The Health Care Delivery System Difficult to Fix??
December 24, 2006 | General
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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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?
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.
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
Comment by JohnPearson January 24, 2007
Nice Post.
That was well said. Always appreciate your indepth views. Keep up the great work!
John
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
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
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.
Comment by wendywonder February 8, 2007
Hi there
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Some solutions for stopping poop eating are: You can put meat tenderizer on it.
What do you think?
By the way, I love that too! Where did you get that at?
Bye, bye - Wendy!
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Comment by Kelly May 19, 2007
National healthcare is not the answer. Nuff Said !
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
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.
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
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.
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.
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
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).
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
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
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.
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
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.
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?