Comments on SICKO Michael Moore movie.

onelongsong

RainDog wrote:

Not to play devil's advocate here, but why can't those physicians become special interests themselves?

because they're busy treating patients. i want my doctor concentrating on medicine and not lobbying for more money.

chopitdown

RainDog wrote:

Not to play devil's advocate here, but why can't those physicians become special interests themselves?

the AMA does do some medical lobbying. http://www.ama-assn.org/ama/pub/category/7834.html http://www.ama-assn.org/ama/pub/category/13404.html
http://www.ama-assn.org/ama/pub/category/8659.html

here's something from JAMA

A NEW FOCUS FOR HEALTH CARE REFORM: REALIGNING COMPETITION AROUND PATIENT VALUE

WASHINGTON, D.C.—The health care policy debate is stuck in a place that undermines physicians and the nation’s health. The real problem is not cost, but value, according to an article in the March 14 issue of JAMA, a theme issue on access to care. The only real solution to the national health care problem is to dramatically increase the value of the care delivered for all the money being spent. And that, the authors argue, is an effort that must be market based, medically sound and physician led.

Michael E. Porter, Ph.D., M.B.A., of Harvard University, Cambridge, Mass., and the Harvard Business School, presented the article today at a JAMA media briefing on access to care at the National Press Club.

Dr. Porter and Elizabeth Olmsted Teisberg, Ph.D., M.Engr., M.S., of the University of Virginia, Charlottesville, examined the status of health care today, and propose a strategy for reform.

The authors write that the health sector today has the wrong kind of competition. Each player in the system gains not by increasing value for the patient but by taking value away from someone else. This does not improve health outcomes per dollar spent—in fact, it often does the opposite. Health care competition does not have to be zero sum. The authors make the positive case for realigning competition around patient value, and they call on physicians to lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.

The authors’ proposal highlights three principles that will put competition on the right track: 1) the goal is value for patients, (2) medical practice should be organized around medical conditions and integrated care cycles, and (3) results—risk-adjusted outcomes and costs for each medical condition—must be measured.

The Goal Is Value for Patients

“Improving value for patients is clearly the only valid goal for ethical reasons. It is also the only goal that aligns the interests of patients, physicians, health insurance plans, employers, and government. If physicians improve value for patients, they will be able to credibly engage Medicare and health plans in new contracting and reimbursement practices that reward such value.”

Organize Around Medical Conditions and Care Cycles

Dramatic improvements in value will require the restructuring of health care delivery, the authors argue. “Organizing care around medical conditions, rather than specialties or procedures, is key to improving value to patients. A medical condition is a set of interrelated patient medical circumstances that are best addressed in an integrated way. This encompasses conditions as physicians usually define them, such as diabetes, congestive heart failure, arthritis, or breast cancer. But this definition differs by including all needed specialties and the prevalent co-morbidities, such as diabetes combined with vascular problems or hypertension.”

“For virtually every condition, the cycle of care begins with screening and prevention and extends all the way through preparation, treatment, recovery, ongoing monitoring, and active disease management in the case of chronic conditions. Multiple specialties, services and even entities are involved in the cycle of care. Value for patients comes from the overall effect of the entire sequence of activities, not from any individual service.” The authors note that physicians are beginning to organize care around medical conditions and are forming institutes, centers, and other types of integrated structures that bring needed specialties and expertise together and encompass the care cycle.

“Better integration of treatment with prevention, rehabilitation, and disease management will reveal obvious ways to improve the overall outcomes and reduce costs. It will also point the way to how to change the broken reimbursement system.”

Measuring Results

“There is simply no way to achieve large and sustained improvements in value for patient without measuring results: the set of risk-adjusted outcomes of care for each medical condition, together with the costs of achieving those outcomes. Processes of care, the focus of much of today’s quality movement, are not results. Good outcome measures are vital feedback indicating what works and what does not. These measures enable professional insight and the development of expertise.”

“Designing risk-adjusted outcomes measures is not easy, but their practicality has been convincingly demonstrated. In some very complex areas of care, such as intensive care, transplant surgery, cardiac surgery, and long-term care for cystic fibrosis, validated measures have been available for many years. Clinicians can and should develop meaningful measures,” they write. “Results information reveals one of the most crucial insights about health care delivery: truly high-quality care is usually less costly. One of the most important reasons to measure results is that the best way to reduce costs is to improve outcomes.”

