Posted on 06/30/2012 7:21:24 AM PDT by varmintman
Mitt Romney is talking about remove (Obungacare) and replace... The following is my stab at something to replace obungacare with.
The country does need medical reform, but not Obungacare.
The size of obungacare indicates to me that it is about power and not about health care. Likewise Mark Steyn notes that the job of director or head of public health has become the biggest govt. job in European countries which have public health care i.e. it would be a step upwards from PM or President or King or Grand Duke or anything else to head of health care. In other words, European health care is ultimate bureaucracy.
If I had the power to I would institute a sort of a basic health care reform which would be overwhelmingly simple and which would resemble the thing we're reading about in no way, shape, or manner. Key points would be:
1. Elimination of lawsuits against doctors and other medical providers. There would be a general fund to compensate victims of malpractice for actual damage and a non-inbred system for weeding out those guilty of malpractice. The non-inbred system would be a tribunal composed not just of other doctors, but of plumbers, electricians, engineers, and everybody else as well.
2. Elimination of the artificial exclusivity of the medical system. In other words our medical schools could easily produce two or three times the number of doctors they do with no noticeable drop off in quality.
3. Elimination of the factors which drive the cost of medicines towards unaffordability. That would include both lawsuits against pharmaceutical companies and government agencies which force costs into the billions to develop any new drug. There should be no suing a pharmaceutical for any drug which has passed FDA approval and somewhere between thalidamide and what we have now, there should be a happy medium.
4. Elimination of the outmoded WW-II notion of triage in favor of a system which took some rational account of who pays for the system and who doesn't. The horror stories I keep reading about the middle-class guy with an injured child having to fill out forms for three hours while an endless procession of illegal immigrants just walks in and are seen, would end, as would any possibility of that child waiting three hours for treatment while people were being seen for heroin overdoses or other lifestyle issues.
All of those things would fall under the heading of what TR called "trust busting". There would also be some system for caring the truly indigent, but the need and cost would be far less than at present.
By far the biggest item is that first one. I don't know the exact numbers but if you add every cost involved in our present out-of-control lawyering, it has to be a major fraction if not more than half of our medical costs. The trial lawyers' guild being one of the two major pillars of financial support for the democrat party is the basic reason nobody is saying anything about that part of the problem.
Other than that, you almost have to have seen some of the problems close up to have any sort of a feel for them.
Item 1, this is what I saw in grad school some time ago, although I do not have any reason to think much has changed. In the school I attended, there appeared to be sixty or seventy first year med students walking around and all but one or two of them would have made perfectly good doctors, they were all very bright and highly motivated. The only way the school should have lost any of those kids was either they discovered they couldn't deal with the sight of blood in real life or six months later they changed their minds and went off to Hollywood to become actors or actresses; the school should never have lost more than ten percent of them. But they knew from day one that they were keeping 35% of that class.
That system says that you know several things about the guy working on your body: You know he's a survivor, and that's highly unlikely to be from being better qualified than 65% of the other students; You know he hasn't had enough sleep (he's doing his work and the work of that missing 65%); You know he's probably doing some sort of drugs to deal with the lack of sleep... One of my first steps as "health Tsar" or whatever would be to tell the medical schools that henceforth if they ever drop more than15% of an incoming class, they'll lose their accreditation.
Item 2. My father walks into a pharmacy in Switzerland with a bottle of pills he normally pays $50 for in Fla. and asks the pharmacist if he can fill it. "Why certainly sir!", fills the bottle of pills and says "That will be $3.50." Seeing that my father was standing there in a state of shock, the man says "Gee, I'm sorry, Mr. V., you see, we have socialized medicine in Switzerland and if you were a Swiss citizen and paid into the systemn, why I could sell you this bottle of pills for $1.50 but, since you're foreign and do not pay into the system I have to charge you the full price, certainly you can appreciate that."
The guy thought my father was in shock because he was charging him too MUCH... Clearly whatever needs to be done with drugs amounts to trust busting, and not extracting more money from the American people.
Item 3. A caller to the Chris Plant show (D.C./WMAL) the other morning, an ER nurse, noted that much of the costs which her hospital had to absorb, as do most hospitals, was the problem of people with no resources using the ER as their first and only point of contact to the medical profession. She said that there were gang members who were constantly coming in for repairs from bullet holes and knife damage and drug problems, that they could not legally turn any of those people away, and that there was zero possibility of ever collecting any money from any of them, and that the costs of that were gigantic.
Clearly throwing money at that problems is not going to help anything either. Again if I'm the "Medicine Tsar", those guys would be cared for, but not at the ER or at least not the part of the ER where normal people go, and they would not be first in line. Mostly they'd be dealing with medical students who needed the practice patching up knife and bullet damage.
