How would YOU fix our health system?

[scrub-jay]

Just to throw it out there, please keep in the spirit of good fun. I find that on this topic, there is quite a lot of anti-physician public sentiment out there. I'd love to get a fresh perspective from the group who I believe to be experts on every topic.

What are some of the most important elements you feel need to be addressed?

How about the elusive -- how do we pay for it?

Disclaimer: I am working on my masters and this is related to a health care systems course, and I really want to supplement my discussion and research with opinions from those of us on the frontline (of course, I am right there with you). Most of my research only reflects the opinions of the average American who feels entitled to free healthcare, the best technology and every treatment option. When asked how to pay for it, the answer is inevitably - pay the doctors less. *gahhh* As I see many potential solutions past just paying the docs less... I am really posting here to stop feeling like such a lone wolf. Or maybe that is your solution too!

[SoonerTexan]

More med schools. It shouldn't be this hard to get a slot if there is/going to be a shortage of doctors.

[Michele]

Delink health insurance from employment. Make health insurance a national thing, meaning you can buy a policy from any company and your insurance is the same no matter which state you are in, no home network type thing. Let the insurance companies fight for our business with different plans. Let the consumer choose which option is best for them....and let's get "safe living discounts."

No one should be able to be denied coverage, but it might be more expensive for an obese chain smoker. More like our car insurance system. We would have to figure out a way to protect people who get diseases like spontaneous cancers from rate increases. And yearly physicals or twice yearly depending on age should be required to renew your policy or keep a discount or whatever. And if you start out with lots of bad lifestyle habits, but you lose weight, lower your cholesterol, quit smoking, your cost should decrease appropriately.

I'm really not well read on this issue, but from my basic understanding I think this would help. But I totally could be missing something important that would make this system fail.

[DCJenn]

I think we have to stop thinking of "health care" as ONE thing because it encompasses so many aspects of life. Sure, it's a lot easier to talk about "Health Care", "Obama Care", etc as if it's just one topic but soundbites don't help the discussion. (and this comment is directed at the TV and online commentators, not anyone here)

One 'illness' can impact everything: Diabetes > Obesity > Food > Corporate Farms or try this one: Diabetes > Kidney Disease > Dialysis > Dialysis Machines > Machine Manufacturers > Component Parts of manufacturing- metal, computer parts, plastics > mining, drilling, etc. or this one: Diabetes > Diabetes Management > Nursing Staff > Nursing Schools > Nursing Shortage. and you can go on and on for every single illness out there. Every. Single. One.

Once you think about it, quite literally every single industry in this country is impacted directly (employee health care costs) and indirectly (we make the cars that the doc buys to take himself to work) by our health care system.

I think that the Health care law is a start. It's better than nothing. I think that there are parts that are fantastic and there are parts with some significant unintended consequences. That said, if the people that we've elected to Congress can't figure out how to have a conversation with out accusing each other of wanting to kill grandma or killing the economy or whatever idiocy that they're throwing at each other, it's isn't going to get fixed. It would be great if they'd all stop running for reelection and actually sit down and listen to people. There are lots and lots of really smart people who may actually be worth listening to- instead of slamming- and that's from both sides of the aisle.

Some quick and easy places to start- mental health and substance abuse treatment (because that's what I do) saves multiples of dollars on the dollar invested. It's not pretty, it's not fast and it's not the most heart-warming group of people necessarily but we've all seen recently the societal costs of untreated mental illness...

Preventative Care- must include dental care. Basic dental care. So much can go so wrong if your teeth are falling out.

It's ok to talk to the old and the terminally ill about what they'd like to have happen at the end. It's ok if they do want all available treatments and it's just as ok if they don't but you kind of have to know if they don't WAY in advance. In fact it's a conversation we all should have with all of our loved ones- and get it in writing.

We've got to get a handle on the tort reform. Doctors have got to stop ordering every test in the universe because they're afraid they're going to get sued and patients have to stop expecting every test in the universe or they will sue. It's a stupid cycle that costs everyone too much time and money.

It's overwhelming and depressing and I honestly don't see a way out of the mess. There is not a 'right' way. There are better ways. There is no such thing as a perfect solution because inevitably someone will get burned.

Jenn

[ides]

One of the major things I think need to change are the insurance companies. They need to be nonprofit & strictly regulated. Right now they are the only ones "winning", while everyone else suffers under their repression.

I would get rid of all these silly mal practice law suits and let the doctor actually practice medicine without fear.

I would get rid of all these silly mal practice law suits and let the doctor actually practice medicine without fear.

There has to be recourse for actual damage -- it's real and cannot go w/o consequences. There should, however, be a repercussion for filing frivolous lawsuits. The sad fact is, the burden of proof always falls to the MD. I understand people being angry and wanting to lash out / find someone to blame, but there isn't always someone to blame. I think the lawyers that TAKE these suits are the worst of all.

