What should be the first step to fixing healthcare in the US?

Ban Health Insurance.

All Dr's get $150k. period. Charge the rest with taking bribes for corruption.

mak2 said:

Our current system does not work. I am not sure if this is what you are saying or not, but an interesting article I read the other day...Doctor shortage: Foreign doctors are just as good as the homegrown variety. So why don’t we let them practice here?

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Our current system works and has worked for millions of people. In fact it serves the third highest population in the world. People still come here from all over the world for treatment, despite the naysayers.

Now, those nations with UHC, they have brain drain to add to their list of wait times and lack of services. The excellent medical students among them come here rather than train and practice in their home countries with UHC. Now, we already have a doctor shortage despite this influx, what happens when we go UHC and become just as undesirable as all those other countries to practice in?

I'm saying I'm willing to try UHC here, but you have to understand EVERYTHING about our healthcare system will change, and some of it not for the better.

India is the most common destination for medical tourism worldwide. By far. I do understand our healthcare system will change. I spent most of my masters degree exploring UHC, I am convinced it is the best way to deliver healthcare to the citizens of this country. I just pray it works out for the best for everyone, I am not trying to argue this just to argue about it.

clownboy said:

Our current system works and has worked for millions of people. In fact it serves the third highest population in the world. People still come here from all over the world for treatment, despite the naysayers.

Now, those nations with UHC, they have brain drain to add to their list of wait times and lack of services. The excellent medical students among them come here rather than train and practice in their home countries with UHC. Now, we already have a doctor shortage despite this influx, what happens when we go UHC and become just as undesirable as all those other countries to practice in?

I'm saying I'm willing to try UHC here, but you have to understand EVERYTHING about our healthcare system will change, and some of it not for the better.

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mak2 said:

India is the most common destination for medical tourism worldwide. By far. I do understand our healthcare system will change. I spent most of my masters degree exploring UHC, I am convinced it is the best way to deliver healthcare to the citizens of this country. I just pray it works out for the best for everyone, I am not trying to argue this just to argue about it.

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Indeed, foreign dollars go a long way there and can buy you the best medical care available (a good portion of the high end US trained). That says nothing for their sort of UHC system. I understand you and many others are convinced UHC is the way to go here, and I'm at the point where I'm more than willing to give it a go and be proven wrong. I, on the other hand, don't see it being successful here. Americans don't like change of that sort unless they are absolutely in need. It'll end up being so that real medical care like we're used to will be even higher priced and will be available to those who can afford it. The rest of us will be stuck with the UHC system, and it won't be better than what we had.

That's my take, but again, willing to be proven wrong by reality (not debate and guessing). One thing for sure, never getting to UHC from Obamacare. It's centered around insurance companies.

Hatuey said:

It's no secret that before Obama came along, the US had major healthcare problems. However, it's clear that fixing it is up for debate. so I took 5 major issues in the healthcare industry and put them up against each other. Which one do you think should have been fixed before ObamaCare? Multiple choice is allowed, votes are public.

Cost:

Medical bills prompt more than 60 percent of U.S. bankruptcies - CNN.com



Medical Malpractice:

10 Things You Want To Know About Medical Malpractice - Forbes



Medicaid/Medicare Fraud:

Medicare And Medicaid Fraud Is Costing Taxpayers Billions - Forbes



Denial of Coverage:

Insurers Denied Coverage to 1 in 7 - WSJ.com



Claim Denial:

PolitiFact | TV ad overstates health insurance denials

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You may not know this, but the Obama admin. (or the Dept of Justice) was pretty successful in tackling Medicare fraud. They rounded up some serious Medicare fraud providers (it's usually the PROVIDERS who are the big defrauders, turning in fake claims).

These things can all be tackled at once. They don't have to be done separately, one before the other. Some of them are ongoing things. Take fraud. No fraud can be wiped out 100%. It's like moonshiners. As soon as you dismantle one still, another one pops up. It's an ongoing "war."

I think it was correct to try to pass a reform act. Given the discord between Congress and this administration, trying to tackle individual items would have meant nothing would have been done, if the admin had to rely on Congress. It was best to pass a reform act. I'm VERY UNHAPPY with what was passed, but there was no other reform act on the table. If only the Republicans had presented a comprehensive competing official bill. There was talk in the campaigning, but nothing was presented, that I know of. Instead, the Republicans just sought to stop Obamacare, w/o presenting its own competing reform act that tackled all the millions of uninsureds and cost, etc.

