miksirhc

In my opinion, the problem with the Health Care Industry is that prices are too high. This is because the Health Care Industry is the most uncapitalistic industry today in use.
Health Care is Expensive for 3 main reasons:
1. Excessive Malpractice Suits
2. High Drug Prices
3. Expensive Doctors

How to fix them:
1.

• Put a cap on maximum amount people can sue for in a lawsuit. This can be reasonable at around 1 million or so. This will severely reduce the price of costly malpractice insurance for doctors.
• Begin hospitals which are 'no-sue' hospitals. Before you take karate or go parachuting, you waive your right to sue via a contract. This same practice will allow for a cheaper medical care option for the poor.

2.

• Fix US patent law. US patent law that drug companies have the sole right to manufacture their drug for 17 years. This is a monopoly, and an especially dangerous one considering that people really need the medicine. Require medicinal formulas to be disclosed, and the drug company can make a percentage of what all the other drug companies make. This will drive prices down by ensuring fair competition.
• Streamline or eliminate the FDA. The FDA has ridiculous requirements, making it very hard for Drug Companies to make money. The process needs to be streamlined or eliminated completely: it could be replaced by a 'consumer-reports' type private business, which would surely be more efficient. It is naturally in the drug companies' best interests to ensure the safety of their products. In every other industry this is a requirement. Let the drug companies take the responsibility for themselves.
• Require publication of all medical prices. This will enable people to 'shop around' for surgery, and can choose the best option. This should cause prices to go down competitively.

3.

• Specialize medical professionals. Now, a doctor has to go through 12 years of schooling, no matter what type of medicine he wants to practice. This is why in a nation of 300million people we have only 600k doctors. Allow surgeons to learn only what is necessary for their job. This will severely lower the prices of medical care.
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1069

1. Raise taxes.
2. Make health care universal.

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independent_thinker2002

Eliminate the middlemen, the insurance companies. Make health care universal.

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You can not eliminate accountability though, since as long as health care is profit motivated, and profit depends on the number of procedures performed, there will always be a tendency to over-diagnose, with the result: more treatments which may place people at unnecessary risk. Also, serious liability can rarely be truly waived, since as long as courts have the discretion to overrule that, and they do, it won't happen.
You are uninformed. All patented medical formulations are well known, as that is a key descriptor in the patent itself. If you are suggesting shortening patent lifespan, then that would have the opposite effect and raise prices across the board since drug companies would have charge more to recoup what they spend in a shorter period of time. Moreover, it would encourge even more slapdash research to create weak and possibly dangerous analog successors to expiring patent drugs. As it is, we already have tons of recalled drugs as drug companies clumsily scramble to grind out new (but tainted) drugs to fill patent voids. Didn't you hear of all the scandals behind Vioxx, Zellnorm, etc. People are dying because of this.

The reality is, there are few new script drugs that really are better than the old ones. The future of medicine is not in traditional drug therapy as much in new medical therapies and patient education about preventive healthcare. The problems you seem to be worried about stem mainly from the fact drug companies market directly to the consumer, if you haven't noticed. There is only one greater weakness over a love of bribes and free stuff from a drug company that a physician has, and that is a demanding patient who wants a cool new drug he saw advertised on T.V. Remember, in a for-profit business, "the customer is always right". Physicians are more than happy to give the free samples and script for an expensive drug a patient saw on T.V. and thinks he needs.


Since when is safety, "a ridiculous requirement"?

Besides the fact that 'consumer reports' is non-profit and not a typical "private business", making a magazine business responsible for drug testing and comparison would probably be the least efficient since (1) most consumers don't have 1/100th the background to understand the implications of the results of complex medical comparisions and likely, don't have the attention span either. (2) You can not compare drugs and treatments like a toaster which may only have 10 features or so to compare in a common sense setting. Medical issues require understanding of pharmacology, physiology, endocrinology, pathology, microbiology, and possibly other disciplines. (3) The statistical analysis is on a quantum different level as well, because you are not just comparing 10 toasters, but the effect of a drug on humans, requiring massive epidemiologic studies on thousands of participants. No magazine is going to have either the money to conduct that research, nor the insurance liability to cover it. Making it "private" would only lead to the abuses you see already from drug companies: corruption to get the results they want to sell an unfit product.


