cost about 2 bucks.anytime i hear a phrase like 3 star chef my bs meter  pegs

[yesitsloaded]

I'm all for no help for those that don't want it. Smokers and drug users can die if they don't have private insurance to cover it. We don't need to spend billions covering for things caused by choice. Yes, I have considered myself a smoker and quit about five weeks ago so don't cry to me about addiction. Withdrawal sucks, but not as bad as cancer. That and disease caused by obesity. If you can afford to eat you can afford to pay for the resulting illnesses caused by it, genuine medical cases of obesity caused by some freak gene not counted. That would probably cut our nationwide costs by at least a third I'm guessing. Focus more on prevention than sick care. Healthy people don't need much in the way of health care so funds available can be spent on the truly sick and disabled. I just don't like the idea of someone working 50 hours a week and still not having a place to live, health care, and food. Then again if you live in a trailer with a 60 inch plasma tv with an xbox 360 don't come bitching to me about not having food because you spent your money on cigarettes and booze. Those people just need to learn a hard lesson in economics 101 and opportunity cost.

[Firethorn]

how do they do a school luch 2 bucks cheaper? i was under impression they only cost about 2 bucks.anytime i hear a phrase like 3 star chef my bs meter  pegs

The standard lunch(in France) averages $5, this school manages to break even at $3.

He does it by avoiding distributers and going directly to the source in many cases - in the examples given, he went to the local fish market(that the local restraunts also use) to get mussels, to a local poultry farm to get turkeys.  Utilized leftovers from the day before to help make today's meal.

Because he is a fairly large buyer, he can get good prices.  Preprocessed crud often isn't cheaper than fresh.

[El Tejon]

How to fix it?

This doctor prescribes a large injection of free marketism.

[Firethorn]

The president of France came to America to see how our system works because he doesn't think his does.

Interesting, especially how the article notes that the program has a $9B deficit and is cutting benefits.

I'd like to see non taxed health dollars continue to come from employers, if they choose, as part of one's pay/benefit package.  Those dollars should not be taxed at the employer level or the employee level.

Good idea.  That'd be easy to tie into a HSP program.  I like the tax credit option.

I continue to believe that the market works better than government.  Letting government do it makes everyone lazy and lets the system decay because there is no accountability.

Agreed.

Focus more on prevention than sick care.

To a point.  There's no sense in spending $1/person to prevent a disease that'll cost $100 to treat, but only pop up in 1 in a thousand people.

[yesitsloaded]

Agreed. I was thinking along the lines of easily prevented dental problems and vitamin deficiencies that come from just not eating right.

[roo_ster]

First off, I no more believe in a comprehensive, "total fix" of anything, much less health care.  The best we can do is bust the gov't brush in the way of progress.




1. Tax-free & pre-tax health care / dental / dependent care / day care / education savings accounts:
Pretty much, if citizens are willing to jump through the hoops and do for themselves what gov't tries to do for us, gov't ought to get outta the way and provide an incentive for the citizens to make it happen.  I would pool the monies for these into a single account that rolls over and does not disappear when the next 01JAN rolls around.

2. Open the insurance market:
Allow any resident from any state to buy health insurance from any provider in any state.  If NY state has too many mandated inclusions that drive up insurance costs in NY state, allow NY citizens to buy insurance from states with fewer mandates.

3. Push hard for near-universal catastrophic insurance
Make is a big bully-pulpit issue.  Use every social tool available to persuade folks it is the responsible thing to do.

4. Have the US Congress refuse jurisdiction of the SCOTUS on illegal alien social program use issues
US Congress has the power to limit SCOTUS's action.  It should do so WRT illegal aliens' access to social program dollars.  And then shut down all such access with the exception of emergency issues.  To get that care, the illegal alien MUST be deported after stabilization.

[Racehorse]

I think those are four very good ideas. Now if only they would happen...

[Tallpine]

How would YOU fix our healthcare system?

Eliminate government enforced MD/FDA monopoly.

90% of stuff doesn't need drugs and/or surgery, but that's where the money is.  Half the time, medical treatment just makes things worse, but that's just fine because now you are a repeat customer. 

I wish I could just get our vet to x-ray for broken bones or sew me up if I need it.

[Firethorn]

I wish I could just get our vet to x-ray for broken bones or sew me up if I need it.

You know, I agree with you.  Why is it that having a medical facility, used to dealing with intelligent cooperative patients for the most part, charges hundreds of dollars for an xray, while a vet can do the same thing with a non-understanding and perhaps uncooperative animal for a couple dozen dollars?

A broken bone is a broken bone.

Same deal with medicine - the human prescription costs $$$, the 'animal' version(with the same exact label) $?

[yesitsloaded]

It probably is because vets don't have to treat dozens of cases that can't pay. They don't have to take illegal immigrants or poor people and eat the loss. Every patient a vet has can pay in full most of the time. That and malpractice for vets is probably next to nothing if it even exists.

