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A Different Take on Health Care

AnnL's picture

This was posted over in the Tavern and it's a really interesting read.  Non-partisan. Making me take a second and third look at this whole health care travesty and worth the read, even though it's long.  Perhaps we should forward this to all of our senators and reps?


http://www.theatlantic.com/doc/200909/health-care


Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

thecooktoo's picture

(post #52971, reply #1 of 195)

Good article and worth reading.  It is a very good rehash of a number of similar articles that have appeared over the last 4 or 5 years.


Do any of you remember the movie starring George C. Scott as the administrator-doctor of a large city hospital (patterened after Cook County in Chicago)?  In one scene he was berating a group of physicians; it seems that the dr's had run the wrong tests, interpreted those wrong, cut off the wrong limb and the poor patient was now suffering from infections and pneumonia.  Scott's words to the doctors: "For Gods sake, discharge the poor ba$tard before we kill him."  I took that and had it made into a small sign that put in every doctors intro pack when they joined the hospitals medical staff where I was administrator.


Jim

Aberwacky's picture

(post #52971, reply #2 of 195)

I didn't read the post (not enough time now), but have to comment on something the VA does that has really cut down on errors: their electronic medical records system, which includes the pharmacy. 


All medical data is stored electronically--patient records, history, x-rays, prescriptions, etc.  It's been a great way to make sure the patient doesn't get a medicine that will kill him (allergies are noted, and if you try to prescribe something they're allergic to, a warning message comes up).


It's also greatly cut down on medication errors (as you know from your time as a medical administrator, that's one of the biggest potential ways patients can be harmed while in the hospital.)


The patient has a barcode on their wrist band, as does the medication.  It and the medication get scanned--if it's not a match in the system, the patient doesn't get the medicine. Prevents a lot of human error.


It's also very convenient for the vets--all their doctors in the system have access to their complete medical record, and can see what their history is,  medications they're on, etc.  As a patient, you don't have to fill out your medical history every time you go see a different doctor, and the doctor gets a clearer view of the patient as a whole.


The system's not perfect, of course, and most physicians had to be dragged kicking and screaming into it since all their notes, referrals, prescriptions, etc.  have to be entered into the system by THEM and not a clerk, but it does have a lot of advantages.


Don't know that cost is one of them (requires a staff to maintain the system, hardware, training, etc.), but it does help in providing better care for patients. 


Leigh


"Happiness does not depend on outward things, but on the way we see them."
-Leo Tolstoy
"Happiness does not depend on outward things, but on the way we see them." 
-Leo Tolstoy
AnnL's picture

(post #52971, reply #3 of 195)

Technology is one of the points made in the article.  The current "claim" is that because of patient privacy they can't convert to "paperless".  Well, they manage to do it for billing and if that doesn't endanger privacy, then it wouldn't in other ways. 


There's also the point about somehow in healthcare advances in technology end up being more expensive, but in a normal "commerce" industry, technology ends up increasing efficiencies and decreasing costs. 


To sum it up, the problem is that healthcare is not a consumer driven industry.  I really only heard about this a couple of months ago and this article really explains it and makes some excellent points. 


Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

smslaw's picture

(post #52971, reply #5 of 195)

One of the most persuasive points in the article was the suggestion that we all should plan to pay most routine expenses and predictable expenses (like end of life care) from currect income or savings, leaving truly catastrophic expenses for insurance. We don't expect our car insurance to cover our oil changes,etc.


He used the example of lasik surgery to show that uninsured medical procedures get pretty cheap when people have the incentive to price shop.

AnnL's picture

(post #52971, reply #6 of 195)

Yes, making health care a consumer driven industry.  If we're paying for it ourselves, instead of the insurance companies and Medicare, we're the consumer.  It makes sense that insurance should be for catastrophic events, although I think I would prefer the baseline to be lower than the $50k the author suggests, but certainly higher than the $2k he said someone else had suggested. 

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

smslaw's picture

(post #52971, reply #13 of 195)

It makes sense that insurance should be for catastrophic events, although I think I would prefer the baseline to be lower than the $50k the author suggests, but certainly higher than the $2k he said someone else had suggested. 


Do you think insurance should pay for a typical childbirth?

Aberwacky's picture

(post #52971, reply #14 of 195)

Not Ann, but I do--and I include pregnancy in that, not just childbirth.  That's one of the best opportunities for influencing someone's future health positively that we have. 


If it's not covered by insurance, too many people would skimp on the care, which means increased costs on down the line.


LEigh


 


"Happiness does not depend on outward things, but on the way we see them."
-Leo Tolstoy
"Happiness does not depend on outward things, but on the way we see them." 
-Leo Tolstoy
AnnL's picture

(post #52971, reply #15 of 195)

I think so, but, I haven't really fully thought this one through,yet.  There's definately lots to be considered.  There's also ongoing chronic problems, like diabetes--should that be covered.  If it's not covered, will that reduce the cost of treatments?  So, I'm not sure how I feel about it all.  But, I definately think this is the way we should be headed... 

