What is the main problem with US Health Care?

[chinaco]

We are all focused on the potential for Health Care changes this election. Specifically affordable health care.

Here are 3 questions. Please comment.

1. What is your personal situation that you feel needs to be solved?
2. Do you have also have social agenda that is broader than your personal situation?
3. Briefly state what you think the basic problem is and the solution to the problem.

I will go first:

1. We have healthcare. I am worried about losing it directly (loss of plan) or via spiraling costs.
2. I would like all American's to have access to affordable health care. But I think we should each pay for it (out of pocket). I have a problem with freeloaders!
3. I think the problem lies with spiraling costs of drug (Pharm Companies), Overhead of middlemen, Overhead of administration (claims, etc), and Insurance companies redlining. I think the best fix would be to eliminate the middlemen and administrative costs. But I do not know how to do that. Eliminating redlining might help. Changing the way we are getting scr3wed by drug companies on the cost of drugs. I do not think the govt would be an efficient administrator of services for a universal HC system. If the govt creates a safety net solution for people that cannot afford healthcare... It should probably by an HMO style mechanism. This is probably the most efficient and services should be rationed. Otherwise we might create one more reason for people to freeload (off of us...). The safety net is essentially a medicaid replacement and it is extended to the working poor (or anyone who want to use it). The working poor (and others) would have a means tested premium they would need to pay and a copay... The copay is important because it incents people to conserve (not waste). Yes some level of copay is needed for everyone... even if it is a couple of bucks. (no system will ever be perfect).

 

[lets-retire]

1) We have health insurance.
2) While I think it would be nice for routine health care be provided to everyone free, I also know that free health care is not good health care.
3) If you follow history, anything sold to the Boomers resulted in the sellers being made very wealthy. Now the Boomers are consuming large amounts of health care due to age related illnesses. I think opening the flood gates to the large influx of people obtaining routine care, that normally does not need to be done, will do nothing, but flood an already flooded system and drive prices higher. I think a second part of the cause for the rapid increase in costs is the fact that insurance companies only pay a percent of what is "reasonable and customary" for treatment. This causes doctors to overcharge people without insurance, so they can receive the correct amount from insurance companies. Short of getting rid of many Boomers, which I don't support, I do not see how the price of medical care can be reduced any appreciable amount as long as boomers are still alive and insurance company policies encourage artificial inflation.

 

[Midpack]

We are all focused on the potential for Health Care changes this election. Specifically affordable health care.

Here are 3 questions. Please comment.

1. What is your personal situation that you feel needs to be solved?
2. Do you have also have social agenda that is broader than your personal situation?
3. Briefly state what you think the basic problem is and the solution to the problem.

1. Bridging the gap between ER and Medicare for us (I have affordable healthcare at work). But I really expect to have to deal with this issue myself.
2. I agree with your answer to #2, but you realize that some people will fall out of the safety net you describe. There are lots of people who can't pay anything, some their own fault, others not. "There for the grace of God go I..."
3. Don't disagree with your answer to #3, but I think you've missed an even bigger issue. If somehow everything you mentioned was addressed, I think our collective health is deteriorating enough to more than offset savings from those issues. If you google the topic, you can find estimates as high as 8 out of 9 diseases are preventable - and most of them are of the most costly variety. I have a tough time with all of us paying for healthcare for people who have little regard for their own health. People who smoke, drink excessively, people who are overweight/obese out of neglect (yes, I realize there are folks for whom it is difficult, but they're a minority - go to any restaurant and watch people eat). A lot of heart disease, diabetes, high cholesterol, lung cancer, joint issues, etc. in this country are almost entirely preventable - but we all pay for it.

I have seen this firsthand over and over again, so please don't ask to debate me on this. I've heard all the 'it's none of your business what I do' personal responsibility/where do you draw the line/fast food is the problem arguments. While they have some merit, this is a significant issue that we have to face up to. He asked for our opinions, this is mine.

