American by birth

[dlminehart]

Overall, I'm quite happy with Kaiser, my HMO. $10 copay ($50 for ER), GP available within a few hours, specialist within a couple weeks, faster in emergencies. Followup visits are often free. Doctors are skilled, caring, responsive. MD can send Rx over PC downstairs to the pharmacy, where it is only a 10 minute wait to pick it up, for $5. I can email my doctor and get a reply with 24 hours. My records are online, so I can check how my latest cholesterol figures compare with a year ago (as can my doctor, on his PC). With my private coverage, the lab work was outsourced, and findings transmitted in paper format to me and my doctor. My Kaiser copay receipt shows my innoculation status (gotta make time to get that tetanus booster!). Flu and similar vaccines are free, with drop-in access during their seasons.

Drawbacks are mainly that care is "rationed" . . . you won't hear about the expensive treatment unlikely to work for you, or even about a more expensive but more convenient treatment (e.g., they'll offer a monthly injection rather than daily transdermal medication). You have to move up a food chain . . . GP refers you to a specialist, and sometimes you need to push for the referral. All in all, after years of hassling private insurers about practically every bill for our family of 4, and having half a file drawer filled with paperwork ("Submitted", "Being Disputed", "Resolved"), it is such a relief to just show up at Kaiser with the ID card and $10, wait the same 15 minutes I did on private insurance before seeing my doctor, stop by the pharmacy downstairs, and get on with my life!

It is probably true that quality of care is suffering somewhat as doctors are forced to see more patients. My MD said he'd been told he'd have 2000 patients when he signed on, and is up to 2500 already. This is not true just of HMOs. I don't find that I get any less time or attention from the Kaiser MD than I did from the private insurance one. I DO get less time chatting with the receptionist about my insurance coverage and the weather; said receptionist tended to handle patients for only a couple private doctors rather than for a dozen as at the HMO. Inefficient office overhead, to my mind.

[dlminehart]

I've seen a couple reports that our health care expenses are heavily concentrated (definitely over half, perhaps over 75%) in extreme measures during the last 6 months of life. How to deal with this? Obama's so-called "death panels" -- actually a proposal by a conservative Republican from Georgia to allow Medicare to reimburse doctors for carrying out the unfunded but already-mandated discussion of end-of-life options (durable power of attorney, health care directives, etc.) -- give some useful information but no obvious financial choices to the patients. I.e., the directives don't result in lower insurance costs, as far as I know. Seems that, in exchange for a Do Not Resuscitate order, one should get a discount!

[JR]

Overall, I'm quite happy with Kaiser, my HMO.

Ah, yes, Kaiser. They're well regarded. Aren't they a bit different from other HMO's, though. I guess I'm thinking of the lower-priced insurance available through work, which is an insurance which pays doctors and hospitals who will sign up with them. Kaiser is sort of an all-inclusive doctor/specialist/hospital/insurance thing, right?

Your point about efficiency is well made. A notable politician, not in office now, wrote an Op-Ed piece in the LA Times yesterday. He noted that among the inefficiencies in our system today is that insurers must be organized on state-by-state basis because current laws demand state regulation. The result is that there are over 1,300 insurers doing business in 50 states. If the market were opened up then efficiencies and national-level competitiveness would drive prices down.

JR

[docrowan]

One of the best articles I've seen on the healthcare issue appears in this month's Atlantic magazine. The only thing the author leaves out is tort reform - fear of lawsuits drives a portion of the market inefficiencies inherent in the healthcare industry, but the rest really makes sense.

http://www.theatlantic.com/doc/200909/health-care

It is a long read, but every bit is good. He hasn't fully thought through a valid alternative plan, but I believe he gets down to the root causes of our current problems. Despite the title he is not a nutball with an ax to grind.

Edit: I am not a doctor of any kind, just a junior high nickname because I was smart and wore glasses.

