ScratchMonkey

http://www.john-goodman-blog.com/100...llars-in-debt/

Check out the responses to the thread, including one from a Senator.

A February WSJ Op-Ed from Goodman:

http://online.wsj.com/article/SB120373015283387491.html

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Sig

Steeler

This is the third juggling of the numbers I've read and they are once again completely different from everyone else's. The intentional obfuscation of the government and interested parties on the topic of Medicare and Social Security (they are two distinct things, btw), makes knowledgable discussion almost impossible.

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Hambergler

These ideas are great, perhaps too good. Trusting Drs with a bigger payment upfront in hopes that it will deter spending later is like giving an alcoholic a gallon of vodka and saying OK after this your going to have to try to stop. Most of them didn't spend 30 years in school because they love helping other, Sorry but it's true. And the part about the sick patients managing their own health care decisions is very wishful. Yes there are some that it may work with, but many of them got sick because they were non compliant to begin with not to mention they are elderly and may have impaired decision making abilities. Preventative medicine and education is the answer to the current reactive system, but get real. This isn't Disneyland people are greedy. It's ironic that this article is in the Wallstreet journal. What makes things worse is more and more private insurers are trying to use the Medicare reimbursement schedule as a model for their reimbursements. So as Medicare payouts go down so does the payouts from priv. ins.to Drs and so does quality of care so people are going to get to medicare age sicker and the insurance companies can wash their hands. If you really want to change the healthcare system we are going to have to get greed out of the equation somehow and make patients come first. Until the motivation is right there will be no progress.

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ScratchMonkey

Greed is part of our humanity. Instead of getting it out of the equation, leverage it. That's what the market is all about.

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Sig

Kerostasis

Seconded, Scratch.

If the program is really in debt 10/50/100 Trillion Dollars (depending on which report you believe), then refocusing on "the needs of the patient" isn't going to do a damn thing to help that. What would help is introducing a standard accounting system like the rest of the world uses (the government doesn't bother with reporting liabilities they wont have to pay this year), and then simply not allowing them to pay out more money than they have.

Granted, we may be going off different definitions of "help" there, but you really have to help the program's insolvency before you can help the patients.

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Steeler

You also need to address the runaway costs of healthcare itself.

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Kerostasis

True, but the runaway costs of healthcare are inextricably linked to the health insurance business. A big part of the cost spiral is due to the fact that the people making decisions on which treatments to get are almost never the same people who will be paying for those treatments.

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Hambergler

How do you leverage a Drs greed? Implementing a healthy patient bonus?

I disagree

Healthier Patients = Less Cost

Insurance companies are aggressively discouraging wellness(preventative testing), education, and regular office visits with high deductibles. As well as denying anyone that is already sick.

Patient maintains poor health because of high deductible through out their life. At 65 the tax payer is stuck paying for a lifetime of health problems. If insurance companies were taking care of the patients and they were reaching 65 healthier there would be substantially less cost until death.

Being in debt is as American as apple pie.

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TheFeniX

Agreed. A big talking point for proponents of the current system claim that "America has the best healthcare in the world."

This is true of emergency medicine. If you need treatment, there's no better place to be. The question is: can you afford it? Insurance companies routinely find ways to not cover costs. Basically, if you get disabled: they'll find a way to drop you.

Essentially: if you can pay out of pocket, you'll get the best healthcare in the world. Good luck with that.

In preventative medicine, we suck. Plain and simple. My current medical insurance is basically a "don't bother unless you get hit by a mac truck" coverage plan. The deductibles are terrible and many things just aren't covered. Surgery has a variable deductible, but anaesthesia isn't covered at all. Oh well, not like numbing pain is really a necessary part of surgery. I should just man up. My employer just can't afford to buy better coverage for us and I can't blame him.

I always found it funny that warranties for cars have a better system setup for maintenance than those for people. When I bought my Dodge and got the extended warranty, one of the stipulations was that I brought the vehicle back in for routine maintenance, most of it free, some of it pretty damn cheap when compared to drive in rates (and this was stuff that needed to be done anyways).

