[Al_U_Card]

ldrews, on 2017-March-08, 11:53, said:

So, the consensus is that the Trump health plan is nonsense, unworkable, etc. The current ACA is imploding, premiums are soaring, deductables are soaring, insurance companies are abandoning, etc.

So what is your solution? Or are we to just sit on the sidelines and complain?

How about:
The guv sets prices based on.inspection and study of a broad spectrum of service providers. If everyone is obliged to pay into (like an income tax with payroll tax part too) then a sliding scale of how much you pay of the "list price" is used based on age and/or contributions to the "system". Thus, in my case I have almost never made use of the medical system so I would pay a smaller pro-rata amount than someone who was in poorer health. Supplementary private insurance would be available as well according to need. Younger people could use actuarial values to price-in their contributions (like term vs whole life insurance) of the cost to them.

[jogs]

Al_U_Card, on 2017-March-09, 08:33, said:

How about:
The guv sets prices based on.inspection and study of a broad spectrum of service providers.

The gov't shouldn't set prices. Just have price transparency by service providers. Let the public decide if they wish to pay more for 'better' providers.

[Winstonm]

helene_t, on 2017-March-09, 08:30, said:

Yes.

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

I wish you good luck.

This sounds SO Paul Ryan.

[Zelandakh]

If America wants to keep an insurance-based multi-payer system, and all evidence suggests that is the case, then reading about the oldest healthcare system in the world might be of interest. Naturally that is completely off the chart for Republicans though, being government-led (over 3/4 of costs) and obligatory (most cannot opt out of the statutory Krankenkasse system). Another system of interest would be in Australia, although even here the government pays for 2/3 of the costs. Perhaps an amalgamation of the two, taking Germany's customer focus and range of choice and merging it with Australia's stronger private options, would be possible but the simple truth is that if America really wants to get a hold of healthcare it has to involve the government stepping in and controlling the majority of it. Allowing the private sector free range is just a recipe for disaster in this field.

[jogs]

Politicians wants an insurance-based system. About 20% of Americans have no access to this healthcare. These Americans are mostly the poor. Would not be able to afford any system designed by politicians. The poor want the most healthcare the public is willing to give them( with their tax dollars).

[kenberg]

helene_t, on 2017-March-09, 08:30, said:

Yes.

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

I wish you good luck.

This is so stunning to me that I honestly am not sure if you are being ironic or you really mean it. Most of it I object to. A couple of things I find totally unacceptable:

1. "Get rid of doctor-shopping."
If I do not like my doctor I will get a new one. Having lived for quite a while I have encountered doctors who needs to find a new profession. This goes way back to when I was an undergrad in the 1950s and got free medical care on campus. I was a healthy youngster but even so it was immediately apparent that not all doctors are created equal. Any plan that prevents me from seeking out someone I prefer would have my strong opposition. It's not easy to make me into a single issue voter, but this might do it.

2, "Get rid of malpractice lawsuits. " No. I take some pride in having gone through my 78 years without suing anyone or being sued. But that is me personally. We did attempt, unsuccessfully, to sue a doctor for something involving Becky. The main objective was to present him as the incompetent boob that he was.

3. "Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care." This maybe sounds good, but it isn't. The problem is that often you do not know how urgent something is until you are seen by the specialist. I'll mention one experience along these lines. A few years back I had a TIA, also known as a mini-stroke. A few weeks later I had symptoms similar to what had preceded the earlier TIA. Becky drove me into the emergency room, I walked up to the desk and said "I hope I am wasting your time". I explained, she understood, I was admitted, thankfully I was wasting their time, I was ok. But at the time I walked in I did not know that I was ok. If we wait until it is clear, that may be too late. Or at least it might be a lot more expensive if we are looking at the bottom line. Of course if I croak it would save a bundle.

I also am not big on cutting doctor's salaries. I'll let them speak to that, but if a guy saves my life I am not against giving him some money. Even quite a bit of money.

Short version: If what you describe is the European version of medical care I want no part of it.

But biking instead of driving appeals to me. I have biked a lot in my life but the roads around here are such that biking on them definitely reduces a person's life expectancy.

