I Think I Just Fixed Health Care . . .

[NickDG 23]

I was working out in the garage on Nina (my motorcycle) this morning, but it's too hot in So Cal for that so I decided to come into the air conditioned house and figure out a way to fix health care . . .

My working in the health care field for the last few years has opened my eyes to what the biggest problem is.

I'm old enough now to remember when I was ill as a child my Mother wouldn't hesitate (much to Dad's chagrin) to call a doctor who would actually come to our house. Dad would grumble but he payed the $35 dollars anyway.

Dad was strictly a blue collar tradesman with five children but he still could afford these occasional costs. The bigger ticket items like the Tonsillectomy procedure I had and the stitches from when I tumbled down the stairs Dad paid off in small installments. To make a long story short, in the 1950s, health care was affordable to the average family.

Fast forward to 2009 and that's not the case anymore. In fact back in the 1990s I was working at the Cal City DZ when I developed a killer toothache. Of course being a AFF/TM didn't come with any health care benefits. "I can pull your tooth for $75, "the dentist told me, "or I can save it for $350, what do you want to do?" Does anyone believe there's a place for such a "Sophie's Choice," in health care?

A few years later I was jumping in New Zealand and I broke my leg on a B.A.S.E. jump. They have free health care there, and it was my first and so far only encounter with such a system. I had two major operations and got a bill for a couple of hundred dollars. In the States I would have been liable for between 30 and 40 thousand dollars. It would have wiped me out.

Being a good old American capitalist I found it hard to believe their system was viable but I finally understood why it worked when at a party I met a woman who was a New Zealand Doctor. Here in America Doctors are considered scientists but more so we endow them with some God like power. But in New Zealand they are just considered workers like the Butcher, Barber, or Panel Beater (auto body worker). They make a good living and nothing more. What are doctors really? They are nothing more than skilled technitions. If "A" or "B" is occurring in your patient you recommend "C" as the fix. Big deal - it's the same thing the auto mechanic does with your car. Nobody fawned over this doctor in New Zealand like would happen here in the in the States. Everyone treated her like a regular person. She had the same exact status as the Panel Beater.

Later back in the States I met a skydiving student who was a traveling surgical instrument sales woman. She was showing me some of the instruments she sold when I remarked a certain clamp she had would make a excellent roach clip. "Well, "she laughed, "I'd give it to you, but that clamp costs eight hundred dollars." And yes, I understand that, in America you have to figure in research and development, liability, and all the rest of it.

Okay, so here's the fix . . .

Of course what works in one country may not work in another because of need, population, and general health. What I suggest is we don't nationalize health care, instead we nationalize health care education. In other words - we make medical school free - come one come all!

We keep the standards for graduation the same (in fact we could actually raise them with such a large pool of candidates) and open a half dozen tuition free government funded medical schools and start turning out doctors by the ton. Eventually supply and demand would level the playing field and bring down health care costs. I used to be in automatic awe (like most people I suppose) of doctors. But now that I see medical practitioners in their day to day roles I think we missed a very big lesson from 1960's television. "Dammit Jim, I'm not a miracle worker, I'm just a doctor!"

NickD

• Quote

[NickDG 23]

Guess I got shoveled off to the SC because the topic didn't measure up with, "Drying Your Ball Sack!"

NickD

[bjadpm 1]

Nick--You are comparing apples to oranges here...In New Zealand, there are NO personal injury attorneys. As a matter of fact, New Zealand has essentially combined medical malpractice, worker's compensation, automobile personal injury and other Medicaid all into one--Imagine trying to do that in America!!!

"In 1974 New Zealand abolished tort law remedies for all personal accident injuries and replaced it with a no-fault compensation scheme administered by a state monopoly. The scheme was based on five principles from the 1967 Woodhouse Royal Commission Report. They are:

1. community responsibility (the community collectively bore a basic responsibility for the social costs of accidents);

2. comprehensive entitlement (equity required giving assistance to all those disabled by accidents, irrespective of cause, time, or location);

3. complete rehabilitation (accident victims should recover in the shortest possible time);

4. real compensation (compensation should reflect real loss); and

5. administrative efficiency (collecting funds and paying benefits should be conducted as efficiently as possible).

Benefits are provided without proof of “fault” no matter how or where the accident occurred, whether at work, home, on the road, or while participating in a recreational or sporting event. In return, the common law right to sue for damages for personal injury (except for punitive or exemplary damages) was abolished. The Accident Compensation Commission (ACC) administers the system.

The universal scheme was built on pre-existing funding sources, workers' compensation and compulsory automobile liability insurance.

