Broken health care system

[7003006]

I was watching the news yesterday and they had a story of a baby that needs a new heart.The hospital that was going to do the transplant wanted 1.5 million first.
In an interview the grandfather stated that our health care system is broken.This got me to thinking,we are talking about taking a heart out of someone, putting it in someone else, hooking it back up and having it function.Fifty years ago when you could pay the doctor with a chicken that just wasn't possible.
One hundred years from now a heart transplant will probably an outpatient procedure. The new thing could very well be cell regeneration and cloning your own organs for future use.People may be living to one hundred fifty or more.
If health insureance costs $5000 a month will we still have a broken health care systen?
I feel bad for people with serious health issues,especialy children.But I think that it's unreasonable to expect the newest most advanced procedures for anyone with insurance unless we want insurance to be so expensive only a few can afford it.
I may not have said that just right but hopefuly you get the idea.

 

[7003006]

I was watching the news yesterday and they had a story of a baby that needs a new heart.The hospital that was going to do the transplant wanted 1.5 million first.
In an interview the grandfather stated that our health care system is broken.This got me to thinking,we are talking about taking a heart out of someone, putting it in someone else, hooking it back up and having it function.Fifty years ago when you could pay the doctor with a chicken that just wasn't possible.
One hundred years from now a heart transplant will probably an outpatient procedure. The new thing could very well be cell regeneration and cloning your own organs for future use.People may be living to one hundred fifty or more.
If health insureance costs $5000 a month will we still have a broken health care systen?
I feel bad for people with serious health issues,especialy children.But I think that it's unreasonable to expect the newest most advanced procedures for anyone with insurance unless we want insurance to be so expensive only a few can afford it.
I may not have said that just right but hopefuly you get the idea.

 

[BOB THE PALINDROME]

The question is what country we will be going to to get our heart transplants in 100 years (or 10 for that matter). As soon as Hussein pushes through socialized medicine it won't be $1.5 million it will be take a number and hope you don't die before they get around to you. Don't think so, check out the number of Canadians who get procedures done in the U.S. every year.

 

[Mickey D]

I feel for the family that has a child in need of care to survive.
I think I know what you are insinuating and I also don't feel it's up to our government (tax paying citizens) to support everyone in need.
We can only do so much. Life is what it is and includes death as a part of that process.

 

[WaterburyBob]

It will be even worse than that with Chairman Maobama's socialized health care system. It will be a points-based system. Your age and the value of your ability to contribute to society will be calculated to give a point value; if your points are less than the points required for the treatment, you lose - no treatment.

"Sorry, Mr. Smith, you're just not worth the expense" ...

 

[HOUSTON RICK]

Before doctors were responsible for generating $100,000,000 bonuses for insurance executives, they were paid directly for what they did. Now we pay the insurance company who extracts their overhead and the "breathing bonuses" for their executives and passes a portion of our payment to the care provider who may be able to afford people to further wrangle with the insurance company for the next 5 years for the rest of what the care provider is due. I predict that we will have a two tier system with low cost health care where you hope to live long enough to get the care, and a "fast track" premium tier for those who have the means to pay on their own.

If all the legal costs embedded in the health care system vanished today it would not even slow down the increase in health care costs.

 

[geoff40]

Rick is on target. In the area where I live, we have a hospital that serves many communities. They like to point this out when they describe themselves. Not lost in old memories was the time they were a community hospital, a true non profit corporation. Today that is long gone, and the CEO earns a base salary of just over 700K. People without insurance hit the ER and get an exam, maybe a prescription, and a bill for $1200. It's insane.
Hospitals are not like other businesses, in the sense there is no routine fee schedule in the industry. They can charge what they want, bill your insurance what they want, even when the fees are absurdly inflated. Fee structures that would put most other businesses out of business quickly, because nobody would pay them. But in this case we hear all about how it's free markets and all the other such BS. Those of us with insurance get to pay higher fees to cover those without it. Who allowed this to be legal? Who here pays more for a can of creamed corn to cover shoplifters lifting the same can for free in another store? You or I don't get to contest what we are charged for any medical services we are provided, in most cases most of us don't even know what our insurance is billed, do we? The last time I was hospitalized, I got an itemized bill because i wanted to see. I had to about pull teeth just to finally get it. They charged 1 fee for an aspirin tablet during the day time, and almost 6 times the amount after 4PM, for each tablet, just because it was after hours. (Like theres after hours in a hospital, right? The aspirin was on the unit 24/7 and they didn't have to send out for it). But insurance get billed like this routinely, millions of times each and every day across this country, and nobody is there to say, hey, wait just a minute here, what is this crap? Our fearless leader politicians, pretty much all of them, smile in to the camera and tell us how they know paying for health care is tough, while they get generous contributions from the health insurance companies, or they own stock in the insurance and drug companies, or both.
Socialized medicine is coming. Because those who elbowed their way in to power and control over our health care system, (back when HMOs first appeared, back when health insurance changed from non profit to for-profit) now have this all wrapped up nicely. We were warned back then, but the so called "free market" crap was what we got forced to participate in. It will regulate itself, how many times will we be forced to swallow that lie? Like the banking industry today, those in the HMO boardrooms are way too greedy and powerful to allow for honest and reasonable profit margins. They whine, they like to divert our attention by pointing out how much the new computerized scanner cost to buy and run, or how many people they didn't bill last month etc., while they collect 50 and 100 million dollar salary and bonuses, work a few hours a day, then head off to the golf course for an afternoon in the sun and drinks in the lounge afterward.
Greed is the #1 cause of so many of our problems in America today, what is ruining this country.

