We don't need over-priced insurance - we need Guaranteed Healthcare.

The idea of guaranteed insurance really scares me. I remember debating this issue of healthcare as a right or privilege in many HealthCare Administration courses. If you ever look at socialized healthcare, you will realize that the pursuit of technology and innovations will decline because the market will not support it.

You will also realize that the people who have the means to circumvent the guaranteed system and seek care elsewhere will do it. You are left with a system that cannot provide care adequately to those that have no other options. Therefore, you have people waiting for months to receive an MRI or joint replacement surgery.

I used to work at hospitals in Michigan, we always got the people with money coming over from Canada for elective medical care. I do agree that the health care system needs a fix. Here are my ideas:

1) Medicare Part D-get rid of all the red tape. Just give each eligible member a preloaded prescription only debit card. Hundreds of millions of dollars would be saved. Not to mention all of the trees that died in order to print all of the marketing materials and formularies.

2) Tort reform-Protect doctors from non-compliant patients. If a patient wins a suit, use that money to cover health care for other patients.

3) Health care premiums should be tax deductible.

Insurance companies are making record profits. They are the ones who make out while cutting reimbursement to doctors and other providers.

How about forget the hyping that everyone needs "health insurance" for health maintenance and instead aim for "affordable health care"? The idea of insurance is too pool resources to cover an unlikely event. You pay into the insurance in the hopes that you'll never need to use it. If everyone expects and demands to get out of it at least as much as they pay into it it won't hold. Thus, the insurance model doesn't work for health care which includes health maintenance, on-going medications, etc.

Instead, what insurance companies do now (and Medicare does this, too) is threaten to take their patient base away if the health care providers don't give them the lowest rates, even if that rate isn't enough to pay for the services. Meanwhile, providers jack up their rates in response to insurance companies only paying a fraction of the bill. So you see these bills for basic service for $250 that the insurance company reimburses for $25.

We could make very low interest loans and reasonable payment plans to cover one-time expenses. A chest x-ray or a 10-day supply of antibiotics for $10/month for 10 months. Sounds better than just having to shell out $100. And it's definitely better than carrying a balance on a credit card.

Chronic disease, though poses a big problem. A problem that health insurance and the private market alone most certainly can't control without guidance and regulation. After all, it does make financial sense for insurance companies to deny those with chronic disease or at risk for chronic disease. And those with chronic disease are the least likely to be able to afford expensive, on-going treatment. There's no money to be made in insuring folks with known or predictable expensive health issues. Which is why society-wide incentives and subsidies need to be considered to ensure the provision of affordable, quality care.

the idea of guaranteed insurance really scares me. i remember debating this issue of healthcare as a right or privilege in many healthcare administration courses. if you ever look at socialized healthcare, you will realize that the pursuit of technology and innovations will decline because the market will not support it.

comment: except that oecd countries that have universal care actually have more mri machines etc/capita than the us does.....

you will also realize that the people who have the means to circumvent the guaranteed system and seek care elsewhere will do it. you are left with a system that cannot provide care adequately to those that have no other options. therefore, you have people waiting for months to receive an mri or joint replacement surgery.

comment: see the french system and how these issues are addressed.

the government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance -- which 86 percent do, most of them through employers, with the poor being subsidized by the state. this allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in france.

france's system is further prized for its high level of choice and responsiveness -- attributes that led the world health organization to rank it the finest in the world (america's system came in at no. 37, between costa rica and slovenia). the french can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed.

http://www.prospect.org/cs/articles?article=the_health_of_nations

i used to work at hospitals in michigan, we always got the people with money coming over from canada for elective medical care. i do agree that the health care system needs a fix.

comment: note the word elective. us and canadian waiting times for services are actually almost identical. see myths and meme's at: http://pnhp.org/facts/myths_memes.pdf

these are mainly patients not wanting to wait for elective or non-urgent care within the system, who gain access to private care through either private insurance or out-of-pocket payments. no evidence is presented that waiting times within the system adversely affect clinical outcomes, and no distinction is made between "need" and "desire" on the part of patients who bypass waiting lists. an exaggerated impression is given of both waiting lists and the "growing number" of canadians traveling to the united states for medical care, based on a 1996 article (16).

...

overcrowding of emergency rooms in canada is increasingly mirrored by the

same problem in the united states, though underreported in this country.

physicians at the los angeles county-usc medical center have testified

that some emergency room patients can wait up to four days for a bed and

that others may die before receiving care (17). of the millions of americans

crowding u.s. emergency rooms, many have problems that could have been prevented by earlier care; they end up being charged the highest rates for

emergency care, then are released with often inadequate follow-up care (18).

* though admittedly the canadian system is underfunded, and extended waits for some elective services may be a problem in some parts of the country, these problems are often exaggerated by its detractors based on unreliable self-reported data. in 1998, fewer than 1 percent of canadians were on waiting lists, with fewer than 10 percent of these waiting longer than four months

(19). waiting times in the united states, even for the privately insured, are now increasing for checkups as well as for sick visits (20).

comprehensive and reliable provincial databases on waiting times show that

in recent years, waiting times have decreased while services have increased. for example, coronary bypass surgery increased by 66 percent between 1991 and 1997 in manitoba, while waiting times were reduced for that procedure and also shortened for five other elective procedures--carotid endarterectomy, cholecystectomy, hernia repair, tonsillectomy, and transurethral resection of the prostate (21).

* although there is a widespread myth that many canadians seek medical

care in the united states, a three-state study reported in 2002 found that

this number is very low for either outpatient or hospital care, and largely due to these canadians needing medical care while traveling in the united states (22).

here are my ideas:

1) medicare part d-get rid of all the red tape. just give each eligible member a preloaded prescription only debit card. hundreds of millions of dollars would be saved. not to mention all of the trees that died in order to print all of the marketing materials and formularies.

comment: 2 ideas as a supplement. a> allow medicare to negotiate for volume discounts. b> adopt a reimbursement system similar to france's for medications.

the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.

http://www.prospect.org/cs/articles?article=the_health_of_nations

2) tort reform-protect doctors from non-compliant patients. if a patient wins a suit, use that money to cover health care for other patients.

3) health care premiums should be tax deductible.

comment: the impact of tort reform is overstated. see :

the numbers show that lawsuits are an insignificant cost both to businesses and to health providers, for whom they represent less than 2 percent of spending. in short, the lawsuit-abuse crisis is a hoax. yet the republican right has launched one of the great propaganda blitzes of recent american history to yank the teeth from the civil jury. http://www.thenation.com/doc/20041025/zegart/4

we actually need to do a much better job at prevention and management of chronic illness as well as managing the impacts: again see:

in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.

http://www.prospect.org/cs/articles?article=the_health_of_nations

From Washington to Sacramento, the air is filled with talk about how to reform our dysfunctional healthcare system. But only a single-payer system would assure that everyone is covered with one high standard of benefits and care, (as opposed to good care for the wealthy only) establish effective cost controls, curb administrative waste, and end insurance industry interference with care.

http://www.guaranteedhealthcare.org/facts

Untrue.

A single payer system in no-way whatsoever assures "that everyone is covered with one high standard of benefits and care," and in fact assures that everyone is guaranteed coverage at the lowest levels routinely available, while people wealthy enough to purchase additional insurance will receive care not available at the single-payor level.

That is unless, you advocate completely eliminating private insurance and private payees and taking away people's right to do what they want with their bodies.