The Health Care Delivery System Difficult to Fix??

I recently read an article on WWW.TheHealthcareBlog.com by Matthew Holt, entitled “Why Is Fixing American Health Care So Difficult?” The article resonates with the NEOS approach to the difficulties within the HealthCare Delivery system. Mr. Holt explains the problems of the American Health Care delivery system in two questions: How do we create a system that ensures that all citizens, and perhaps residents, have access to health insurance and how do we contain the huge cost increases??

The focus of insurance was to have dollars available when one became sick. We as a health care delivery system put all of the sick people into one pool and marveled at how much money it cost to treat them. We read lots of discussion of how the health care delivery system should subsidize the poor. Should we?? Would this help fix the cost of the health care delivery system with just a transfer of dollars for those who attempt to stay healthy and manage their health, to those who for what ever reasons become sick??

Is the Health Care delivery system “really” that difficult to fix??

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23 Comments »

  1. Comment by Jessica December 26, 2006

    I think that heathcare is a problem that only the direct indivudual can fix for themselves. I think the government looks at healthcare as your problem therefore you fix it. You go get benifits an you go ensure that YOU are taken care of. Im not sure we will ever fix this problem until we fix the governments way of thinking…I may be off track but i think that healthcare is just another respobsibility of life and that we can only cater to ourselves if thats all we think about. I think that if the majority of humans had more compassion twards the welfare and the health of others our government would reflect that and it would be a different society all together… What do you think?

  2. Comment by jp December 27, 2006

    The government is only a reflection of the poeple who get out and vote. Many times the election process is more about the people who possess enough passion about a topic to get other poeple of their same thinking process to get out and go to the poles. I agree, I think our government would represent what ever healthcare process we wished if we were demanding enough ask for it. We can’t wait for the government to wake up and take care of our health for us. The healthcare delivery system is broken. It has and continues to be used by the free market enterprise for the accumulation of wealth for a selected group of people. Yes that is what capitalism is about, but we need to create ways that educate people that they can take control of their health and save money in the process. This allows for free choice and that as well is what capitalism is about.

  3. Comment by Pharmacy January 24, 2007

    Who really now is engaged in the control of health? To mine it neglected the large pharmaceutical companies and the medical centers. There should be a centralized management WBR LeoP

  4. Comment by JohnPearson January 24, 2007

    Nice Post.

    That was well said. Always appreciate your indepth views. Keep up the great work!

    John

  5. Comment by School of Pharmacy January 30, 2007

    What components definition includes a healthy way of life? Whether it is necessary to add in food of the additive? WBR LeoP

  6. Comment by Pharmacy Times January 31, 2007

    A national health promotion and disease prevention initiative bringing together many individuals and agencies to improve the health of all Americans WBR LeoP

  7. Comment by jp February 1, 2007

    We as consumers will begin to give up our power to have the imput into how our healthcare delivery system works if we do not begin to stand up and demand to be a part of the soluton. We need to look at better ways of prevention and wellness. We need to address the problem of our children being over weight and having greater healthproblems as a result. The collective”WE” need to take responsibility for what we eat and how we eat.

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  9. Comment by Kelly May 19, 2007

    National healthcare is not the answer. Nuff Said !

  10. Comment by Ray McNally October 26, 2007

    Hi,

    I personally think our health system should be more like that of Canada’s. Paid by the Government.

    We would no longer have to worry about the cost ourselves, and the people with “success” in life would be able to get the health care then need.

    Now, we would have to pay in the form of Taxes, but the Government would find someway to raise taxes on us anyway.

    Whay not let them raise it a bit for health care and at least KNOW we’re paying for something worth the deduction.

    Just a thought!

    - Ray

  11. Comment by shana January 30, 2008

    it will improve when the gov. stops trying to make a profit and make money from people’s health.

  12. Comment by Doc February 6, 2008

    We will never live enough to see the system working like a charm. A fix? You must be joking. They can’t fix their tie not to mention the health system. They don’t care what happens, it’s not their problem. Herbal Doc

  13. Comment by Mike T February 6, 2008

    By simplifying the system, we can cut almost half the cost of what is being spent today. Just get rid of the so called ‘health insurance’ from the scene for every single procedure (like doctor’s office visit).

