How would you fix the health care industry, if you could

[Iamme]

This would also include the health insurance industry.

My health insurance escalated from around 7% in the mid-late 90's, to ariound 20% a year from then on forward! One year was at 25.2% between 2 consecutive 6 month periods. Wisconsin law says that health insurance rates cannot go up any more than 25% in any one given year! Hmmmm.

Anyway...no common working man can afford these kind of continued rate hikes, when our cost of living index only goes up 3-4% a year. That is commonly the amount one receives in wage increases. In just a few short years, at the exhorbitant rate hikes I described....the cost of insurance will soon equal the entire yearly wage of the worker!

The health industry keeps saying these increases are necessary due to their higher costs due to a variety of factors. I am not buying it!!!

Back in the mid-late 90's (at the far lower yearly rate hikes) we still had CT scans, MRI's, ultrasound, transplants, malpractice, helicopter transport, hospital additions...and on and on. So why did it take these big jumps up to the mid teens to twenty-plus percent yearly increases? Were they all losing money in these years, and now decided to make up for it?

And what are we going to do about it? It HAS TO be fixed!!!....and NOW!!!!!!

Should we start rationing health care? Should we make doctors more accountable as to what multiple test procedures they are using? Is there a scam going on between hospitals and medicare/medicaid reimbursements? (i.e., ridiculous charges..like one pill costing $10 or something) We know drugs keep going up...but even if THAT went up 20% a year, would not cause the entire industry to go up 20% a year!

Anyway...let's hear what you have to say.

[geni]

Get yourself an NHS! It may be big buractic and slow but at least you know who to blame when things go wrong.

[WildCat]

Originally posted by Iamme
Should we start rationing health care? Should we make doctors more accountable as to what multiple test procedures they are using? Is there a scam going on between hospitals and medicare/medicaid reimbursements? (i.e., ridiculous charges..like one pill costing $10 or something) We know drugs keep going up...but even if THAT went up 20% a year, would not cause the entire industry to go up 20% a year!

Anyway...let's hear what you have to say.
Malpractice lawyers are getting big $ settlements when they don't even have a real case (because they cause you to pay huge legal bills to defend yourself, cheaper to just settle), this encourages more frivolous lawsuits. States w/ caps on punitive damages (such as California) haven't had rates increase nearly as fast as other states.

Also, remember that the insurance companies invest their premiums in stocks, bonds, etc. and when these investments suffer (as they have the last 4 years) the $ must be made up for in premium increases.

[davefoc]

I have never been sure that a much more libertarian approach wouldn't work.

Many of the problems are caused by health consumers that are inadequately incentivized to care about the cost of their health care. This is a situation guaranteed to lead to runaway health care costs. Milton Friedman made the point that almost immedicately after the inception of medicare retired people were back to paying the same amount for there health care as before medicare and yet government was dumping billions into the system. Baisically the health care providers just made more money with little net increase in the amount of care provided.

For years doctors utilized the state licensing mechanisms as a means of stifling competition. Doctors fought against midwives, paramedicals and the like. They claimed that they did it because only they could provide the highest quality care. I suspect that is largely BS. It just doesn't take an MD education to burn off warts take throat swabs or pap smears. Government licensing has been used more to ensure high salaries for doctors than to maximize the care available for people.

Doctors fought against the expansion of medical school enrollment to further reduce the supply of medical providers. All of these things worked to make medical practice extremely lucrative. Having a baby in this country that you actually have to pay for is staggeringly expensive. The costs involve thousands of dollars to obstetricians and anesthisiologists for a few hours work.

A lot of people think that socializing the whole system might be the best, and maybe they're right, but in this country the government is awash in special interest money and the idea that they would stand up to the medical industry and bargain in the interest of the country seems to be a fantasy right now. Canada pays much less for its drugs than the US. Why? Because despite the massive purchasing power of the US government it seems unable to make a good deal for medicare patients with the drug companies.

So I'm not sure, the US system seems to be caught in some hell between a libertarian free market system and a managed socialist system. Of course its only a hell for those of us that see an increasing percentage of our disposable income sucked up by the medical industry every year. It's a pretty nice deal for the medical providers.

I for one am timed of seeing a huge percentage of my disposable income swallowed up my the medical industry, but there's not a damn thing I can do about it.