Hatuey said:

It's no secret that before Obama came along, the US had major healthcare problems. However, it's clear that fixing it is up for debate. so I took 5 major issues in the healthcare industry and put them up against each other. Which one do you think should have been fixed before ObamaCare?

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My suggestions:

Eliminate the AMA's government granted monopoly, and let people purchase health care services from whomever they want.

Eliminate the FDA and allow people to buy medicine from whomever they want.

Outlaw employer provided health insurance.

Eliminate barriers to buying healthcare insurance across state lines.

Allow people to purchase any insurance they wish.

You mean purchase healthcare from anyone? Like your barber or butcher?

I think the FDA does slow down drug introduction but is necessary. Individuals do have have the capacity to do studys before they take a drug.

I dont get what buying accross state lines is suppose to do. If you want to go this route it seems to me you have to proport ending healthcare insurance all together and pay out of pocket all the time. No pay, no healthcare.

Green Man said:

My suggestions:

Eliminate the AMA's government granted monopoly, and let people purchase health care services from whomever they want.

Eliminate the FDA and allow people to buy medicine from whomever they want.

Outlaw employer provided health insurance.

Eliminate barriers to buying healthcare insurance across state lines.

Allow people to purchase any insurance they wish.

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Everybody pays, no matter what.

Cost, naturally, but all these things are interconnected.

While ultimately I prefer pure free market in health care (with a subsidy for the poor), in the current situation the best solution would be (unfortunately) to resort to a simple, streamlined socialist program that would eliminate the parasitic intermediaries that stand between the buyer (patient) and the seller (doctor, nurse, drug-maker).

Repeal Obamacare (of course). Disband Medicaid and Medicare. Institute a National Health Care Debit Card: every citizen gets a yearly allowance for medical expenses. People who qualify for Medicaid now get more proportionally. If not spent this year, the money does not disappear but accumulate - and becomes simply cash you spend in any way you wish at some maturation point (say, at the pension age).

Government cuts the check - and that's it. All other decisions are made by the patients/caregivers and actual providers of health care - not "insurance" companies or government bureaucrats.

This will boost the suffocating medical market, reignite competition, and return people to their natural, influential role of buying customers. As prices of medical goods and services decline, we could begin phasing out the Debit Card subsidy for the better-off, starting from the very top by income.

Naturally, chances for such radical revamping are close to zero in the current environment. Republicans as a group will never dare to deliver such blow the insurance companies, and Democrats as a group will never agree that actual people can be trusted to make decisions on something as important as their own health.

The best single thing that can be practically done in the foreseeable future is a tort reform. But even for that to happen, Democrats as a group have be weakened far beyond where they are now.

Realistic expectation: Costs will keep rising, and the quality of care will decline for the majority of Americans in the foreseeable future. The benefits from scientific advances will keep trickling down, but at a lower rate, except for the rich. The ACA is a brand-new huge boulder blocking the way to any meaningful reform.

mak2 said:

I dont get what buying accross state lines is suppose to do. If you want to go this route it seems to me you have to proport ending healthcare insurance all together and pay out of pocket all the time.

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Exactly. Except "the pocket" has to be filled (at least for the not-so-rich) with some help from the government.

Health "insurance" is nonsense. You can insure, of course, against a broken leg, a sudden rare illness, and so forth, but not against events that are certain to happen - like annual checkups, common cold, or just plain getting older. This is just a convoluted way of OVER-paying for medical goods and services. Just like government bureaucracies infesting the field, insurance companies are parasitic intermediaries in the current setup.

Green Man said:

My suggestions:

Eliminate the AMA's government granted monopoly, and let people purchase health care services from whomever they want.

Eliminate the FDA and allow people to buy medicine from whomever they want.

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Neither is realistic. Licensing of medical professionals is crucial to the quality of health care, and so is the rigorous process of clinical trials for drugs.

Of course, many things have to change in the manner both are done. It is really absurd that a super-qualified doctor or nurse from Japan or Australia cannot start practicing in US soon after immigrating, or that many procedures nurses can do just fine are mandated to be done only by M.D.s, for much higher fees.