I mention these things because indeed this is a political hot potato. Part of what has to be done is to understand what people feel strongly about, and I believe I am in the (in the U.S.) majority in what I say here.

[jogs]

kenberg, on 2017-March-09, 12:58, said:

3. "Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care." This maybe sounds good, but it isn't. The problem is that often you do not know how urgent something is until you are seen by the specialist. I'll mention one experience along these lines. A few years back I had a TIA, also known as a mini-stroke. A few weeks later I had symptoms similar to what had preceded the earlier TIA. Becky drove me into the emergency room, I walked up to the desk and said "I hope I am wasting your time". I explained, she understood, I was admitted, thankfully I was wasting their time, I was ok. But at the time I walked in I did not know that I was ok. If we wait until it is clear, that may be too late. Or at least it might be a lot more expensive if we are looking at the bottom line. Of course if I croak it would save a bundle.

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

[kenberg]

jogs, on 2017-March-09, 14:14, said:

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

We might agree, at least sort of. I have long felt that there is a limit to how much my family should pay to keep me alive, and if there is a limit to what they should pay then clearly there is a limit to what the tax payer should be expected to do.

But it depends a bit on the situation. And the problem is that sometimes the situation is not clear.

I favor helping people in need. On the other hand, I find the system works pretty well for me as it is right now and I don't want someone (Dem. or Rep. or Trump, whatever he is) screwing it up with some badly thought out changes.

[barmar]

jogs, on 2017-March-09, 14:14, said:

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

The problem with a 2-tier system like this is that many of the best doctors will abandon the public health system and go into "concierge" practice, treating the rich people who are willing to pay more.

Capitalism means you get what you pay for, and free things are worth every penny you spend.

[cherdano]

barmar, on 2017-March-09, 16:43, said:

The problem with a 2-tier system like this is that many of the best doctors will abandon the public health system and go into "concierge" practice, treating the rich people who are willing to pay more.

I think the bigger problems is with doctors who (as jogs suggests) take both public and privat patients. Taking public patients means that they are in charge of public resources - making judgement calls on who needs a surgery most urgently, etc. Taking private patients means you can bribe them, sorry, in a private consultations they may become more aware of this particular patient's urgency.

[jogs]

kenberg, on 2017-March-09, 12:58, said:

2, "Get rid of malpractice lawsuits. " No. I take some pride in having gone through my 78 years without suing anyone or being sued. But that is me personally. We did attempt, unsuccessfully, to sue a doctor for something involving Becky. The main objective was to present him as the incompetent boob that he was.

I wave my right to sue. Give me the inexpensive healthcare, no insurance companies and no lawyers.
$100 a month with medicare. If you wish to retain your right to sue, you should pay $1,000 a month premiums into medicare.

If the doctor is incompetent, decertify him. But give the plaintiffs and lawyers nothing.

[jogs]

Winstonm, on 2017-March-08, 08:46, said:

What you want is from the progressive agenda, not from Donald Trump. Why continue to support a con man? I mean, it's O.K. to be conned. We are all susceptible. It is not O.K. to stay conned.

I don't agree any progressive agenda. On healthcare both democrats and republicans got it wrong. If the GOP plan isn't hated by health insurance CEO's, it is not an improvement over Obamacare.
Since I don't need to be re-elected to any office, I can offer my plan which would anger many. On a temp basis, all uninsured can join medicaid. Only it's not free. They will be billed. The young and healthy should be pleased. They will have access to healthcare. And only when they need it.
This doesn't solve the problem with older unhealthy Americans without health insurance. I'm amazed how old looking and unhealthy Americans who are 20 years younger than I are. Republicans can repeal Obamacare with no replacement. Put them into medicaid(and bill them for use) til republicans can agree on a workable plan. Not optimistic. Who will come forward and agree to foot the bill for the poor who are sickly?

[helene_t]

kenberg, on 2017-March-09, 12:58, said:

This is so stunning to me that I honestly am not sure if you are being ironic or you really mean it.

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

Of course you may have different priorities.

