There is a long thread on "where do you stand on universal healhcare" that prompted lots of interesting replies. Clearly some are "for" and some are "against" universal healthcare--whatever that is.

But there are a couple of problems that remain that everyone agrees need to be addressed. "Everyone" includes Democrats, Republicans, ultra conservatives and flaming liberals. The problems everyone agrees on are...

-- Healthcare in the U.S. is too expensive, and it is getting even more expensive at a rate that is simply not economically sustainable over a relatively short timeframe. Healthcare in the U.S. costs 50% more per capita than any other developed country, and the quality of care is not that much better.

-- Far too many Americans have no form of healthcare insurance whatsoever. For one of the most well-developed countries in the world to have almost 50 million people--almost 20% of it's population--with no form of healthcare insurance is not only unbelievable, but bordering on criminal.

So, presuming that regardless of our political leanings, I'm assuming that everyone here on this forum lines up with their political representatives in recognition of these two problems. The problems cited above are real and need to be addressed.

So, if you were a member of Congress, what sort of plan to address these problems would be acceptable to you? We've heard from our elected representatives ad infinitum in recent days. Their comments range from "these are the general concepts that President Obama wants in any plan passed by Congress" to "xxx makes any healthcare bill a non-starter for our party".

Recognizing the confusion of "the 545" regarding this issue, maybe we can enlighten one another with just a few important points in whatever plan we might find acceptable? Specificity would be helpful.

Let the creativity begin.

Single payor, similar to Canadian system.

Any existing models of universal health care, involves rationing. I am against rationing. Most health care is needed the closer to the end of life that we get. I am not for some snot nosed RMV caliber worker determining that I am not worth the expense. Perhaps I don't pay enough taxes? Perhaps I voted the wrong way.

Call me selfesh but, I WANT TO LIVE.

Yoda

A member of the loyal opposition

Random thoughts for starters.

First order of business - a full frontal assault on tort reform with a concentration on medical malpractice. It is obvious that these claims drive a significant part of medical costs.

Our educational system needs to increase opportunities for talented young Americans to receive their medical training in this country. Concurrently, we need more doctors to create more competition and hopefully lower costs.

Major incentives for businesses small and large to adequately insure their employees.

Restructure medicare

Stop treatment of illegal immigrants - very tough decision because it goes against the values we preach and live by. However, the drain on our system is clearly demonstrated in California's predicament. If rationing is the current administration's plan for the future of medical care in the USA, ration by taking Americans first. Their taxes support the system.

Form a special task force to work with every major drug company in America and the FDA to find creative ways to reduce costs for those in difficult financial circumstance. Explore tax incentives for those companies that participate.

Create a task force of medical professionals, insurance professionals, business and financial professionals to develop a serious single payer system NOT under government control. Government oversight? Possibly.

Excuse the hipshooting style.....this serious subject needs a lot more thought.

I think that the government's history of respecting life is not a good recommendation for overseeing a "Health" plan. The government "sanctions" sacrificing lives in war and also looks the other way when millions are aborted.
With that track record...how long do you think it would take before the elderly were expendable?

Originally Posted by Yoda

Any existing models of universal health care, involves rationing. I am against rationing. Most health care is needed the closer to the end of life that we get. I am not for some snot nosed RMV caliber worker determining that I am not worth the expense. Perhaps I don't pay enough taxes? Perhaps I voted the wrong way.

Call me selfesh but, I WANT TO LIVE.

Yoda

A member of the loyal opposition

Everything you described ALREADY exists in our health industry. I deal with 'snot nosed RMV's daily telling me it's "not medically necessary". Almost everybody WANTS TO LIVE. So the 32 year old who stuck the palm trees in your yard who is trying to start his own business has a serious injury on the job... medical bills of over 20 K. What say you?

Originally Posted by Keedy

I think that the government's history of respecting life is not a good recommendation for overseeing a "Health" plan. The government "sanctions" sacrificing lives in war and also looks the other way when millions are aborted.
With that track record...how long do you think it would take before the elderly were expendable?

Keedy, I cannot argue with your logic because I agree. You are succinctly on the mark. What a sad commentary on our government.

Originally Posted by Villages Kahuna

....
The problems everyone agrees on are...

-- Healthcare in the U.S. is too expensive, and it is getting even more expensive at a rate that is simply not economically sustainable over a relatively short timeframe. Healthcare in the U.S. costs 50% more per capita than any other developed country, and the quality of care is not that much better.

-- Far too many Americans have no form of healthcare insurance whatsoever. For one of the most well-developed countries in the world to have almost 50 million people--almost 20% of it's population--with no form of healthcare insurance is not only unbelievable, but bordering on criminal.

So, presuming that regardless of our political leanings, I'm assuming that everyone here on this forum lines up with their political representatives in recognition of these two problems. The problems cited above are real and need to be addressed.

......

I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are they evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.

Originally Posted by SteveZ

I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are the evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.

