Healthcare deserves its own thread

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

[GrnBay007]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Tell us about a "perfect plan".

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Tell us about a "perfect plan".

Hmm. I could respond next week (meeting with CFO of large west coast health system tomorrow and headed to Austin for a bachelor party this weekend). It won't be simple to understand but what is these days.

[bobblehead]

Its worth reading, yea, some is worth skipping, but if you read mainly the posts where we actually address the issue (I'm guilty of sidetracking too) its not all bad. I would like to hear your input.

[texaspackerbacker]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Framing the discussion that way MUST MEAN that favor the status quo or damn close to it, as "delivery" of care in this country is second to none in quality, convenience, and choice. The cost to most of us "haves" is tolerable, while the "have nots" basically still get the treatment they need even if they can't pay.

What do you think of Digitaldean's fairly moderate fine tuning of the system discussed above, Fosco?

[Fosco33]

Is this worth reading 4 pages and catching up? Should I engage in this debate? Don't know when someone crosses the line to being an 'expert' but I'm getting dam close.

I've spent 6 years in HC consulting (which is said to be about 18 years in 'real-world' experience). I've heard some of the top experts speak on heathcare - and literally live/breath this all day. I work for one of the top rated firms in the country regarding healthcare financing and have done work with some of the top health systems in the country.

What are the hot issues you all are discussing? I'd suggest focusing on cost and delivery instead of reimbursement...

Framing the discussion that way MUST MEAN that favor the status quo or damn close to it, as "delivery" of care in this country is second to none in quality, convenience, and choice. The cost to most of us "haves" is tolerable, while the "have nots" basically still get the treatment they need even if they can't pay.

What do you think of Digitaldean's fairly moderate fine tuning of the system discussed above, Fosco?

Only have a minute.

I'm not saying patient liability as cost.

Cost in terms of charges/liability to the provider/hospital. Tons of unnecessary waste/tests to cover a doc's trail. All of that gets passed to you guessed it - us (whether it's higher cost of goods by companys to pay for hc or actual hc related costs, taxes, etc.).

The approach we need will not happen overnight, but MUST be done:
1.) Tort reform (malpractice laws have to be more stringent, far too many large payouts have been given, plus the burden to the judicial system is enormous)
2.) True portability regardless of income status or medical condition.
3.) Provide health care to all citizens in its most basic form. If one wants to have a private room at a hospital or other elective add-ons, they can purchase a supplemental plan.
4.) Regulation to a certain degree is necessary regarding drug manufacturers. I have seen first hand the amount of money companies have thrown at doctor's just to prescribe their medication. My sister has also through her pharmacy. The drug companies are providing kickbacks to doctor's for prescribing certain drugs. Same goes for procedures. My crappy insurance only covered $400 for a $2000 MRI on my knee last month. Considering a Japanese hospital can only charge $100, something appears a bit wrong. I can deal with a happy medium here.

I do not want the government involved. But when we have the current free market system falling flat on its face, something needs to be done.

Agree on #1. But it's slight - I used to think this was a bigger problem. True that MD's pay a shit ton for malpractice insurance and that likely gets passed on - but the cost of profees is very small % of total (and most outrageous claims are never paid).

Not sure what he means by portability (#2) (go anywhere you want) - like generous PPO or CARE?

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I'm typically against gov't regulation in most forms (i'm a libertarian). Drug costs are a bit wild -- and it's tough because patents don't seem to be protecting cheap knockoffs and foreign market influence (i.e., a drug mfg would typically make money on US and then rest of the world -- the rest of the world and cheaper knockoffs mean higher initial/long-term cost for the US). If there's no incentive ($) for companies to make better drugs b/c of regulation, be prepared for a stagnant quality of life (or a better one if the access/availability of drugs were in question).

Now the 'charges' that facilities give you for an MRI and reimbursement by your insurance... I've got lots to say and no time. My current client is one of cheapest in the country and they still have about a 40% cost/charge ratio (i.e., charge $1K for an MKI that costs them $400). But they discount your charges usually at b/w 50-75% (so the $1K becomes $500 or $750, which insurance pays 80-90% and leaves you with like $100 +/-). In competitive areas, providers jack up prices and force insurance to pay --- IN ORDER TO PAY FOR THE UNINSURED. Gotta make money somewhere (Surgery/Radiology for insured is the key).

Watch for more regulation though - requirements for nonprofits to provide a certain amount of charity to maintain tax status and 'maybe' price transparency (meaning you could price shop for that $2K MRI and find the best deal).

[hoosier]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

[texaspackerbacker]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

[hoosier]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Nobody's talking about forcing anyone into anything, except maybe you, who invented that claim out of thin air and tried to make it stick. My position is that everyone should have the RIGHT to affordable preventive care.

