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

What should be fixed first?

  • Total voters
    37
Hatuey

Hatuey

Rule of Two
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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

Woolhandler and her colleagues surveyed a random sample of 2,314 people who filed for bankruptcy in early 2007, looked at their court records, and then interviewed more than 1,000 of them.

They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.
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Medical Malpractice:

10 Things You Want To Know About Medical Malpractice - Forbes

Fact: According to the Journal of the American Medical Association (JAMA), medical negligence is the third leading cause of death in the U.S.—right behind heart disease and cancer.

In 2012, over $3 billion was spent in medical malpractice payouts, averaging one payout every 43 minutes.
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Medicaid/Medicare Fraud:

Medicare And Medicaid Fraud Is Costing Taxpayers Billions - Forbes

How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid. Big money!
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Denial of Coverage:

Insurers Denied Coverage to 1 in 7 - WSJ.com

The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation released Tuesday.
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Claim Denial:

PolitiFact | TV ad overstates health insurance denials

The researchers reported that from 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care, or 22 percent of all claims. According to the nurses' group, during the first six months of 2009, PacifiCare denied 39.6 percent of claims; Cigna denied 32.7 percent; HealthNet denied 30 percent; Kaiser Permanente denied 28.3 percent; Blue Cross denied 27.9 percent and Aetna denied 6.4 percent.
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Cost, but if we can make a dent in any of them I'd be surprised.
 
First is cost. Not so much because of where it is, but because of how fast it is rising. All of them are areas that should be looked at. Claim denial is one that I that hit close to home and I got to learn about such things as "first denial", where the insurance company denies as many claims as it can when first submitted, even when they know they will have to pay out, simply because slow paying makes them a shockingly large amount of money and there is no downside to doing it. Denial of coverage and fraud are probably the hardest to fix, but that does not mean working towards improvements is not worthwhile.

Excellent poll by the way.
 
Cost should not be the first consideration but UHC based on sound evidence based practice would bring the cost in line while providing the best care possible.
 
I'd say cost, but you can't fix cost without addressing the majority of the other points. Therefore I said medical malpractice, it's absurd that doctors have to carry such ridiculously huge malpractice insurance policies on the off chance that anything ever goes wrong (and it doesn't even have to, people can sue and win even if the doctor does everything right). That cost is passed to the consumers. We need to eliminate this ridiculously litigious society that we've built.

I vote we shoot all the lawyers, especially the ambulance-chasing variety.
 
Cephus said:
I'd say cost, but you can't fix cost without addressing the majority of the other points. Therefore I said medical malpractice, it's absurd that doctors have to carry such ridiculously huge malpractice insurance policies on the off chance that anything ever goes wrong (and it doesn't even have to, people can sue and win even if the doctor does everything right). That cost is passed to the consumers. We need to eliminate this ridiculously litigious society that we've built.

I vote we shoot all the lawyers, especially the ambulance-chasing variety.
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There have been done some studies on how much tort reform would lower cost, and it is pretty small. If I remember right, it would be less than 1 percent. Does not make it not worth doing, but when costs are rising 2 to 3 times the rate of economic growth, there is a major problem and 1 % ain't gonna do it.
 
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
Click to expand...


I say costs.Here is 3 ideas off the top of my head.

1.Remove the Certificate of Need requirements that many states have.Doing so will allow more hospitals to be more easily built.Currently many states have this requirement.This requirement was literally created to stifle competition.As most people know competition is a good thing because it generally lowers prices.

2.Award multi-billion dollar cash prizes to individuals or groups who actually make a cure a actual disease or make working medical devices.Pharmaceutical companies are motivated by profit just like every other company on the planet,this means its more in their interest to develop and provide treatments not cures.By awarding multi-billion dollar prizes this can motivate individuals to create cures and eliminate the cost of research and developed that often gets tacked onto the price of many medications.

3.Subsidize the cost of medical schools and training and import doctors from other countries.This could add more doctors and other medical professionals which could lower their pay.The more people you have available to do a job the less you have to pay them.
 
jamesrage said:
3.Subsidize the cost of medical schools and training and import doctors from other countries.This could add more doctors and other medical professionals which could lower their pay.The more people you have available to do a job the less you have to pay them.
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This option actually shocked me. Would you be alright with importing doctors from any other country? Or specific countries?
 
