Healthcare (political)

[Anonymous]

I am in health care, and I am curious about how people feel about this issue. I have noticed that many of my friends say that something has to be done, but they don't know what. I understand that there are many problems with our system. They somehow feel that there can be a way to get it for "free", at the first class level, if the right policies are put in place.
I am nervous, because I like my job, but will not do it for free. I will not even do it for 25% less than now. I work way too hard and I am under too much stress.
I have spoken to my cousin who is a doctor in England. She says that the little experience that she had working in the US scared her. US doctors work very hard and long hours, and the compensation is not that good. She also said that American patients are too demanding to accept their ( British) type of health care.
Can someone please tell me what people are expecting with reform?

[jsteele]

I don't think anyone expects healthcare to be "free" in the sense that nobody pays for it. Rather, they expect that either an insurance company or the government will pay for it. The insurance companies and/or the government would in turn be paid through premiums or taxes.

In my experience, there are two primary issues that upset people about the current healthcare system: 1) its expensive, and 2) its complicated. The first may not impact most of us who have access to insurance, but is a real problem for those who need to pay their own bills and/or governments who must pick of the fees for emergency room service and so on.

The second especially irritates me. To get a simple physical recently, I had to go to one place for most of the exam, another location to have blood taken, and a third location for an x-ray. The doctor's office used to be able to do all three, but the insurance company has contracts with other providers and doesn't allow that anymore. My son was recently proscribed medicine for which the insurance company refused to pay. My wife was told by her doctor that she needed a specific test, but the insurance company required prior authorization so we had to jump through a bunch of hoops for her to get the test. You don't have to go through this sort of thing very many times before you want things to change.

Basically, our system is divided into three tiers: 1) the poor who get little to no healthcare that is paid for by the government or charities; 2) the wealthy who get whatever they want; and 3) the middle who struggle with various levels of insurance and are provided healthcare based on spreadsheet calculations.

I don't believe that basic healthcare should be treated like just another commodity. There should be a basic level that is guaranteed just like a basic level of education is guaranteed.

[Anonymous]

Here is the tough question: What types of services do you feel are "basic"?
Also, from what I can see, the system seems expensive, but if you take a close look at the providers, from nurses, to x-ray techs, pharmacists, doctors, physician assistants, we are all working very hard for moderate wages. We all go home very tired. Where do you cut to decrease the expense?
I know not everyone is an expert, but I am curious about public opinion.

[jsteele]

Anonymous wrote:Here is the tough question: What types of services do you feel are "basic"?
Also, from what I can see, the system seems expensive, but if you take a close look at the providers, from nurses, to x-ray techs, pharmacists, doctors, physician assistants, we are all working very hard for moderate wages. We all go home very tired. Where do you cut to decrease the expense?
I know not everyone is an expert, but I am curious about public opinion.

I'll leave the question of "basic" to the experts but ideally it would include a host of preventive services.

As for cutting expenses, a more streamlined system with less paperwork would certainly save on overhead. If the government negotiated bulk purchases of drugs and other equipment, that would probably result in savings. But, an easy target is executive pay. I can imagine what the average nurse or x-ray tech earns a year and I certainly wouldn't want to see it cut. But, look at what the top guys make:

http://www.forbes.com/lists/2008/12/lead_bestbosses08_CEO-Compensation-Health-Care-Equipment-Services_9Rank.html

Marijn E Dekkers, CEO of Thermo Fisher, $69 million
H Edward Hanway, CEO of Cigna, $30.16 million
Dale B Wolf, CEO of Coventry Health Care, $20.86 million

These are ridiculous sums of money. These people aren't interested in helping people live healthy lives. They are interested in keeping stock prices high so that stockholders continue to stomach these salaries. If they need to refuse a procedure or reject a prescription to meet their quarterly targets, well that's just to damn bad for the poor sap who needed the service or medicine.

Ideally, the system needs to be refocused on the goal of providing healthcare rather than the goal of creating a handful of obscenely rich people.

[Anonymous]

Agree that those salaries are out there, but those guys would say that even if they gave away 90% of their incomes, it would be a drop in the bucket when you consider what you could actually buy each subscriber with the money. But it would make a difference if ALL of the health care execs got paid more like airline execs.
I would like to see better access to mental health care. That is one of the greatest needs. When people get nuts, they lose their jobs, that is when the vicious cycle really kicks in.

[Anonymous]

Cutting overhead, administrative costs and exec salaries might help some, but that is really not what's driving our health care expenses to be spiraling out of control. No one wants to hear/admit it but we cannot provide first class service for every single procedure that anyone could want at reasonable price levels. We need to move the direction of the Europeans and have a government-run program that provides some BASIC level of service (prevention and proven treatment - not out there experimental procedures or heroic efforts to prolong life by just a couple more months in terminal patients). In order to get some handle on costs so that Medicare/Medicaid spending doesn't end up consuming our entire federal budget in a few decades, we need to us government coverage to get whatever cost savings we can. But we also need to recognize that government can't be expected to provide every conceivable health service out there. A lot of money is spent on prolonging the life by a very short amount time in very very sick patients. This doesn't seem to make sense to me. It would be better spent on keeping more people healthy, treating more people that are curable and in researching cures to wide-spread diseases.

[Anonymous]

I am coming to this from the legal angle. Insurance companies make a decision re approving/paying for treatment based on financial calculations not the individual case. I guess overall it works out for them to average each care plan but it does not always work and then the consequences are horrific for the patient (death or serious injury) and costly for the insurance company because they have to defend or settle a lawsuit. I see way more careless or even deliberate neglect by medical personnel that is driven by what the insurance co will pay for than I see frivilous injuries where somebody wants millions for pouring hot coffee on their lap.

[Anonymous]

Agree to the basic safety net, but I know that we will not agree on what BASIC is.
Also, those basics would still be discounted if the government were involved. It is not unheard of for a pediatrician to get $27 for a physical on a Medicaid patient. That would surely continue. The doctors would start to refuse to care for those people.
Agree about the overspending in the last weeks of life being ridiculous.
I think that for anyone to get federal health care bennies, they should have to sign a living will. That would not mean that you deny to right to long term care, it would just force everyone to think about it, potentially saving lots of money.

[Anonymous]

Have you seen Michael Moore's SICKO? OP - you should watch it, it is available on download from a number of sites. It will answer alot of the questions that you have.

[Anonymous]

I have seen it, but I think that he is waaay out there. Unrealistic.