Not having health insurance absolutely and most definitely does mean uninsured people do not get health care services. What is the first question you get asked when you call a new provider for an appointment? "what kind of insurance do you have?" Do you think the example I gave above.. the young fellow who stuck the palms in your yard... is a rare, uncommon, poor example? he can't get medicaid (makes too much), he's too old for medicare, his monthly premium for his family of 4 would be over 1000 dollars and last year he made 26 thousand.

BTW, the "pool" you refer to above has a limited amount of money. As such, those that manage the pool (aka... "managed care") will tell you what you can or cannot take out of the pool. Thus, rationing. There is only 1 group that has no rationing at all--> those that pay cash for all of their care. For that group this debate has no meaning or impact on their care.

Originally Posted by rshoffer

Not having health insurance absolutely and most definitely does mean uninsured people do not get health care services. What is the first question you get asked when you call a new provider for an appointment? "what kind of insurance do you have?" Do you think the example I gave above.. the young fellow who stuck the palms in your yard... is a rare, uncommon, poor example? he can't get medicaid (makes too much), he's too old for medicare, his monthly premium for his family of 4 would be over 1000 dollars and last year he made 26 thousand.

BTW, the "pool" you refer to above has a limited amount of money. As such, those that manage the pool (aka... "managed care") will tell you what you can or cannot take out of the pool. Thus, rationing. There is only 1 group that has no rationing at all--> those that pay cash for all of their care. For that group this debate has no meaning or impact on their care.

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/...irectory.html# )

1. Tort reform. Eliminate the large settlements, force arbitration, and set a maximum allowable amount that a doctor could be sued. Eliminate bad doctors, and create subsidized insurance pools. When 40% of someones income goes to insurance, cost of medical care will never be contained.

2. Insurance payment reform. When a $20,000 bill gets settled for $2000 the system has already failed. First because the bill is so high and second because the payment is so low. Attack the cost side with number 1, attack the income side here and provide reasonable reimbursement for services provided.

3. Education reform. Help bright young people pay for college and medical school with the provision that they spend X number of years as a GP. Most doctors who graduate today will not become general practitioners. Not enough money to be made to pay for their education. So incentives to get doctors in these roles is needed. More nurse practitioners as well. Need to pay them more so they get to this role. Without addressing this issue we will have rationing of health care weather you can afford it or not.

4. Drug cost reform. It costs to much to develop a drug today. To much testing, the maintaining of a validated environment, meeting FDA rules, time from development to on the shelf, and also part of tort reform.

5. 50 million without insurance does need to be resolved. However if you are here "illegal", we need a different solution. It is not up to the American tax payer to take care of someone who broke our laws. If you are here legally and do not have insurance then we do need to create some sort of basic care and make it available at an affordable price to those in need. Clinics, pro bono work, generic drugs, some way to care for those in need.

6. Keep the government out of the solution except for these 5 things. A government run system will fail worse then the current system. I have not heard a single politician even mention tort reform and to me that is the number one problem.

I heard just this morning in order to sell his plan, Obama is offering the AMA malpractice reform. Question is, if it's good for the system, why not just do it anyway?

On forums we have spammers. In Washington we have scammers.

Originally Posted by SteveZ

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/...irectory.html# )

Excellent idea--pro bono. Following your idea... pts pay for ALL time the physician spends on their case. You know, "the meter is running" concept.... "billable hours".... phone calls, reviewing lab results, consulting with other physicians, talking with attorneys, filling out forms are all billable to the patient.... in fact, everything is billable to the patient since physicians will now be like attorneys and simply charge per unit of time, directly to the pt.... there are actually a growing # of physicians doing exactly this. When you call their office you are not asked what type of insurance you have.... instead you are told, "DR Smith does not accept any insurance.... he accepts cask, Mastercard and Visa. " Also, if we are going to "mitigate health care the same way legal care is" we need to keep the playing field level... so malpractice ins needs to be on an even plane too.

"The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem."

This is part of an article written by a respected business writer, Robert Samuelson, and the link to the entire article is below...

http://www.realclearpolitics.com/art...orm_96997.html

I have been trying hard to get a bit of "smarts" on this subject, but it sure gets confusing.

Seems most, if not all, want some kind of REFORM, but the shape is quite a debate. There are even those who feel that the reform being touted will REDUCE the care for the most needy folks in society.

Thought I would drop this article off for comments as it was the first I had heard this particular viewpoint !

Thanks for the thoughtful list of what can and maybe should be "done about healthcare". Hopefully many more of our colleagues here will produce their lists to give us all something to think about. Too often we revert to doing the same things that our elected representatives do most of the time--argue about what we wouldn't do, as opposed to presenting some ideas for consideration, discussion, negotiation and maybe legislation.

If the electorate would take the time to figure out what we think is necessary as individuals, we'd be in a lot better shape when the time came to choose who we intend to vote for the next time around.

The top item on your list would be tops on mine, as well--tort reform. But as I'm remembering, that isn't among anyone's plans for reforming healthcare, is it? Or have I just missed someone's proposal?