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

MadMom's picture

(post #52971, reply #18 of 195)

My eldest grandson was born of a typical childbirth, no real complications, and his mother took him home within 24 hours.  He is seven years old, and his hospital bill should be paid off next year.  His mother had insurance, but her workplace, although it withheld her premiums, didn't process the insurance until a few days after the obligatory nine months, so the benevolent insurance company refused to cover the birth.


My youngest grandson was born almost three months early, spent over two months in the NICU.  His parents' share of the hospital bill?  Zero, due to the horrible "socialized" medicine which the Army practices.  He got excellent care, BTW, and is over five now.


 




Not One More Day!
Not One More Dime! Not One More Life! Not One More Lie!

End the Occupation of Iraq -- Bring the Troops Home Now!

And Take Care of Them When They Get Here!
AnnL's picture

(post #52971, reply #19 of 195)

Read the article.  

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Napie's picture

(post #52971, reply #21 of 195)

Yeah, read the article.

MadMom's picture

(post #52971, reply #22 of 195)

I did.  Just responding to the poster who suggested that delivery and prenatal care should be included.



Not One More Day!
Not One More Dime! Not One More Life! Not One More Lie!

End the Occupation of Iraq -- Bring the Troops Home Now!

And Take Care of Them When They Get Here!

butterscotch's picture

(post #52971, reply #23 of 195)

About grandson #1--Your daughter had (and maybe still has) a perfectly valid claim against her employer or the employer's insurance administrator--whoever was responsible for not submitting the bills to the insurer on time--for all the money she has had pay for the birth.  She should have sued the employer/administrator--she would have won.  And, to top it all off, the employer/administrator probably would not have been out very much money since they usually have errors & omissions professional liability insurance which covers just this type of negligent error.


Because it's been 7 years, though, since the refusal to pay your daughter might have a problem with the statute of limitations if she decided to sue now.  I suggest she get some legal advice on that point from an attorney who is familiar with ERISA.  She may yet be able to recover the money.

MadMom's picture

(post #52971, reply #25 of 195)

I told her at the time to look into suing, but guess she decided against it.  I believe she had a valid claim, but she didn't, so she's paying for it.



Not One More Day!
Not One More Dime! Not One More Life! Not One More Lie!

End the Occupation of Iraq -- Bring the Troops Home Now!

And Take Care of Them When They Get Here!

MadMom's picture

(post #52971, reply #26 of 195)

Saw this cartoon in the morning paper today.  Thought it was apropos:


 




Not One More Day!
Not One More Dime! Not One More Life! Not One More Lie!

End the Occupation of Iraq -- Bring the Troops Home Now!

And Take Care of Them When They Get Here!
butterscotch's picture

(post #52971, reply #29 of 195)

I hate to hear about your daughter being deprived of insurance benefits through no fault of her own.  It may not be too late for her to recover them.  There is usually some sort of internal appeals process that a plan member has to utilize before filing suit.  Have your daughter take a look at the literature she was given when she first took the job explaining her insurance benefits.  It should give her some idea of how to file an administrative claim--something she could probably do on her own. If the internal appeal fails, urge her to consult a lawyer about the statute of limitations.   

Napie's picture

(post #52971, reply #20 of 195)

I’d say the HSA option covers that.  Planned pregnancies are a family choice and planning for the cost of having the baby is no different than planning for paying for college. Insurance doesn’t pay for formula, clothing, a crib etc. That is the point of this guys argument, make healthcare a consumer good that operates in the real economy.

smslaw's picture

(post #52971, reply #30 of 195)

The concept seems to offer a solution that people on the left (me) and on the right (you?) can get behind. Let the gov't mandate, or even provide, coverage for unanticipated or unusually large expenses, while expecting everyone to pay out of pocket or savings for routine health maintenance, predictable expenses, etc.


The article really did change my view of what we, as a nation, should be moving toward.  We don't expect our car insurance to cover oil changes or new tires.


The checkup I had yesterday is a perfect example of a urrent problem. My Dr. will send a ill to my insurer, who will allow a portion of it, but not pay any of it because I have a big deductible. The insurer notifies the Dr., who mails me a bill, which I will pay. There is no mechanism by which I could simply pay at the time service was rendered. Someone, ultimately all of us, has to pay for all of the paper pushing, etc.

ashleyd's picture

(post #52971, reply #31 of 195)

OK, quick preamble. Here the NHS will treat you, eventually, in general it's acceptable and some conditions get treated faster than others, but if you have private health insurance you have more choice over the timing, location and accommodation (private room vs open ward) than the standard provision, especially for things like elective surgery.


When I left my last employer, who provided private health cover as part of the salary package, I was given the option of continuing that cover at a discounted rate, so no exclusions for existing conditions etc. So I looked at the costs of procedures that I might be likely to want/need based on my existing history and likely future needs and was, quite frankly, amazed at how inexpensive they would be if I paid for them myself. An ear operation I had a few years ago would cost about 6 months premium. So I did the math and came to the conclusion that unless I had something really serious (in which case the NHS would cover it) or suddenly needed a string of treatments it would be cheaper to pay per treatment rather than continue with the insurance. So if we abandoned the NHS then the "critical cover" insurance would be the way to go, with lesser procedures self funded.



