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Coveny’S Plan For Health Care


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#1 Coveny

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Posted 06 October 2017 - 02:22 PM

This is going to be a fairly long post about what I believe is the solution to health care in America. I’m going to touch on the scientific reasons, the economic reasons, and also discuss the emotion impact. I’m going to try and give goals for each of my positions, as well as explanations on how this position is going to achieve that goal. As a for the record thing I’m not getting anyone to review this before posting it so it likely will have spelling and grammar errors, and may not be as organized as it should be, and while you are welcome to criticize those parts my hope is that you will look past them and discuss the various points and how valid you feel like they are.

 

The problem

Our current system is too costly because of regulations which prevent small at home type hospitals from operating, as well as the lawsuits against medical personal. These regulations also prevent new drugs from being brought into market, and increase the time and costs involved to bring the drug to market. On the flip side the patents or copy rights to drugs keep drug prices very high in this country because once a drug is created only that company can legally produce it for many many years. This is all designed through corruption of our state and federal government to benefit the few at the cost of the many.

 

Universal healthcare cuts back much of company’s corruption, lowers medical and drug costs. It is not without its problems though as it removes much of the incentive to become a doctor, which leads to less doctors, longer wait times, or patients not qualifying for needed treatments. This again remove options of the poor to get healthcare.

 

The goal

To create a system where everyone can get healthcare, provide an incentive for people to become medical professionals, and lower healthcare costs.

 

The solution

1) Deregulate medical buildings

2) Lower patent and copy right terms

3) Making being a medical personal easier

4) Regulate the amounts of lawsuits

5) Bringing it all together

 

1) Deregulate medical buildings

Did you know that in an abortion clinic it’s required to have hallways big enough to fit two gurneys side by side? Did you also know that they don’t use gurneys in an abortion clinic? The point being there are many laws in place that regulate what a medical building must have, and these laws double if not triple the cost require to build these facilities. By removing these regulations, we could have doctors who saw patients out of their homes completely removing the overhead costs of having a hospital at all. Obviously, this opens concerns about infection and hygiene but if we want to lower costs and allow more people to make money in the medical profession we need to be able to treat it like any other profession. If you want to pay the extra money for a nice that is always an option, but for the poor this gives them other options to get the treatment they need. And as with everything else, as the demand in the hospitals drops, the cost of going to the nicer facilities will drop as well. This is what capitalism excels at. Once we’ve done that we can setup classification of facilities by standards.

 

2) Lower patent and copy right terms

Many drugs are patented and copy righted for life, and they have a monopoly on the market so they can charge through the roof. Other companies have to wait years before they are able to make generic versions of the drugs. Companies spend a LOT more on marketing than they do on research. The government is doing most of the research. “75% of so-called new molecular entities with priority rating (the most innovative drugs) trace their existence to NIH funding” source: http://www.latimes.c...1027-story.html

Government pay for the research (as with the case of the epi-pen) and then private company buy the patient, regulated all the schools to use it, and then increased the price by 5000%. We need to break the patent/copy right monopoly sooner, and force drug companies to invest into research rather than milking what’s already been created.

 

3) Making being a medical personal easier

One of the best ways to lower the cost of something is to have a better supply. Currently to be a doctor you need over a decade of school, from which you will exit with a mountain of debt, and there are no half measures here. The closest being a nurse practitioner who is still over a decade in the making. Also let’s be clear, medical malpractice is the 3rd cause of death in this country (at over 200 thousand a year) so it’s not like the people who go through all those classes are providing. So, let’s make it easier to break into the medical profession. Let create tiers like what we do with emergency personal. EMT is the first, paramedic is the second, ER nurse is the third, doctor is the fourth. My suggestion is to have 5 tiers for both general and surgery. The higher the tier the more schooling that’s required, and obviously testing and certification for each of level. I purpose to do the tiers in two year increments so Tier 1 = two-year degree, Tier 2 = four-year degree, Tier 3 = six-year degree, Tier 4 = eight-year degree, and Tier 5 is what we have today. Now this could mean 75% in class and 25% on the job, or whatever the industry feels is best, but the amount of time it takes to get to the point where you can see someone needs to be shortened. Also, the ability to prescribe drugs would be attached to the various levels as well.