 

[Martha]

1. What is your personal situation that you feel needs to be solved?

I have health insurance through COBRA. When it expires, I will have it though the Minnesota risk pool. Once I am off the group plan and in the risk pool I am seriously limited in where I can live. I essentially cannot move. Most states, if they even have an open risk pool with adequate coverage, would require me to live there 6 months before I could apply for their pool and then there might be a pre-existing condition waiting period.

1. Do you have also have social agenda that is broader than your personal situation?

Most certainly. I have posted repeatedly on the issues facing the uninsured and the underinsured. Also, small employers are having a difficult time in keeping an insurance plan for their employees with now only 60% of small employers (those with less than 100 employees) offer health insurance. And some of those only offer health insurance at a very high cost to the employees, often not affordable.

I also am concerned about a significant underclass of people who are unemployed or underemployed and have no insurance. Their income is low and they can't buy on the market. They might have health conditions that require expensive prescriptions. I volunteer with a shelter for troubled young people. Often they are unable to get SSI even though they have many characteristics that make it hard to impossible to find and keep a job. No one is helping them get on their feet. If they are over 18 and not disabled under the opinion of the SSA and have no kids, they don't get medicaid. There is some drug assistance programs we track down for them but there are copays and they have no money. I am paying copays for two young people right now. One lost an SSI appeal. She takes an antipsychotic drug, an antidepressant and a drug to help her sleep at night. Without the drugs I have no question she would try to commit suicide. She also has been in the hospital several times for mental health issues. No one pays so the hospital's costs increase for all.

1. Briefly state what you think the basic problem is and the solution to the problem.

A disjointed health care sector, there is no "system." Costs are a problem. Delivery of care is a problem. Insurance is a problem. Administration costs of 30% of the health care dollar is a problem.

There is no one simple solution. We have to look at what are driving the cost issues and how to bring that down. Former Minnesota senator Dave Durenberger, a republican, chairs the National Institute of Health Policy which is spending its time looking at health care cost issues and delivery issues. National* Institute of* Health Policy

My particular interest is the access issue. I favor some form of national health care like Medicare for all. Alternatively, I favor a plan like Senator Wyden's that requires everyone to have health insurance, but does not allow underwriting. It is paid for on a sliding fee scale through income taxes.

 

[Coach]

1. I worry about insurance from retirement to Medicare. Currently my employer will allow me to remain in their group plan, but I worry that might change. Without that I would need to use the state high risk pool. I also worry about cost increases.

2. I believe we in the US can afford to make sure everyone has access to health care.

3. I think we're using the wrong model to pay for health care. It's called insurance but it's really more of a prepaid plan. I favor a single-payer plan.

Coach

 

[Gumby]

1. The young wife and I have no personal problems with healthcare. Currently w*rking and still insured and I expect that we will be able to purchase insurance after retirement. We are both currently healthy and take no medications, so that helps.

2. I am concerned that all Americans have access to essential medical services. I see this not only as a moral imperative but as a practical matter; we cannot have a first rate country and economy with an unhealthy population.

3. The problems are excess middlemen (i.e - insurance companies); profiteering drug companies and a system that, for a too large number of people, ensures that their first choice of medical care is the emergency room. There is insufficient focus on preventive care. I favor a single government payer, tax supported system for all. I think your idea of an HMO type system with modest co-pays is a good one, for the reasons you have noted.

 

[Zathras]

1. I have insurance through COBRA and will have private insurance after that. Wife has her own individual plan. Rates are high, but I am diabetic and we both have our fair share of perscriptions.

2. I believe everyone should have access to preventative and basic/livesaving care. Morally, practical and financially I think this is extremely important.

