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Health Care Reform Options
Professor
Posted: Monday, April 2, 2018 1:26:06 AM

Rank: Advanced Member

Joined: 9/9/2009
Posts: 227
Neurons: 41,129
Location: Mesa, Arizona, United States
I am interested in gauging the pulse of America regarding Healthcare Reform. It seems that health insurance companies not only hold the patients hostage but they also mug the doctors along the way. One doctor told me that he needed 4 full time employees just to manage the insurance company paperwork mess. If you're like me, the Statement Of Benefit paperwork is overwhelming. America's forprofit healthcare providers are out of control. My observation is that America needs "WholePerson care," not simply healthcare.

What I mean by that is -- instead of having a policy for optical, medical, dental, mental health, etc. American's should be able to purchase "WholePerson Care." Of course they must pay for this service as it is not free but... The Insurances companies should move to a not-for-profit model that recognizes their only responsibility is to be an aggregator of risk among the members. Of course the government Medicare program should help provide the standard payment schedule as the basis for physician pricing on a Medical procedure. And, our government should be encouraged to manage the risk in the early years of the healthcare notforprofit transition especially for managing preexisting conditions. However, over time, the medical WholePerson carriers would clearly see what the aggregated risk would be for each medical condition and then price the policy accordingly. I think in the end we will get control of the skyrocketing medical cost that America is grappling.



"You reveal your character by what you do with what you have."
FounDit
Posted: Monday, April 2, 2018 12:29:50 PM

Rank: Advanced Member

Joined: 9/19/2011
Posts: 8,786
Neurons: 47,279
Professor wrote:
I am interested in gauging the pulse of America regarding Healthcare Reform. It seems that health insurance companies not only hold the patients hostage but they also mug the doctors along the way. One doctor told me that he needed 4 full time employees just to manage the insurance company paperwork mess. My doctor said something similar.If you're like me, the Statement Of Benefit paperwork is overwhelming. America's forprofit healthcare providers are out of control. My observation is that America needs "WholePerson care," not simply healthcare.

What I mean by that is -- instead of having a policy for optical, medical, dental, mental health, etc. American's should be able to purchase "WholePerson Care." Of course they must pay for this service as it is not free but... The Insurances companies should move to a not-for-profit model that recognizes their only responsibility is to be an aggregator of risk among the members. Of course the government Medicare program should help provide the standard payment schedule as the basis for physician pricing on a Medical procedure. And, our government should be encouraged to manage the risk in the early years of the healthcare notforprofit transition especially for managing preexisting conditions. However, over time, the medical WholePerson carriers would clearly see what the aggregated risk would be for each medical condition and then price the policy accordingly. I think in the end we will get control of the skyrocketing medical cost that America is grappling.


But you also left out the pharmaceutical companies and the DME companies. This whole system has become an incestuous cesspit of back-scratching, profit-gouging corruption, but I don't trust the back-scratching, profit-gouging corruption of government bureaucracies to be any better. So I'm not comfortable with your suggestion of putting government bureaucrats in charge of physician pricing or medical availability either.

It has become a very tangled web of difficulty over the last century and I admit I don't have a simple answer, but looking to the very participants of the corruption to solve it seems a bad approach. So far, we haven't heard a great many arguments for alternative plans, so I'd like to hear some before deciding on any one solution.

I do like the idea of a wholePerson insurance plan, but I think it would have to be available nation-wide, offered by all insurance companies, and perhaps risk-pooled by all also to spread losses. Something similar to catastrophic insurance. But there should also be something done about pharma and DME, as I mentioned. We need a national discussion and some good ideas presented for debate.


A great many people will think they are thinking when they are merely rearranging their prejudices. ~ William James ~
Drag0nspeaker
Posted: Monday, April 2, 2018 12:48:19 PM

Rank: Advanced Member

Joined: 9/12/2011
Posts: 28,459
Neurons: 162,138
Location: Livingston, Scotland, United Kingdom
FounDit wrote:
But you also left out the pharmaceutical companies and the DME companies. This whole system has become an incestuous cesspit of back-scratching, profit-gouging corruption, but I don't trust the back-scratching, profit-gouging corruption of government bureaucracies to be any better. So I'm not comfortable with your suggestion of putting government bureaucrats in charge of physician pricing or medical availability either.

Applause Applause

The UK Health Service (the publicly funded National Insurance) is
1. Much better than anything I experienced in the USA (luckily, all I had in five years was 'flu once, one finger needing to be stitched back on and a bad tooth) - but I lost an arm and a leg to get the antibiotics for the tooth!
2. The UK system is flawed in itself. It is inefficient with more administrators than nurses, the nurses are not paid what they're worth, most GPs are not paid what they're worth.
3. "Big Pharma" is as much a problem here as it is in the USA. Luckily, the scams which seem to plague the USA (doctors falsifying records, charging for treatment and drugs never given etc etc) don't work so well under the National Health.

Wyrd bið ful aræd - bull!
progpen
Posted: Tuesday, April 3, 2018 8:53:22 AM

Rank: Advanced Member

Joined: 10/2/2015
Posts: 1,694
Neurons: 246,956
Location: Minneapolis, Minnesota, United States
Drag0, I believe the UK Health Service can negotiate with pharma for special pricing and there are also restrictions in place on how much pharma can charge. Those would be major benefits compared to the US system. Although US insurance companies can negotiate with pharma to lower prices, the federal government cannot. This puts Medicare in a bad situation where it is left trying to work around pharma's artificially high prices. Insurance companies simply pass the cost through to customers.

Nolite te bastardes carborundorum
Drag0nspeaker
Posted: Tuesday, April 3, 2018 9:39:05 AM

Rank: Advanced Member

Joined: 9/12/2011
Posts: 28,459
Neurons: 162,138
Location: Livingston, Scotland, United Kingdom
That would be an advantage.

Of course, if you don't like the National Health Service, there is always the alternative. . .



Wyrd bið ful aræd - bull!
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