How Value-Based Care Delivery Could Change Medicine

The authors write that implementing these reforms will create powerful ripple effects throughout the health care system, including more effective collaborations between physicians and care teams, greater patient involvement in their health care, fewer malpractice suits, more supportive health plans and government payers, new means for reimbursement, and higher performance levels by physicians and care teams and an improvement in overall value of patient care.

“Paying for care cycles and rewarding value is ultimately the only feasible way to change a reimbursement system that everyone knows to be broken. When value rules, the nation will finally get better outcomes for every dollar spent on care. Competition on value, then, must become the nation’s health strategy. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system. In the economy at large, competition on value underlies the wealth of nations. It can transform the health of nations as well,” the authors conclude.
(JAMA. 2007;297:1103-1111. Available to the media at http://www.jamamedia.org)

Editor's Note: The George W. Baker Foundation at Harvard Business School and the New England Healthcare Institute provided financial support for the authors’ research during the time that this article was written. The authors receive royalties for their book Redefining Health Care and honoraria for presentations and discussions related to it. They each own stock in a number of companies that are suppliers to the health care sector.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations@jama-archives.org.

RainDog

onelongsong wrote:

i can understand your point and it's a good one. but i can't get past the fact that medical costs will remain the same. a nerve conduction test will still cost $8K usd so the amount of additional taxes would have to equal that of private healthcare premiums. the additional healthcare recipients would have to raise the premium costs. i can't see how it wouldn't.

So, on the one hand you're saying that many people who need $8K nerve conduction tests aren't getting them now. But I don't want to get into a morality discussion right now (I'm too busy at work earning my health insurance )

They had this problem in Germany. Their solution, and it's not a bad one, was to continue with a co-pay system. You pay the tax so that there's universal coverage, but you also have to pay when you go to the doctor. Not alot - I believe a standard doctor's visit is around $10, but it helped fund the system and keep people from visiting doctors willy-nilly just because they have an afternoon off.

onelongsong

RainDog wrote:

So, on the one hand you're saying that many people who need $8K nerve conduction tests aren't getting them now. But I don't want to get into a morality discussion right now (I'm too busy at work earning my health insurance )

They had this problem in Germany. Their solution, and it's not a bad one, was to continue with a co-pay system. You pay the tax so that there's universal coverage, but you also have to pay when you go to the doctor. Not alot - I believe a standard doctor's visit is around $10, but it helped fund the system and keep people from visiting doctors willy-nilly just because they have an afternoon off.

that would work in theory; but what about those that can't afford the copay? the idea was free healthcare for all.

RainDog

onelongsong wrote:

that would work in theory; but what about those that can't afford the copay? the idea was free healthcare for all.

Well, we've already established that it isn't free. Policies would have to be put in place, though, wherein if a person couldn't afford even the barest minimum of co-pays, they would still get treatment. Likely, the person would have to be homeless to not afford it - and today even the homeless are able to generate enough for co-pay shelters.

But, yeah, for some it would be completely free. Theres no getting around that - and it's something we're doing already anyway through our emergency rooms. Nothings perfect. I'm just looking for better.

onelongsong

RainDog wrote:

Well, we've already established that it isn't free. Policies would have to be put in place, though, wherein if a person couldn't afford even the barest minimum of co-pays, they would still get treatment. Likely, the person would have to be homeless to not afford it - and today even the homeless are able to generate enough for co-pay shelters.

But, yeah, for some it would be completely free. Theres no getting around that - and it's something we're doing already anyway through our emergency rooms. Nothings perfect. I'm just looking for better.

fair enough.

kenny olav

onelongsong wrote:

ps: more participants also means more paperwork and thus more administrative costs.

Single-Payer National Health Insurance

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.

ssdr18

comments to the above; for starters if a drug is only available in brand it is the smae in mexico, and anywhere else. The generic drugs can vary. This is a known fact, and do so in the US as well.
Amen to the last post. Yes that is the answer. Get rid of the bullshit costs, and direct costs to actual practice of medicine.
And guys, doctors are barely making a living now, so a cut in pay..thats a joke. Most doctors depend on reimbursement from insurance companies. IF they keep lowering the fees as they do, then the net overhead continues to exceed the net gross and the shop closes. this is where we are now in america.

hippiemom

onelongsong wrote:

thank you for a doctors insight on the movie AND on the problem. i hear the movie didn't point out that cuba is a communist country and doctors don't get "paid" as we know it. everyone wants free healthcare but there's no such thing. someone must pay and if government supplies healthcare; the taxpayers pay. not only for themselves but for the non-taxpaying population. since madicare doesn't pay for your type of services; you can expect a dramatic drop in patients because socialized healthcare won't cover it either. people can expect to be treated the same as our seniors are treated.
people need to be more careful about what they ask for; they just may get it.