3. Costs are so out of control it isn't funny. Part of the issue is our current system is a 'fix it once it becomes broken'. It is FAR more cost efficient to practice preventative medicine. Get a filing, then you don't need a root canal. That type of thing. I also agree there are many other contributors to costs, this is just one that hasn't been mentioned much

 

[figner]

1. Currently I have health insurance through my employer. However I have some pre-existing conditions and am concerned that I would not be able to purchase private insurance at a reasonable cost if I lost my job (or decided to ER). If I lost my job because of an illness and couldn't afford private insurance after COBRA ran out, I'd be screwed. (state risk pools vary from state to state, are not always good coverage, and as Martha said may lock you into living in that location.)

2. I think anyone should be able to have health insurance / affordable care. This doesn't mean free - I think the consumer needs to bear some proportion of the cost to provide incentives to keep costs down.

3. Health insurance should not be tied exclusively to employment for many people. I would support having health insurance required of everyone, much like car insurance, in order to spread the costs over the entire population. Then you could reduce underwriting (maybe only allow certain percentage increases over the "standard" cost for things like age ranges, also like car insurance). I agree with Coach that health insurance should be more like insurance than a prepaid plan. I know a lot of people who see the doctor for every little issue because it costs them hardly anything to go in and order a bunch of tests. If people had to pay more of their non-catastrophic costs directly, I think these costs would become better known and better controlled.

Another part of health care that seems broken to me is the whole insurance reimbursement model. Spending hours on the phone trying to figure out what procedures are covered under your insurance, having to submit the reimbursement paperwork in exactly the right way, trying to get a life-saving procedure approved through bureaucracy, being told that while you were unconscious in the OR an out-of-network anesthesiologist provided you with services that the insurance company won't cover - these things all seem like a life-draining, cost-inflating waste of time. I'm not sure what the solution is.

 

[growing_older]

1. What is your personal situation that you feel needs to be solved?
2. Do you have also have social agenda that is broader than your personal situation?
3. Briefly state what you think the basic problem is and the solution to the problem.

1. I currently have health insurance through employment. That means I am dependent on the plan my employer chooses and my continued coverage is dependent on my continued employment. When I reach FIRE I will need to get private coverage from a new plan and am concerned about whether such plans will be easily available or what the cost might be. The option to self insure in pretty much non existent due to pricing games played with insurance (see below).

2. I think it is in the interest of everyone to have affordable health care available to everyone. Making healthcare a luxury item makes for social unrest. I hope we can do so without excessively high costs.

3. In the current system profit motives are not aligned with public policy motives (such as quality care). Any efficiency which could inrease profit or decrease liability is quickly adopted by the system. I recently had three tests done. My insurance paid $200 for two of them and zero for the third. Had I been uninsured my cost would have been $1800 but provider accepted $400 from insurance. I'm sure they still made money, so why the price distortions. Forces everyone into health plans or face userous bills. Similarly, my father was recently hospitalized briefly. In three days, we found a dozen incidents where medication was ordered but not given, was given wrong, was delayed for hours or was incorrectly countermanded by a different department. Care is compartmentalized so one dept requests something, another dept transmits the request and a third department does the work. No one is responsible for anything, they just work from the list and sometimes make mistakes - oh well. By turning it into an assembly line for efficient profits, the actual concept of care is becoming lost in the process.

 

[TromboneAl]

1. Health insurance is expensive, even if we're healthy.
2. Too complex for me to have a social agenda
3. Basic problem is illustrated by this: The equipment shown here

Must be disposable, and have an extremely low failure rate. The companies that produce it have to deal with lawsuits. As a result, it has to be unreasonably expensive.

 

[bright eyed]

We are all focused on the potential for Health Care changes this election. Specifically affordable health care.

Here are 3 questions. Please comment.

1. What is your personal situation that you feel needs to be solved?
2. Do you have also have social agenda that is broader than your personal situation?
3. Briefly state what you think the basic problem is and the solution to the problem.

1. I have health coverage for myself and whole family, totally covered by my job - no out of pocket and $5 copay.
2. Yes, however, aside from my basic ideas of fairness, I think the current system does not make economic sense to individuals or the country - we're all paying more than we should because of things others have cited like admin costs etc. I don't understand what people mean by "free" health care - it won't be free - it's just whether we pay out of paychecks or pay at the counter - it's going to be paid for - however different individuals may pay according to their ability.

