Ok if it's broke, let's fix it.

[TeyshaBlue]

Ok, we’re a buncha geniuses here at SpursTalk.com. Lets figure this out.:downspin:

Let's run with the premise that our contemporary healthcare model is morbidly damaged and needs repair/reform/destruction. Pick your poison.

My take. The current healthcare model has failed because Health Insurance morphed into something it was never intended to be. As a tool of risk apportionment, profit, above what was necessary to sustain it's organization, was not a primary motive. But over the centuries, it has become commoditized....just like pork bellies and FCOJ. Now, it is seemingly impossible to remove or strip away the multigenerational layers of this commoditization (Did I just make up that word?) by legislative fiat. We, and by we, I mean the consumer across a couple of centuries, have melded insurance to a commodity. We accomplished this by creating the market for HMO models where the insurance company now covers the routine visits and medications. It wasn't always that way, but it is now and we're largely responsible for it.

The fix. Is reform a zero-sum game? I think it should not be. A public option, as it's been structured thus far, would kill off the private insurers over time.....and while many believe this to be a good thing, eliminating an entire industry generally never is. That belief is also held by those that are currently quite content with their healtcare plan.

It seems to me that it's fatally counterproductive to consider that approach...the either/or. However, what's to keep us from structuring them in a progession of care? Let the public option take the role of an HMO...let it handle the routine appointments...the prescriptions and outpatient services such as physical therapy. Let the private sector handle the large ticket items...specialists...the surgeries...the ongoing therapies...etc. Free the private sector from the costs and expense of serving as an HMO and let them go back to being what they once were...tools to apportion risk..with the caveat that they cannot deny pre-existing conditions and that they will tier their pricing. With the cost reductions, we should demand an equal reduction in premiums. This in turn reduces the cost of both private and public options by sharing the populations.

Ok. There's what I consider a starting point. What's wrong with it?

Figure it out, braniacs.:king

[boutons_deux]

"would kill off the private insurers over time.."

a great idea. The current for-profit health insurance industry is a subsidized racket.

Expanding Medicare to everybody will cause the for-profit insurance industry to shrink, one estimate is by 70%. For-profit insurance companies exist in countries with national plans.

Instead of employer's contributing to for-profit insurance greed, employers contribute all the same money to Medicare.

"That belief is also held by those that are currently quite content with their healtcare plan."

You mean employed people on their employer's plan?

80% never use it for serious expenses, and most them pay 25% for for down to nothing for it, and none of them pay income taxes on the benefit (thank you, Hated Big Govt). What's not to love?

[Wild Cobra]

Simple.

1) Add a medicaid tax to what is called payroll taxes. Set it at maybe 2% to start with. Everyone pays, so everyone can access it.

2) Extend current medicate coverage to every legal resident in the USA, up to a point where they can pay for insurance themselves. Then it goes to a sliding scale for payments.

3) Coverage will include a free annual check up and other service as needed with a small copay.

4) the initial 2% will be adjusted as needed to cover all medicaid costs.

[TeyshaBlue]

boutons, I don't know whether you're an old, forgotten Turing program left running on a 386 machine in the basement of UT's computer science building, or just a wheels-off anarchist that would run Gary Busey for President.

[boutons_deux]

Teysha darling, just for you, GFY

[TeyshaBlue]

Teysha darling, just for you, GFY

ROFL...Gary Busey in 2012 it is!:lol:lol:lol:lol

[LnGrrrR]

What about a plan to reduce claims of malpractice? That seems to be a big puzzle piece in our current problem.

[101A]

a great idea. The current for-profit health insurance industry is a subsidized racket.



What makes insurance company's profit a "racket"?

Is a doctor's profit a "racket".

How about a Hospitals?

A drug company's or a pharmacy's?

How about a nursing home, or a hospice center?

A farmer? (how dare he make a profit providing food)

Or a builder? (same thing, except for shelter)

All of the Healthcare industries profits, plus the salaries of their CEO's couldn't run Medicaid for two days!

Profit isn't the problem.

Sick people and expensive cures (or expensive non-cures) ARE.