    We can either
    – have a system just like what is in Canada or UK or France; if people are concerned about waiting time for elective procedures, then let them have private insurance on their own OR
    – let the individuals pay the doctors or hospitals directly from their HSAs which can be funded at least partially by employers. And for catastrophic/emergency events, let the Govt provide Medicare like coverage and of course people would not mind paying a few hundred additional tax dollars for the purpose. When the individuals take control of the payment for majority of the procedures, the cost will be significantly less.

  14. Comment by Robert February 8, 2008

    I agree with Mike T.

    Health insurance can not be the solution; it is THE problem. Let the Govt provide Medicare-Part E (new) only for catastrophic/emergency services and let the people pay the doctors/hospitals directly for all other services.

  15. Comment by PJ May 5, 2008

    Yes, without involving patients in payments to doctors/hospitals, the cost can never be controlled. If someone else (Govt or insurance) pays, we don’t care whether the procedure is required and how much any given procedure costs; this is the fundamental problem for the failure of the system.

    But, how do you know what you are paying is reasonable or not. Here is some information to help you effectively deal with providers especially hospitals:
    1) Before you avail any service, ask the providers for the procedure codes (CPT/Current Procedural Terminology codes) for the services you need. This is a 5 digit code; some codes may have an additional 2 character suffix.
    2) Go to American Medical Association website, (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp) and select your state, location and the CPT code/s….boom, you will get what the Govt pays (for Medicare) for that service in your location. This is public information. Now you have the ammunition to deal with the provider; you don’t need to pay a penny more. You don’t even need to ask several providers to find the cheaper ones.

    What you will notice will definitely surprise you. This will be a much smaller amount than what you would expect. You would feel that you don’t need insurance; the premium what you pay could be much more than what you would need to pay the doctors directly.

    Please feel free to browse the American Medical Association website for checking how much Govt pays for different procedures in your area. Knowledge is power.

    PJ

  16. Comment by PJ May 5, 2008

    Thanks JFR. Sure, each and every hospital, doctors office, labs and other providers (at least their billing departments) know this very well. This process has been in practice for decades.

    There is an elaborate process (already in place) which is updated very regularly by Centers for Medicare & Medicaid Services (US Dept of Health & Human Services). For more information, please visit http://www.cms.hhs.gov/PhysicianFeeSched/01_Overview.asp#TopOfPage

    How many people know this info? My guess is, outside healthcare industry folks, over 90% of the general public do NOT know this. I think, at least half the healthcare related personal bankruptcies can be avoided when they have this information.

    Yes, healthcare cost can be significantly reduced, if people are involved in the payment process. When people are made to pay for most of the services directly (at least a significant percentage as co-pays), then they will certainly ask the hospitals as to 1) how much the service/procedure costs? 2) are there any alternatives? This is enough to reduce the cost drastically.

    Today, people are scared when you say they need to pay a significant percentage as copays because they are used to seeing exorbitant amounts in their hospital bills. If they get to know what Medicare pays (and hospitals accept), they will be very comfortable in making similar payments even fully (if they don’t have insurance).

  17. Comment by JF Rock May 6, 2008

    It is my preception, albeit biased, that the Provider’s and Insurance companies operate in a heavily regulated, hugely beaucractic , and mostly faceless environment to the (paying)public. Again, in my humble opinion, many of the my public constituents do not regard the providers and payors of our healthcare system, a system that offers the most personal service we offer any citizen in this country, as entirely trustworthy. Has anyone checked out the Billions in capital outlays of 8 out of 10 of this nations top healthcare provider systems( all TAX exempt), not to mention the profits of Wellpoint(Anthem), Humana, and United Healthcare….while the rest of us are made to feel guilty about the uninsured? Just allow me to publish the real “price list” to America’s MOM’s. Mom we’ll fix the system. Our children will have healthcare, our parents will have healthcare, and within two years this will be a non-event, no more political discussion, no more rising cost….just shopping at Wal-Mart for everyday lower prices. Yes Doctor, it really is that simple.

    JFR

  18. Comment by Mike T May 7, 2008

    Yes. It can be very simple….if we can get rid of the complexity and make the price totally transparent. The cost will be much less than what it is today and the crisis will be over.

    When a third party like health plan is involved, administrative & legal components of the healthcare cost take it to astronomical levels.

    Looking forward to your “price list” JFR. Thanks in advance.

    Mike

  19. Comment by Frank May 8, 2008

    Healthcare is the only industry in the country where pricing is ‘hidden’ and ‘fraudulent’ ; you should not be surprised to receive hospital bills charging 10 – 20 times more than what Medicare pays.