3.There was a professor I heard say it best - "if the american people want us to figure out the public policy to fix the system -we can do that - but they have to be willing to pay for it" - that has been the biggest road block - but obviously we are all starting to realize we're all in the same pot of poop regardless if we currently have care or not. Politicians are coming up with zany ideas because they are trying to please too many different interests - once those align, the policy will align and make more sense.

 

[maddythebeagle]

I am a working professional and get health insurance through work...and probably will always have available...I have used a fair amount of health care for my age and would say the system is broken and had significant hassles advocating for myself even with insurance...I have changed my mind and think that some form of universal health care is the way to go.

 

[chinaco]

Great posts.

Interesting, we all pay for our healthcare (through working, out of pocket, etc). But we all think people should have affordable access.

I have heard some people express (in articles, interviews, etc) that some people do not take care of themselves and are a large portion of the extra expense. I would be in favor of an unhealthy lifestyle surcharge. I am not sure how to do it fairly. But it seems reasonable.

Some commented that certain people might not be able to pay the copay. I agree some are strapped for funds. I would think it would be reasonable to have them do some work (community service) to pay the copay. There is no shortage of things to do in our communities. Of course, if someone is disabled (special conditions) this too could be waived. I think the copay is an important part of the program to ensure people do not waste. Plus, I am big on personal responsibility.

 

[Marquette]

1. Working professional with employer-subsidized group insurance.

Here's my personal situation. I'm partially looking where to retire based on ability to get health insurance (for instance, current state has a high risk pool). Even if I was able to self-insure, I don't think I could stand trying to negotiate costs down like an insurance company. (I recall seeing the differences in costs between a negotiated and non-negotiated hospital stay... much less differences in costs just between providers).

Once I do find insurance, I'm not sure how comfortable I'll be with moving. I assume I'll be stuck.

As far as coverage situations... I have Factor V Lieden (positive side, when I get cut I clot fast. downside, I'm at risk for blood clots). I have a benign (we hope) tumor or bone growth inside the back of my rib cage. My wife has beta thalassemia minor and general anxiety disorder.... I'm not looking forward to shopping for coverage.

2. Social agenda.... I suppose

I think that, as rich and creative as we are as a country, we should be able to come up with some scheme to provide health care coverage for everyone. It's not a black-and-white issue and it covers all sorts of socio-economic boundaries.

3.
I'm not smart enough to figure it out, but I see a lot of waste in the system. Between administrative costs, expensive procedures that don't do any more than what they replaced, etc, I would think we could do better.

 

[lazygood4nothinbum]

What is your personal situation that you feel needs to be solved?

when i switched from group to individual insurance, even though i stayed with the same underwriter (now issued through it's subsidiary) i suddenly had a pre-existing condition (glaucoma) which developed while i'd already been paying into--not just "the system" but--this same company for about 18 years. only now that i switched policy from group to individual, suddenly my glaucoma is no longer covered.

Briefly state what you think the basic problem is and the solution to the problem.

the problem is a lack of continuity in their coverage while i have not missed a payment in all these years. the solution is continued coverage for conditions developed while paying premiums and i don't care if it just went from group to individual within the same company, or--and i'm sure i'll get flack on this because i could argue against it myself--even if it is between companies as long as i have paid to maintain continuous coverage.

now that i'm considering a vagabond lifestyle overseas, i am concerned that if i get international insurance and then develop another condition that i won't be able to come back to the u.s. system until medicare kicks in because insurance could become cost-prohibitive. so i'm trying to judge just when to leave. maybe i'd like 10 years so i should stick around for another five. but maybe i'd have more fun now, well, then i better like it for 15 years (yikes, 14 already, time sure flies when you can't sell your real estate).