[scrub-jay]

Tort reform is huge, I agree with Shakti though - you cannot complete obliterate malpractice lawsuits, there must be accountability for those few doctors who are at fault.

One thing I found interesting in my research is the definition of "healthy" between our country and other countries. Our country views healthcare as "without illness" which establishes the standard that if physicians treat the illness, the person will be healthy. Other countries put more emphasis on being healthy regardless of illness, including such factors as mental and social health into the equation.

Some issues I'd like to see addressed:
- Tort reform to control frivolous lawsuits: perhaps the losing party has to pay all legal bills for the opposition? If this were better controlled, malpractice insurance and defensive medicine could subsequently be better controlled.
- Pay for Performance based system - similar to what exists in the UK. Patient populations are standardized (so physicians cannot only accept healthy patients to boost the annual bonus). We currently have a fee-for-service based system and that promotes over use of resources whereas a pay for performance based system would encourage positive patient outcomes.

[SuzySunshine]

My main points have already been mentioned.

Like Shatki said - tort reform is huge but there are quacks out there that need to be held accountable. Lawyers should also be accountable for frivolous suits.

Insurance is also HUGE - like Michele said, why isn't it like car insurance? Make it more competitive, make it required (like cars) that you carry it, some people won't but that will be another issue.

Finally the med school spots - like DCJenn mentioned in another thread they decreased spots eons ago and never rectified that now there aren't enough people in some specialties.

[bobk]

I'm very skeptical of universal health care administered by the federal government, and think we need to explore more reforms to our current system before we can consider going there.

I agree with Michele that separating insurance from your employer is a good start. I think it would be better for the economy as well. Having to deal with health insurance is a huge burden for small businesses and makes them less competitive. It would also make it easier for employees to move to a better job or work independently without having to worry about losing health insurance.

[SoonerTexan]

I think health insurance needs work...I'd like to hear from some "health insurance" spouses first though, before universally declaring they are the only ones benefiting.

One 'illness' can impact everything: Diabetes > Obesity > Food > Corporate Farms or try this one: Diabetes > Kidney Disease > Dialysis > Dialysis Machines > Machine Manufacturers > Component Parts of manufacturing- metal, computer parts, plastics > mining, drilling, etc. or this one: Diabetes > Diabetes Management > Nursing Staff > Nursing Schools > Nursing Shortage. and you can go on and on for every single illness out there. Every. Single. One.

This is so true! There are huge industries with powerful lobbies that make a lot of $$$ off the illness of America and you could argue there are others (the Food industry comes to mind) that makes lots of $$$ causing these illnesses. It's a broken chain to begin with, and health care reform is a start, but that's about it.

I agree with Michele that separating insurance from your employer is a good start. I think it would be better for the economy as well

I think it would promote lower costs overall, but I highly doubt costs for everyone would get as low as they are for employees of large corporations. Separating health insurance from employers takes away the employer's (significant) financial contribution, which has to be made up by someone.

[scrub-jay]

I think health insurance needs work...I'd like to hear from some "health insurance" spouses first though, before universally declaring they are the only ones benefiting.

FWIW - I am one of those spouses. I work in the insurance industry (IT as you know), although mostly I deal with life insurance and annuities, however my company also covers dental. At this point, they are not in the health care insurance industry (they want to see what will happen too!) And I also agree that the insurance companies have many things that need to change - for example, private pay insurers CANNOT purchase maternity coverage at all? wth? Preexisting conditions? Dropping coverage when an individual is diagnosed? Lifetime maximums? Yes, I agree these things need to change (some actually have already with the Accountable Care Act). Can I get on board that there is only one problem with our system and if we fix it all will be lovely? No, this is a complex issue with many facets that must be addressed. At this point, there are many broken pieces that need to be fixed.

[QUOTE=bobk;514282]I'm very skeptical of universal health care administered by the federal government, and think we need to explore more reforms to our current system before we can consider going there.

I agree with you. Universal Health care run by our government would be horrible. I think all we need to is to look at Medicaid and Medicare to see that they cannot do it. I can speak from personal experience my kids are on Medicaid where we live and it is horrible. I also lived in a country that had universal health coverage and it was horrible. A couple of my friends go sick and it took them forever to find out what they had. Having universal health care is not all it is cracked up to be.
I think that we should have open insurance like they do for car insurance. If we live in AL and there is only one company then one should be able to look outside their state. Competition is good.

I agree there should be recourse but there has to be limits. Like, suing a doctor because he tells someone they are too fat. I agree with the lawyer thing, but I also think the same could be said about the judge that gives the money. I just there are too many people that want something for nothing.

[ides]

How about limiting the lawyers fees/compenstion for medical cases. They go hunting or should I say ambulance chasing for the huge cut they get if they win. Something nominal to discourage frivolous cases.