    As Mike commented, about half the healthcare cost is wasted in the form of administrative & ‘litigation related’. May be even more. The ‘litigation related’ components include ‘defensive medicine’ (where patients undergo unnecessary tests) and doctors’ malpractice insurance.

    First, make the pricing absolutely transparent; force the hospitals publish their rates for every procedure. Then take care of wastage in administrative and ‘litigation related components’; it can be done only by simplifying the system. We don’t need millions of companies like health plans, brokers, agents, administrators, etc.

  20. Comment by JFROCK May 8, 2008

    Transparency would be good, but I think it will be a while coming. Also, I do not think we can go to the providers (hospitals, etc) for pricing. Why? Because your insurance company negotiates different rates for each provider. For instance, in my city if I needed a colonoscopy, there are six hospitals that can perform the exact same procedure. I can also tell you that the price that my insurance company pays each of the six hospitals for the same colonscopy varies. It really depends on what the individual hospital has negotiated.

    Therefore, I seek my pricing information from the insurance side. Afterall, I’m a paying customer. I pay the premium and therefore I want to know what my insurance company has agreed to pay for my care at facilities in my area. That’s not easy to obtain, but persistence, exerting one’s rights, and being out spoken does save money.

    Also, more insurance companies are negotiating fee’s at or below the medicare fee schedule. Since this fee schedule is available to the public, it is a very good guide. Typically a medicare recepient is someone over 65. As a human being, I have observed that the older we get the more things seem to break down. So, if you are younger than 65 and in pretty good health, perhaps you may not want to pay more than the population that is a higher health risk than you.

    Again, I think the key is to know the prices my insurance company has negotiated. Then considering price, I pick which facility or provider that best suits me. It would seem that if myself and my fellow employees would focus on selecting the low price provider, then perhaps our premiums wouldn’t keep rising. Currently, I am content to let the providers and insurance companies fight it out over the “cost” and “charges” of healthcare. I simply want to have the prices my insurance company has arranged(agreed to pay) for my care. If I don’t like them, then I will just change insurance companies(and probably keep my same provider).

    JFR

  21. Comment by Frank May 12, 2008

    Thanks JFR for thinking about it. The “key is to know the prices my insurance company has negotiated”. It is just impossible.

    “Americans know the price of almost everything they pay for, except for one of the most important things they pay for — their healthcare. With a point and click, they can find the price of anything from clothes to cars. Yet they don’t know what they are paying for healthcare and what sort of quality to expect in return. There’s no Carmax for healthcare.” By Secretary Mike Leavitt, US Dept of Health & Human Services. Posted: 05/10/06 12:00 AM — http://hill6.thehill.com/healthcare-may-2006/
    transparency-in-healthcare-a-priority-2006-05-10.html

    Secretary of HHS tried for over 2 years to make the healthcare cost transparent. He has gotten nowhere. Why? Healthcare companies spend $100 million every year for lobbying alone. Once it is transparent, they lose control; but they don’t care even if thousands of people die early because of this mess.

  22. Comment by Deron August 24, 2008

    Most of the discussions in healthcare blogs include a lot of blame. and very few meaningful solutions. The only way we can find a comprehensive solution will be to get all of parties to the system together (doctors, hospitals, health insurers, the government, patients, etc.) and look at how the various links can be strengthened.

    One of my biggest frustrations is the fact that no one seems to be placing responsibility on individuals. Obesity, smoking, stressful lifestyles, women having 4-5 children on public assistance, etc. add a lot of cost to the system. When do we start taking personal responsibility for some of the excessive cost in the system?

  23. Comment by Beth August 11, 2009

    By Deron: “One of my biggest frustrations is the fact that no one seems to be placing responsibility on individuals. Obesity, smoking, stressful lifestyles, women having 4-5 children on public assistance, etc. add a lot of cost to the system. When do we start taking personal responsibility for some of the excessive cost in the system?”

    I take responsibility for myself. But there are some things out of your control. One is the diseases that can affect your body and you never asked for them. Some are minor and some are major. Yes, there are people who are obese, have tried diets, exercise, etc. One example is my husband, he was morbidly obese and had diabetes and high blood pressure. He was on medication to control his diabetes and high blood pressure. He watch his diet and all of his blood test came back under the number for having diabetes. However, his weight was still a problem. His doctor finally told him, after he had lost 30 lbs., that because of his situation, he would not be able to lose any more weight. He started to get neuropathy in his eyes and legs. He was worried that he would die young. What was his solution? Gastric By-Pass surgery. It cured his diabetes and his high blood pressure. We had to pay for it out of pocket because insurance didn’t cover it. But it was the best thing we have ever done. He is the healthiest he has been in 20 years.