[coyotes_geek]

1. Start taxing junk food and alcohol like we tax cigarettes.
2. Take those tax proceeds and divvy them up amongst everyone with a social security number. Proceeds to be paid into individual health savings accounts which individuals can use to help pay for their health care expenses.
3. Remove legislation that's keeping out foreign prescription drug competition.
4. Tort reform.
5. Tell hospitals and emergency rooms to turn away anyone who doesn't have insurance, or can't pay cash for the services to be provided, with the obvious exception of someone who's life is in imminent danger.
6. No public option, but the government would be allowed to set up their own insurer, provided that the govt's program would be funded solely through member premiums. No support from income or payroll taxes.

[boutons_deux]

"What about a plan to reduce claims of malpractice"

a complete red herring. Tort reform is bullshit. Frivolous claims are a tiny percentage of total claims, like cadillac-drving welfare queens/welfare fraud is a tiny percentage of total welfare payments.

About 100K deaths due to avoidable medical errors, and probably several 100K injured for same reason.

How about reducing medical malpractice, then the suits for medical malpractice will automatically come down. aka, solve the problem, not the symptom.

[Wild Cobra]

What about a plan to reduce claims of malpractice? That seems to be a big puzzle piece in our current problem.
I agree. The hard part is separating what is a legitimate claim from frivolous. We have to start by acknowledging that any procedure or drug my have unintended circumstances. We can only sue if fault can be clearly demonstrated, and not on suspicion. Maybe have a third party interview all medical persons involved with a polygraph to establish if there is fault to assign. Many jobs have you acknowledge you may be subjected to a polygraph for employment. Let's add that to medical practitioners. Let's stop the practice of people suing unless cause is established.

[boutons_deux]

Amazing, Wild Goober proposing to raise payroll taxes.

In the right direction, so everybody pays, but wimpily timid.

[ChumpDumper]

So how much has tort reformed lowered health care costs in Texas?

[TeyshaBlue]

So how much has tort reformed lowered health care costs in Texas?

Not much if any. Studies that I've read (I'm looking for them now) show that tort related costs are between 3-10% of healtchare expenditures. Now that aint chicken scratch, but it's not the big ticket issue many believe it to be.

[coyotes_geek]

Not much if any. Studies that I've read (I'm looking for them now) show that tort related costs are between 3-10% of healtchare expenditures. Now that aint chicken scratch, but it's not the big ticket issue many believe it to be.

True, but that doesn't mean tort reform shouldn't be part of the solution though. I haven't seen anyone provide any evidence as to how we'd all be better off by not doing it.

[Wild Cobra]

Amazing, Wild Goober proposing to raise payroll taxes.

In the right direction, so everybody pays, but wimpily timid.
I am not opposed to all taxation. I am fine with flat taxation. When everyone who votes is paying if they work, then I trust people will make better and more responsible voters. I am against taxes that have nearly half the voters having a say in who we elect, but pay no taxes, then vote for the people who promise them benefits.

How is it timid?

I have in the past, acknowledging Social Security will fail us, proposed we mandate a pay raise to give all workers the employers share of SS/medicare, then taking everyone the approximate 15.3%. Call it a social tax, and everyone pays. No exception. When government wants/needs to raise or lower taxes, this tax gets raised or lowered, and the income tax structure remains unchanged.

Everyone has a stake in the system that way. Equal suffrage.

[TeyshaBlue]

1. Start taxing junk food and alcohol like we tax cigarettes.
2. Take those tax proceeds and divvy them up amongst everyone with a social security number. Proceeds to be paid into individual health savings accounts which individuals can use to help pay for their health care expenses.
3. Remove legislation that's keeping out foreign prescription drug competition.
4. Tort reform.
5. Tell hospitals and emergency rooms to turn away anyone who doesn't have insurance, or can't pay cash for the services to be provided, with the obvious exception of someone who's life is in imminent danger.
6. No public option, but the government would be allowed to set up their own insurer, provided that the govt's program would be funded solely through member premiums. No support from income or payroll taxes.

I like #3, #4. I don't want to tax junk food....most of the time it's cheap food and that hits the wrong segment of the population too hard. Kinda like the flat tax.
Substitute WC's idea of a 2% (+- .5%) payroll tax. Then proceed with your point #2. I'd be curious to see what this would total.