“Item 2. My father walks into a pharmacy in Switzerland with a bottle of pills he normally pays $50 for in Fla. and asks the pharmacist if he can fill it. “Why certainly sir!”, fills the bottle of pills and says “That will be $3.50.” Seeing that my father was standing there in a state of shock, the man says “Gee, I’m sorry, Mr. V., you see, we have socialized medicine in Switzerland and if you were a Swiss citizen and paid into the systemn, why I could sell you this bottle of pills for $1.50 but, since you’re foreign and do not pay into the system I have to charge you the full price, certainly you can appreciate that.”
Your Father could walk into any walmart and get those pills for just .50 cents more, in 99% of cases.
Does this mean this jasper is actually advocating socialized medicine.....the one that you see condemned far and wide by many many writers in foreign countries tied to it’s vicissitudes? THAT type of gobernment sponsored failure?
What we need is for people to pay for their own medical care. It doesn’t matter if it’s the government or an insurance company paying the bills, the customer has little real incentive to price shop or consider cost when making healthcare decisions.
Of course lawyers and paper pushers need to be cut out of the loop. They are just parasites adding to the costs.
“3. Elimination of the factors which drive the cost of medicines towards unaffordability. That would include both lawsuits against pharmaceutical companies and government agencies which force costs into the billions to develop any new drug. There should be no suing a pharmaceutical for any drug which has passed FDA approval and somewhere between thalidamide and what we have now, there should be a happy medium. “
How do you propose to break the incestuous relationship of big pharma and congress? Pharma buys off congress to keep their cozy monopoly on drug development and distribution.
Simple reforms become almost impossible when you have to try and and force logic thru a money laundering system which is congress.
Remember when you paid the doctor out of your own pocket first, then went home and filled out the insurance papers and submitted them to your insurance company and waited for them to pay you?
You knew what it cost, and it sure cut down on the paperwork costs for the doctor.
Remember when you paid the doctor out of your own pocket first, then went home and filled out the insurance papers and submitted them to your insurance company and waited for them to pay you?
You knew what it cost, and it sure cut down on the paperwork costs for the doctor.
That would be a huge step in the right direction. Now when I ask a doctor what a procedure is going to cost I get a blank stare yet they still want to be referred to as professionals.
1. Elimination of lawsuits against doctors and other medical providers.
We have tribunals like this. Eventually they get captured. Checkout the reports about non-judicial foreclosures and what happens when the Banks lie to force folks into foreclosure. This won't work. Elimination of stupid lawsuits would be a good idea, and there are any number of ideas on how to do this. Let each state try to figure it out.
2. Elimination of the artificial exclusivity of the medical system.
Absolutely. This was part of HillaryCare, the idiot idea that too many doctors drove up the price. The whole idea of 'Certificate of Need' for hospitals and medical schools is counter productive. We just need a 'Certificate of Quality' for such things, and it need not be a government certificate.
3. Elimination of the factors which drive the cost of medicines towards unaffordability.
No lawsuits against Vioxx or Thalidomide? Again, the problem is stupid or trivial lawsuits. And trusting the FDA (or any government puke wanting a better paying job in big pharma) is not the right way to go. You can't sue the FDA now, but you should be able to.
There are suggestions like 'loser pays' for trivial lawsuits. Let the different states try different things. Maybe let Pharma refuse to sell in states that allow ridiculous trials and verdicts. Maybe let the FDA and FDA employees be sued if bad results were hidden. Maybe have the government should publish on the web, in formal form, all test studies done with government aid. Right now there is a bias to publish only positive results.
4. Elimination of the outmoded WW-II notion of triage in favor of a system which took some rational account of who pays for the system and who doesn't.
Triage is always needed. But what we need is Four-age. Check the ability to pay first, and put those who can pay to the head of the line.
What we have now is a system where it's easier for the hospital to get paid for the illegal than the insured. One of the reasons you get a bill of $10,000 reduced to $300 under insurance, is that the bill of $10,000 for the illegal is what is present to the government as a loss for indigent care.
Maybe hospitals and doctors should be allowed only a couple of price points that must be publicly listed - those paying cash, those paying with insurance. And cash customers should get a lower price. Nobody should be forced to provide charity care.
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Pretending that the indigent should get Rockefeller quality care, while the rest of us don't, is a major problem. This odd way of thinking is a problem beyond easy fixes.
I would not yank Med school credentials, but I might make them swallow the cost of failed students. Carnegie Mellon tells the parents of their students that the school knows that they are getting the cream of the crop of young minds, and that if the kid fails, the school has failed them in some way. They won't swallow any costs, but they do much more to monitor progress and keep parents informed in the first year.