    And yes, there are people who are on the public dole. But, we as a country need to help these people out. I know there are women out there who keep having children so they can get money and not have to work, They need education and help. I know personally that you do not make much money in that situation. Not that I have had lots of children. My example is that I became an orphan at 15. I had no family and no one to turn to. I got Social Security, but it was only $109 dollars a month. I went to see about assistance and their solution was to take my $109 dollars and give me $90 dollars in food stamps. Thankfully I had friends that I could stay with from time to time. But there were a lot of times, I spent the night sleeping out side in a sleeping bag.

    Enough about that.

    We, the tax payers pay for our governments health insurance. I think that they should have to pay for their own health insurance. Then they would REALLY see what we, the uninsured have to go through.

    I told you my husband is the healthiest he has ever been, yes. His only problem is he has arthritis in his lower back.

    But five months later and multiple insurance companies he has been denied. Why? 1. He has a history of diabetes (even when we say we have the blood test to show he doesn’t have diabetes, they say once you have diabetes, you always have it). 2. His Gastric By-Pass surgery. Which like I said has made him healthier than he has ever been. Insurance companies do not look at the individual. They look at old medical information, statistics about what procedures have problems and formulas that they use to determine if this person is a medical risk. They don’t want to have someone insured if they think they will have to pay out money for medical bills.

    Also, for the uninsured, hospitals, doctors and other services inflate their costs because they can.

    From PJ: “Before you avail any service, ask the providers for the procedure codes (CPT/Current Procedural Terminology codes) for the services you need. This is a 5 digit code; some codes may have an additional 2 character suffix.
    2) Go to American Medical Association website, (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp) and select your state, location and the CPT code/s….boom, you will get what the Govt pays (for Medicare) for that service in your location.

    This only works if you know that you are going to get some sort of procedure beforehand. What if you end up in the emergency room? I have an itemized bill, have done as you said and the codes they have on the bill do not match anything I can find on the web.

    My husband was recently in the ER for a life threating accident. He spent 24 hours in the ER on a ventilator and had a 2 1/2 day stay in the hospital. The total cost – $27000.00. That does not include the paramedics and ambulance. The ER doctor. The doctor who was supposed to see him in ICU (but he was never in ICU because they didn’t have a bed). The consultant that worked with the ICU doctor and also the doctor he ended up with when he was down graded and moved to a regular bed. They charged him $111 for one pill that would cost $3 at the pharmacy. Also, the hospital is church based and to me that means they should have compassion and some sort of charity to help people. One other thing to add to our situation is that my husband is unemployed and I am disabled. (Do I wish I could work again, yes I do, but due to brain damage and other things, I have no short term memory). Also, my husband is a disabled veteran. He gets little compensation and does not qualify for help from the VA. Sham on them, they should help every veteran.

    I have an itemized list (which some of the items are not itemized) and all of his medical records. One note, if you ever ask for medical records, they will give you about 5 pages of summary for free. If you want all medical records, you need to ask for them and they charged us .60 a page. total $152.

    But well worth it. I have found that they stated that they gave my husband medication in the form of tablets and liquids while he was intubated.

    I also found out that someone messed with his ventilator settings and he was not getting enough air. (My husband told me about this, but to find it documented just floors me). He said it took two hours for someone to come see that he was in distress (he could not let them know because he could not talk and his hands and legs were strapped to the bed, even after he came off the vent). He said that for those two hours, he felt like he was drowning.

    They also stated that he had a GI tube in place. Knowing that he was a Gastric By-Pass patient and if they did this, it would have killed him. He did not ever have a GI tube. One more error on their part.

    I don’t have the answers to the problem, I only have examples of the problem.

    But one thing I believe, the insurance companies have to redo their criteria for insuring people and that hospitals, doctors and other services should not be able to inflate their costs to the uninsured.

    I am angry and bitter with the whole thing. My faith in doctors and hospitals and insurance companies is gone.

    I have searched the web for help and yes, there are place out there that will help you..for a fee.

    If anyone knows of any place, person, organization that can help, I would sure appreciate the information.

    Thank you and sorry about the rambling, but I think that people need to know what happens to the uninsured (especially those who are trying to get it and are doing their best to stay healthy)

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