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The Economist on Healthcare

I can echo the above, if the rates for medicare and medicaid get much worse many physicians will discontinue seeing these patients or greatly restrict the number they see. We (tertiary care hospital) see every medicaid child in the state of NH at our hospital for routine ENT care that could definitely be done in the community. Why would you come two hours to get your kids tonsils out (an operation our first year residents do)? Cause your local doctor won't take medicaid.

Keep pinching things financially and doctors will refuse to operate at hospitals and will move to outpatient surgery centers and leave the hospitals and whoever they can hire to take care of the rest.
 
I'm surprised that no one has brought up the insurance costs that Doctors and hospitals pay in case of malpractice litigation.
 
myDeaconmyhand said:
I'm surprised that no one has brought up the insurance costs that Doctors and hospitals pay in case of malpractice litigation.
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That's the biggest scam there is. Recovery rates have been flat for decades, yet premiums have gone through the roof.
 
ONW said:
That immigrants are so hated when the entire fucking country are immigrants.

"Bizarre faith", have you been to church lately? Like the pope and preachers are experts?
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Immigrants are so hated? Where prey tell do you get the concept that immigrants are hated?

I agree with equating intellectual "experts" with popes and preachers. I'd say they play the same roles for many of the non-religious.

Thx to the coward who neg repped me BTW.
 
ONW said:
You know this field, how did healthcare get linked to employers in the first place?
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Not exactly unions, but the post war economy (which was much more union than it currently is). Companies had to compete for talent and they started offering healthcare as an incentive. It ballooned after the Korean war.
 
ONW said:
What would you change to fix things?
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I would tie risk to healthcare insurance. Right now, premiums are set without assessing true risk because that's deemed unfair. But without that link, prevention becomes hard to promote because prevention incentives should be targeted at the people at risk.

One way to do that might be to tie health insurance to risk behavior...such as recreational drug use, even alcohol. If we legalized drugs and then tied stated controlled access to legalized drugs to insurance, then maybe we could transfer a lot of the dollars going to illegal drugs into the health system as well as promote healthier behavior at the same time. Then people doing drugs (or possibly if doing to much) might be asked to pay a little more premium to compensate for their higher risk. Smaller prison pops, better access to addiction treatment, etc....companies producing safe rec drugs?

People would not be denied access to health care without insurance as it is now, but people would be hit with severe penalties for engaging in risk behaviors without insurance...sort of a privilege system like car insurance.
 
pourdeac said:
I would tie risk to healthcare insurance. Right now, premiums are set without assessing true risk because that's deemed unfair. But without that link, prevention becomes hard to promote because prevention incentives should be targeted at the people at risk.

One way to do that might be to tie health insurance to risk behavior...such as recreational drug use, even alcohol. If we legalized drugs and then tied stated controlled access to legalized drugs to insurance, then maybe we could transfer a lot of the dollars going to illegal drugs into the health system as well as promote healthier behavior at the same time. Then people doing drugs (or possibly if doing to much) might be asked to pay a little more premium to compensate for their higher risk. Smaller prison pops, better access to addiction treatment, etc....companies producing safe rec drugs?

People would not be denied access to health care without insurance as it is now, but people would be hit with severe penalties for engaging in risk behaviors without insurance...sort of a privilege system like car insurance.
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I agree with you about tying risk behavior to insurance premiums, but I don't think that most people who are addicted to illegal drugs (besides pot), have health insurance anyway.
 
WFU71 said:
"According to a 2010 survey of physicians by Gallup for Alpharetta-based Jackson Healthcare, one of every four dollars spent in health care goes to defensive medicine..."
http://blogs.ajc.com/health-flock/2011/05/18/the-hidden-costs-of-healthcare/
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This gets more to the meat of the issue than simply talking about lawsuits and recovery rates. It is refreshing to see how authoritative RJ is on issues that he knows little or nothing about though.