 

4) Regulate the amounts of lawsuits

If we put tiers in place then there needs to be an understanding that the less you spend on a doctor the less you can sue them. This could be regulated based on the tier of the individual who saw you or the amount of money you spent to receive care. For instance, if you saw a tier 1 then you couldn’t sue him for more than 10k, tier 2 30k, tier 3 100k, tier 4 200k, and tier 5 unlimited, or it could be something like 100 times what you spent so that if you had a $20 doctor visit then the most you could sue that doctor for would be $2,000, but if you spent $300 then you could sue for 30k. Accidents are going to happen, and if you want to take a higher risk to save money then the person trying to provide you care needs to have the incentive that one mistake isn’t going to bankrupt him.

 

5) Bringing it all together

Once we have a system in place where medical care is much cheaper and more available we can cheaply subsidize it. For instance, it wouldn’t be expensive to cover 100% the cost for tier 1 medical professions in a tier 1 building, 80% for 2/2, 60% for 3/3, 40% for 4/4, and nothing for 5/5. Insurance companies could easily adapt to this system, and allow for MUCH more flexibility in healthcare plans that cover the difference, and work on top. Making it affordable to even see tier 3 medical professionals. Doctors have the freedom to build their own practices without having to worry about the regulations of the facilities, and our society would likely even have doctor house calls again. If we can stop trying to remove risk, and stop trying to force people to work for less I think we can easily provide healthcare for everyone.  



#2 Buffy

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Posted 06 October 2017 - 05:13 PM

I love healthcare discussions, partly because they are so complex!

 

I don't have much time right now to respond comprehensively, but I wanted to throw out a few things on the basic topic of "small hospitals"....

 

Hospitals tend to be large because there are very significant economies of scale in both talent and assets:

  • Many people think that any surgeon can perform any surgery, and in desperate times where expectations are low, that's basically true. But the fact is that all surgeons specialize, so most hospitals must have many many surgeons signed up in order to provide decent services across the various types of surgery that people need. And it's not just doctors, nurses and support personnel are highly trained too.
  • Lots of equipment that hospitals need is specialized and very expensive, most notable examples being things like MRI and CAT scanners, although there are many others. Just the building itself represents a huge upfront capital cost, when you consider that there is a need not just for electrical and water, but oxygen, plain air, electrical battery/generator backup for the entire building for significant periods, hazardous waste disposal, hyperclean walls, foundations, air conditioning... the list goes on.

But the thing is that these factors aren't a product of regulation, they're just demands of the market, and thus when you see any indication that smaller markets are "underserved," it's actually just plain an issue of there not being enough demand to cover all the fixed costs but also the quite likely need to pay for the opportunity cost of having access to resources that in a small market simply don't have enough demand for the specialization.

 

An example I'm familiar with is a small resort town in the Eastern Sierra Nevada in California (Mammoth Lakes): they have a fabulous "small" hospital but with only a few dozen beds. The town itself has only about 7000, residents and a large seasonal (winter) population, so they do have enough of a market to exist. Moreover the clientele tends to be relatively wealthy in the winter with a very high rate of insurance coverage (although a good chunk of the local service population is relatively poor, most are employed and have coverage of some kind thanks to Obamacare). Thus they actually do have a number of specialists in orthopedic surgery because there are rich skiers who are happy to pay when they twist a knee on the slopes. Conversely, when my step-dad had a heart attack, they took great emergency care of him, but he had to fly to Reno on a ambulance jet for open heart surgery. They just don't have the demand for a cardiac surgeon locally.