I don't know which socialized system you're using as your basis for comparison, but I have to disagree that psychiatric services wouldn't be covered. I know a woman in Germany who is on the equivalent of welfare due to multiple disabilities. She's bi-polar and has severe anorexia and she has received excellent care, both standard medical and psychiatric.

Why such a low opinion of America? You don't believe that we could do at least as good a job as Germany if we set our minds to it?

hippiemom

onelongsong wrote:

i can understand your point and it's a good one. but i can't get past the fact that medical costs will remain the same. a nerve conduction test will still cost $8K usd so the amount of additional taxes would have to equal that of private healthcare premiums. the additional healthcare recipients would have to raise the premium costs. i can't see how it wouldn't.

No, the premiums would NOT have to stay the same, because we would no longer be paying insurance company advertising costs, profits to stockholders, etc. Instead of dozens of CEOs making millions per year, there would be one. Each hospital wouldn't have to employ an entire office building full of people to decipher the different paperwork and requirements of each insurer because it would be the same across the board. These things and more would reduce the cost of providing a nerve conduction test.

RolandTD20Kdrummer

In order to have a happy and balanced society I believe it starts with providing universal health care and giving everyone a feeling that they will be properly taken care of and looked after by their country no matter what happens.

Only until this societal reality is established can real growth begin imo.

This "me first....fuck the other guy" mentality is ass backwards Chachi.

Jeanie

hippiemom wrote:

No, the premiums would NOT have to stay the same, because we would no longer be paying insurance company advertising costs, profits to stockholders, etc. Instead of dozens of CEOs making millions per year, there would be one. Each hospital wouldn't have to employ an entire office building full of people to decipher the different paperwork and requirements of each insurer because it would be the same across the board. These things and more would reduce the cost of providing a nerve conduction test.

I can't really see that happening. When has anything that was supposed to translate to a reduction in cost ever actually meant a reduction in cost for the average person?

Shareholders, ceo's, all the advertising people, will still all want their money. I can't see any of them taking a pay cut or finding less money to fund the lifestyle to which they've become accustomed being a suitable outcome for them.

Nope, as far as I can see, it'll cost the same, probably more.

You only have to look at the government initiative here in Australia to get everyone onto private health insurance. The government offered a rebate, said that more people paying for private health would eventually lower the premiums and with the influx of people moving off the public system things would be better for everyone. But that's not what happened. Private premiums are going up and less things are covered under the premiums. The public system is still completely groaning from lack of government funding and too many people that need it. And the fat cats keep getting richer.

Yup, too much money to be made for some folk in health. There's no way it's ever going to cost less.

blackredyellow

Am I just oversimplifying comprehensive health care with the steps below, or am I missing something?


1. A government department takes the place of for profit insurance companies.
2. Everyone above X income level pays a monthly premium. Like we currently do, the employer and worker usually split this cost however the company decides. In theory, the monthly premium would be around what we currently pay.
3. When you go to a doctor, you present your insurance card like you currently do. Doctors get reimbursed at a predetermined set rate for each visit/procedure.
4. Patients pay a small copay like we currently do
5. Things like cosmetic surgery or elective procedures typically aren't covered, or covered at a percentage rate depending on the procedure.

It would basically work the same as it does now, but the profits that an insurance company currently make, get's put back in the system to help cover those who can't afford healthcare.

I don't work in the industry so maybe this is too simple and I am missing something that could put us back in the same mess now, but it just seems simple to me... Any thoughts?

jeffbr

RolandTD20Kdrummer wrote:

giving everyone a feeling that they will be properly taken care of and looked after by their country no matter what happens.

