Originally posted by Jeff However, wouldn't that also encourage them to maximize profits? There has been the suggestion that less money has gone into find a cure for cancer than a treatment (same for AIDS) because the treatments fund an entire insustry of oncologists.... Is that really logical, Jeff? Since the pharmaceutical companies stand to make a fortune off of a cure, why would they be concerned about the profitability of oncologists? And there is an inherent risk for a Pharmaceutical company to spend $300 million developing a treatment...it's competitor may develop the cure. In the same way, wouldn't the healthcare industry make more money by holding back cures if the treatments were more valuable? .... Thats not very realistic. It would entail the health plan ORDERING the physician to provide treatment over a cure. Even if the Plan was so inclined (from both ethical and legal perspectives), do you think the physician would stand for it? The gray area is when a treatment or cure is considered experimental. Some health plans probably do take advantage of the practice, but in some instances they have been right. For instance, health plans were being forced to provide painful and expensive bone marrow transplants for advanced stage breast cancer patients, yet a recent study showed NO benefit to the patients. ...If you are poor in America, it is treated like a crime. No matter how good a person you are, you are viewed as a failure because of your lack of income. You can see it in every advertisement, in how we treat the sick or those accused of crimes and how they are represented (or more accurately, NOT represented) in government. I don't understand this. I keep mentioning that we spend $200 billion a year on healthcare for the poor, but everyone keeps acting like we pay $0. Have you seen the coverage that Medicaid recipients recieve? This fall, they will finally have to pay a copay when visiting the ER or getting a prescription...the copay is $3.
I do think that its not happening in the main. But that does not mean that its not happening in a few instances or will not happen in the future. But I pretty much agree with you. You seem very knowledgable on these issues and we agree quite often. Are you in the healthcare professions?
Related. I have been in managed care for almost 15 years and presently help health plans report on their quality, access to care, financial, etc.
We come at this from different perspectives but reach a lot of the same conclusions. My father in law is a doctor and my wife does medical malpractice defense. I have studied these issues quite a bit...I hope it shows.
HayesStreet: Healthcare *is* a basic human right as far as I'm concerned. End of story. I don't really give a damn about 'influencing' people. My post was mainly a p!ssed off reaction to FranchiseBlade's awful, awful story. His experiences flat out suck and they are *inexcusable* in such a rich country. Your system *needs reform* if that can happen to someone. Now, *nowhere* did I say that a) your system has no redeeming qualities, because obviously it does - for some well-off folk, it's a truly excellent system and b) that New Zealand's system is perfect, because it isn't, for various reasons which would bore the crap out of you. Do you feel better about your system now, everyone? (I can't *believe* I even had to explain this at all. )
But, what if they choose not to pursue a cure in the first place? If a person needs one treatment to cure an illness or 50 treatments to treat an illness, which is worth more? Long-term care is more expensive than a short-term cure. That is the reality of the situation. Again, what if they just don't find a cure? I'm not saying this happens, but if even holding back a cure for a few months or a year might mean $50 million more for a company because the cure would make their treatment obsolete, would they consider it? I think they would. What I'm saying is that falls short if you are poor. With 30 million Americans living as working poor and more than 40 million without healthcare, a $3 co-pay may not work. What if you need 10 different medications every week? If you can't afford your bills, how do you afford medication? To me, this is a practical reality, not a subjective one. I can understand and appreciate temporary or emergency care. Those things seem to be working, if not perfectly. What I'm talking about is significant medium to long-term care for a sick person. If your child has a long-term illness, you have no insurance and you are broke, what exactly are you supposed to do? For me, I just cannot accept that one person has to suffer because the healthcare system fails them. If one person dies because of that, we should all find that unacceptable. It may seem distant because we aren't suffering, but if it was my family member, I'd be terrified.
Originally posted by dimsie Healthcare *is* a basic human right as far as I'm concerned. End of story. Yea! dimsie has decreed healthcare for all. Yipee! I don't really give a damn about 'influencing' people.... Good. I guess that means you will just shut up.
Good. Then YOU pay for it. YOU make it workable in a real world. YOU make it so the government doesn't usurp 10 to 14% of the GDP. If you can't develop a workable solution then perhaps you shouldn't be so caustic. Well, those types of reactions are devoid of logic anyway so that explains a lot. Now wasn't that a loaded response. It also shows your blatant ignorance of the system you are bashing.
