Health Care Law vs Patient Outcomes

[cassiemassey]

The way I understand our current Third Party Payer system the major decisions are made by a company looking to cut costs and make a profit. Drs are encouraged not to order 'unnessasary tests' (as if they would waste their time or effort on any test that is truely unnessasary) and Nurses are encouraged to not bring 'unnessasary' equipment into the patients room, streaching our care between 8-10 patients in the acute care setting and in LTC the ratios are extreemly frigtening.

But at the same time countries with a Single Party Payer system run into their own chalanges; Wait lists, higher taxes, and some treatments are not covered, not to mention it can be a buerocratic nightmaire. While I have never worked in a country with a Single Party Payer system, I am sure Health Care Providers are met with just as many chalanges.

As Nurses our priority isnt cost, profit, or politics; it is and always will be our patients. So my question is; Which system shows better Patient Outcomes, and why? Has there been a study done compairing them that I am not aware of? I want to better understand what is best for this country, and more importantly my patients.

[PMFB-RN, RN]

I don't know. I think there is a reason people come to the US for medical care.

*** And millions of Americans going abroad from heath care.

"A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue."

[elkpark]

You and many others are missing a big point. That is, what we have now IS NOT a free-market healthcare system. A free market system would be where the consumer controls how their healthcare dollars are spent. Not an insurance company. And not the government.

Consumers controlling the where, when, and how their healthcare dollars are spent will lead to competition, innovation, lower costs, and better quality of healthcare.

I'm not missing any "big point." Our current system is a highly warped, distorted version of free-market capitalism. However, it is still a "free market" system to the extent that employers are free to make decisions about spending on health insurance, and insurance companies are free to seriously screw over individuals attempting to purchase insurance. Individuals are free, in most cases, to opt out of their employers' insurance plans and make their own choices about spending money on healthcare if they choose, although most people would be crazy to do that, considering how the insurance companies and healthcare providers penalize individual consumers.

[cassiemassey]

I think you guys are getting off topic, I want to better understand healthcare in relation to patient outcomes, not the budget. It is a NESSESITY, and it if its right, then we will find a way to pay for it just like we find a way to pay for social security. I do not think that healthcare should be tied to someones employment. Im glad to hear that there are so many healthy people out there that can go the few months it takes to find a new job without healthcare, or those that are financially stable enough to afford cobra. I am not among them. I eat right and exercise regularly, I am in my early 20's. I also have a +3 murmur requiring maintencance medication for me to function, hypothyroidism, asthma, a skull base mass that we are 'watching' becouse it may or may not effect my carotid. I recently had my appendix out as well. Im one of those people that insurance companies hate becouse they know they will have to pay out the nose for my care. but if i went without these medications for even a day i would be incapacitated. one of the scaryest things for me is the risk of losing my job, becouse it could risk my life. I hear people saying that healthcare is not a human right issue, it is. I have the right to LIFE liberty and the pursuit of happyness. As a nurse and a patient I want to better understand what we need, then we can find a way to pay for it. lets keep politics out of it and discuss this problem as only nurses can!

[elkpark]

... lets keep politics out of it and discuss this problem as only nurses can!

(But, unfortunately, this is an inherently "political" question. Any significant change to our existing system has to be legislated.)

[SC_RNDude]

I'm not missing any "big point." Our current system is a highly warped, distorted version of free-market capitalism. However, it is still a "free market" system to the extent that employers are free to make decisions about spending on health insurance, and insurance companies are free to seriously screw over individuals attempting to purchase insurance. Individuals are free, in most cases, to opt out of their employers' insurance plans and make their own choices about spending money on healthcare if they choose, although most people would be crazy to do that, considering how the insurance companies and healthcare providers penalize individual consumers.

You are missing the point. You are dismissing the ideas of a free-market healthcare plan based on the experiences you have had in a healthcare system that you call a free-market, but in reality is nothing of the sort.

[SC_RNDude]

I think you guys are getting off topic, I want to better understand healthcare in relation to patient outcomes, not the budget. It is a NESSESITY, and it if its right, then we will find a way to pay for it just like we find a way to pay for social security. I do not think that healthcare should be tied to someones employment. Im glad to hear that there are so many healthy people out there that can go the few months it takes to find a new job without healthcare, or those that are financially stable enough to afford cobra. I am not among them. I eat right and exercise regularly, I am in my early 20's. I also have a +3 murmur requiring maintencance medication for me to function, hypothyroidism, asthma, a skull base mass that we are 'watching' becouse it may or may not effect my carotid. I recently had my appendix out as well. Im one of those people that insurance companies hate becouse they know they will have to pay out the nose for my care. but if i went without these medications for even a day i would be incapacitated. one of the scaryest things for me is the risk of losing my job, becouse it could risk my life. I hear people saying that healthcare is not a human right issue, it is. I have the right to LIFE liberty and the pursuit of happyness. As a nurse and a patient I want to better understand what we need, then we can find a way to pay for it. lets keep politics out of it and discuss this problem as only nurses can!

I am in favor of a free-market based healthplan because it will lead to better patient outcomes.