Age is unimportant unless you’re a cheese.

Age is unimportant unless you’re a cheese.

Napie's picture

(post #52971, reply #33 of 195)

Because of my financial situation I basically self insure and my policy covers only catastrophic needs.  When I looked at usage versus premiums the cost benefit to the policy was no there, so most stuff is out of pocket and I can negotiate rates just like I did in 25 years in business.  Remember, up until the 70’s almost all prescriptions and doctor visits were out of pocket, that never busted anyone back then.

ashleyd's picture

(post #52971, reply #34 of 195)

It looks like we're reading off the same page here.


Age is unimportant unless you’re a cheese.

Age is unimportant unless you’re a cheese.

hambiscuit's picture

(post #52971, reply #35 of 195)

Prescriptions didn't cost thousands of dollars then either.

AnnL's picture

(post #52971, reply #36 of 195)

Well, that's part of the problem with having Medicare and insurance companies as the real "customer".   Prices would be driven down if we, the patients, were the real consumer.   Look at Walmart--they're providing very reasonable prescription prices.  If I had to pay for my meds, I would probably be getting them there for a much cheaper price than through the mail order pharmacy that my insurance company offers.  Then, other pharmacies would reduce their prices, etc.


Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

Ann
"The elders were wise.  They knew that man's heart, away from nature, becomes hard; they knew that lack of respect for growing, living things, soon led to lack of respect for humans, too."  Chief Luther Standing Bear, Lakota Sioux

hambiscuit's picture

(post #52971, reply #37 of 195)

Some other pharmacies have reduced the prices on generics. The list of meds might vary from Target to Walmart, but several discount type stores have a list of $4 rx drugs. These are the only drugs that are discounted however. The expensive name brand drugs are still expensive. I use a plan D mail order, but buy some $4 generics over the counter...it helps to keep the 'donut hole' in the distance a bit.


I agree that if we were the customer, it might change prices some, but think that volume buying will always be cheaper. Too bad the Bush administration chose not to negotiate drug prices for Medicare. That was a huge mistake, and a silly one.


 

thecooktoo's picture

(post #52971, reply #39 of 195)

Under my plan with Kaiser, I have a $10 deductible per 30 day supply of drugs or $30 for a 30 day supply if it is not on the approved list.  I recently went to Sams Club with five of my prescriptions.  The co-pay would be $150 for a 3 month supply of the 5 drugs.


Total cost at Sams Club for the same drugs...$56.


Wife just hit the donut hole...paid $650 for two prescriptions last Friday, and that was after the $365 that took us up to the donut hole.


JIm


Jim

hambiscuit's picture

(post #52971, reply #42 of 195)

So, you do take some more expensive medicines after all. I'm remembering your Motrin analogy. From that I figured you had never experienced the donut hole.

Gretchen's picture

(post #52971, reply #43 of 195)

DH hit the donut hole last year. When it came time to resign with our pharm provider, he changed insurance companies, and should not come near it this year. You need to re-evaluate every year because the pharm companies change what they cover and what it costs.

Gretchen

Gretchen
Lee's picture

(post #52971, reply #45 of 195)

DH hit the donut hole this past week.  He called me from the pharmacy, incredulous that he had to pay several hundred dollars for a prescription and, of course, the costs will continue through the end of the year.  I can hardly wait until he has to refill his Plavix.


Did your DH change from a Medicare part D plan to a private plan?  We need to look into something else for next year.

Gretchen's picture

(post #52971, reply #46 of 195)

DH's meds are $300 per fill WITH the plan. Then hitting the donut was like $1000 per fill.


He volunteers with a free pharmacy here in town and they plugged his meds into "something" (But I think you can do it on the Medicare site) and found a different (we had Humana, which was the best year before last!) company in the Part D plan--it is Fox, Ithink.  He does get a couple of his at Target or such rather than Walgreen's for the $4 generic.  It will make a BIg difference, particularly with paying off the $10,000 hearing aids!!  The amount we deducted on income taxes last year was astronomical.


Gretchen
Gretchen
Lee's picture

(post #52971, reply #47 of 195)

We went through the same kind of questionnaire on the AARP site and found that changing to another plan in our area wouldn't save much.  I was hoping you had something else.  Once you go through this, you fully understand why so many seniors on fixed incomes have to choose between buying their meds or paying for food and shelter.  It's a disgraceful situation. 


I sympathize with you on the huge cost of hearing aids.  DH has a neurological problem that he may have been born with that affects his hearing, mostly in one ear, at certain levels and timbres of sound.  His hearing had slowly deteriorated to the point that he finally bought hearing aids a couple of years ago.  They are amazingly tiny and efficient, but the cost is eye-popping!