[Headless Thompson Gunner]

I think the root problem lies in the averaging behavior of insurance.  When people are insured, they pay for the average cost of service for everyone in the system.  Nobody pays their own individual costs, and individually everyone is free to use as much unnecessary extra service as they want without regard to cost.  Individuals have no incentive to economize.  But when everyone uses extra services, the average cost for everyone goes up.  Health insurance costs inevitably rise.

If private insurance is replaced by some sort of government funded or single payer system, we'll have exactly the same problem.  The averaging action remains the same.  The only difference will be that the insurer is replaced by the FedGov, and your inevitably rising insurance premiums will be replaced by inevitably rising taxes. 

I don't think our healthcare system is going to be "fixed" until everyone accepts that you aren't entitled to the best possible cost-no-object care whenever you step into a hospital or doctors office. 

We literally know how to do things to people that we simply cannot afford to do.  These treatments are expensive.  They require tremendous expenditures of extremely limited resources. Think of all of the highly skilled man-hours, of all the extremely sophisticated equipment, the specialized facilities, and the supplies and materials.  Those resources are finite, yet everyone thinks they are entitled to use as many of those resources as they want, whenever they want, just because.

Unless a given patient can offer up comparable resources (i.e. money) in like quantity to offset what they're consuming, then he cannot demand that all of those limited medical resources be given to him.  If everyone consumes those resources without replenishing them, then the pool of resources is quickly used up.

[MechAg94]

IMO, the first thing to do is find a way to completely separate Emergency Health Insurance and Regular Health Benefits.  I don't need much health care on a normal basis.  I can pay my own way for annual health checkups and such.  All I need is Emergency Health Insurance to help out if something bad happens.  IMO, regular doctor's visits, prescription drugs, and regular health care needs should be handled separately.  Why should emergency premiums be put in the same pool of money?  IMO, people are used to getting all that in one package from their employer so they don't think the two are separate. 

I like the idea of putting incentives out there for people to find their own health coverage.  If you wanted to force the issue, cut off tax breaks for employer provided benefits at same time.  Force people to look for individual plans and make personal decisions based on their own circumstances.  I think that alone would force changes in the system.  If someone else is always paying for it, it will never change.  What HTG said. 

[MechAg94]

We need to find a way for Hospitals to reduce the number of people who can't pay or won't pay and reduce stress on emergency rooms.

In that same vain, what is a good solution for medical malpractice?  How can we reduce the impact of that while still holding doctors/hospitals accountable?
-----------------
I separated this from my original post as this is another component of costs.  What to do about malpractice costs and people treating emergency rooms like free clinics. 

1.  Let Hospitals kick people out who don't have life threatening injuries? 
2.  Should they kick people out who can't pay?  Can they legally be held accountable if they can't pay?   
3.  Are the malpractice insurance rates currently charged realistic?  Should legal damages and such be capped? 
4.  Should we just execute all lawyers and go from there? 

[Firethorn]

HTG, Mech, I agree with you - that's why I listed Healthcare savings plans(HSP), ans stuff like 'not involving insurance except in extreme cases'.

Insurance should be just that - covering major unexpected expenses.  I wouldn't cut off the benefits in employers providing healthcare coverage - but I'd work to put it on an even footage with privately obtained coverage.

We need to find a way for Hospitals to reduce the number of people who can't pay or won't pay and reduce stress on emergency rooms.

Agreed.

1.  In general, yes.  At the very least, require proof of citizenship/legal residence.  Enter into some agreement with countries that have national healthcare systems that they pay for their citizens while they're in the USA, some sort of tit-for-tat system(they pay for US citizens while they're there, we pay for them while they're here), or get companies to offer critical care traveler insurance plans.
2.  If they can't pay, no treatment(life/limb and such saving exempted).  If the hospital treats anyways - yes, the bill can be treated as any other legitimate debt.
3.  Depends.  Personally, I think that punative damages should equal that doctor not working in medicine again, because he deliberately did something, and can no longer be trusted.
4.  Sounds good.

[Marvin Dao]

IMO, the first thing to do is find a way to completely separate Emergency Health Insurance and Regular Health Benefits.  I don't need much health care on a normal basis.  I can pay my own way for annual health checkups and such.  All I need is Emergency Health Insurance to help out if something bad happens.  IMO, regular doctor's visits, prescription drugs, and regular health care needs should be handled separately.  Why should emergency premiums be put in the same pool of money?  IMO, people are used to getting all that in one package from their employer so they don't think the two are separate.

Already doable. You can purchase catastrophic medical insurance with high deductibles ($500-1000) that will do exactly what you want. Free market and irrational consumers being what they are, the "all in one" plans are still more popular at their much higher cost, even for those who don't need the care.

3.  Are the malpractice insurance rates currently charged realistic?  Should legal damages and such be capped?

The damage from malpractice suits is a minuscule percentage in the total cost of health care. The bigger cost is incurred when doctors perform defensive medicine in order to close off avenues of legal exposure. Course, a lot of this is just incompetent doctors covering up their knowledge shortcomings.

[Tallpine]

Already doable. You can purchase catastrophic medical insurance with high deductibles ($500-1000) that will do exactly what you want.

We looked into that, and it was going to cost as much as our house/land mortgage payment each month 

[BridgeRunner]

In that same vain, what is a good solution for medical malpractice?  How can we reduce the impact of that while still holding doctors/hospitals accountable?