As for waiting lists, I agree with you. The problem is, apparently, that without the price incitement to keep down demand there has to be a different mechanism to avoid overconsumption. But there must be a better way. There are countries like OZ and France that have reasonably short waiting lists but it comes with a price tag. I think Denmark has managed to get most of the waiting lists down to more or less acceptable lengths, though.

As for doctor-shopping, of course you should be allowed to switch doctors but what is not a good idea is to keep switching all the time. Of course every patient is different. If you only see a doctor once every several years it doesn't matter.

As for malpractice lawsuits I really would encourage you to reconsider your position. Malpractice lawsuits may work in particular cases but overall their impact on health care quality is almost certainly negative. Have your heard about the book "Complications"? https://books.google...WMC&redir_esc=y

[kenberg]

helene_t, on 2017-March-09, 17:57, said:

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

Of course you may have different priorities.

As for waiting lists, I agree with you. The problem is, apparently, that without the price incitement to keep down demand there has to be a different mechanism to avoid overconsumption. But there must be a better way. There are countries like OZ and France that have reasonably short waiting lists but it comes with a price tag. I think Denmark has managed to get most of the waiting lists down to more or less acceptable lengths, though.

As for doctor-shopping, of course you should be allowed to switch doctors but what is not a good idea is to keep switching all the time. Of course every patient is different. If you only see a doctor once every several years it doesn't matter.

As for malpractice lawsuits I really would encourage you to reconsider your position. Malpractice lawsuits may work in particular cases but overall their impact on health care quality is almost certainly negative. Have your heard about the book "Complications"? https://books.google...WMC&redir_esc=y

Maybe all three of these could be grouped under the general problem of people behaving badly. I don't doubt that lawsuits are a serious problem and not just for lawyers. There have been various times, no details come immediately to mod, where I have felt like saying to a doctor or some other professional, "Relax, I am not the suing kind". But some are.
And I have no idea why anyone would hop from doc to doc. We moved eleven years or so ago, I got a new doc, I would not recommend him to a cat. I got a new one who left for parts unknown, then the next guy I am still with, for maybe eight years.
It's like anything else, some products/services are better than others. But if a person is never satisfied then the problem is probably with them .

There can be little amusements. Back during my TIA days I was getting many tests. At one of them the woman about to administer it said "I am not certain Medicare will pay for this but they will if you feel dizzy. I ask you sir, do you feel dizzy?". Well the whole business was very confusing and no doubt causing some dizziness. "Oh yes, I feel dizzy". I have always been good at pop quizzes. The TIA had produced dizziness and beyond, so I have a clear conscience about that one.

[ldrews]

Al_U_Card, on 2017-March-09, 08:33, said:

How about:
The guv sets prices based on.inspection and study of a broad spectrum of service providers. If everyone is obliged to pay into (like an income tax with payroll tax part too) then a sliding scale of how much you pay of the "list price" is used based on age and/or contributions to the "system". Thus, in my case I have almost never made use of the medical system so I would pay a smaller pro-rata amount than someone who was in poorer health. Supplementary private insurance would be available as well according to need. Younger people could use actuarial values to price-in their contributions (like term vs whole life insurance) of the cost to them.

It seems like anytime you put the government in charge of regulating an industry, the industry immediately starts trying to "capture" the regulators with bribes, campaign contributions, entertainment junkets, etc. The industry is usually successful. Look at banking, insurance, education.

And everyone tries to game the system: the regulated companies, the clients and patients, everyone. Each individual and company trying to change or move the the laws/regulations in their favor, or find loopholes to give them some advantage.

Expecting everyone to behave themselves and cooperate for mutual benefit seems naive given our history.

[jogs]

helene_t, on 2017-March-09, 17:57, said:

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

The four richest counties in the US are all near Wash DC. We need to put all lobbyists out of business.

[helene_t]

kenberg, on 2017-March-09, 18:35, said:

"I am not certain Medicare will pay for this but they will if you feel dizzy. I ask you sir, do you feel dizzy?".