I'll have to pay attention day to day but I think the above number is probably close. Many, many tests and scans are ordered for things that are of extraordinarily low probability, simply because missing them would result in lawsuits. It wouldn't happen often, but it really only takes one to ruin your reputation and your career.

Secondly in terms of cost containment is end of life care. I in no way favor pulling the plug on people or setting up death commissions, but patients and families MUST discuss their wishes for end of life care and death must become an acceptable outcome. As it stands now we spend a disproportionate amount of money on futile end of life care. Keeping a patient in the ICU for one day costs thousands of dollars. Extend those futile days because the family has some mystical belief things will get better and the meter keeps running. This happens across the country every day. People should not fear a comfortable death as opposed to a needless and prolonged ICU stay.
 
myDeaconmyhand said:
I agree with you about tying risk behavior to insurance premiums, but I don't think that most people who are addicted to illegal drugs (besides pot), have health insurance anyway.
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One of the major problems with our system is that people with the greatest risk don't participate until care is needed, then they use the most expensive solution. That's why people want to force insurance. Instead, I think we need to find ways to incentivize people to join, not force people.

Like you point out, many illicit drug users don't have health insurance, but they spend a lot of $$$ on their habits and those habits create health needs, some long term. It would be ideal for everyone for them to get insurance. If you legalized pot, then the cost of it would drop significantly right? There's a high blackmarket premium that would go away. If you could move that premium to healthcare then that would pay for joining the healthcare system within the drug users current budget. The user would be faced with buying legal rec drugs with insurance, or going to the black market without it, at the same cost. If you simultaneously penalized the user for taking risk without coverage, then you have both a carrot and a stick to join the system.

It's just like car insurance. Reward good risk with lower premiums and a privilege, and higher risk with higher premiums and/or loss of privilege.

Legalizing drugs would also free up $$ from the war on drugs, reduce prison pops, etc. so there are a lot of other $$$ benefits that could go back into healthcare. I see it as a win-win situation.
 
^if you allowed individuals to write off their healthcare costs like corporations do, that would solve a lot of it. It is still amazing that we discriminate against the self employed like this.
 
I can assure you insurance companies assess risk when you are insured through your employer. Their actuaries can estimate through inductive inference (educated guess) how many people will have heart attacks, broken limbs, spine surgery, etc. for a given group of people. Then they negotiate a contract with your employer... sometimes they win (usually) and sometimes the employer makes out better (seldom).

Medicare and Medicaid are an entirely different animal. It has more to do with "fairness" and less to do with actual risk in my estimation, which is why it is in the trouble it is in. Just my opinion. I don't have charts and graphs...

And before we laud examples of socialist/centrist whatever you want to call it health care, bear in mind we have the best health care providers on the planet. I would not have a craniotomy or total hip replacement anywhere else on earth. And therefore it is going to be more expensive. You really do get what you pay for. The problem we have is the misuse of the quality resources we have.
 
DirkTheDeac said:
I can assure you insurance companies assess risk when you are insured through your employer. Their actuaries can estimate through inductive inference (educated guess) how many people will have heart attacks, broken limbs, spine surgery, etc. for a given group of people. Then they negotiate a contract with your employer... sometimes they win (usually) and sometimes the employer makes out better (seldom).
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Global risk is assessed, but not individual risk. That's one of the problems with pooling insurance. The number of heart attacks in a given group can be estimated, but which individuals might respond to prevention of the heart attack is not.

So how does one incentivize prevention of a heart attack? Right now the prevention has to be cost effective for the entire pool for it to be promoted, does it not?
 
pourdeac said:
Global risk is assessed, but not individual risk. That's one of the problems with pooling insurance. The number of heart attacks in a given group can be estimated, but which individuals might respond to prevention of the heart attack is not.