The biggest problem with the FDA is that as a rule it is focused fiercely on safety, and not at all on overall benefits of a potential drug or procedure. A drug that kills someone in clinical trials has no chances of advancing, even if it can save 10,000 lives for every death it may cause. Unfortunately, it is a general problem in our litigious society: We get sued for something bad that happened, never for something good we stopped from happening.

mak2 said:

You mean purchase healthcare from anyone? Like your barber or butcher?

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Yes, I mean allow people to purchase health care services from whomever they want.

I think the FDA does slow down drug introduction but is necessary. Individuals do have have the capacity to do studys before they take a drug.

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Okay, we can keep the FDA, if you wish. I'd just strip them of power to prevent a drug from being put on the market. They could do the studies and publish them so people are informed. But I would still allow people to buy medicine from whomever they want.

I dont get what buying accross state lines is suppose to do.

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Give people more choices. Choices are good.

If you want to go this route it seems to me you have to proport ending healthcare insurance all together and pay out of pocket all the time. No pay, no healthcare.

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I don't propose ending health insurance at all. If people want insurance, they should be allowed to buy insurance.

This is one of the many areas liberterians fall into the abyss. But it is the logical extension of the ideology.

Green Man said:

Yes, I mean allow people to purchase health care services from whomever they want.



Okay, we can keep the FDA, if you wish. I'd just strip them of power to prevent a drug from being put on the market. They could do the studies and publish them so people are informed. But I would still allow people to buy medicine from whomever they want.



Give people more choices. Choices are good.



I don't propose ending health insurance at all. If people want insurance, they should be allowed to buy insurance.

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Cyrylek said:

Neither is realistic. Licensing of medical professionals is crucial to the quality of health care, and so is the rigorous process of clinical trials for drugs.

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Okay, keep your licensing and clinical trials, if you wish. Simply allow people to choose whether to buy their healthcare services from licensed or unlicensed provider. Same with FDA. Keep it, if you wish, but still allow people to choose from whom they wish to buy their medicine.

mak2 said:

This is one of the many areas liberterians fall into the abyss. But it is the logical extension of the ideology.

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I'm not a libertarian. I'm just using common sense.

Then what makes you think the pharmacutical and healtcare field should be unregulated?

Green Man said:

I'm not a libertarian.

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mak2 said:

Then what makes you think the pharmacutical and healtcare field should be unregulated?

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I don't think that pharmaceutical and health care field should be unregulated. I merely proposed specific changes to fix these fields.

Green Man said:

Okay, keep your licensing and clinical trials, if you wish. Simply allow people to choose whether to buy their healthcare services from licensed or unlicensed provider. Same with FDA. Keep it, if you wish, but still allow people to choose from whom they wish to buy their medicine.

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People are not prohibited from buying anything that is on the legal market. Providers are prohibited from selling stuff that is not shown to be safe and efficacious. Or to practice medicine with being verifiably competent. This is not about consumer choice, like with the insurance policies Obama lied about. It is about safeguarding against harmful, potentially lethal substances and malpractice.

I am a biotech professional, and I often work closely with biopharmaceutical companies. Trust me, my feelings toward the FDA in its current form are very remote from tender love. But I also fully realize that even I, a biochemist, am not competent to decide whether some new drug may be dangerous for me or not, outside of a very small number of substances/diseases I happen to know a lot about. And 99% of people in the country are less qualified.

Allowing for sales of whatever medicine by whomever is not real free market - because it would lack a mechanism for fraud prevention, and fraud can be easily lethal in this case. Policing after-the-fact, when somebody drops dead or gets sick/er is hardly practical, and we will drown in litigation - if the ethical part is not an objection enough.

Now, the medical market is cornered in many ways, and, as I said, it has to be busted open. Americans should have, among other things, easier access to drugs not approved by the FDA but released on the markets in EU, Japan, Switzerland, Down Under...But that is another level.

Verification of safety of consumables is a proper "night guard" function of the State, and if cost-benefit analysis may suggest to go easy many goods and services that are overregulated now, it is not the case for drugs or qualifications for surgery.

mak2 said:

Then what makes you think the pharmacutical and healtcare field should be unregulated?

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Why do you think that every libertarian must think that way? Confusing us with anarchists?

Yes, you are correct. I dont really see much difference.

Cyrylek said:

Why do you think that every libertarian must think that way? Confusing us with anarchists?

