Health Care Law vs Patient Outcomes - page 3

by cassiemassey

4,200 Views | 30 Comments

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... Read More


  1. 0
    Quote from JMBnurse
    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.
  2. 2
    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.
    JMBnurse and laborer like this.
  3. 2
    Quote from SC_RNDude
    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.
    elkpark and laborer like this.
  4. 0
    Quote from 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.
    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.
  5. 0
    Quote from PMFB-RN
    *** 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.
    You are right, we don't have evidence. We don't have any model to choose from as an example that we can replicate and predict the results with certainty.

    I know you mentioned earlier too your % of taxes were less in the other country. Unless you know how all your taxes are broken down, it's hard to say if that is meaningful or not. The government in your other country probably spends a lot less on other things then the U.S. And do you really know how much you pay in taxes? I know many of us just look at our paystubs, and then forget that we often get a big refund once a year. Most of us in the end pay a lot less then we think.
  6. 1
    Quote from SC_RNDude
    You are right, we don't have evidence. We don't have any model to choose from as an example that we can replicate and predict the results with certainty.

    I know you mentioned earlier too your % of taxes were less in the other country. Unless you know how all your taxes are broken down, it's hard to say if that is meaningful or not. The government in your other country probably spends a lot less on other things then the U.S. And do you really know how much you pay in taxes? I know many of us just look at our paystubs, and then forget that we often get a big refund once a year. Most of us in the end pay a lot less then we think.
    *** Uh, yes I know how much I pay in taxes, except sales tax. I don't keep close track of that. I also knew how much I paid in taxes when I was working in New Zealand.
    laborer likes this.
  7. 2
    If this healthcare situation isnt sorted out in a way to improve patient outcomes, Im not going to live long enough to recieve SS. Heck, I was talking to a friend today who wears her contacts twice as long as recomended becouse she cant afford to go to the optomitrist every year, and her insurance only covers every other year (which as we all know predispositions her to infection). It is not financially possible to put enough money in a HSA to cover multiple chronic illnesses, and it certianly wont help you for illnesses yet to come. People would wait to recieve preventative and early care which would compromise their long term health, we've all seen that first hand, so the methoid your proposing doesnt seem to be effective for giving our patients a long health productive life. Your argument is still strongly based on finances and not on patient outcomes, give me some facts as to how this is better for our patients and I might change my mind but right now a single party system has more facts to back it up, and as some other countries have proven it is financialy possible.
    elkpark and JMBnurse like this.
  8. 0
    Quote from cassiemassey
    If this healthcare situation isnt sorted out in a way to improve patient outcomes, Im not going to live long enough to recieve SS. Heck, I was talking to a friend today who wears her contacts twice as long as recomended becouse she cant afford to go to the optomitrist every year, and her insurance only covers every other year (which as we all know predispositions her to infection). It is not financially possible to put enough money in a HSA to cover multiple chronic illnesses, and it certianly wont help you for illnesses yet to come. People would wait to recieve preventative and early care which would compromise their long term health, we've all seen that first hand, so the methoid your proposing doesnt seem to be effective for giving our patients a long health productive life. Your argument is still strongly based on finances and not on patient outcomes, give me some facts as to how this is better for our patients and I might change my mind but right now a single party system has more facts to back it up, and as some other countries have proven it is financialy possible.
    If you take the few hundred dollars or more you pay for insurance premiums a month, and if your employer kicks in a few hundred dollars a month that they would for insurance and instead put it into a HSA, this would be $5 to 10K a year. In most cases, this would be more then a enough for preventive care and management of many chronic conditions and to purchase a insurance plan for emergencies and serious illnesses. For those in need, the gov't would contribute to a HSA.

    You are correct, I don't have definate results to show what outcomes would be in a free-market healthcare system as there is not one that exists to model it after. However, I do know that almost every good and service I have in my life offers a variety of choice, price, quality, and value because of a free-market economy. And innovators are always looking for ways to improve these goods and services.

    You say that a "single party (I think you meant payer) system has more facts to back it up". But you haven't supplied these facts. Please show me where 300 million people who are currently in a healthcare system where, although far from perfect, everyone gets some level of care, who are then put on a single payer system. Show me the better patient outcomes that have resulted.
  9. 0
    Quote from 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.
    Here is one such study:

    http://www.ncpa.org/pdfs/sp_Do_Other...he_Answers.pdf
  10. 0
    You know it occures to me that I have experience as a patient and working in two single payer systems. One in another country and one run by our own government, the VA. The VA has great outcomes and is relitivly low cost.
    How Veterans' Hospitals Became the Best in Health Care - TIME


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