Originally posted by Jeff But, what if they choose not to pursue a cure in the first place? If a person needs one treatment to cure an illness or 50 treatments to treat an illness, which is worth more? Long-term care is more expensive than a short-term cure. That is the reality of the situation. That might have been possible under fee for service, but not so easy under managed care. Why? Well if the provider is capitated (i.e, prepaid), they'll lose money with the extended care scenario. If it's a specialist, the services must be authorized, i.e. no games. If its fee-for-service or point-of-service, patients must be somewhat responsible for researching their ailment and the best therapies. I also imagine that few physicians would like to expose themselves to litigation under your scenario. Regardless, your scenario seems highly hypothetical. Have you heard of any instances, or any medical conditions where this is likely to occur? I've never heard of it. Again, what if they just don't find a cure? I'm not saying this happens, but if even holding back a cure for a few months or a year might mean $50 million more for a company because the cure would make their treatment obsolete, would they consider it? I think they would. Who they? Medical schools? Pharmaceutical companies? The disincentives are greater in all circumstances. Again, 1 example? What I'm saying is that falls short if you are poor. With 30 million Americans living as working poor and more than 40 million without healthcare, a $3 co-pay may not work. What if you need 10 different medications every week? If you can't afford your bills, how do you afford medication? I may agree about the Rx copay, but not about the ER. Too many people use the expensive ER instead of a clinic, reducing available services since Medicaid is budgeted. To me, this is a practical reality, not a subjective one. I can understand and appreciate temporary or emergency care. Those things seem to be working, if not perfectly. What I'm talking about is significant medium to long-term care for a sick person. If your child has a long-term illness, you have no insurance and you are broke, what exactly are you supposed to do? To answer your specific question, CHIP. Of course I understand your general point and agree with it. A most frightening and real scenario is extended care for Seniors. There is a fairly low limit for a lifetime allotment of skilled nursing facility days under Medicare. Many don't realize this and do not purchase extra coverage (or cannot afford it). Then a senior gets sick and the spouse cannot care for them, so they are admitted to the SNF. When their days allotment is used, the remaining spouse must spend-down their assets to a few thousand dollars to be able to get the more generous SNF coverage allowed under Medicaid. Ironically, the senior may not last very much longer, leaving the remaining spouse alone and destitute. The government is very aware of this, yet takes no action since it will cost a lot of money. In addition, many seniors not only had pharmacy covered when they enrolled in an HMO, but they also got some extended SNF coverage. Clinton's team at HCFA decided to squeeze the HMOs, and dropped reimbursement so much that Plans actually closed down in many urban areas, forcing many thousands of Seniors back onto crappy Medicare coverage (my parents were effected by this, now spend $2000 more a year on healthcare). Sick, eh? For me, I just cannot accept that one person has to suffer because the healthcare system fails them. If one person dies because of that, we should all find that unacceptable. It may seem distant because we aren't suffering, but if it was my family member, I'd be terrified. I agree wholeheartedly, and it doesn't seem that distant to me at all. Personally, I am doing what I can to improve the system. I just don't want us to screw it up worse with the wrong solution.
Jeff-- One thing to remember here. The drug companies that develop disease cures are corporations. The guys calling the shots have tons of stock. How high do you think the stock price of say Merrill Dow would go if they introduced the cure for AIDS? They would line their pockets with LOTS more cash than if they suppressed the cure. In short, there is a significant financial incentive for them to cure these diseases.
These are all good points. I was just using a hypothetical as an example. I have no reason to think this is the case. I'll admit I am not fully versed on the industry as a whole, but I do see the limitations. This is where the system needs to adjust because there are reasons the ER is used more often. 1. It is generally better care than a clinic. If you had your choice between Memorial ER and the free clinic in the Third Ward when your child was sick, where would you go? 2. People work during the day and the clinics are closed at night. Many low income workers would risk losing their low-paying jobs to take themselves or a child to a clinic during the day. The system needs to adjust to the needs of the patients because the patients are unable to adjust. Absolutely, particularly because most of them are on fixed incomes. Cool. I'm glad someone is. I agree that it shouldn't get worse. I'm just not sure that profit is always the best motivator when it comes to fixing healthcare because there is the chance that they system will be abused for profit and in this industry, that spells serious problems for patients. Refman: I agree with one exception: long-term treatable disease. The ideal scenario for a drug company isn't a treatment that fails or a cure that works. The ideal is a treatment that works but must be maintained for long periods of time. That helps the patient enough to keep them healthy but not enough to keep them off the medication.
Oh, my ass. It's perfectly workable in other countries, so why not yours? Why are you so different? You're actually *richer* than other countries with universal systems! I'm not ignorant of your system at all. I lived in Houston for three years and in the States for four. I'm also a historian and I've studied your health and welfare provisions, particularly during the twentieth century, rather extensively. But you don't need *any* kind of credentials to note that your system needs reform. Shrug.