The argument that because "there aren't enough providers to go around" we should be satisfied with a situation in which almost 40% of Americans are uninsured or underinsured, is completely full of holes. You of all people should know that the demand creates the supply: if there are patients, doctors will follow.

"The horrors of waiting": have you ever sat in an ER at a busy time waiting to be seen for something non life threatening? If not, you have no idea what true horror is.

[Tyrone Bigguns]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Preventative care dubious in its value. That has to be the funniest thing you've ever said.

Yep, Docs love to see you when you are fat, high cholesterol, out of shape, poor diet, and your symptoms are out of control.

Perhaps you don't understand the concept of an ER...it stands for Emergency Room...as we only want to see you because it is an EMERGENCY. They don't want to see you because your kid has the sniffles.

And, they certainly don't want to see ANY emergencies..they would much rather prefer that you saw them before it became an emergency..so, they can prescribe care/drugs/etc...or schedule surgery.

[texaspackerbacker]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

As for preventative crap, here again, you fulfill your sick leftist intrusive government-loving stereotype. Your nutrition Nazis want to tell people what they can and can't/should and shouldn't eat? Yeah right! The sick thing is, if your side gets in power, we could end up with exactly that--another quantum leap size grab at OUR freedom--in that and a helluva lot of other areas.

[Tyrone Bigguns]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

As for preventative crap, here again, you fulfill your sick leftist intrusive government-loving stereotype. Your nutrition Nazis want to tell people what they can and can't/should and shouldn't eat? Yeah right! The sick thing is, if your side gets in power, we could end up with exactly that--another quantum leap size grab at OUR freedom--in that and a helluva lot of other areas.

WHo is complaining about the poor using the ER? The doctors..my friend. Taxpayers..who have to pay for it.

You like to say we all can get adequate care..going to the ER isn't adequate care.

As for nutrition..nice strawman. Who said anything about enforcing it by the gov't? Your doc tells you what to do..you make the choice.

As for you...i wish you would continue to eat poorly, etc...the quicker you shuffle of this mortal coil, the better.

[bobblehead]

#3 is obviously hottest issue. 99% of people can get basic/good medical care with no discussion on finances at a defined Emergency Department (whether/not it's really emergent/urgent) at a much high end cost to the patient/hospital and actual urgent cases. Very few facilities defer in EDs. As far as providing hc to most people - wait for my breakout on the '45' M uninsured... the current system provides basic care for those who need it.

I see this claim made all the time, and I realize you might not be arguing that this is a good thing (uninsured using ER as primary care) from a cost perspective. But it's definitely not a good thing from a clinical perspective: not only a tremendous misuse of valuable resources but also very poor "management" strategy. Preventive care is much more likely to reduce costs AND produce good results for patients, whereas waiting till your high blood pressure or diabetes warrants a trip to the ER means it's likely that the condition is out of control. Universal health care won't guarantee that all patients manage their health well, but it certainly won't hurt.

Forcing people into "preventative care", much of which is dubious in its value, is the height of "nanny-statism"--government intruding into people's lives, reducing freedom of choice and freedom in general.

Also, you the supply factor--there aren't enough providers to go around, so you will have the horrors of waiting, etc. that Canada and other such systems are so well known for.

Nobody's talking about forcing anyone into anything, except maybe you, who invented that claim out of thin air and tried to make it stick. My position is that everyone should have the RIGHT to affordable preventive care.

The argument that because "there aren't enough providers to go around" we should be satisfied with a situation in which almost 40% of Americans are uninsured or underinsured, is completely full of holes. You of all people should know that the demand creates the supply: if there are patients, doctors will follow.

"The horrors of waiting": have you ever sat in an ER at a busy time waiting to be seen for something non life threatening? If not, you have no idea what true horror is.

I think what badger said was that you can get pretty much any care including preventive if you go to the ER, with no questions asked about finance.

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

And tyrone, since tex isn't complaining about poor using the ER, it doesn't really refute his points. Quite the opposite, he is advocating it.

And lastly, tex, the patriot act was the worst "quantum leap size grab at OUR freedom" that I can recall, so its both sides on that one.....oh look tyrone, I disagreed with tex AGAIN.

[hoosier]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

[Fosco33]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

Only partly true. There are definitely people w/ the means/ability to pay for hc that use ERs because they're too lazy to get a primary MD or they can't stand waiting one day to get their service (or use an urgent care clinic, etc.).

AND there are some alternatives to ERs for people that don't have the means. I did 2 days of work last year pro bono for St. Johns Well Child center in/near Compton (feature this past week in WSJ). Really no requirement to pay anything and all state/federally funded - and about 90% undocumented aliens.

I've implemented processes to screen/triage then discuss finances and possibly defer care for non-urgent/emergent cases - result - ER volumes remain slightly less (meaning urgent ppl get served faster) and a push to scheduled care.

It all goes back to what many of us here have said - where did responsibility for average US (or long-term 'residents') go?