Do you have also have social agenda that is broader than your personal situation?

yes, but it is unrelated to medical insurance.

I think our collective health is deteriorating enough to more than offset savings from those issues.

you stole what was going to be my rant on first reading the original post.

 

[Dean]

Medical insurance.....

Well, I am old enough to remember going to the doctor as a kid and having my parents pay a reasonable fee for services rendered. They most likely had insurance but only for catastrophic stuff, and I think this system is one to which we should return. This so called insurance we now have just encourages people to seek care when they don't really need it because "it doesn't cost me anything". Of course it does in the long run -- higher fees!! As a dyed in the wool Republican I, too, am big on personal responsibility and would prefer to keep the government OUT of personal affairs as much as possible. If one can afford to pay for oneself and family, that is the model we should adopt. Those who truly can't afford care for some good reason like disability, unemployment for a time, etc., should certainly have some form of government care for which taxes would pay. But what we have now is a huge overblown nightmare that causes doctors to overprotect themselves at their and our expense, and frankly I don't blame them! We need to return to a sensible fee scale for which people would pay as they needed care. Then care could be used for those who truly need it and these giant "insurance" providers could stop spending their time and our money on deciding who and what is covered or not and basically driving us all nuts with their unintelligible "policies" and sky high fees. Just think of what would happen if the current insurance model were applied to something like energy consumption. Now the people who drive the most pay the most for gas -- just as it should be. Imagine having some sort of "insurance" that would allow people to just drive as much as they wanted because they and their employers were "covered" for fuel expenses would simply encourage people to drive because they COULD!! We would have MORE energy problems and lots more waste. Let's get this current system FIXED by returning to one based on common sense!!

 

[d]

3. there are many "problems" with health care systems (any, not just "ours"). fundamentally, i believe one of the major cost drivers has been overlooked: technology and scientific advances. if you were willing to live (or die) with 60's medical care, our health care costs would likely be well under control.

 

[chinaco]

...

As far as coverage situations... I have Factor V Lieden (positive side, when I get cut I clot fast. downside, I'm at risk for blood clots). I have a benign (we hope) tumor or bone growth inside the back of my rib cage. My wife has beta thalassemia minor and general anxiety disorder....

Sorry to hear that. Hope things work out.

 

[Rich_by_the_Bay]

I have employer-sponsored and adequate heatlh insurance. I can continue it since it is a retiree policy from a job I recently retired from (though now full time with another employer). It will be at my personal expense when I retire, but at least I've got it.

I definitely have a social agenda in this regard: I favor universal access and government-subsidized coverage for under- or uninsured citizens; for those with means and employment, premiums/participation should be mandatory. I'm OK with private practice as the predominant delivery model, but would prefer a more centralized oversight rather than state by state. I also favor either high deductible or co-pays to motivate patients to use the system with discretion. I would strictly police big pharma, and outlaw services, gifts, and other kiss-ups to providers, as well as direct-to-consumer prescription drug ads (propaganda, misleading, and not reasonable to expect a layperson to do their own due diligence). I would limit damage awards to an amount needed to provide financial security to the harmed patient after expenses.

While I don't think it is politically likely, I favor a Medicare-like system using fair reimbursement (commensurate with training, risks, and intensity of the profession), private group practices, limit insurance company role to that of fiscal intermediary. I am against "pay for performance" since there is serious doubt about how this is measured, and the influence of selection bias (sometimes the best doctors get the sickest patients), but I do support incentives for adherence to "best" practice when a) there is one and b) when peer-review confirms that non-adherence was for valid reasons.

And that's jut my executive summary ...

 

[free4now]

1. I feel a bit trapped by my insurance situation. Since it took months and several rounds of appeals to get the private insurance policy I now have, I don't feel like I can count on being able to get private insurance. This tends to reduce my interest in working side jobs with insurance or moving to another state.


2. Social agenda: Pretty simple. I know that my hassles are much less than what many deal with, and I don't want anyone to suffer unnecessarily.