 

Now this is similar to what small towns in the middle of nowhere have to deal with, but with a much, much less wealthy-and therefore less profitable-base on which to support all those fixed assets and limited resources. This means there are indeed lots of places where it's quite frankly dangerous to have a medical emergency. In many of these areas, the medical facilities are-very much like you're starting to describe-low-cost facilities that are in fact owned and operated by the local government. Mammoth's hospital was funded by the city and now operates under a quasi-governmental association under the auspices of the county government, and you'll see this sort of thing all over rural America.

 

The "bottom line" here unfortunately is that most hospitals are for-profit operations, and it's just not profitable to operate out in the middle of nowhere.

 

What this means is that the lowering of costs, predominantly through governmental support of infrastructure is a key to lowering the cost of healthcare in rural areas that don't have the money to afford much. It will always mean though that specialized medicine does happen in the cities. That's unlikely to change no matter what without major changes to availability of specialists and their interesting costs (which I'll come back to at some point).

 

There's definitely a lot here to discuss!

 

 

A hospital bed is a parked taxi with the meter running, :phones:
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#3 Farming guy

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Posted 07 October 2017 - 04:14 AM

There was a time when insurance was only used for the really big expenses, such as hospitalization or surgery, and the patient would just pay their regular doctor for the small stuff.  I realize we have this whole "preventative care" thing where everybody is expected to visit their doctor at least every year and in some cases twice, but do you really need to see a doctor that often if nothing is wrong?  Sure, if you have diabetes or some chronic condition, regular checkups are probably in order.  Also by requiring insurance companies to cover all "preventative" care, you are just inserting a bunch of people who need to be paid in between the patient and doctor.  The local doctor's office has a fairly large staff, and a lot of what they do is paperwork for the insurance.  

 

There was also a time when we had non-profit insurance companies.  Oddly enough my state was under control of the Democrats when the last non-profit insurance company was given permission from the state to become a for profit company, so there is not just one political party to blame here.  



#4 Coveny

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Posted 07 October 2017 - 09:41 PM

Buffy while I agree with the majority of what you posted, and I feel like there is a need for government to support the healthcare in rural areas, I would just like to add that I have concerns about abuse, and that subsides be reasonable. Like you said there is a lot to discuss though.



#5 Buffy

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Posted 08 October 2017 - 11:26 AM

 

Buffy while I agree with the majority of what you posted, and I feel like there is a need for government to support the healthcare in rural areas, I would just like to add that I have concerns about abuse, and that subsides be reasonable. 

 

 

Well, that of course is what I'm arguing. In the case of Mammoth Hospital, the government funded it, and for a while they turned over management to a private hospital group, but that group (Centinela, which was big in Los Angeles at the time) decided it wasn't profitable enough, and they turned it back over to the county.

 

And this isn't just healthcare, it's everything. Getting high-speed internet to rural locations verges on living in a third world country.

 

The point here, to get to Farming Guy's post, is that mindless worship of private enterprise and the belief that, as Reagan said, the scariest words are "I'm from the government and I'm here to help," have done tremendous damage to society, and the people who have borne the brunt of this are the rural parts of America. It's absolutely flabbergasting to me that for a huge part of our population, this whole discussion has to be prefaced with convincing proof that government should not be "drowned in the bathtub."

 

The excess profits in the healthcare sector are a key indicator that our costs are out of control. The demise of non-profits in healthcare is directly attributable to there being so much money on the table, non-profits are actually a threat to the for-profits, and legal and legislative means are being used to take them out of the market, with only big organizations like Catholic hospitals and Kaiser Permanente avoiding the mostly legislative assault on switching Blue Cross/Shield organizations to for profit (note they're insurance, not providers, so this can be done more easily).

 

I'm putting this up as kind of a shot across the bow of arguments that go down that path: anyone who disagrees with the basic premise that government should have at least some role in solving the healthcare problems in this country is just plain not dealing in the realm of scientific evidence or logic. We should be talking about how much of a role, and how different the healthcare market is from corn or cars, but that's a long way from the sadly common opinion that there should be none.