Not necessarily. Any product which whose effect is vague or has a result in which the consumer has no easy way of evaluating, can not be subject to the same market forces as some consumer product with more obvious grounds for comparison, like a car. Also, if a patient dies, who is to complain, and who will be around to put the pieces together to even know if the drug was responsible for a bad effect? A malfunctioning drug is not nearly as obvious as a malfuctioning car.


There is more to the cost of surgery than its price. The false presumptions you make are: (1) the diagnosis was made correctly to begin with, (2) surgical quality is standardized, with only price being variable, (3) medical treatment consists of no more than a point of purchase transaction. Most of the medical treatment which tends to fit those premises tends to be fairly trivial treatment, probably unnecessary, and not the important stuff, which really counts.


What planet do you live on? Medicine already is specialized in many diverse fields. If you are suggesting doctors skip basic medical training, then you are a nut. You can not isolate knowledge to just one part of the body without some knowledge of the other parts as they are all connected. This is not a car assembly line in which one job position can be completely isolated from another with complete confidence of safety and efficiency. Moreover, a lengthy training period helps insure the person is more likely committed to the career of medicine rather than just the money of medicine. If you want a boiler room operation, with reduced consumer protection, and simple market forces dictating cost of treatment, then there are plenty of 3rd world countries where that is already done. There is also a much higher fatality and mistake rate.

Summary:
I agree with 1069: the only real solution to the expense and inefficiency of the market driven healthcare industry is to establish universal healthcare. I disagree with 1069 that taxes would have to be raised though, as the expense of universal care across the world is half that per capita as healthcare in the U.S. The hidden taxes that we already pay in out-of-pocket expense, deductibles, and premiums would be more than enough to not only pay for universal care, but possibly lower individual outlays for health as well.

Solidus

"1. Raise taxes.
2. Make health care universal."

This does NOTHING to make health care cheaper. It only changes who pays the bill.

while I agree with you about risk and accountability, I disagree with the cause of the number of procedure performed. Demand drives up the number of procedures, which is why in countries with socialized medicine you have waiting lists. Furthermore, doctors in countries with socialized medicine still operate a for profit practice ... so how does socialized medicine resolve this (alleged) source of unnecessary risk?

What 'hidden' costs are you refering to? Why is mis-diagnosis relevant to price competition? Quality does not have to be standardized to compete on price, companies regularly compete on both fronts. Why does multiple-visit or long term care defy the principles of price competition? How does the 'triviality' of a treatment defy the principles of price competition?

Plastic surgery is usually not life saving. Yet the service competes on quality and cost, while the costs are more transparent than most other medical care. As a result costs have consistantly fallen while quality has risen. Plastic surgery is usually a multiple visit operation, with follow up checks as well. The diagnosis is often debateable, the quality is certainly not standardized, and the treatment is more than a point of purchase transaction; and consumers have still managed to benefit from price competition.

Universal healthcare does nothing to solve the problems you raised. How does universal health care remove profit motive for doctors? How does universal health care ameliorate mis-diagnosis? How does universal health care standardize quality of care? How does universal health care reduce the cost of performing procedures?

False. The infamous "savings from reduced administration costs", is not enough to cover everyone. Furthermore, removing those administration costs breeds inefficiency.



The problem with our health care system stems from government interference. Adding more government control will not improve the situation. We need to return to free market principles which are successful in EVERY OTHER insurance market.

J

[1] Medical Progress Report 5 | Comparing Public and Private Health Insurance

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Where is your proof of this? All the stats I have seen show that per capita healthcare costs in countries with universal care are at least half of what is found in the U.S., yet as you pointed out further down, universal care promotes greater useage thereof. In aggregate, people get more healthcare for less outlay.

Unnecessary surgery is very common as is other form of fraud, and I would not consider the milking of hypochondriacs legitimate "demand". This is a typical example. As long as practice is for profit, that risk is there, that is precisely the point I am making. There will always be people who for reasons of convenience, are willing to take such risks, and as with any for-profit transaction, it is always "buyer beware". That hardly is an indictment of socialized medicine, it is an endorsement. So what is your point, other than to agree with me?

The high risk of death or permanent injury is a pretty good risk to worry about. Or are you immune to such mortal issues?