So how does one incentivize prevention of a heart attack? Right now the prevention has to be cost effective for the entire pool for it to be promoted, does it not?
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It's already happening. We tax all sorts of "bad" behavior. When you set the tax high enough people will stop doing it. When a Big Mac costs $8... goodbye McDonalds. And the news today is sitting is almost as bad as smoking. So, if you have an office job you can look forward to a chair tax.

Insurers just react to this sort of thing and try to make money banking on the fact that people who will not have serious medical issues will subsidize the others in the pool that do. The government does the same thing through taxation. Perhaps I could eat an $8 Big Mac every day for the rest of my life and not have a heart attack but my neighbor does. The government doesn't care. The tax is the same for both of us. The government is no different from United Health Care in that regard. And I know we don't tax Big Macs today but don't bank on tomorrow. And watch your office chair...
 
BacktoBack said:
I can echo the above, if the rates for medicare and medicaid get much worse many physicians will discontinue seeing these patients or greatly restrict the number they see. We (tertiary care hospital) see every medicaid child in the state of NH at our hospital for routine ENT care that could definitely be done in the community. Why would you come two hours to get your kids tonsils out (an operation our first year residents do)? Cause your local doctor won't take medicaid.

Keep pinching things financially and doctors will refuse to operate at hospitals and will move to outpatient surgery centers and leave the hospitals and whoever they can hire to take care of the rest.
Click to expand...

Very true. As little as 4 years ago, my wife used to set aside 20% of her practice to see Medicaid patients because she felt it was the right thing to do. Now, she doesn't see any (other than children whom she previously treated) because she lost so much money because the low reimbursement rates on that 20% relative to her per capita cost of treatment was basically wiping out the profit that she would make on the other 80% of her patients.
 
RJKarl said:
I wonder how many of those would be immediately eliminated if there was no profit incentive.

Also many of those expenditures are propped up by the whores at the malpractice companies.
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I hope you're not suggesting that physicians order worthless and useless tests to pad the bottom line?? Anyone who is employed by a hospital sees nothing from tests and ancillary studies like CT scans. A private doc might see some of that only if they offer it within their office, which is usually more trouble than it's worth. It can be nice to offer only from convenience standpoint to the patient.

But more importantly, there may be a small percentage of docs that are shady with their business, but we are professionals and as such are bound ethically to behave to a higher standard. We aren't car salesman. Your premise is downright insulting. But it's clear you have no idea what it's like to be a professional.
 
2&2 Slider To Leyritz said:
Very true. As little as 4 years ago, my wife used to set aside 20% of her practice to see Medicaid patients because she felt it was the right thing to do. Now, she doesn't see any (other than children whom she previously treated) because she lost so much money because the low reimbursement rates on that 20% relative to her per capita cost of treatment was basically wiping out the profit that she would make on the other 80% of her patients.
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Sad to hear. I had planned the same or similar for my practice but it's hardly feasible anymore. You basically lose money due to overhead for the patients that likely need your help the most. It puts more and more of a strain on tertiary care hospitals to pick up the pieces.
 
BacktoBack said:
I hope you're not suggesting that physicians order worthless and useless tests to pad the bottom line?? Anyone who is employed by a hospital sees nothing from tests and ancillary studies like CT scans. A private doc might see some of that only if they offer it within their office, which is usually more trouble than it's worth. It can be nice to offer only from convenience standpoint to the patient.

But more importantly, there may be a small percentage of docs that are shady with their business, but we are professionals and as such are bound ethically to behave to a higher standard. We aren't car salesman. Your premise is downright insulting. But it's clear you have no idea what it's like to be a professional.
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FUCK YOU!!!

Either I struck a personal nerve of your own actions or you have ridiculously thin skin.

At NO point did I insult doctors. If I want to insult someone, I will say it.
 
RJKarl said:
FUCK YOU!!!

Either I struck a personal nerve of your own actions or you have ridiculously thin skin.

At NO point did I insult doctors. If I want to insult someone, I will say it.
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Mature and rational as ever, I see...

not worth it....carry on ole rambling one
 
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