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The Ideas Thread: Health Care (New) Ideas

jhmd2000 said:
Enough kvetching. Here's a thread (maybe even a genre of threads) where we take an issue and throw out concrete policy proposals to solve real world problems.

Problem: We have some of the highest quality health care in the world, but the distribution is poor. I view this as a quantity of care problem more than a quality of care issue. ACA tried to expand health coverage without expanding the number of providers (one among many of its fatal flaws). Part of the "supply" problem is that the standards for health care professional education are so high and limited, that seats in med schools act as a choke point for the system.

The Proposed Solution: I would treat medical education as a federal issue and try to solve the problem by expanding the number of licensed providers by expanding the number of medical schools (when was the last time we added a medical school to this State? How many times has the population doubled since then? One on the way for Campbell, but that's hardly keeping pace). I say the States get federal money to build one new medical school for every ten million people, and the docs who enter these public medical schools go to school for free, in exchange for an eight year service commitment to community hospitals (after residency). The newer doctors graduate debt free (tuition, at least) and get a living wage while they gain experience, providing near-free care (people pay a co-pay as a sincerity test and to prevent doctor shopping, but it's modest and in lieu of separate insurance) to the uninsured. High end medical care continues as is, and actually increases as these newer docs complete their service commitment. I think it is cheaper to educate and pay ten thousand new docs every year than it is to have a single payer system pay for 300m people.

eta: If North Carolina did this on its own, it would be a talent magnet for deserving students who can't afford med school. Put the campus in some place like Morganton (it can be the counterbalance to ECU), and you'd blow the doors off of other state's solutions.
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I'm on board with this and, as I've said a few times on here before, I would fund the medical schools in question directly via new, extremely high (like 100%) taxes on fast food, soda, beer, potato chips, cigs, and other items that are creating our major health problems in the first place. Create a solution and disincentivize the causation behavior in one shot.
 
JHMD,
People in the military are ordered to bases, kinda different than ordering a private citizen to move his family to Hyde county NC for 8 years of servitude. AS stated, most of these supply solutions were tried in the late 60's through the 70's and did not work but feel free to rehash them again, there are some good suggestions on here just not the simplistic ones that have already failed.
 
RJKarl said:
The reality is the amount of cases that get settled have been stagnant over the past several decades as a percentage of HC costs.
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Well, most people think HC costs are out of control. If the awards have remained stagnant as a percentage of HC costs, they must be out of control as well.
 
bcobbdeacs said:
JHMD,
People in the military are ordered to bases, kinda different than ordering a private citizen to move his family to Hyde county NC for 8 years of servitude. AS stated, most of these supply solutions were tried in the late 60's through the 70's and did not work but feel free to rehash them again, there are some good suggestions on here just not the simplistic ones that have already failed.
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How do you solve a supply problem without more providers? That's the point I'm getting at. "We" tried to solve an insufficient access to care by increasing funding on the demand side. Insanity.
 
Lots of good pragmatic ideas at decreasing costs and improving distribution, but the Tea Party House will never support any form of mandate. Status quo is broken and free riders utilizing emergency rooms for routine care is indefensible, but the Tea Party is intractable.
 
WFU71 said:
Well, most people think HC costs are out of control. If the awards have remained stagnant as a percentage of HC costs, they must be out of control as well.
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They have been static at .3 of 1% -.5 of 1% of costs basically since we were at Wake.
 
Let's think of a couple of things. Think of how much better it would be if:

We didn't waste at least 12-15% of our healthcare dollar paying insurance companies.
If we didn't have to pay 10+% of our premiums to cover the uninsured.
If everyone was in the same pool, think of the economies of scale. Pricing could be competitive and lower.
 
RJKarl said:
They have been static at .3 of 1% -.5 of 1% of costs basically since we were at Wake.
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where do you get these figures? would like to look at them myself.

The result of medical malpractice usually is a lot more medical costs, unless it's death. So it's unsurprising that medmal awards would track the escalating cost of health care to some extent, because a component of the award is paying for the additional medical treatment that would have been unnecessary without the original malpractice.
 
jhmd,
I am not sure that you have a supply problem, but let's see how it works in one of these states that are fully on board with the Health care law and see, then maybe our state can move forward also.
 
bcobbdeacs said:
As a follow up, if you want to do anything about healthcare cost you have got to know where the major expenditures are. I have been told by Cone Health that the biggest medicare expenditures occur in the last week of life. You figure it out.
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They were wrong. About 25% of Medicare expenditures occur in the last YEAR of life. Over 50% of Medicare expenditures go to the management of long-term chronic conditions.
 