 

[pps]

See how expensive things get when it's free.

 

[m657]

Re:

Those of us with insurance get to pay higher fees to cover those without it. Who allowed this to be legal? Who here pays more for a can of creamed corn to cover shoplifters lifting the same can for free in another store?

We ALL pay for those stolen cans of creamed corn. The store, if it wants to stay in business, has to charge 'overhead' plus 'profit' to do such.

Should there be a way to eliminate the 'overhead' and 'profit' aspect of the business, item expense would fall tremendously. And it isn't just greed that drives the fact the consumer likely would NOT see a reduction in their grocery bag.

Certainly I'm not in support of the $1200 aspirin fees, in fact medical services all are identified by a "CPT" code (current procedural terminology), which is tied with another code (RVS-relative value schedule)denoting the time/expense of providing that service. These are multiplied by a conversion code intended to act as a way of giving some kind of value to that service. X-ray services in Oregon had a code of (example only, don't have the current list) of ".89" while a physical therapy code may be ".48" or a surgeon may be "1.89". The insurance carrier then uses this formula to determine which charges they can squiggle out of paying, what deductibles to apply, what exclusions and non-covered charges, what kind of provider and whether in- or out-of-network, etc.

The grand total bill, of whatever it may be assigned by the provider, may be "$1200" for a given service. The carrier will exclude perhaps up to 50% or more of that. They pay according to tightly guarded rules identifying that amount and the provider is left holding the difference. Whether the patient is charged or it is written off, whatever the billing may be, has to include multiple layers of employees to wade through the sham and BS paperwork--"overhead". The actual service (can of creamed corn) itself may cost pennies while the song & dance buys the CEO his new Mercedes.

And IF there is anything perceived as actionable in the provision of that service, tort attorneys feast on the rotting flesh. Legal costs, to the best of my information, amount to a relatively small % compared to redundant bureaucratic hierarchies in all aspects of the health care system.

So that $1200 aspirin isn't for the actual tablet, it's for having it available at a certain time; it's for the overhead of the entire hive that supports the physical apparatus of having it there for the patient at the time he needs it.

 

[geoff40]

m657, and others:
Yes I know! What makes me so

about this system we all think we have to accept (we have been programmed to think is A okay and legit) is this comparison to us, the little guys and gals out here:
If I were a carpenter lets say, and submitted a bid for a job in the home of one of those insurance company or hospital CEOs, and my bid (or final bill after the work was done) had an extra $50 listed to help cover future clients who did not pay me in full....
I don't think I need to say more. I don't CARE what their explaination or reasoning is, it is STILL complete BS!

 

[BarbC]

I spoke with a man the other day who is a retired VP of Operations for Johnson & Johnson. He believes that the key to reining in health care costs is fee-based healthcare, such as what is outlined in this article, which is basically like having a doctor on retainer. He believes that the incentive is to keep the patient well and out of the office. He also feels that we do need more doctors in the field and a type of government scholarship program, paid back by "X" years of service, would cost-effectively fill that need.

My concern is that this fee-based system will insist that you are well and send you home early. He felt that a medical ombudsman could act as an impartial third-party evaluator.

I also believe that contributing to the high cost of health care is an MRI on every corner and a high-tech lab in every office. Centralizing these services would cut back on enormous medical overhead.

 

[n4zov]

The proponents of government provided health care say there are 40-50 million uninsured Americans. What do you think would happen if all those people were suddenly given "free" health care? How would it affect your access to health care?