Car makers found out long ago that spending a bit of money up front would likely save them a lot of money in the long run. For some reason, our current healthcare system laughs at such a prospect.

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Kerostasis

I'm going to go against conventional wisdom here and say we've fallen down on preventative medicine largely due to the widespread belief that someone else should be responsible for your health care! Whether that's the employer buying your corporate health coverage, or the government taking care of you with medicare, or even just your insurance company telling you how often to go get your regular checkup -- why is it always somebody else's fault? Why can't you, as a responsible adult, come to the conclusion that you personally will be better off if you expend some time and effort and cash on preventative care? Having insurance cover preventive care doesn't make any economic sense -- that should just be something you do on your own because it is good for you.

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Steeler

There is a severe economic hurdle for preventative care. Most of us cannot zip down to the local Princeton Longevity Clinic and get a full-body scan on a regular basis. We're lucky if we can afford an emergency MRI when we find a lump or a dark spot. Healthy living and diet is a personal choice that can affect our lifetime out of pocket costs. But true preventative care, including simple checkups, requires an outlay of funds that is not commensurate with the percieved value. In short, it already costs too much.

Especially if the average $200 checkup that MIGHT spot a potential health risk usually consists of an hour's wait for 5 minutes of exam and an admonishment to eat more greens.

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TheFatKidDeath

Actually, it's not going against conventional wisdom to assume that American citizens should be reponsible for their own healthcare. That is a very widespread belief. Generally speaking, the mainstream press, the health care industry, along with a majority of Democrats and Republicans propagate the idea that citizens should be responsible for their own health.

Tens of millions of dollars are spent by healthcare lobbyists to convince the American people that their system is the best in the world. If the conventional wisdom were that others are responsible for the individuals health care than we would have a single payer system like the rest of Western industralized world. Instead, we have a inefficient over priced and poorly run system of health system that is not serving the needs of it's citizens.

In fact, most Americans vote against their own interests and keep this system in place.

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Kerostasis

@Steeler:

So are preventative medical visits worth their value or not? Apparently we can't make up our minds one way or the other. But I'll tell you one thing -- either way, adding that $200 annual checkup to your insurance plan will make the premiums go up by $210 per year. You might as well just save the administrative fee and pay for it yourself.

@ Thefatkiddeath:

You and I must be watching different media. But I think we knew that anyway.

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Hambergler

Your right everyone should be responsible for their health, but they are not and we end up paying for it. What your saying is not going to happen by itself. There needs to be enough education coming from the health care side to battle the onslaught of magic pill eat all the bigmacs and soda you want ads. I feel like the doctor needs to be a piller in the community and you should be able to see him and discus your health when you want to. When I was growing up I spent an hour in the Drs office talking to him about whatever issues I wanted too. Now when I go to the Drs he in and out so fast, I can't remember what he looks like. Obesity, diabetes, heart disease, bone disease, back problems, alcohol/drug abuse, prescription drug abuse, lack of excersise all have seriously contributed to medicare cost.

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Steeler

Which is what a lot of people do. It's the same with car insurance - minor claims are not worth filing, because if they go above the deductible, the company will just raise your premiums for the next 6 years to make up the cost. Just as I can choose to either fix it out of pocket or just drive it broken, I don't necessarily have to get a medical checkup I don't feel is worth the expense. And most people do not see the value in a single checkup, even if regular medical attention over many years is a proven way to help maintain health.

Most everyone would agree that you should be responsible for your own health, but economic realities make that luxury only available to those that rise above a certain income level, and even then you're still only one bad day away from permanent bankruptcy. Which is why I don't think any healthcare insurance overhaul can take place unless we examine the outrageous inflation of medical expenses. That includes administrative cost inflation, materials, R&D, "specialist" vs. "generalist" inequities, liability insurance, pharmaceutical costs, and gouging.

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