[Kristofor]

In the last case, I don't see why there isn't a cheap pump the guy could buy for $200 (like an iPod) and use generic meds at a few dollars a day, but that isn't an option in today's system. Medical economics ain't like real economics where demand encourages supply, prices drop as supply increases and competitors offer similar products, etc.

As a doctor you're probably familiar with a lot of the medical device regulations in play, but for those who may not be...

There are close to 15 support people for every every one manufacturing employee at the medical device facility where I work. Some of those people would be needed for any type of operation, but if we were selling the exact same products as investigational equipment for researchers we could do the exact same work with a quarter the number of people, and do it faster to boot. The products would be way less expensive.

The decision to change a screw, hose, battery, pump, chemical, process, etc. will require anywhere from a couple hundred (like for like screw), to several thousand (major assemblies, chemicals, some processes) man-hours of justification, verification, validation, documentation, and perhaps re-submission to the FDA and other regulatory bodies.

There is fairly high profit in these markets, so you would assume that there would be good incentive for strong competition to bring prices down, and that happens sometimes. But the relatively high barriers to entry makes that a slower process than I would like (as a consumer, rather than an employee)

Someone could make that pump you want for $200 (I'm guessing, without details), but are you going to go out on a limb and risk using it on a patient when it hasn't been approved as a medical device? I'm guessing your malpractice insurance provider would prefer that you didn't. Heck, it probably exists already today, but how are you going to even know it exists since it cannot be marketed to medical professionals for such a purpose?

[cgallery]

There are lots of "small" things we could do now that would greatly improve things (depending on your perspective).

(1) Eliminate pools to flatten rates. They don't have to be completely flat, but should be substantially flatter. Young and healthy people pay more so that they may pay less in their later years.

The way things are now, the young and healthy can get cheap insurance because they're assigned to a new pool. As time marches on and some pool members get sick, the insurance company starts raising the rates they charge to all members of that pool. Healthy members of the pool shop for lower rates and leave the pool, thereby further increasing the rates that the remaining members have to pay. Eventually, the only people left in the pool are those that can no longer switch to a lower cost policy because they have preexisting conditions. They're trapped.

(2) Eliminate private insurer's right to turn down applicants for coverage.

(3) Eliminate medical and legal marketing. No more drug, hospital, or personal injury commercials.

(4) Eliminate state-to-state licensing requirements for health insurance. Outfits selling health insurance would be allowed to sell the same policy in all 50 states.

(5) Use expert jurists to settle medical malpractice cases.

(6) Force hospitals to bid on expansion of services (adding beds, new $$$ equipment, etc.).

There are a ton of things we can do to fix what we have now. No need to toss this baby out with the bathwater.

[dlminehart]

How about bringing down costs by increasing the supply of doctors, and subsidizing the costs of a medical education? I hear about doctors, facing $250,000 of loans, opting for a specialty in order to make $400,000 per year and pay off the loan quickly. It could be cheaper to, say, double the number of professors and med school graduates at public expense resulting in more competitive salaries. I wonder what the elasticities of supply and demand are for doctors?

[bruce hylton]

Health care is not a political issue, but a life issue. We need to have something to let those in power know how we feel every day, not just at town hall meetings. Bumper stickers anyone? A lot of very good info here today.
I would like to eliminate some of the drug type adds. I am tired of seeing smilng Bob all the time.

[Gator95]

Gator, what's the difference between the first option you posted and the current system?

Yeah- currently we do have a big gap between the wealthy and the poor in terms of health care.

Was trying to get at the idea that instead of trying to eliminate that gap, there is a philosophy that says that there is nothing wrong with that gap, since any of us can become rich and one of the incentives for wealth is getting better stuff. Also that driving to the elimination of medical insurance to get back to a pure fee-for-service system that would make a greater incentive for cost savings, and decrease the cost of the system overall.

I am not saying this is a good idea. This is simply a libertarian arguement that I've heard which is intellectually consistent. Personally, I don't agree with it but it is a counter-argument to universal health care.