Maybe the med school needs to swallow 1/2 the tuition for washed out doctors. Or just maybe the government gets out of the business of worrying about and paying for Med schools and just publishes the results. It could be that some students think Med schools that wash out more students are better and are willing to take the risk. If the government isn't subsidizing it, it's not a problem for the government to fix.
Getting the government out of the field would drastically reduce the cost of Medicine. The armies of bureaucrats would not have to be supported by your insurance or doctor's fee payments. The compliance stffs(private bureacurats) would be drastically reduced. ERs, no longer being required to treat all comers would have their costs drastically reduced as they don't have to use thousands of dollars of space and time and services assets to treat a sniffle. Illegal aliens would no longer get their free ride paid for by the rest of us but would have to find their own funds or insurance.
Consider how much we have to pay out of our own health money for those bureaucrats and all the government hoop;s that have to be traversed. Go to Thailand or India for freemarket treatment. The cost is perhaps a third or less, sometimes a lot less, for same or better quality of treatment than here and the plant expenses are not much different.
We need to start using axioms based on reality.
1) Everyone who *wants* to provide for their own care can do so on their own initiative, without government interference. They may refuse insurance entirely without penalty.
2) Strict limits must be placed on insurance for routine medical needs. Contracts for routine insurance must be limited to individuals, paid directly by those individuals, and while such insurance may be required by an employer, they may not specify through what insurer.
3) HMOs, medical cooperatives, and individual physicians should be encouraged to offer cash services at less cost than paid for by insurance or government medical care.
4) Government backed medical insurance for other than government employees and veterans should be limited to catastrophic and nursing home insurance, as these are not profitable enough to be backed by private insurance. Payments for these and Medicaid should be made exclusively through block grants to the individual states.
5) Emergent medical care must be treated, and as now non-emergent care is forwarded to for pay urgent care. But any follow up non-emergent care should be through the state Medicaid provider (often the “County hospital”).
You could start by simply creating an absolutely open market for all drugs with FDA approval meaning that a drug has FDA's approval/recommendation and also that a drug with that approval was immune from lawsuits.
Fantasy worlds are fun, unfortunately some evil fate has consigned me to living in the real world...
You have the idea more or less. We need to be looking at rational ways to reduce the cost of medicine, not just extend the present system to any and all at yours and my expense.
There is a generic for all but the newest of drugs.
I’m assuming that if walmart had generics for everything, things like supersavermeds.com would not exist.
I thought the same think until I checked. I was paying $38 at a local drug store, went to wally world and got the same exact generic for $4.
http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf
My daughter and her family were staying with us, her hubby had re-joined the Army, they were waiting for paperwork to complete, so had no insurance.
She got a sore throat that appeared to be strep. I made her an appt at my doc, told them I’d be paying cash.
She was seen by doc, throat cultured, medication, and 2-wk re-check. I about fainted when I got the bill. $35.
My other daughter got a band on her stomach for weight control. Was going in about every 6 weeks for “fills”. In April, she got a bill from the doc for $1000. When she called them, she was told that her insurance had quit covering the fills on 1 January, so she’d have to pay for the TWO visits she’d made that year.
She went to talk to them, she was going to tell them that she couldn’t afford 500 dollars a visit and to cancel her future appts. They asked her if she’d seen the financial dept about cash visits. Curious, and to set up a payment schedule for the 1000 dollars, she went to the finance dept. They told her that cash-only visits were 50 dollars each, and yes, she could convert the 1000 dollar bill into a 100 dollar bill if she paid in cash, which she did.
What’s the answer? Get rid of the insurance companies? I don’t know. If you need heart by-pass, it’s not going to be that cheap, but those two incidents show the difference between with and without insurance.
I wonder how she defines "costs which her hospital had to absorb" and "no resources." Medicaid under-reimburses for care and the government's own statistics show that Medicaid patients are TWICE as likely to use the ER as uninsured patients. Stats consistently show that insured people use the ER in higher percentages than the uninsured. Still, the dems get away perpetuating the myth that ERs are clogged because of the uninsured.
If you look at page 2 of this CDC report, you will see that Medicaid beneficiaries far exceed privately insured or uninsured persons use of ER.
This report shows the reasons publicly/privately insured persons use the ER. Unless reform addresses access to primary care and empowers ERs to limit ER access to true emergencies--eliminating the unfunded mandate to care for everyone, particularly those who seek ER care as a matter of convenience not true emergency--ERs will remain overburdened and care overpriced.
That's a good idea, I'll add it to the list. Give ERs the right to limit ER care to real emergencies and/or life threatening conditions.
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