[coyotes_geek]

I like #3, #4. I don't want to tax junk food....most of the time it's cheap food and that hits the wrong segment of the population too hard. Kinda like the flat tax.
Substitute WC's idea of a 2% (+- .5%) payroll tax. Then proceed with your point #2. I'd be curious to see what this would total.

There's no arguing the point that obesity is a major factor in driving up our health costs, so why not hit up that segment of the population for the increased costs their behavior is going to put on the health care system?

Also, I wholeheartedly disagree with the premise that lower income Americans can't afford to make healthy choices when it comes to food. If you can afford a combo meal every day you can afford to go to a grocery store and buy something healthier.

[TeyshaBlue]

There's no arguing the point that obesity is a major factor in driving up our health costs, so why not hit up that segment of the population for the increased costs their behavior is going to put on the health care system?

Also, I wholeheartedly disagree with the premise that lower income Americans can't afford to make healthy choices when it comes to food. If you can afford a combo meal every day you can afford to go to a grocery store and buy something healthier.

You're only hitting one side of the junk food problem, tho. The consumers. Why not the suppliers as well? Yeah, it'll likely get passed on to the consumers, but if they offered a healthier item, it would automatically have a better margin.

[Wild Cobra]

You're only hitting one side of the junk food problem, tho. The consumers. Why not the suppliers as well? Yeah, it'll likely get passed on to the consumers, but if they offered a healthier item, it would automatically have a better margin.
How about instead of food stamps, we do like WIC does. They send you a check like paper that lists what you buy. Cereal, cheese, milk, etc. The items are rung up then the amount placed on the check, and the supermarket gets reimbursed. Make people getting government assistance only able to use them for government approved foods. No junk food. Now if people have the money to buy McDonald's, etc. Let them. If you restrict them to only healthy food paid for with other people's money, then more I'm sure will use their spare money for other choices besides fast food.

[LnGrrrR]

How about instead of food stamps, we do like WIC does. They send you a check like paper that lists what you buy. Cereal, cheese, milk, etc. The items are rung up then the amount placed on the check, and the supermarket gets reimbursed. Make people getting government assistance only able to use them for government approved foods. No junk food. Now if people have the money to buy McDonald's, etc. Let them. If you restrict them to only healthy food paid for with other people's money, then more I'm sure will use their spare money for other choices besides fast food.

Hm.. I think that'd be a good idea. If you go on the government dole, then you shouldn't (theoretically) balk at eating the foods the government says you have to eat.

It would also give motivation to those who want to eat some junk food once in a while.

[coyotes_geek]

You're only hitting one side of the junk food problem, tho. The consumers. Why not the suppliers as well? Yeah, it'll likely get passed on to the consumers, but if they offered a healthier item, it would automatically have a better margin.

The suppliers only supply what the consumers want. I think it would be much more effective to hit the consumers directly and force them to acknowledge exactly why they're paying more for their junk food, as opposed to just hiding that cost behind all the other factors that get buried into a supplier's cost. When consumers start demanding healthier food the suppliers will be more than eager to provide it to them.

[SpurNation]

There's another aspect of health care costs that doesn't get discussed much throughout the nation but is one of the largest contributors to it's esculated cost.

That is the free health care already in place paid by tax dollars, private insurance premiums and losses in the industry due to illegal allien care.

Also, I already pay to support free loading welfare recipients who by the most part have no intention on giving up their monthly government checks and food stamp cards just to have to actually sustain a job.

Unless these areas of government waste are addressed and corrected...I see no way that "government" health assistance is going to function any more proficient.

It should remain as a free enterprise system but...I would condone government regulations throughout the entire health care industry including rate regulations and subsidation amongst Physicians, Hospitals, Pharmeceutical Companies, Insurance Companies and by all means Tort Reform.

[Wild Cobra]

Hm.. I think that'd be a good idea. If you go on the government dole, then you shouldn't (theoretically) balk at eating the foods the government says you have to eat.

It would also give motivation to those who want to eat some junk food once in a while.
Yep. It's pretty bad when you can have a vending machine business under the table. Buy your products with food stamps, and keep your vending machines full, pocketing the cash, tax free.

