How would you design Health Care Reform

[Not_A_Hat_Person, RN]

It seems that many opponents of Health Care Reform aren't opposed to the idea, just Obama's implementation of the idea. So what would you do differently?

[tewdles, RN]

This is a really good question...

hhhmmm...I believe that there needs to be a not for profit level of health access that covers most basic preventative, maintenance, and acute care. This should be without copay or deductable below a certain wage. I believe there should be access to care above the basics which the person could pay for out of pocket or through an additional insurance package (I am thinking things like all cosmetic surgery which is not restorative, infertility, etc). I think that all medications prescribed by the physician should be covered...if a 20 something young woman needs birth control pills the insurance should pay for it just like they pay for cialis or viagra for an elderly man. I think that abortions should not be covered unless a medical physician can make a case that it is necessary to preserve the health of the mother. (yes, that was a value statement) I think that this should be paid by an annual fee which is deducted from your paycheck (like SS etc).

Thats a few things...

I am a libertarian, so I believe that there are a ton of things which our country currently spends our dollars on which are NOT the business of government in any way. And, yes, I know that my views on health care are not consistent with the libertarian platform...show me someone who agrees 100% with a political platform and I will see a scary person who looks like a morph of Ted Kennedy and Sarah Palin.

I offer up my attempt at humor fully aware that most who comment on these health reform threads are not in a laughing mood.

I am anxious to read some ideas from my peers across the spectrum of health care in America. I know that we can do better than we currently are in caring for our population.

[Rebel Yell]

I thought your post was funny, twedles!

Have to keep our humor - only way to stay sane. My thoughts are this; there are things we can do right now, to decrease some costs. We need to actively persue fraud and abuse in Medicaid, Medicare, and the private sector. Social workers I have spoken to in the hosp. I work at say it is very widespread. We need to have people pay more for their health care across the board, increasing their awareness of their responsibility for taking care of themselves, I would hope. We should pass legislation that would allow state to state insurance policies, and not allowing an insurance company to drop people after they get sick, or for pre-existing conditions. We need to itemize bills for people, and let them know how much said proceure would cost. We need to have more assistance for those who "fall through the cracks" or have huge bills for treatments that would put them out of a house or put their family in huge sums of debt. Have people pay their co-pays at the time of service, to decrease billing costs. (I am sure there is a lot more to be done here!)

Tort reform. Cap unless it is gross neglegence.

There are a zillion little things we can do right at the "point of service" - work on eliminating waste - how much do you see go into the garbage at work? What part of a "kit" gets tossed?

And this may seem cold, it is not intended to be, but what about adopting more of the code status and choices of care to be applied when said person is ill? The family doctor should be addressing this well ahead of time, as is required when people enter the hospital. But then it is too broad, and frequently too late. Decisions to stop treatment are made well after the initial episode. The VA has a very detailed form, (I wish I could find it again), it discussed many different scenarios. A doctor at work said that the most money in health care is spent in the last month of the person's life. I look around in the adult ICU's where I work, and I can see why.

And why don't doctors offices accept cash payment in full? I ask at the desk and they look at me like I have three heads. Some dentists do this. They work out a payment plan with me before the dental work. Most offer a discount if you are paying cash.

Just a few thoughts . . . sorry so long.

[Not_A_Hat_Person, RN]

I would expand Medicare to everyone. The infrastructure is already there, so it would be relatively easy to implement.

So Medicare has fraud. Any large organization will have fraud. That's why auditors, investigators, and forensic accountants exist. There is a lot of fraud among defense contractors, but no one seems to mind.

[tewdles, RN]

I am so in agreement with sniffing out fraud, giving more, proper, and earlier information about care choices and end of life options, and encouraging cash only transactions at more medicals points of care.

I look forward to more ideas...

[HM2VikingRN, RN]

Single Payer for all...Everyone can buy into Medicare....90% of premium dollars must go to patient care....Eliminate Medicare Advantage overpayment

[tewdles, RN]

expanding medicare seems to be a popular option, but it doesn't seem to be that popular with our politicians...why do you suppose? are they intent on making something more difficult than it requires simply because they are predominately lawyers?