I'm sure the government agrees with you - as long as we can give them that "feeling" that's all that matters. Of course, we tried that with the miserable failure of a program called Social Security. It hasn't worked in the past.

onelongsong

hippiemom wrote:

No, the premiums would NOT have to stay the same, because we would no longer be paying insurance company advertising costs, profits to stockholders, etc. Instead of dozens of CEOs making millions per year, there would be one. Each hospital wouldn't have to employ an entire office building full of people to decipher the different paperwork and requirements of each insurer because it would be the same across the board. These things and more would reduce the cost of providing a nerve conduction test.

the "profits" the insurance companies now enjoy would quickly be eaten up by the extra 280 million people that would be brought into the program. when my sister had cancer her treatments and surgeries exceeded 1/2 million. add the scripts and co-pays plus the doctors visits and we're close to $1 million for each cancer patient. if 25% of the population has cancer; that could be $70 million put out for 25% of the population.
part of the cost of a nerve conduction test is the cost of the equipment. next is a trained tech to perform the procedure. we all know the government likes paperwork and will do everything possible to make sure the test is needed; (as medicare does now) and make sure the person taking the test is elligible and in fact that person. getting authorization from medicare is harder to do than any insurance company. my best friend is an office manager for a doctor and i hear about it a couple times a week.
i also know someone that received medicaid for her children. going to the "clinic" was a sickening experience for her. they never saw the same doctor twice and each visit gave only minutes with the doctor.
medicaid is the model by which socialized medicine will be formed. take a look at that.

onelongsong

blackredyellow wrote:

Am I just oversimplifying comprehensive health care with the steps below, or am I missing something?


1. A government department takes the place of for profit insurance companies.
2. Everyone above X income level pays a monthly premium. Like we currently do, the employer and worker usually split this cost however the company decides. In theory, the monthly premium would be around what we currently pay.
3. When you go to a doctor, you present your insurance card like you currently do. Doctors get reimbursed at a predetermined set rate for each visit/procedure.
4. Patients pay a small copay like we currently do
5. Things like cosmetic surgery or elective procedures typically aren't covered, or covered at a percentage rate depending on the procedure.

It would basically work the same as it does now, but the profits that an insurance company currently make, get's put back in the system to help cover those who can't afford healthcare.

I don't work in the industry so maybe this is too simple and I am missing something that could put us back in the same mess now, but it just seems simple to me... Any thoughts?

once again; taxpayers are paying for those that don't pay taxes. you're also putting a CAP on a doctors earnings. this is not communism. in america; a person is allowed to make and KEEP what they earn. my pain management doctor became a good friend when i started selling him horses and other animals. he plans to work his tail off for 10 years and then retire. he sees 40 patients a day and he'll be able to do it. this is what america is. put a cap on doctors earnings and you'll see medical schools empty.

hippiemom

onelongsong wrote:

medicaid is the model by which socialized medicine will be formed. take a look at that.

Why? Why do you assume that? Again I ask you, why the negativity towards America? Why do you think we are incapable of looking at the 160+ other countries in the world that provide care for all their citizens, looking at what works best and what doesn't work so well, and coming up with a brand new system?

None of the candidates who have thus far proposed a health care plan is saying "Let's expand Medicaid to cover everyone," so I don't know where you get the idea that anyone is planning to do that. I would most definitely not be in favor of that. I believe we are capable of much more.

hippiemom

onelongsong wrote:

the "profits" the insurance companies now enjoy would quickly be eaten up by the extra 280 million people that would be brought into the program. when my sister had cancer her treatments and surgeries exceeded 1/2 million. add the scripts and co-pays plus the doctors visits and we're close to $1 million for each cancer patient. if 25% of the population has cancer; that could be $70 million put out for 25% of the population.

You're paying for them NOW, just more inefficiently than you might be under another system!

Cancer patients do not go untreated in this country. Yes, those who are poor are made to jump through hoops to get care, but they do get it, and you pay for it. Those who are privately insured get care more easily, and everyone who is insured by the same company helps to pay for it. It's wasteful to have dozens of public and private organizations providing duplicate services, each with it's own set of rules and paperwork that must be navigated. It requires many thousands of employees, and rest assured that at some level you are paying for all of them. It could and should be handled more efficiently, resulting in reduced costs.

RolandTD20Kdrummer

jeffbr wrote:

I'm sure the government agrees with you - as long as we can give them that "feeling" that's all that matters. Of course, we tried that with the miserable failure of a program called Social Security. It hasn't worked in the past.

What I've found is that pretty much every country that can make it work, likes it, and cant imagine changing it for any reason.

surferdude

In Canada we know there is a desperate need for more private practice and delivery of health care. We just have to make sure that the private care is still paid for by the government at the prescribed rate. Hopefully the system will allow for doctors to charge a premium to be paid by the patient for premium service.