Because it relates to the amount of unnecessary surgery or procedures performed. Whether it is unintentional or intentional is not particularly important to that point.

Because there is no rational way for the typical consumer to consistently make comparisons in such a complex field with relatively few markers for success. Almost all pathology can make some improvement on its own, but that is not an indication of treatment success. How would a consumer know what is actually happening? In a complex market, consumer oriented competition usually reduces to whether the consumer likes the waiting room, the staff, or the doctor. Only an idiot would bet his life on a system which mostly sells itself on the appearance of good health rather than its actual basis.

Exactly my case in point: As practiced today, plastic surgery has little to do with health, and in fact puts people at risk for death and injury unnecessarily. In order to stimulate demand back in the 1980's, the American Society of Plastic and Reconstructive Surgeons announced that small-breastedness is itself a disease: "There is a substantial and enlarging body of medical information and opinion to the effect that these deformities [small breasts] are really a disease." They even gave this disease a name—micromastia. I would not call something "healthcare" if it takes healthy people and puts them at risk for death and injury.


How about results-oriented reimbursement on a larger scale: epidemiology is employed in some universal healthcare systems to establish reimbursement. That is not really possible on a realistic basis when consumers and advertising sets the market, but it is when sophisticated medical oversight examines the result.

It probably won't eliminate unintentional mis-diagnosis, but will certainly do a lot to wipe out the intentional profit-oriented mis-diagnosis. I would rather have some improvement than none. You may be a masochist, but most people would not aspire to it, as it is not healthy.

If doctors are not motivated by profit to pad bills with unnecessary tests or procedures, then the problem of over-treatment will automatically correct itself. That would provide immediate reductions in cost. If the functional basis of healthcare is not profit, but health through an educated oversight panel, the basis of treatment would naturally return then to the "standard of care" rather than the "cost of paying my bills".

The current system of legal oversight enforces "standard of care" only in obvious errors, and does not typically involve itself with the more complex issue of wellness. Legal threat does nothing directly to develop proper medical procedure longitudinally through daily constructive analysis and feedback to the doctors themselves. Unless, of course, you are proposing "fear" is constructive feedback.

What are you smoking? Everything you said there contradicts itself. If you have some insight into why "less" is not "less" or "more" is not "more", then you need to present it when making a contradictory statement. "Administration costs", btw, are more than just the insurance company's overhead, which is why your article is irrelevant to my argument. It's scope is too limited. The high administration costs in the U.S. system are a direct result from inefficiency...I take it you are afraid of actually debating this since you are, in fact, wrong.

PeteEU

US malpractice suits are an issue I dont deny that, but hardly the main issue. They are however used as an excuse by HMOs and others to hike up prices even more. What the US could do is to put in a system for patient complaints, basicly take it out of the courts. There would be a set amount of how much you could get in compensation. In Europe often they go by the scale of potential earnings in a lifetime and scale it down depending on how "bad" the injury is and how it effects your profession. On top of that you can often get a maximum amount depending on the country.

Drug prices, yes thats the main issue as far as I see it. Not only in the US but also in Europe. But they are 2 different aninmals depending on where we are talking. In the US, the drug companies have defacto monopoly where they set the prices as the market is protected from any competition whatsoever. When the goverment is not even allowed by law, to negotiate with the drug companies then you got a problem. This year the European drug companies managed to convince the various goverments to not open up the drug market in europe, much to the discust of the European Commision and Parlement.

Changing patent laws wount help and will in fact cause loads of issues. I have no problem with a drug company having a monopoly on a drug for X years, so to recover the costs. What I do have an issue with is that there is no system in place to make sure that said drug company does not fleece the population needing that drug. Such a system we have in Europe, where there are organisations that do NOT set prices, but do monitor prices to make sure that the companies do not extort the patients.

As for doctors earning too much. Well, considering how long it takes to become a doctor and how hard it is, then fine. However money should never be the main motivation for becoming a doctor. Would you want to goto a doctor whos only motivation is get money off you? I would not frankly, as I could never be sure if he was not in the pocket of a random drug company or other compnay and payed to promote whatever wonder drug the company is pushing. A doctors motivation should always be the urge to heal people pure and simple. If they can earn a good living from doing this, then fine.

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