It shows. I remember that you had some exposure to the malpractice, but I wasn't certain if that was your practice or not. Do you mind me asking what area of law you specialize in? I heard that a small number of physicians is responsible for a large number of malpractice suits. Does your wife agree? If that were true, I wish that the AMA would make that information readily available so people could use that when selecting a doctor. They could adjust for geographic, medical specialty and volume variations, I don't care, just let us use something. I'm glad to hear that your wife is involved in defense. I think that it has gotten out of hand, and as we touched on previously, it is seriously damaging the profession and also squeezing the healthcare system.
Originally posted by Jeff ... I'm just not sure that profit is always the best motivator when it comes to fixing healthcare because there is the chance that they system will be abused for profit and in this industry, that spells serious problems for patients. You concerns is valid. For instance, mammograms save lives, but only after many years of tests. Employers were asked whether they would be inclined to pay for the service, even though they wouldn't probably see a 'return' on their expense since it would not be cost-effective. The majority said 'no', they would prefer not to pay (the study was irrelevant anyway since the system not only covers the test, but health plans' mammogram rates are monitored and reported). On the other hand, what is missing in this industry is information and knowledge. That is the most damaging factor in the system presently. Information is needed by consumers to select the quality provider; information and knowledge by providers to provide necessary and appropriate care. All is sorely lacking, so the system fails. The best approach to fix it is with the profit incentive. A provider group that can improve quality and efficiency could make loads of $ since up to 30% of healthcare is wasted. But even once a provider group improves the care, the system will still not work properly until the consumer can identify (quantitatively) the higher quality provider. One last thing to mention, is that universal coverage is not mutually exclusive with market forces. Both Medicare and Medicaid HMOs are examples of government healthcare and market forces. Unfortunately, the government does not have a great track record here. There are some good intentions, but that apparently is not always enough.
Until April I was specialized in real estate and contract law in the telecommunications sector. I made sure we had all the legal documents necessary to ensure proper title to tower sites, made sure the legal descriptions matched and making sure we had all the needed regulatory documents. I also negotiated with customer coundel and ran ideas past corporate officers. They closed the Houston office in April. It looks as though I will be doing med mal defense in the near future myself. My wife and I do not find that it is a small number of doctors in these suits. While there are some egregious cases out there, the majority of suits are not grounded in fact. We are finding that a lot of these suits are of the variety where Mom dies and it has to be somebody's fault. So they sue every doctor who got within 10 feet of Mom. Part of the problem is that most plaintiff's lawyers do not understand the standard of medical care. So they just sue all the docs and the defendants will fight it out as to who pays. This is why pure stats on how many times a doctor has been sued would not be really informative. Specialists do get sued more often, but there is a reason for it. These doctors have patients who usually end up hospitalized. In order to see their patients while in the hospital they have to do at least one weekend a month on call, where they see anybody who comes through the door with an appropriate case for their specialty. These cases are the most likely to sue. US News & World Report reported in a July 1, 2002 article about an OB/GYN who was called in to deliver a baby for a woman who is a crack addict. Without this doctor the baby would have died from the complications. when this woman was not presented with a perfect child (go figure...crack addict Mom), she sued. Shockingly, she WON. This is a big reason why we are where we are in the healthcare industry. BTW...I don't mind you asking at all.
Well...that's helpful to your point. It's not workable. It is intrusive governmentally. But more importantly patients do not get quality care. Anybody who has been to a university health center has experienced socialized medicine. If it really worked, wealthy Canadians would stay home for their healthcare rather than going to Minnesota. And all I asked you to do is to suggest a workable solution. I guess that takes more than saying that a system is unfair.
Interestingly, this map, which is part of an article on health care efficiency worldwide, notes that the universal systems of Australia, Canada and the United Kingdom have greater "health system efficiency (performance) in maximising population health" than the United States (and, incidentally, New Zealand! Bummer for us!). http://bmj.com/cgi/content/full/323/7308/307/F1 The article is published by the World Health Organisation. I'm sure you'll rip its credentials to pieces, but hey, I tried. Oh, and 'intrusive governmentally' is a really silly phrase. What does it mean?
Well...when there is a system that causes undue governmental INTRUSION on business, it is intrusive on some governmental level. Therefore it is intrusive governmentally. Or you could say governmentally intrusive. After all of this I can't believe that you have boiled it down to calling my choice of phraseology silly. Between that, rampant profanity and being generally caustic, you really don't have much of a point now do you?