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I picked Cost simply because the others cant be fixed without fixing cost and fixing cost fixes or helps to fix the others.

All one has to do is look at pricing studies and how inconsistent they are even from hospital to hospital in the same county, yes county not state, not country.

Knee replacement at one hospital vs a next is sometimes different by 50000? how is this possible?
even the prosthetic itself is off by 500% sometimes

same knee, same procedure, same quality of doctor/nurses/facilities but 50K different? and other procedures are worse

mak2 said:

Yes, you are correct. I dont really see much difference.

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Anarchists advocate complete replacement of coercive government with voluntary associations. Sounds sweet, but not gonna work.

Libertarians (classical liberals) recognize that coercion is morally wrong, but want to keep government as a guard against coercion or fraud by individuals, groups, corporations or other governments.

Of course, both anarchists and libertarians are diverse groups of people: some moderate and gradualist, others - radical and impatient to the point of functional imbecility. Not unnaturally, pragmatism is more often found among libertarians.

AGENT J said:

I picked Cost simply because the others cant be fixed without fixing cost and fixing cost fixes or helps to fix the others.

All one has to do is look at pricing studies and how inconsistent they are even from hospital to hospital in the same county, yes county not state, not country.

Knee replacement at one hospital vs a next is sometimes different by 50000? how is this possible?
even the prosthetic itself is off by 500% sometimes

same knee, same procedure, same quality of doctor/nurses/facilities but 50K different? and other procedures are worse

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Medical care insurance profit works off of a percentage of the sales price - much like a real estate commmiission on sales. While it takes no more effort to pay a $100K claim than a $10 claim the profit is far higher on the larger claim. There is absolutely no incentive for an insurance company to try to control the cost of care especially since having that "private" service is now mandatory.

Cyrylek said:

People are not prohibited from buying anything that is on the legal market. Providers are prohibited from selling stuff that is not shown to be safe and efficacious. Or to practice medicine with being verifiably competent. This is not about consumer choice, like with the insurance policies Obama lied about. It is about safeguarding against harmful, potentially lethal substances and malpractice.

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Yes, allowing anyone to sell on the market is the way I imagine that consumers would be given the freedom to choose from whom to buy.

I am a biotech professional, and I often work closely with biopharmaceutical companies. Trust me, my feelings toward the FDA in its current form are very remote from tender love. But I also fully realize that even I, a biochemist, am not competent to decide whether some new drug may be dangerous for me or not, outside of a very small number of substances/diseases I happen to know a lot about. And 99% of people in the country are less qualified.

Allowing for sales of whatever medicine by whomever is not real free market - because it would lack a mechanism for fraud prevention, and fraud can be easily lethal in this case. Policing after-the-fact, when somebody drops dead or gets sick/er is hardly practical, and we will drown in litigation - if the ethical part is not an objection enough.

Now, the medical market is cornered in many ways, and, as I said, it has to be busted open. Americans should have, among other things, easier access to drugs not approved by the FDA but released on the markets in EU, Japan, Switzerland, Down Under...But that is another level.

Verification of safety of consumables is a proper "night guard" function of the State, and if cost-benefit analysis may suggest to go easy many goods and services that are overregulated now, it is not the case for drugs or qualifications for surgery.

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As I said, keep the FDA, but allow people to also buy from whoever they choose. That way those, like you, who trust the FDA to can buy only FDA approved medicine. Those who trust others can have medicine approved by others. That way, everybody should be happy.

ttwtt78640 said:

Medical care insurance profit works off of a percentage of the sales price - much like a real estate commmiission on sales. While it takes no more effort to pay a $100K claim than a $10 claim the profit is far higher on the larger claim. There is absolutely no incentive for an insurance company to try to control the cost of care especially since having that "private" service is now mandatory.

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of course they dont care but this is the part that needs regulated and the rest will fall in line, its one of the areas where other countries are ahead of us.

I have no problem with Agent J knees costing 1500 and captain courtesy knees costing 10000 especial if my knee is rated for 10 years and his is rated for 25 THATS how business works.

But my knee should never be available at one hospital at 1800 and at another hospital literally in walking distance 15000. Thats complete bull**** and what needs looked at and fixed.

business is business but simply ass raping the customer (PATIENT) especially in an industry where lives are on the line is just wrong and a serious problem.