Ha-ha that sounds familiar, could certainly happen here. Not so much with drugs which are reimbursed at rates which may depend of all kind of things but usually don't depend on the indication. But things like dental care (I once had a pre-existing problem diagnosed as a work accident because my employer was insured and I was not), cosmetic surgery (we say the scar comes from your last surgery), haptotherapy (we call it "physiotherapy" then you don't have to pay).

Yeah there are cases where you need to be able to go somewhere with your complaint about a doctor. If a builder commits an oops he will usually just admit it himself and offer compensation. Happens all the time. With mechanics it's a bit different and with doctors very different.

But taking them to court is just ineffective. It doesn't prevent him from keeping practicing and in most cases it shouldn't either because there is almost zero correlation between bad practice and losing malpractice lawsuits.

There is a need for a system that will make sure that whenever something goes wrong we all learn from it and draw the propper consequences. Maybe to reschool, reemploy, deregister or even punish the doctor but more likely to review the procedures, or just to register the oopses so that at least future patients will know what risks they take. It requires that nobody has perverse initiatives to sweep problems under the carpet or to find scapegoats for random accidents.

It's not anywhere near ideal here, either. Many of the problems described in the book I referred to can be summarized as a sweep-it-under-the-carpet culture which you will find here also. He compares it to the rules in aviation which are designed to give pilots and engineers incitements to report mistakes in an unbiased way, regardless of whether it was their own mistake or somebody's else. Sounds impossible and probably is but that doesn't mean that one shouldn't strive in that direction.

[kenberg]

There is something in WaPo today about tort reform:
https://www.washingt...m=.1dcd6be88f3f

It can be complicated. Capping the awards sounds wrong to me in theory since I can well imagine situations where a large award is very justified. The problem is that the possibility of a large unjustified award encourages some people to fle a law suit that has very little merit, trusting that their target will pay off with a small amount to avoid the gamble. This predatory suing doesn't fit into my self-image, nor of most people's, but some are fine with it. One of the more disgusting phrases is "I wouldn't do this but my lawyer says I have to". No, they don't have to.

People need to practice some restraint on what they go into battle over. Back to politics for an example. The Russian intervention in the election is serious business, we need to find out what all happened, deal with it, and see how best to protect ourselves in the future. On the other hand, Kellyanne's suggestion that everyone go out and buy Ivanka Trump jewelry is a triviality. I cannot stand Kellyanne. I don't like her voice, I don't like her looks, I don't like what she says, I don't like the way she says it. I just don't like her. But her "endorsement" of Ivanka products was frivolous. Stupid, but frivolous. Possibly she technically broken some law. I really don't care. The sale of men's undershirts supposedly dropped dramatically after Clark Gable, in It Happened One Night, revealed that he wasn't wearing one.There is no accounting for how some people come to a buying decision, but if anyone out there buys Ivanka jewelry because Kellyanne said so, I have no interest in stopping them. George Bush, I forget which one, created a firestorm when he mentioned that he didn't like broccoli. Shocking.

At any rate, some people deserve to be sued just as some people deserve to be fired and some people deserve to be put in jail. But suing can turn into a profession. i agree with efforts to make it an unprofitable one.

[billw55]

jogs, on 2017-March-09, 17:39, said:

I wave my right to sue. Give me the inexpensive healthcare, no insurance companies and no lawyers.
$100 a month with medicare. If you wish to retain your right to sue, you should pay $1,000 a month premiums into medicare.

Actually, this sounds like a pretty good idea. Voluntary waiver of right to sue in exchange for substantially reduced premium. Maybe there could be a middle option that accepts arbitration - yes claims, but no courts and greatly reduced lawyers.

[Winstonm]

jogs, on 2017-March-09, 21:44, said:

The four richest counties in the US are all near Wash DC. We need to put all lobbyists out of business.

I still don't understand why you voted for Trump and why you seem to still support him when your ideas and values lie elsewhere. Populists elected a con man who is simply using populism as a means to an end - and he sure isn't about middle class values, you can bet on that.

I understand that you thought Washington D.C. was broken and needed to be fixed. But turning the U.S. into a Russian-style oligarchy is not a solution to our problems.