[Black wallnut]

Health care is not a political issue, but a life issue. We need to have something to let those in power know how we feel every day, not just at town hall meetings. Bumper stickers anyone? A lot of very good info here today.
I would like to eliminate some of the drug type adds. I am tired of seeing smilng Bob all the time.

You are correct in that health care, or the health care services provided is not a political issue. However the question of mandating coverage and using tax dollars to pay is a political issue. Top two reasons this topic has not yet been locked in order of importance!

1. I just now noticed it!
2. It has so far been civil and not full of political statements.

That said there are some replies that are leaning political. As long as this stays civil I'll not lock it but please carefully consider your reply.

The problem as I see it is the customer usually has no knowledge at the time of service what it costs. I do not have an answer exactly how to fix this but socializing medicine is not one IMHO. My gripe is the way some things are billed for example I had a buildup of wax in one ear that was discovered during a checkup. The bill for having a nurse irrigate my ear was $100+ for a proceedure that took less than 5 minutes. That is simply way out of line.

[Gator95]

One of the best articles I've seen on the healthcare issue appears in this month's Atlantic magazine. The only thing the author leaves out is tort reform - fear of lawsuits drives a portion of the market inefficiencies inherent in the healthcare industry, but the rest really makes sense.

http://www.theatlantic.com/doc/200909/health-care

It is a long read, but every bit is good. He hasn't fully thought through a valid alternative plan, but I believe he gets down to the root causes of our current problems. Despite the title he is not a nutball with an ax to grind.

Glad this thread was not locked early just so I could see this post.
Excellent article that articulates what I've been trying to say, but in a much better way and with data examples.

Thanks.

[docrowan]

The problem as I see it is the customer usually has no knowledge at the time of service what it costs. I do not have an answer exactly how to fix this but socializing medicine is not one IMHO. My gripe is the way some things are billed for example I had a buildup of wax in one ear that was discovered during a checkup. The bill for having a nurse irrigate my ear was $100+ for a proceedure that took less than 5 minutes. That is simply way out of line.

Mark,

Read the article I've linked to from the Atlantic. It is precisely the issue you raise that he addresses in detail.

[Kristofor]

I would like to eliminate some of the drug type adds. I am tired of seeing smilng Bob all the time.

I'm not going to do the search from this computer, but I think if you're talking about the recent smiling Bob adds (as opposed to the Bob Dole ED adds) that the product they're selling isn't classified as a drug but as a suplement so it falls under some other set of rules (eg they could advertise that stuff even when they couldn't advertise prescription drugs).

[DonHo]

"The second solution is the opposite- if we decide that healthcare is not like other services that those who can afford it get more or better, then the most efficient way to administer it would be through a single-payer state run system."

I totally disagree with this statement IF the single-payer is the government. I'm on a government run insurance program (medicare ) and if medicare qualifies as efficent, I'd hate to see inefficent. Medicare has a set fee or a service, that service is very low and your suppliment coverage is based on that set fee. At least anound here it's hard to find a new Dr. that will take medicare patients. You need to have been a long time patient when you qualify for medicare or settle for a Dr. who can't make it anyother way and has to take medicare patients.
I guess this qualifies as a political statement but it includes both parties. I don't think it's possible for a government agency to run in an efficent manner. There is waste, corruption, and fraud in every government agency I know about.

DonHo

[billwmeyer]

My grandson had an earache Friday. My daughter took him to urgent care and got 2 prescriptions for treatment. When she went to fill it, it came to $290!! the ear drops were $150 and the antibiotic was $140. When her husband lost his job awhile back they lost their health insurance. He is working again at lower pay, but has not qualified for insurance yet.

They called urgent care, but it had closed for the evening. She called the next morning and they gave her samples of the drops, and they wrote a new Rx for a different antibiotic that cost around $15.

I can grudgingly accept the price of the drops, but that seems ridiculous. The antibiotic I cannot understand. Why would a Dr. write a Rx for a $140.00 antibiotic. He has no health problems that would cause a special antibiotic. We figured the Dr. thought they were insured and for some reason chose that one.

Bill