[jack sommerset]

We need to start gathering all the illegals up and sending them home. If a business hired illegals they need to be fined to the point they never hire another one. Put a cap on lawsuits. If the person who took a doctor to civil court loses that person needs to be fined and his/her lawyer as well. It's a start.

[jack sommerset]

Also legalize pot. That will save alot of money on doctor bills

[FuzzyLumpkins]

So how much has tort reformed lowered health care costs in Texas?

None whatsoever. Whats fucked up is that while the rise in litigation payouts annually has increased by an average of 5% per year which is parallel to the 5% inflation rate, the rise in malpractice insurance premiums has gone up 25%.

[FuzzyLumpkins]

What makes insurance company's profit a "racket"?

Is a doctor's profit a "racket".

How about a Hospitals?

A drug company's or a pharmacy's?

How about a nursing home, or a hospice center?

A farmer? (how dare he make a profit providing food)

Or a builder? (same thing, except for shelter)

All of the Healthcare industries profits, plus the salaries of their CEO's couldn't run Medicaid for two days!

Profit isn't the problem.

Sick people and expensive cures (or expensive non-cures) ARE.

Actually profit is exactly the problem. Ina typical market you have a slanted demand curve such that the higher price you charge the less people you will get to pay for your goods/service.

HC isn't like that. The demand curve is pretty much vertical. IOW, they can charge whatever the fuck they want and people will pay whatever it takes to get care.

If your arm is broken and you will lose partial function and risk osteomyalitis if you don't get care then your going to pay what it takes.

People will mortgage their homes sell everything they have and live out of their car to pay for their child's medical care.

We will pay whatever the fuck they want, they have us by the balls and they know it.

THEY HAVE NO INCENTIVE WHATSOEVER TO CUT COSTS.

[SpurNation]

None whatsoever. Whats fucked up is that while the rise in litigation payouts annually has increased by an average of 5% per year which is parallel to the 5% inflation rate, the rise in malpractice insurance premiums has gone up 25%.

Tort reform as generally defined is...
"that sum of money which will put the party who has been injured in the same position as he would have been if he had not sustained the wrong for which he is now getting his compensation or reparation."

Malpractice is a separate entity that is between patient and physician, hospital or pharmeceutical and has nothing to do with compensation for the injury itself unless the physician, hospital or pharmeceutical is deemed neglegent in their treatment of said injury.

[FuzzyLumpkins]

Tort reform as generally defined is...
"that sum of money which will put the party who has been injured in the same position as he would have been if he had not sustained the wrong for which he is now getting his compensation or reparation."

Malpractice is a separate entity that is between patient and physician, hospital or pharmeceutical and has nothing to do with compensation for the injury itself unless the physician, hospital or pharmeceutical is deemed neglegent in their treatment of said injury.

And your point is?

WTF do you think has happened when malpractice insurers payout? WTF do you think the insurance is for?

There is no accusation of malpractice without an accusation of negligence.

You act as if there aren't malpractice suits.

You can make the same inane comment about liability. Quite frankly your post is stupid.

[SpurNation]

And your point is?

WTF do you think has happened when malpractice insurers payout? WTF do you think the insurance is for?

There is no accusation of malpractice without an accusation of negligence.

You act as if there aren't malpractice suits.

You can make the same inane comment about liability. Quite frankly your post is stupid.

My post is directed at your post regarding cost percentages in the medical industry as compared to cost of living and malpractice insurance premiums. It looked to me that you were saying Tort Reform doesn't work because of the cost of malpractice insurance premiums.

If so I was trying to explain...
Malpractice is the act of giving inaccurate treatment to a patient. Are physicians not liable for giving inaccurate treatment to a patient? If it is proven that the patient suffered due to the effect of inaccurate treatment should a physician, hospital, or pharmeceutical be exempt from the cost of correcting such procedure?

That's why malpractice insurance premiums are up. Not because of Tort Reform...but because there is more than just the treatment of the first problem...there is the treatment(s) of the insuing problems because of the mistake.

[FuzzyLumpkins]

My post is directed at your post regarding cost percentages in the medical industry as compared to cost of living and malpractice insurance premiums. It looked to me that you were saying Tort Reform doesn't work because of the cost of malpractice insurance premiums.