2&2 Slider To Leyritz said:
I'm on board with this and, as I've said a few times on here before, I would fund the medical schools in question directly via new, extremely high (like 100%) taxes on fast food, soda, beer, potato chips, cigs, and other items that are creating our major health problems in the first place. Create a solution and disincentivize the causation behavior in one shot.
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Even New Yorkers couldn't get on board with a soda ban.
 
WFU71 said:
You're wrong
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"Efforts to lower health care costs in the United States have focused at times on demands to reform the medical malpractice system, with some researchers asserting that large, headline-grabbing and “frivolous” payouts are among the heaviest drains on health care resources. But a review of malpractice claims by Johns Hopkins researchers suggests such assertions are wrong.

In their review of malpractice payouts of more than $1 million, researchers said those payments added up to about $1.4 billion a year – far less than 1 percent of national medical expenditures.

“The notion that frivolous claims are routinely resulting in $100 million payouts is not true,” said study leader Dr. Marty Makary, associate professor of surgery and health policy at Johns Hopkins University School of Medicine. “The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them. That costs upward of $60 billion a year. It is not the payouts that are bankrupting the system – it’s the fear of them.”
 
jhmd2000 said:
We do it all the time.

How many military members want to live in Thule, Greenland? None of them, I assure you. But they all go there, for far less compensation than a paid for medical school degree.
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The military is not a good example. Compliance motivation works in the military unlike elsewhere (except maybe prisons). In the private sector, people have choices.
 
RJKarl said:
"Efforts to lower health care costs in the United States have focused at times on demands to reform the medical malpractice system, with some researchers asserting that large, headline-grabbing and “frivolous” payouts are among the heaviest drains on health care resources. But a review of malpractice claims by Johns Hopkins researchers suggests such assertions are wrong.

In their review of malpractice payouts of more than $1 million, researchers said those payments added up to about $1.4 billion a year – far less than 1 percent of national medical expenditures.

“The notion that frivolous claims are routinely resulting in $100 million payouts is not true,” said study leader Dr. Marty Makary, associate professor of surgery and health policy at Johns Hopkins University School of Medicine. “The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them. That costs upward of $60 billion a year. It is not the payouts that are bankrupting the system – it’s the fear of them.”
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Links are always nice and LOL at your highlighted text - read it again. It is talking only about judgements over $1 million.

Most studies estimate the % at 2%. I'm sure you came across that in your search to find one that bolsters your POV.
 
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Shorty said:
The military is not a good example. Compliance motivation works in the military unlike elsewhere (except maybe prisons). In the private sector, people have choices.
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At the risk of agreeing with me, I think it's a great example. The number of conscripts we currently have on active duty is small. People have choice in the military too: To join or not to join, to re-enlist or not to re-enlist. I'm not proposing replacing all of the med schools with a no options system: if you want to go into debt, you have that choice. If you want to graduate debt free and serve the public (like a teaching fellowship), then you have more choices about how to fund your medical education.
 
WFU71 said:
Links are always nice.

Most studies estimate the % at 2%. I'm sure you came across that in your search to find one that bolsters your POV.
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The text RJ posted said "In their review of malpractice payouts of more than $1 million", those claims were less than 1%. I'm sure adding in all the claims less than $1 million gets it up closer to that 2% number you're citing.
 
jhmd2000 said:
At the risk of agreeing with me, I think it's a great example. The number of conscripts we currently have on active duty is small. People have choice in the military too: To join or not to join, to re-enlist or not to re-enlist. I'm not proposing replacing all of the med schools with a no options system: if you want to go into debt, you have that choice. If you want to graduate debt free and serve the public (like a teaching fellowship), then you have more choices about how to fund your medical education.
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Basically it's a ROTC scholarship to med school, with a lower risk of getting shot during the payback period.

By the way it's not uncommon for pre-med students to go the ROTC route, go to med school on the government dime, serve out their time as a military doc and then hit private practice. It's a good route. No reason that program couldn't be expanded for non-military public service.
 
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