The answer is that health care would be rationed and long waiting lists would be created for health care services. The much touted Public Health Service in the United Kingdom has long waiting lists for virtually every kind of service. How would you like to wait a year for gall bladder surgery or some other "routine" medical procedure? The truth is that there is not enough money or medical personnel to handle the influx of new patients.

 

[glypnir]

This should be in the political section.

We used to have a decent health care system. Much of it was "faith based" and/or not for profit.

Then the beloved Ronnie Reagan decreed "let market forces rule. It will make health care more efficient."

More efficient at generating corporate profits, and executive salaries, maybe.

Heart and liver transplants are rationed anyway, simply because there aren't enough donated organs to go around. Mickey Mantle got a liver transplant. A nurse I knew at the time said, "He shouldn't get one, he's only going to live another year anyway. He's only getting one because he's famous." Sure enough, a year later, he was dead anyway.

I agree with the OP anyway, don't complain about the health care system being broken because you can't get a cheap, right now, heart transplant.

The other thing about health care is that it is a really difficult issue. We can't afford to give everyone everything health-care wise. There aren't enough donor organs. We can't afford to give every really sick person 1 on 1, 24 hour care. By highly skilled RNs.

And people all die eventually anyway. Our current privatized system is fairly screwed up. If we ever get a socialized system, it will probably be screwed up too. It has something to do with being fallible mortals.

You can say "politics", but what is the alternative? Whenever you have more than one person involved, it's politics.

 

[Bat Guano]

I don't know, but my son and his wife have a baby on the way. He is a professional pilot flying Caravans--degree, and ratings up to here. Aviation careers are in the dumpster; his pay is moderate and his health plan--well, it's lousy. He just put his wife on it. The monthly premiums are high, and the deductible is $5700.

So much for work hard, get an "education", acquire skills, and manage your money and affairs carefully.

Needless to say, he's a little ticked of at "Octomom".

 

[bk43]

Originally posted by n4zov:
The proponents of government provided health care say there are 40-50 million uninsured Americans. What do you think would happen if all those people were suddenly given "free" health care?

They get it now. All these millions have to do is show up at an emergency room and care must be provided. It's the law. Now here's a question for you, where do you think the money to pay for these services comes from?

Bob

 

[deralte]

Yes, there are a lot of uninsured - estimated at 47,000,000. Of course at least 17,000,000 are ILLEGAL aliens. The goverment plan will make it easier for them to care for the world while letting us fend for ourselves.

 

[m657]

IMHO this is a great discussion thread, and not 'political' in that 'partisan' is not yet part of the thread.

BarbC: re :"My concern is that this fee-based system will insist that you are well and send you home early. He felt that a medical ombudsman could act as an impartial third-party evaluator."

Your concerns have been demonstrated as all too true!!! The Oregon Worker's Comp system went through amazing changes the past 15+ years. One of 'improvements' they made was to shuffle a large number of on-the-job injured into 'intense 30 day therapy' modules. After which, they were declared to be at "Maximal medical improvement" and "Stationary" which meant they got the heave-ho, all based on a model of care that gave more concern to CASE management than to PATIENT care....2 very different things.

And while the notion of ombudsman is great, in practice here it was severely flawed in both policy and execution.

 

[7003006]

Wow,this thread took off in a direction I didn't see coming although I guess I probably should have.
My original thought was look at the things we can do today,taking a heart out of someone and putting it in someone else to save their life. How about prostetic limbs that can function almost exactly like real limbs.MRI and CT scans find problems that would have not been discovered without surgery,if at all.
How can a system that is making all these incredible advancements,even if they are extremely expensive,be broken?
Since we have gotten into the insurance / socialized medicine debate I come down on the side that says "I don't want my health care run by the same people who run the DMV."

 

[bk43]

Originally posted by 7003006:
How can a system that is making all these incredible advancements,even if they are extremely expensive,be broken?

It's not really broken. There are several problems facing the industry that need to be addressed. While a few are being handled, many have not as some very complex moral, financial and/or political issues are involved.

Bob

 

[Smithfan]

Interesting and entertaining thread.

Those who assail the insurance industry or whomever, have points worth considering.

But keep in mind that there is no country on the planet with a socialized medicine, er..."national health care" system that is doing any significant medical or pharmaceutical research. What do you think the impact is likely to be when the US goes to socialized medicine and such research essentially stops?

And try to explain, if you can, the curious phenomenon of "free" medical coverage for all that invariably needs to institute various kinds of health care rationing.

Bill