If so I was trying to explain...
Malpractice is the act of giving inaccurate treatment to a patient. Are physicians not liable for giving inaccurate treatment to a patient? If it is proven that the patient suffered due to the effect of inaccurate treatment should a physician, hospital, or pharmeceutical be exempt from the cost of correcting such procedure?

That's why malpractice insurance premiums are up. Not because of Tort Reform...but because there is more than just the treatment of the first problem...there is the treatment(s) of the insuing problems because of the mistake.

I never said anything about tort reform. If anything I think its funny that the insurance companies wasted so much lobby money to get it. At the end of the day, adjusted for inflation they are paying out the same as before.

The only issue is that in the case of what doctors have to pay to the insurers, they are paying out 5 times more than what can be explained by inflation. IOW, the insurers are jacking up the prices arbitrarily.

[SpurNation]

The only issue is that in the case of what doctors have to pay to the insurers, they are paying out 5 times more than what can be explained by inflation. IOW, the insurers are jacking up the prices arbitrarily.

I'm not an expert in the nuances of malpractice insurance but let me interject a thought about that from a business owner perspective.

The 5 times the amount may be a figure that represents the average cost of having to correct a mistake that might be made.

As a business owner if my company were to create damage to a client while performing the service they hired me to do or even perform a task they did not authorize me to do...then the expense of fixing the damage could easily be 5 times the cost of what that client intended me to do in the first place.

[TeyshaBlue]

And your point is?

WTF do you think has happened when malpractice insurers payout? WTF do you think the insurance is for?

There is no accusation of malpractice without an accusation of negligence.

You act as if there aren't malpractice suits.

You can make the same inane comment about liability. Quite frankly your post is stupid.

The intent of the OP is to suggest fixes. In the context of the OP, quite frankly, your post is stupid.

[FuzzyLumpkins]

The intent of the OP is to suggest fixes. In the context of the OP, quite frankly, your post is stupid.

Awww, you don't like me now. I am going to need a box of tissues. This line of discussion is in the context of a proposed fix. Given that it is perfectly germane.

[TeyshaBlue]

Awww, you don't like me now. I am going to need a box of tissues. This line of discussion is in the context of a proposed fix. Given that it is perfectly germane.

Relax, little fella. It'll be ok. I like you just fine.

Fix something, will ya?

[FuzzyLumpkins]

Relax, little fella. It'll be ok. I like you just fine.

Fix something, will ya?

Oh I am fine.

Really what I feel is needed is some serious market intervention. I know that pure capitalists freak out at the idea but quite frankly the industry in general outside of pharmaceuticals to a degree has zero incentive to keep costs down.

The demand curve is as such that the consumer will pay any price regardless of supply or demand for that matter and as such something has to be done.

I am not overly fond of the public plan. Ideally, I feel that it would be a good tool to keep the honest but I know how it would really go. In Texas there is a state run auto insurance company. Most people don't know this because it is a steaming pile of shit because of the way the lobby force it legislated.

In the industry, there are what are called risk categories. If you get into an accident your rates auomatically go up by a percentage but it can also put you in a different risk category which increase your base rates that the multiplier applies to. This allows you to appropriately charge the consumer and still minimize risk.

The state run agency can only have one risk tier and its a flamin pile of shit that no one would be willing to pay so no one uses it. That is exactly what the lobby would try to do here. As such a public option isn't going to work

Instead the first thing I propose is simple. Open all insurance companies' actuarial tables annually and grandfather that for the last 25 years. Make them justify their bullshit.

Before people start clamoring about this keep in mind that this is exactly what happens for property and casualty insurance in all 50 states. AllState for example has to go to the Texas Insurance Commision with their actuarial tables and proposed rates and if the commission says its bullshit then they have to fix that shit and come back or they dont sell insurance in Texas.

(continued)

[FuzzyLumpkins]

Malpractice would be beholden to these same ideas.

The collusion between the insurance companies and hospitals needs to end and the manner in which charging is done needs to stop. Prices need to be standardized. IOW, there is ONE COST and everyone who gets that good/service pays that one cost. Now different costs can be set at different hospitals and clinics but that is the limit. On an individual basis that would be illegal.