Doctors already come from other countries. I know a physician from Panama. If the sole issue is needing more doctors, well, it's already exceedingly difficult to get in medical school. More could be built here. If it's about "cheap immigrant labor," are you sure you want that responsible for your health?
 
None of the above, the first thing to be fixed is public health. Cost is very high because people aren't adherent to medications and therapy, they live unhealthy lives that cause the utilization of services and put more risk into their potential costs, and many who believe healthcare is a right that skip out on medical bills and drive up costs on others.

Also FYI, many many foreign doctors do not have the education that US trained physicians and surgeons have. Many have the equivalent of a masters degree to practice medicine and require about 6 years to complete. They get less training on average and in my experience tend to make more errors. Their credentials may be legally recognized here, but their training is not the same as a US MD/DO
 
Hatuey said:
This option actually shocked me. Would you be alright with importing doctors from any other country? Or specific countries?
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Why not? My lung doctor is from India and he is one of the best. Wife's heart doctor from Canada, our family doctor from Thailand. All are outstanding doctors. One needs to keep in mind that according to CNN that by 2015 there will be a 150,000 doctor shortage in the U.S. Now that was before Obamacare and the addition of what? 10-20-30 million new patients or how many it is.
 
Perotista said:
Why not? My lung doctor is from India and he is one of the best. Wife's heart doctor from Canada, our family doctor from Thailand. All are outstanding doctors. One needs to keep in mind that according to CNN that by 2015 there will be a 150,000 doctor shortage in the U.S. Now that was before Obamacare and the addition of what? 10-20-30 million new patients or how many it is.
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It was shocking because jamesrage isn't really a fan of "immigrants taking our jobs".
 
Perotista said:
Why not? My lung doctor is from India and he is one of the best. Wife's heart doctor from Canada, our family doctor from Thailand. All are outstanding doctors. One needs to keep in mind that according to CNN that by 2015 there will be a 150,000 doctor shortage in the U.S. Now that was before Obamacare and the addition of what? 10-20-30 million new patients or how many it is.
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What is the answer here? We probably will have the problem of millions of new patients at the same time there is a critical shortage of doctors. Everyone accepts that possibility, but my question is what is likely to happen if there are 100 people waiting to see one doctor? It seems to me that it will likely be much the same as the doomsday scenario predicted by the government in case of a nuclear attack. Is that our future?

Greetings, Pero. :2wave:
 
Hatuey said:
It was shocking because jamesrage isn't really a fan of "immigrants taking our jobs".
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I call it common sense. The one up till now the U.S. had to offer foreign doctors is good pay. I am not sure how Obamacare will or will not effect this. But if the pay falls off we may not get the influx of foreign doctors we do today. A lot of countries will send their students to the U.S. to go to school here to learn the Doctor trade and those students end up staying here because of the financial rewards. I suppose time will tell.
 
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
Click to expand...

I can't understand why people would vote "cost." Yeah, of course cost! But you don't magically wave a wand to fix cost -- you attack it one step at a time.
 
Cost.

However there are various aspects of that which must be addressed, so it's not as simple as just reducing the cost.

I have heard from several sources that one of the issues that is both cause and effect is how much hospitals charge insurance companies for a procedure.

At some point in the past, apparently, insurance companies decided to "settle" a cost by paying the hospital a fraction of what they asked for - thus hospitals started raising prices so they could at least break even with the reduced amount they actually were paid.

And as I understand it, this has been slowly spiraling ever higher in a cycle of "well we'll offer them this much", and "charge them more so when they offer us 50% we can actually break even".

This is, I think, one of the reasons for increasing procedure, operation, and testing costs.
 
Perotista said:
Why not? My lung doctor is from India and he is one of the best. Wife's heart doctor from Canada, our family doctor from Thailand. All are outstanding doctors. One needs to keep in mind that according to CNN that by 2015 there will be a 150,000 doctor shortage in the U.S. Now that was before Obamacare and the addition of what? 10-20-30 million new patients or how many it is.
Click to expand...

They may have come from other countries but where were they trained? Except for the Canadian doctor, the others I expect would have had training in the US, Japan or Europe. At least in Canada doctors from developing countries (trained in those countries) have a very difficult time in getting certified to practice
 
polgara said:
What is the answer here? We probably will have the problem of millions of new patients at the same time there is a critical shortage of doctors. Everyone accepts that possibility, but my question is what is likely to happen if there are 100 people waiting to see one doctor? It seems to me that it will likely be much the same as the doomsday scenario predicted by the government in case of a nuclear attack. Is that our future?