Well, in Michigan we have virtually no med-mal anymore thanks to tort reform.  Nothing has changed, except that people who are hurt through gross negligence and ludicrous deviations from standard of care are generally sol.  Insurance premiums haven't gone down.  Costs are still rising.  

I separated this from my original post as this is another component of costs.  What to do about malpractice costs and people treating emergency rooms like free clinics. 

1.  Let Hospitals kick people out who don't have life threatening injuries? 

Yes!  Of course!  The way ER's should work is that people are immediately triaged.  If there is a ludicrously non-emergent reason for the visit and there is clearly abuse or misunderstanding of the point of the ER, they are then asked to leave.  If their condition is in doubt, they can wait for more thorough triage, and then sent home if a more thorough evaluation shows no emergent problem.  Those in a clear state of emergency are treated immediately.
 

2.  Should they kick people out who can't pay?  Can they legally be held accountable if they can't pay? 

No.  People shouldn't die because they can't prove they have coverage.  People should live because they are willing to lie.  That would come down to providing proof of coverage and/or a very large bank balance while in the midst of a life-threatening emergency.

As someone who was in such an emergency fairly recently, I can state unequivocally that that is virtually impossible.  I couldn't even park my car properly, let alone sort out financial documents.
  

3.  Are the malpractice insurance rates currently charged realistic?  Should legal damages and such be capped? 

No, and sort of.  There are some serious problems with damage capping.  One of those, incidentally, is that with the kind of intensive discovery required, lawyers cannot afford to take on contingency cases when damages have been tightly capped, because 1/3 of the recovery will not pay for the cost of the trial.  Some caps are reasonable, some are not.  

I think it would be more reasonable to change the burden of proof and the standards of care measured, and to limit the number of parties who may be joined in a suit.  Why on earth should the doctor be sued if it was the hospital's screw-up and the doctor wasn't in the room?  Why should the nurses be sued if it was clearly gross negligence on the doctor's part?  
 

4.  Should we just execute all lawyers and go from there? 

Well, maybe all insurance executives and the legislators in their pockets.

Keep in mind that there aren't that many med-mal lawyers.  There are only two or three in my local area, and hundreds and lawyers.  

[MechAg94]

I wasn't suggesting we kick someone out who is bleeding to death.  There has to be a way to improve the current system.  A friend of mine coach's a girls softball team.  One of the girls hurt her ankle and he took her to the emergency room to see if they could get x-rays and make sure it wasn't a break.  He said he ended up waiting forever as the hospital only had one doctor on staff that night and she didn't seem to give a damn.  I am not even sure he needed an emergency room, but it was a Friday night and there wasn't much other choice.  I am not sure if clinics would be much better.

[MechAg94]

Already doable. You can purchase catastrophic medical insurance with high deductibles ($500-1000) that will do exactly what you want.

We looked into that, and it was going to cost as much as our house/land mortgage payment each month 

I was thinking about more like a $2000 to $5000 deductible.  If the cost is lower, I can maintain a separate savings account.  I have heard it is still high myself, but I haven't actually shopped for it.  I am an engineer and health benefits are pretty much standard compensation so it is not likely I would need it the way things are now. 

[Tallpine]

Already doable. You can purchase catastrophic medical insurance with high deductibles ($500-1000) that will do exactly what you want.

We looked into that, and it was going to cost as much as our house/land mortgage payment each month 

I was thinking about more like a $2000 to $5000 deductible.  If the cost is lower, I can maintain a separate savings account.  I have heard it is still high myself, but I haven't actually shopped for it.  I am an engineer and health benefits are pretty much standard compensation so it is not likely I would need it the way things are now. 

I don't remember exactly now, but it was something like $5K deductible. 

If you can afford health insurance, then you probably already have a job that provides it as a benefit.  Though at the end we were paying $500/month for the family for group insurance 

I went to the doctor last fall when I broke my elbow and we had to pay for it.  In retrospect, I should have just stayed home and nursed it because they didn't do anything anyway.  It really did "feel better when it quit hurting" about three months later 

[MillCreek]

I see that many of the people here have clearly not heard of EMTALA, the Federal law regulating the triage and treatment of people in hospital emergency departments.  Your thoughts about kicking people to the curb would be a violation of Federal law. 

And I also point out that I do malpractice defense for a living, and in most locales with damage caps, the cap applies only to "pain and suffering" awards.  Economic damages such as lost wages, impairment of future earning capacity, rehab, future medical costs, etc. are not capped. 

And FYI, the typical medmal plaintiff attorney contingency fee in a medmal case is 40% if it settles before trial and 50% if it goes to trial and they win a verdict.  Take for example a $ 100,000 settlement.  The plaintiff counsel takes 40% or 40,000 off the top.  Then they take the costs of working up the case: expert witnesses, travel, photocopies, long distance calls, etc.  Say that equals $ 15,000.  So the total fees and costs equal $ 55,000 and the injured party gets the remainder, or $ 45,000.  The defense attorneys are paid via an hourly fee win or lose.