In a free-market based plan, employers would be getting out of the management of your healthcare. And insurance companies would as well.

Health insurance would be for emergency care and for lack of a better term, "catastrophic" situations only, much like your car, home, life, etc. insurance. For example, you get a cancer diagnosis, the insurance company would give YOU a payout. You then decide on the treatment. YOU are in control of your care, not the insurance company.

This insurance would not be tied to your employment. You would buy this as an individual, and and long as you keep paying premiums, they can't drop you. Insurance companies will set rates by your risk factors, again much like car, home, and life insurance. Instead of doing everything they can to keep unhealthy people away like they do now, now they will be competing for all types of customers.

The consumer will be responsible to pay for routine exams, RX's, diagnostics, etc. They will do this with tax-free Health Savings Accounts. As an employee benefit, employers will contribute to these accounts as well. Your care will be managed by YOU, not your employer and not your insurance company.

Of course there will be situations in which people still will not be able to afford their healthcare for a variety of reasons. That is when medicaid/medicare, charity, etc. will kick in.

As the healthcare consumer, you will be managing your own healthcare. You will have the power of choice. Those in the healthcare industry will then have the motivation to keep innovating in order to provide the best options for healthcare at the best values possible.

Neither political party is promoting such a plan right now, unfortunately. However, Obamacare is a speeding locomotive in the opposite direction, and will take a very, very long time to recover from if ever fully implemented.

[musingmom]

Edited to say: I replied without reading the rest of the new posts.

SC_RNDude has made my point about free markets better than I could.

I always suspect, in these conversations, that the individuals proposing "free market" systems and that people who have a problem with paying for insurance just don't want to be responsible probably don't have any experience as an individual customer in our current free market system. You don't really get how bad the system is until you've tried to buy insurance on your own in our wonderful "free market."

Actually, I do not think our current system is a true "Free Market." There are hundreds of health care laws on the books, tax laws that affect health care, a myriad of ways the government and the insurance companies collude to the consumer's detriment. I would suggest that those are some of the reasons we find ourselves in this mire, which I agree with you, is unsustainable.

Also, if I implied that people who don't want to purchase insurance just don't want to be responsible, I apologize, that was not my intent. I was trying to point out the the current reforms are not worth the panic level they are often assigned.

[JMBnurse]

I am in favor of a free-market based healthplan because it will lead to better patient outcomes.

In a free-market based plan, employers would be getting out of the management of your healthcare. And insurance companies would as well.

Health insurance would be for emergency care and for lack of a better term, "catastrophic" situations only, much like your car, home, life, etc. insurance. For example, you get a cancer diagnosis, the insurance company would give YOU a payout. You then decide on the treatment. YOU are in control of your care, not the insurance company.

This insurance would not be tied to your employment. You would buy this as an individual, and and long as you keep paying premiums, they can't drop you. Insurance companies will set rates by your risk factors, again much like car, home, and life insurance. Instead of doing everything they can to keep unhealthy people away like they do now, now they will be competing for all types of customers.

The consumer will be responsible to pay for routine exams, RX's, diagnostics, etc. They will do this with tax-free Health Savings Accounts. As an employee benefit, employers will contribute to these accounts as well. Your care will be managed by YOU, not your employer and not your insurance company.

Of course there will be situations in which people still will not be able to afford their healthcare for a variety of reasons. That is when medicaid/medicare, charity, etc. will kick in.

As the healthcare consumer, you will be managing your own healthcare. You will have the power of choice. Those in the healthcare industry will then have the motivation to keep innovating in order to provide the best options for healthcare at the best values possible.

Neither political party is promoting such a plan right now, unfortunately. However, Obamacare is a speeding locomotive in the opposite direction, and will take a very, very long time to recover from if

ever fully implemented.

This sounds like just a slight revision of our current system. This sounds to me like, again, it would only benefit the wealthy and college graduates with good jobs. The working poor who are not eligible for Medicaid would struggle with this type of system. They would pay higher premiums if they have a medical condition/s? And if they miss a payment, their coverage can be cancelled? I also think this would lead to a decrease in receiving primary care. We desperately need "affordable" health care for all. This will improve our outcomes.

[SC_RNDude]

This sounds like just a slight revision of our current system. This sounds to me like, again, it would only benefit the wealthy and college graduates with good jobs. The working poor who are not eligible for Medicaid would struggle with this type of system. They would pay higher premiums if they have a medical condition/s? And if they miss a payment, their coverage can be cancelled? I also think this would lead to a decrease in receiving primary care. We desperately need "affordable" health care for all. This will improve our outcomes.

It is more then a slight revision. Currently, most people get insurance through their employer. You have little choice in what insurance company to use. And when you use healthcare services, the insurance company has the most say in where, when, and how you use those healthcare services. When you lose your job, or change jobs, you lose your insurance. You go without until you get a new job, or you shop for a private plan. That is when those with pre-existing conditions have problems.

