Originally Posted by l2ridehd

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.

People want $$-Limits on medical malpractice claims until they are harmed. When the GP made house calls, claims were rare, as the family patients and the GP had a relationship which provided understanding. Once the house calls ended and was replaced with the multi-exam-room approach where the patient became a "file folder with a number" and expected to endure waiting-room-itis and made to feel unimportant, the expectation of care quality jumped in response, as the "family doctor and the family" relationship deteriorated into nothingness. Physicians for the most part have forgotten that medical services is a "personal services" business, and without the "personal" factor, perfection becomes the expected occupational standard. Put "personal" back into the service equation, and claims will drop like a grand piano falling from a rooftop.

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.

When high bills are settled for whatever, the next person billed finds their bill a little higher to make it up. That's the same in every business.

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.

That exists already. The military has been doing that forever, and so has the US Public Health Service. If making the most money possible is the only incentive, then the Hippocratic Oath needs to be replaced with the preamble to TARP. And medical schools are businesses, too. They charge whatever the market will bear, and as long as student applications outnumber seats, it's a seller's market.

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.

I remember Thalidomide and a host of other drugs whose performance did not match the plan. When one takes shortcuts with the scientific process (especially in the evaluation phase), the risks can become deadly.

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.

But is this a federal problem? The fed cannot manage local use programs. There are many ways to resolve this without more inefficient federal programs which only reward politicians and appointees.

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.

If the federal government is involved 1%, they control things 100% - every businessman who has ever dealt with federal regulation knows this painfully well.

Originally Posted by rshoffer

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.

Malpractice insurance matches the expectation of care standard, and physicians have screwed themselves on this by dehumanizing their relationship with their customers. When the customer is treated as less-than-important, the expectation of perfection rises accordingly. When physicians stop treating their customers impersonally, the playing field changes big-time. Attorneys, accountants and other professionals who are in a competitive environment know this and nurture their client relationship, and the insurance costs reflect this business practice.

And the medical profession does use the "taxi meter" approach now. Try to get a physician to spend longer than the 10-minutes-per-examination-room - they follow the meter, and ration the time to match the money. The exception are those on the per-session basis.

Originally Posted by SteveZ

...If the federal government is involved 1%, they control things 100%...

...your proposal is that the federal government do nothing about the "healthcare problem", whether real or just perceived.

You also suggest that some part of the issue appears to be for the individual states to resolve. But government being government, when it came to that, would we want to keep state government's fingerprints off of healthcare, as well?

I agree with a lot of what you write, but not this time. These problems have been festering for decades. Doing nothing--something our Congress is really good at--has been the easy way out for Congress for a long while. Things aren't getting any better. Healthcare costs and the resultant insurance premiums have skyrocketed to the point that the number of uninsured Americans is far more likely to increase than decrease. Medicare is going broke.

These don't seem to be problems that "doing nothing" will fix. The free market approach has lead us to this point. Is it reasonable to believe that letting the free market work will ultimately correct them?

If the government had an ounce of common sense or competency (let me rephrase that) a gram of common sense I’d maybe say let’s give it a go and see if we can fix this.

Problem is, the government AWAYS makes it worse. They NEVER fix anything. Everyone knows that even if you don’t want to admit it.

VK says...

"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? "


Maybe....

"Daschle: Tort Reform "On The Table"

"As if taking his case to the most powerful physicians group in the United States to push his controversial health care proposals wasn't a big enough headline, a New York Times report says President Obama has been working behind the scenes to protect doctors from malpractice. lawsuits.

"Tort reform is going to be on the table," Mr. Obama's initial nominee for Health and Human Services Secretary and former Senate Majority Leader Tom Daschle told The Early Show Monday."

http://www.cbsnews.com/blogs/2009/06...y5088733.shtml

Originally Posted by Bucco

"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 !

Fee for service or a financial incentive to get paid more for doing more procedures is an invitation for trouble

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# )

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Originally Posted by Bucco

"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 !

Healthcare providers exist in a price controlled environment, dictated by government payers and private insurance companies. You get what they say you get...period.
For those of you that have owned your own business, how would this fly for you...to be told what you could charge and what you would be reimbursed for you goods and services?

Originally Posted by SteveZ

Malpractice insurance matches the expectation of care standard, and physicians have screwed themselves on this by dehumanizing their relationship with their customers. When the customer is treated as less-than-important, the expectation of perfection rises accordingly. When physicians stop treating their customers impersonally, the playing field changes big-time. Attorneys, accountants and other professionals who are in a competitive environment know this and nurture their client relationship, and the insurance costs reflect this business practice.

And the medical profession does use the "taxi meter" approach now. Try to get a physician to spend longer than the 10-minutes-per-examination-room - they follow the meter, and ration the time to match the money. The exception are those on the per-session basis.