[Quasi]

What is a paramedical? As for worts, you can buy a cheap fix at the pharmacy. I do not know what your obsession with MD's is, but most doctors graduate from medical school over 200k in debt, then have to spend up to seven years to become board certified. This does not even include debt from undergraduate degree. So all in all, you could easily be 300k+ in debt and be 33 years old with no house or savings. Lets compare this to lets say someone with a degree in computer science. They pull in 65k when they are 22, and almost 100k by the time they are 30. By the time they are 33 they have a house, a huge retirement chest and several nice cars. Who is benefiting from society here? And all these farkers did was program some childs toy. Compare this to an MD, and sure, when the MD is 34 they might be pulling in 150, but all that debt will not be paid off for a long time.
Most of the money that is spent on US healthcare goes into both supporting the insurance industry (lawsuits, highly paid executives etc,) the rest goes into salaries, and quality control (FDA regulatory testing, paperwork etc.) And while it is expensive, changes are always underway. We should switch to a europe style approval process, and then limit lawsuit settlements to a few hundred thousand dollars. Christ, chiropractors can kill someone outright and they only get fined a few hundred bucks. So you're barking up the wrong tree here.

[NoZed Avenger]

Before advocating fixes, it is important to isolate the causes of the increases -- and not just by anecdote. There are a number of factors leading to health care increases, beginning with the third party payor system. Fixes such as co=pays, PPOs and HMOs have done some good, but have not erased some of the effects.

Keep in mind that one of the forces driving the increases is the increasing number of elderly -- the 'very' aged. People living over 80-85, on average, need a -lot- more health care, and also the most expensive types of care. Ina sense, medicine is the victim of its own success.

[Tmy]

Blaming malpractice suits is bullshiznt. They are difficult cases to bring and prove and that isnt done easily. You could eliminate all malp suits today and health care woudl be just as expensive.

My beef is with the prescription side of health care. The costs are out of control. HMO's piss me off too. Everyone cries poverty yet these HMO's turn a good profit and the RX compaines make more than god. Drug dealing pays well.

[Luke T.]

Originally posted by Iamme
In just a few short years, at the exhorbitant rate hikes I described....the cost of insurance will soon equal the entire yearly wage of the worker!


Is this what Bush calls "fuzzy math?"

[davefoc]

Quasi,
I gave no evidence to support my points, no information about when medical groups worked to restrict the supply of doctors to reduce competition, no evidence of when and how medical groups worked to restrict the use of less trained personel to perform routine procedures at less cost. My post didn't provide quantitative estimates of the effects of what I was tlaking about.

In general I would concede that my post was pretty much of a factless rant. If I was judging it for quality I might give it a two out of ten because I give it a little credit just since I didn't completely make the stated facts up, but perhaps I am being a little generous there.

Alas, while your response was better than my post, I didn't think much of it either. You didn't respond to any of my main points. You just came back with something like doctors are really good guys and software engineers make a lot of money with less training.

While, I might have not made the case very well, I continue to believe that it is possible that the government;s involvement in medical care has led to the development of a kind of monopoly that savages this country with excess cost, unnecessary procedures, insufficient oversight of medical providers and the restriction of innovation that might have improved the situation. But I agree, I don't really have the facts to back up that idea.

[Michael Redman]

My old man is a doc, and he's been saying for years that we're approaching a crisis because we spend way too much money at the end of life, because we're too afraid to admit that people die, and we do all sorts of extraordinary things to buy extra days or weeks. I think he says the majority of healthcare costs are spent the last couple of months of life. Some good education, and realistic approach to care at end of life could save a lot of money.

Another problem is that preventative care needs to be much more of a priority, but the health insurance companies don't reap the rewards from unilaterally promoting preventative healthcare because of the transience of their clients. Some more universal promotion of general good health is needed.

In addition, allowing poor people to see doctors in primary care clinics instead of waiting until they require emergency care would save a lot of public money.

I would start with these issues.

[Tmy]

Originally posted by Michael Redman
My old man is a doc, and he's been saying for years that we're approaching a crisis because we spend way too much money at the end of life.

Yeah, Like that zombie in florida that they are fighting to keep alive.

A buddy of mine works as an EMT and he talks about how these people call the ambulance for all such of minor crap cause thats the only way theyll be covered by insurance. OR just to get transportation. All a bunch of waste.

It freaks me out how 1 month of my health insurance premeiums is about equal to 1 year of my car insurance.