In a free-market plan, insurance is cheaper then now. You will buy your insurance from any company you want, and you will keep it regardless of your employment. Insurance will only pay for emergencies and serious illness. They will be able to charge more for higher risk people. They will now want to sign up both healthy and higher risk people, and they now will be competing with all other insurance companies to do so. They will be getting rid of the task of managing your healthcare, they will simply write the checks, thus further driving their costs down.

Think of how car insurance is set up. If you have a good driving record or drive a less expensive car your rates are cheaper. Higher risk customers pay more. Car companies compete for both kinds of business. Most people have a long-term relationship with their car insurance companies, which goes a long way in making the industry work for both the insurance company and customer. Despite the fact that a car insurance company may have to pay out thousands and even hundreds of thousands (in the case of liability, including medical costs), car insurance is attainable and affordable for most.

When it comes to using healthcare services for things such as primary care, the consumer will use their own money out of an HSA to pay. Or in the case of a serious illness the insurance company will make a payout. The consumer will be deciding where the money goes, not the insurance company. That means healthcare providers will be competing for these services. This kind of competition fosters innovation and better values in healthcare, which also means lower costs.

Have you seen those clinics in Walgreens? That is an example of what happens in the free-market. This is a innovation in primary care that people are willing to pay an affordable price for without using their insurance.

For people in bad financial situations there is still Medicaid, Medicare, charities, etc.

Obviously, not all the answers are here, nor does any one person even have all the answers. The most important thing to get out of this discussion is that there are many ideas out there about improving healthcare. Most people seem to be stuck on the thought that we have only the flawed system we have now, Obamacare, or "Medicare for all" to choose from. That is not true.

[cassiemassey]

In the system your discribing people would shun preventative and early care due to finances and wait until an issue is catastrophic and irreversable. And what about those with chronic conditions, just go bankrupt and die? this isnt whats best for our patients. i know im asking an idealist question but i want to understand what is best for the PATIENT, and from the sounds of it your proposal is not. This is why i want to keep the politics to the minimum and look at it from a nurses prospective. we are the people who should be designing this new healthcare system not administrators and not politicians becouse, though they see the numbers on the page, they do not fully comprehend the impact of their decisions.

[PMFB-RN, RN]

In a free-market plan, insurance is cheaper then now. You will buy your insurance from any company you want, and you will keep it regardless of your employment. Insurance will only pay for emergencies and serious illness. They will be able to charge more for higher risk people. They will now want to sign up both healthy and higher risk people, and they now will be competing with all other insurance companies to do so. They will be getting rid of the task of managing your healthcare, they will simply write the checks, thus further driving their costs down

*** I would like to see the evidence of that being true. Sounds OK but I am sceptical. With my fantasic experience as a patient, the father of a patient, the husband of a patient, the grandson in law of a patient and as a nurse in a single payer health plan I lean hard in that way. Especialy since I paid less in taxes as a percentage of my income in that country than I do now in USA.

That said I am willing to concede that just becuase a single payer system can provide great and timely care at a low cost, that doesen't mean it can be pulled off by Americans.

[SC_RNDude]

In the system your discribing people would shun preventative and early care due to finances and wait until an issue is catastrophic and irreversable. And what about those with chronic conditions, just go bankrupt and die? this isnt whats best for our patients. i know im asking an idealist question but i want to understand what is best for the PATIENT, and from the sounds of it your proposal is not. This is why i want to keep the politics to the minimum and look at it from a nurses prospective. we are the people who should be designing this new healthcare system not administrators and not politicians becouse, though they see the numbers on the page, they do not fully comprehend the impact of their decisions.

I am a nurse, so I am looking at it from a nurse's perspective. I'm also a healthcare consumer, and all my friends and family are as well. Just as much as you, I want a healthcare system that provides great patient outcomes.

Why would finances keep people from seeking preventive care? Again, people would have tax-free health savings accounts, of which employers could contribute to as a work benefit. Given the choice, employers will jump at the chance to drop insurance coverage to instead contribute a few or even several hundred dollars a month to a HSA. Between the employee and employer, it would be easy to get a few thousand dollars a year for this, and probably significantly more. This is more then a enough for preventive care, and would cover a lot of care for chronic conditions.

For the chronically unemployed, or for those catastrophic type of situations, there is Medicare, Medicaid, Insurance, and charity.

And, don't underestimate the benefits of the consumer controlling where the money goes. The competition for this money fosters innovation and value. The current system, or a single-payer system does not. Lazik and cosmetic surgery are examples of this. The options available and quality have increased for these procedures while the prices have dropped. This because these services are offered within a free-market. Third-party payers are not part of the picture.

You mentioned earlier that "if it is right, we will find a way to pay for it". You used social security as an example. I believe you also said you are in your 20's. You may be interested to know that as of the present, you do not have social security coming your way. It will be gone by the time you are able to collect it. And do you know what is being done to fix it? Zilch!

Medicare is in even worse shape. Dr's are increasingly refusing medicare patients, and hospitals are cutting back. How is this better for patient outcomes?

I know you don't want to talk about hpw to pay for things, we will just find a way. However, this is very naive and unrealistic. Everyone wants a healthcare system that will work for everyone. Some of us just have different opinions on how to get that done.