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

Originally Posted by serenityseeker

...The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change....

Thanks, Serenity. It's always good to hear from someone who have first-hand knowledge of some of the things we discuss here. All too often, we wind up trading the soundbites provided by others far less knowledgable and experienced.

The purpose of my original posting was to get all of us thinking about what changes in our healthcare system would be important to each of us. Once each of us had a few such thoughts, I thought it would be far easier for us to understand and assess the plans being circulated by the various members of Congress or other entertainers, many of whom have special interests that we all don't share.

Thanks again for the insight.

Originally Posted by Villages Kahuna

Thanks, Serenity. It's always good to hear from someone who have first-hand knowledge of some of the things we discuss here. All too often, we wind up trading the soundbites provided by others far less knowledgable and experienced.

The purpose of my original posting was to get all of us thinking about what changes in our healthcare system would be important to each of us. Once each of us had a few such thoughts, I thought it would be far easier for us to understand and assess the plans being circulated by the various members of Congress or other entertainers, many of whom have special interests that we all don't share.

Thanks again for the insight.

VK,

My comments were not directed to you at all. It is a very timely post and certainly worth discussion in detail. I think I am also voicing some frustration at the folks that make unfounded assumptions and present them as fact, without an inkling of what truly goes on behind the scenes. I am also troubled by the attitude of "I'vr got mine, you worry about yours" attitude from many that are blessed enough to have good healthcare coverage.

You are completely on point about the special interests, and unfortunately their influence appeals on emotion and popularity basis.

This is indeed a multifaceted problem, but there are inherent simplicities also.
Malpratice is out of control and a gigantic player here. Estimated costs of overhead in health care are 30% at large. Lack of not only maintainence care but self accountability from patients contributes greatly to cost (read compliance with medication, smokers, obesity etc etc). We are innapropriate and inneffective as a society with regard to end of life care and appropriate utilization of resources. As a society we want the best of everything and we want it yesterday in medicine, but is has to be paid for.

As usual you have raised a timely topic in an articulate manner and as always I appreciate it.

Originally Posted by rshoffer

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

My point is, when there was a human-to-human relationship between the family physician and the family members, there were no lawsuits. The family physician, even if he screwed up, was known for having tried his best, was at the wake, and cried at the funeral as loud as any mourner - and meant it. Once health care delivery became an emotion-free action, and "Mr. Jones and Mrs. Smith and young Johnny" became "the patients in Examining Rooms A, B & C," whose relationship with the physician was a brief encounter after an hour in a waiting room, the physician became as faceless as the insurance company, and given the same amount of leeway.

The medical industry, in finding a way to be more profitable by greater "office efficiency," also acquired an additional liability in that the leeway given to the Dr. Welby's of old was lost in the bottom line. It was a perfect example of "for every action, there is an equal and opposite reaction." A "wall" was created between the physician and the customer/patient where that "have a cup of coffee after the home visit - which friends do" was replaced with the medical experience having as much human sensitivity as an oil change at Jiffy Lube. That "wall" between health care provider and recipient is the problem - and it's that "wall" that has made medical malpractice as much of an item on the health care scene as Viagra commercials.

And VK - yes I think the health care matter is one for the states, not the fed. There is nothing wrong with different states trying different ways to better the lives of their citizenry. Several states already have health risk pools for uninsurables (see http://www.healthinsurance.org/risk_pools/ ), several also have either enacted or in the process of enacting their own version of health care reform (see http://www.kff.org/uninsured/kcmu_statehealthreform.cfm ), and the experiences from these efforts give the rest of the states an opportunity to see what's best for them based on real data, and not just on political hyperbole. The fed always ends up with a "one size fits all" solution, and it usually fits no one other than those within the DC beltway who get rich off it. So, unless we want another TARP and bailout "the bill is too long and confusing, so I'll just vote for it and hope for the best," the states are still the best bet to get it right for what works with their constituencies. And since the states already are in the medical oversight business via licensing and other regulation, it's better to work within one existing body of law than try adding more layers.

Originally Posted by serenityseeker

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Thank you, Dr. Serenityseeker. Your post is outstanding. And it comes with great credibility. Your points are excellent. You are speaking from the reality zone, not the comfort zone.

Boomer

Originally Posted by rshoffer

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

Couldn't agree more. It simply becomes a theatrical contest between sides, and the attitude in today's society is "somebodies gonna pay" regardless of whether any real malpractice occured or not. Whoever puts on the best show wins.
Lawyers know this and manipulate the system, even making good living on lawsuits without merit, because the insurance companies and the lawyers all know it is cheaper to give up a settlement than to fight in court. It is a sickening game in a perverted system and there is no end in sight. Without meaningful change there is no hope of improving the healthcare system.

Originally Posted by rshoffer

Single payor, similar to Canadian system.

the great general once said in ww11