 

 

Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare, :phones:
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#6 Farming guy

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Posted 08 October 2017 - 04:11 PM

 

Well, that of course is what I'm arguing. In the case of Mammoth Hospital, the government funded it, and for a while they turned over management to a private hospital group, but that group (Centinela, which was big in Los Angeles at the time) decided it wasn't profitable enough, and they turned it back over to the county.

 

And this isn't just healthcare, it's everything. Getting high-speed internet to rural locations verges on living in a third world country.

 

The point here, to get to Farming Guy's post, is that mindless worship of private enterprise and the belief that, as Reagan said, the scariest words are "I'm from the government and I'm here to help," have done tremendous damage to society, and the people who have borne the brunt of this are the rural parts of America. It's absolutely flabbergasting to me that for a huge part of our population, this whole discussion has to be prefaced with convincing proof that government should not be "drowned in the bathtub."

 

The excess profits in the healthcare sector are a key indicator that our costs are out of control. The demise of non-profits in healthcare is directly attributable to there being so much money on the table, non-profits are actually a threat to the for-profits, and legal and legislative means are being used to take them out of the market, with only big organizations like Catholic hospitals and Kaiser Permanente avoiding the mostly legislative assault on switching Blue Cross/Shield organizations to for profit (note they're insurance, not providers, so this can be done more easily).

 

 

The trouble is finding a balance between free enterprise and government regulation.  The problem with free enterprise is that it is purely profit driven, and the problem with government regulation is that it tries to impose a one size fits all solution.  We need a system that is held accountable to the people it serves and attuned to their needs. 



#7 Buffy

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Posted 08 October 2017 - 06:04 PM

The trouble is finding a balance between free enterprise and government regulation.  The problem with free enterprise is that it is purely profit driven, and the problem with government regulation is that it tries to impose a one size fits all solution.  We need a system that is held accountable to the people it serves and attuned to their needs. 

 

Yep. No one says it's easy, and unfortunately the biggest challenge is keeping the folks that insist that only all one or all the other is the solution, at bay.

 

One of the key things about this dynamic though is that government is frequently the only party that is "accountable to the people." Certain unique dynamics of the healthcare market exacerbate this: the push against non-profits that you mentioned, and the fact that "the people" are not the consumers in this market, they're the *product* that the insurance companies sell to the healthcare providers. Both of these conditions get worse when government allows unfettered mergers and consolidations, reducing or eliminating any competitive pressures at all.

 

 

Oligopoly is an imperfect monopoly. Like the despotism of the Dual Monarchy, it is saved only by its incompetence, :phones:

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#8 Farming guy

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Posted 10 October 2017 - 11:22 AM

I was discussing health insurance with my wife who gets coverage for both of us through her job in healthcare, and she pointed out that we have an emergency room copay of $100, but only if we go to the right hospital.  Any other emergency room will cost us big time.  My opinion is that if you have to pay for insurance, it should pay the same wherever you get treatment.  

 

Yep. No one says it's easy, and unfortunately the biggest challenge is keeping the folks that insist that only all one or all the other is the solution, at bay.

 

One of the key things about this dynamic though is that government is frequently the only party that is "accountable to the people." Certain unique dynamics of the healthcare market exacerbate this: the push against non-profits that you mentioned, and the fact that "the people" are not the consumers in this market, they're the *product* that the insurance companies sell to the healthcare providers. Both of these conditions get worse when government allows unfettered mergers and consolidations, reducing or eliminating any competitive pressures at all.

 

 

Oligopoly is an imperfect monopoly. Like the despotism of the Dual Monarchy, it is saved only by its incompetence, :phones:

Buffy

Where you have businesses that face no real competition in a field that has been deemed essential, there needs to be price controls.  I've seen what some medications cost, and I know that some of those medications are also used in veterinary care, and how inexpensive they are for the vet (our vet doesn't mark up his medication costs), and it is downright shocking.  

 

If the price of milk and meat paid to farmers can be held at or near the same price for 40 years, we can do the same for medications.  We just need enough political will to overcome the greed.