3. The main problem seems to be that the insurance companies are motivated more to deny coverage than to provide coverage. The only way out from this situation is to have a disinterested third party (probably the government) handle the claims approval process. Also, the only way out from having insurers motivated to drop or avoid people with sickness is to have everyone be covered by one entity. I agree with others that it should be more insurance than prepaid healthcare... deductibles/copays that rise from zero for those in poverty to high levels for the wealthy would do this. The cost for the health insurance should be paid just like income tax: witheld from your paycheck and progressive according to income.

 

[DblDoc]

1. What is your personal situation that you feel needs to be solved?
2. Do you have also have social agenda that is broader than your personal situation?
3. Briefly state what you think the basic problem is and the solution to the problem.

I currently have coverage through work - but it is a high deductible plan. Covering costs for health insurance is the biggest unknown for us in planning for retiring early.

As I work on the front lines I certainly have an agenda. The system is broken and worsens every year. Here in Seattle in the last 5 years we have gone from rarely closing our ED to ambulances to doing it daily due to ED and Hospital overcrowding city wide. We board patients - even critically ill ones in our ED hallways every day now. Even a Democrat controlled White House and Senate would take years to make any significant change in this - and that assumes that health care remains a priority and funding exists.

The basic problem? We want (demand) the "best" health care in the world and whole industries strive to provide it at a profit.

DD

 

[Insanity]

What is your personal situation that you feel needs to be solved?

We have employer-sponsored health care and I have a congenital blood disorder that requires ongoing care.

There are several problems I think need to be addressed, starting with our nation spending more per-capita on health care than any other nation on earth while getting less for our dollar. I'm also concerned about the drum beat of stories in the news about insurance companies issuing automatic denials for implicitly covered services and forcing consumers to jump through hoops (or die, as some do) before getting approval, the lack of portability while traveling or moving from one employer to another, the cost to employers of providing inefficient health care to their employees and . . . .

Boy, the list goes on and on and on. Probably better to ask what I like about my health care coverage through Kaiser than the long list of things I see going wrong.

Do you have also have social agenda that is broader than your personal situation?

Yes. See what I think is wrong, above.

Briefly state what you think the basic problem is and the solution to the problem.

There are so many things that are wrong that, at first, I thought you were asking me to write a book. Then I thought of this one thing, and how it seems to be at the root of the problem. Right now the people who collect the health care dollars get rich by not providing timely and efficient health care. Drug companies, for example, earn more by inventing a drug for arthritis pain that is taken twice daily for years and years than developing a three-shot vaccine that cures cervical cancer and saves lives. Insurance companies make money by denying claims. Businesses save money by working employees long hours instead of hiring additional help because it costs them more money to pay for health care for those additional employees than it does to pay overtime.

So my simple solution is to change the equation to one that pays to keep people healthy instead of paying them to keep people sick.

 

[chinaco]

Interesting article. U.S. Health Care Spending In An International Context -- Reinhardt et al. 23 (3): 10 -- Health Affairs


If there is much truth to the observations in the article, the US may need fundamental change. Bandaids on the current system may not work.

We are likely to be caught up in a political quagmire. There are powerful business interests that do not want to disrupt the current cash machine. Probably similar to big oil. They are fine with the status quo (as long as they make money). Changes will rearrange the balance of power and money.

 

[bpp3]

1) I'm covered under national health insurance, so this is not an issue for me directly. Though I do have relatives left behind in the US for whom health care could be an issue.

2) No particular agenda, but as long as you are asking for my opinion:

3) The problem is that you need to make sure everyone is covered, at least to some basic level. Institute a health-care tax, plus use copays to keep frivolous use down -- just suggestions.

 

[ziggy29]

There are issues with the current insurance model and how drug pricing works, but the main problem with U.S. health care is we want it to be ALL of (a) affordable, (b) top quality and (c) highly accessible/not rationed. In reality, at best we can pick any two.