Author Topic: A real moderate approach to fixing American healthcare and health insurance.  (Read 1806 times)

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Offline Shine

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A great read, and I think addresses the problem of not only our past healthcare system, but what our system is turning into with the ACA. If you take the time to read it, please provide your thoughts!  :tup
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Offline GuineaPig

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I found it interesting that he didn't mention any other countries at all in this chapter (albeit, there may be more to this work not currently available).  He writes well and offers some interesting suggestions, but his proposals are only "moderate" insofar that he ignores the rest of the world.
"In the beginning, the universe was created. This made a lot of people very angry, and has been widely regarded as a bad idea."

Offline j

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Good read, I'm at work and don't have time to read the final section just yet, but I will when I get a chance.  He seems to understand the broader problems with American politics, although why he is so optimistic that they can be overcome outside of "civil unrest" I'm not sure.

More specifically, his account of the care he received in the ER is disturbingly accurate in many ways.  The ER doctors and other staff are intentionally left rather poorly informed with regard to the financial side of things and are frankly trained to completely disregard such factors lest it compromise the care they provide or have an affect on their decision-making outside of the patient's well-being.  They are required by law to treat any patient who presents to the ER, and even though the actual degree of "emergency" of the patients' conditions varies wildly, they're all given the same "emergent" care, with relative priority given to the higher acuity patients.  The hospital has collectors that come around from room to room to inform patients about approximate costs and to find out what they will be willing to pay and when (often the answers are "nothing" and "never").  These people are the only ones who will directly address anything of a financial nature while the patient is in the hospital.

The same medications, treatments, and other costs incurred in an ER--versus some primary care facility or something--are billed at obscenely high rates.  Some of the biggest obstacles to remedying this are all the middle men like billing companies, management companies, insurance companies, etc.  And the ER doctors are usually contractors rather than direct employees of the hospital (whether this is the same for nurses I don't know), which adds another layer of insulation between the actual services provided and the fees being charged.


Offline El Barto

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Haven't read much of the guy's article, but I intend to as what I did read seemed promising. 

Just addressing J's post, which is fairly accurate with regards to my trip through the ER.  Two things I can add is that nobody ever tried to explain any costs to me at all, which was quite disconcerting.  Somebody did show up very early on with a credit card scanner to ask if I wanted to pay my deductible up front, while providing no details whatsoever about what it could be.  I thought it was a pretty lousy practice, since if you're new to the ER experience, you're not exactly thinking real clearly. 

The other thing is that I got a separate bill from every doctor and imaging technician that got within 10' of me, but none from the nursing staff, so I suspect that they're employees of the hospital and not contractors. 
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Offline Scheavo

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I think he touches upon some good issues, but I don't think he proposes anything close to a full response to the issue. He's right to point out that the customer needs more control and knowledge over the costs he'll pay, and he brings up some really good points about tort reform, but he doesn't seem to deal with some of the major issues of the ACA, like requiring a certain amount of money to go towards health care costs, or not being able to deny people with pre-existing conditions coverage, or drop them later when they try to use their service

Let's be honest, in a private for-profit market, the old and the sick are going to be at a disadvantage, even though they're the very ones we're taking care of. Private health care insurance is the problem, there are several private health care models around the country that don't use insurance that work better.