Greetings, Pero. :2wave:
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Glad to have you back Pol, it was a lonely night last night. I don't know. I might be a pretty good political prognosticator and I do have my senate update number 3 for 1 Nov posted. I don't have an answer, it seems everyone is forecasting what will happen, either heavenly panacea via the ACA or the nuclear holocaust. My guess is something in the middle which will be worse for those who already had insurance and a whole lot better for those who had none or very poor policies.

What I can't understand is why all the major hospitals down here are buying up all these private practices. Has that happen up there where you live? Emory has bought our our original family practice, Piedmont has bought out our lung and heart doctors practices, Northside the cancer treatment place in our county, Peidmont bought our county hospital, Now Emory, Peidmont, Northside are huge, huge big hospitals in Atlanta. I feel something is amiss.
 
Lord Tammerlain said:
They may have come from other countries but where were they trained? Except for the Canadian doctor, the others I expect would have had training in the US, Japan or Europe. At least in Canada doctors from developing countries (trained in those countries) have a very difficult time in getting certified to practice
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yes, most went to school in the countries you mentioned. Although I spent 6 years in Thailand and I was impressed with their doctors who were trained and educated there.
 
Perotista said:
Glad to have you back Pol, it was a lonely night last night. I don't know. I might be a pretty good political prognosticator and I do have my senate update number 3 for 1 Nov posted. I don't have an answer, it seems everyone is forecasting what will happen, either heavenly panacea via the ACA or the nuclear holocaust. My guess is something in the middle which will be worse for those who already had insurance and a whole lot better for those who had none or very poor policies.

What I can't understand is why all the major hospitals down here are buying up all these private practices. Has that happen up there where you live? Emory has bought our our original family practice, Piedmont has bought out our lung and heart doctors practices, Northside the cancer treatment place in our county, Peidmont bought our county hospital, Now Emory, Peidmont, Northside are huge, huge big hospitals in Atlanta. I feel something is amiss.
Click to expand...

Same thing happening here in Ohio. The World famous Cleveland Clinic is partnering with Summa Health Systems and Catholic Health Partners, which are the largest hospital systems in Ohio. It looks like everyone than can is merging with others. Plus, one of our largest local hospitals has just closed down an entire wing of the hospital. That does not make sense, Pero, but they're doing it! The problem is that they are laying off "non-essential" health care personnel, and creating problems for nurses who are being expected to pick up the work. When you're sick or injured, you do not need to be cared for by a tired, overworked and angry nurse who is working 50 to 60 hours a week!
 
Clearly cost is going to be the runaway winner.

The only significantly effective way to get costs down in such a constantly changing high-tech industry as healthcare where supply is naturally comparatively very limited is to significantly reduce the population and thus demand .. then, foundational rules of economics will drop the prices.
 
Ontologuy said:
Clearly cost is going to be the runaway winner.

The only significantly effective way to get costs down in such a constantly changing high-tech industry as healthcare where supply is naturally comparatively very limited is to significantly reduce the population .. then, foundational rules of economics will drop the prices.
Click to expand...
So you're saying the only way to reduce costs is to either decrease the number of people using health care or decrease the number of people alive (which effectively does the same thing)?
 
polgara said:
Same thing happening here in Ohio. The World famous Cleveland Clinic is partnering with Summa Health Systems and Catholic Health Partners, which are the largest hospital systems in Ohio. It looks like everyone than can is merging with others. Plus, one of our largest local hospitals has just closed down an entire wing of the hospital. That does not make sense, Pero, but they're doing it! The problem is that they are laying off "non-essential" health care personnel, and creating problems for nurses who are being expected to pick up the work. When you're sick or injured, you do not need to be cared for by a tired, overworked and angry nurse who is working 50 to 60 hours a week!
Click to expand...

Something is going on. I wonder if it is a way for all these big hospitals, now to include family and specialized practices to get around Obamacare and the cuts they are expected to receive in reimbursement. Forming their own in family network so to speak. I don't know what is happening, but something certainly is. It looks like soon our medical field will be just like our banking system where 5 or 6 huge mega banks control the whole U.S. It might be the same with 5 or 6 huge medical type facilities, companies, corporations, hospitals, call them whatever applies controlling all the health care in the U.S.

Is this another unintended consequence of Obamacare? I just don't know but it is scary.
 
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