Additionally, pricing would have to be up front given and agreed to before the procedure/service/good is given. Obviously in the case of a medical emergency this would be waived but this bullshit of going to the hospital and having no idea what its going to cost until two weeks after you get home would be over.

You will be told what a private room costs total not just how much more it is than an alternative. If a CAT scan is to be administered then you will know how much it costs before they give it to you. You will know how much that tylenol costs or that morphine drip or that cast or WTFever BEFORE you get it. The worst are the leeches like OTs that go from room to room peddling wares you don't need/want only to fucking bill you.

The hospital trust will go away. Currently most of the hospitals in the US are owned by 3 holding companies. Now it would be illegal to own or be part of an ownership group of more than one hospital. The collusion will end.

Doctors would get additional benefits in paying out their student loans if they go into general medicine for a period of time, say 10 years or until their loans are paid off whichever happens first. Subsidize them or lower the interest rate whatever.

Pharmaceutical companies can no longer advertise on TV and no longer can they send reps to doctors offices. You can send mail to them you can ship drugs whatever but prescriptions based on salesmanship rather than intelligence will end. IOW, if youre a doctor go read a fucking medical journal.

Medical patents would not be privy to the same benefits as other goods. It would be reduced from 7 years to 2 years.

I think all of that would be a good start.

[TeyshaBlue]

Malpractice would be beholden to these same ideas.

The collusion between the insurance companies and hospitals needs to end and the manner in which charging is done needs to stop. Prices need to be standardized. IOW, there is ONE COST and everyone who gets that good/service pays that one cost. Now different costs can be set at different hospitals and clinics but that is the limit. On an individual basis that would be illegal.

Additionally, pricing would have to be up front given and agreed to before the procedure/service/good is given. Obviously in the case of a medical emergency this would be waived but this bullshit of going to the hospital and having no idea what its going to cost until two weeks after you get home would be over.

You will be told what a private room costs total not just how much more it is than an alternative. If a CAT scan is to be administered then you will know how much it costs before they give it to you. You will know how much that tylenol costs or that morphine drip or that cast or WTFever BEFORE you get it. The worst are the leeches like OTs that go from room to room peddling wares you don't need/want only to fucking bill you.

The hospital trust will go away. Currently most of the hospitals in the US are owned by 3 holding companies. Now it would be illegal to own or be part of an ownership group of more than one hospital. The collusion will end.

Doctors would get additional benefits in paying out their student loans if they go into general medicine for a period of time, say 10 years or until their loans are paid off whichever happens first. Subsidize them or lower the interest rate whatever.

Pharmaceutical companies can no longer advertise on TV and no longer can they send reps to doctors offices. You can send mail to them you can ship drugs whatever but prescriptions based on salesmanship rather than intelligence will end. IOW, if youre a doctor go read a fucking medical journal.

Medical patents would not be privy to the same benefits as other goods. It would be reduced from 7 years to 2 years.

I think all of that would be a good start.
I knew if we banged around long enough we'd agree on something.:toast

Good, solid points....all of 'em. I'm especially glad someone sees the larceny that is pharmaceutical pricing in the US. To further expound on your price point mods, I would abolish all GPOs...every single one of them. Their "negotiated" pricing is nothing more than subterfuge to enable the rebates pharma companies pay to them to list their products.
The thought that a bottle of Tylenol costs $5 at one hospital and $25 at another, by fiat of GPO contract pricing is ludicrous. I believe a fair price can be arrived at for any product once the bullshit of GPO manipulation is removed. Severly throttling back the advertising and marketing would throw millions if not billions, back into the mix.
I administered the VA pharmaceutical contracts for years. Like the DOD, you don't fuck around with the VA. They demand the best GPO pricing, period. If Novation lists Tylenol at $4, and that is the best pricing of all the GPO contract prices, then that is what the VA demands....and woe be unto the pharma company that screws up that pricing. I watched the VA spank Bristol Meyers-Squibb once for that. The VA simply put the disputed item on contract for $1 until BMS corrected their mistake. It wasn't pretty.:lol