The system now has six accounts: Employers; Earners; Non-Earners; Motor Vehicle; Subsequent Work Injury; Medical Misadventure. When initially set up, the primary focus was on providing compensation and promoting rehabilitation. Increasing costs have led to concerns that the behavioral assumptions underlying the scheme are inadequate. As a result the scheme has been continually reviewed.

In 1979, it was decided to review the scheme and assess its overall cost. The review also took into consideration employers' concerns that they were subsidizing the cost of non-work claims. A Cabinet Committee recommended that (1) claimants should meet part of the cost of the first two visits to the doctor and (2) lump-sum awards for minor injuries, pain and suffering, and loss of enjoyment of life be abolished except for serious cosmetic disfigurement.

As a result, several amendments were made to the Act in 1982. These included: changing from a fully-funded to a “pay-as-you-go” system: first week compensation paid by employers for work accidents was reduced from 100% of pre-injury earnings (exclusive of overtime) to 80 % (including overtime); the ACC was given the power to refuse to pay compensation to people injured while committing a crime; and compensation for work-related motor vehicle accidents were no longer funded from the Earners Account but from the Motor Vehicle Account. The maximum compensation for the loss or impairment of bodily function was increased from $ 7,000 to $ 17,000. However, the compensation paid for pain and suffering and loss of enjoyment of life remained at the 1974 level of $ 10,000.

Employer pressure in 1992 led the government to set up another review committee. The Accident Rehabilitation and Compensation Insurance Act 1992 was aimed at controlling premium costs its objective being: “to establish an insurance-based scheme to rehabilitate and compensate in an equitable and financially affordable manner those persons who suffer personal injury. ” Lump-sum compensation was abolished, and compensation for work-related motor vehicle accidents was transferred from the Earners Fund. "

Much of the expense(s) incurred in our health care system are either directly or indirectly caused by lawyers--as is the case with many of the products we enjoy in America.

If we could eliminate the fear of being sued for anything some ambulance-chaser has the audacity to bring before a judge, I am certain that we would lower the cost of healthcare and many other services in this country.

[airtwardo 7]

Quote

Guess I got shoveled off to the SC because the topic didn't measure up with, "Drying Your Ball Sack!"

NickD

What's it cost to get yer Ball-Sack dried these days?!

~ If you choke a Smurf, what color does it turn? ~

[TomAiello 26]

What about the people who borrowed a few hundred thousand dollars to become doctors, and now need to pay off that debt? Wiping out the earning potential they borrowed (not to mention working their asses off) to attain isn't exactly fair.

I read somewhere that the average new doctor has about $100k in educational debt, but from the doctors I know, I'd say that number is way on the low side.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[NickDG 23]

Brian, good stuff, thanks . . .

I remember in Hawaii in the 1970s they had something for automobile drivers called "No-Fault Insurance." Everyone paid a flat $50 a year and no matter the outcome of any accident my insurance paid me and your insurance paid you. No trials, no courtroom, no nothing.

I know it scares people (not you) when we get close to using the "socialism" word. But that's a hold over from us being so scared of fat bald headed Communists who banged their shoes on the table at the UN Building.

I prefer to think of it now as Yankee Ingenuity . . .

NickD

[Thanatos340 1]

A few comments:

Quote

A few years later I was jumping in New Zealand and I broke my leg on a B.A.S.E. jump. They have free health care there

No such thing. People get paid. Someone pays them. You did not pay, But the health care was NOT free. It costs money that someone somewhere earned.

I have a totally different take on how health care can be fixed. You touched on some of the points that I feel are very relevant.. such as "To make a long story short, in the 1950s, health care was affordable to the average family."

Why was that?? and why is it not affordable now?
The first reason most want to scream is "Lawyers and Greedy corporations". I certainly agree with this some extent but it goes well beyond that. The first reason is that we have a MUCH higher expectation of what Basic Health care should cover.
Back then, People generally only went to the doctor when needed. Many of the things that people are now routinely treated for were not even discovered back then. People now feel that they have a god given right to treatment for every little minor ache and pain. Restless leg syndrome, Irritable Bowel syndrome, Carpel tunnel syndrome, ADD and ADHD.. These things were not problems back then. I am not saying that these are not real problems as they are for the most part. Now combine this MUCH higher expectation of health care along with astronomical overhead for healthcare providers due to federal regulations and Liability insurance and frivolous (And not so Frivolous) lawsuits.

Another MAJOR problem I think is that at one time Doctors were some of the most respected members of society. The brightest of our young minds wanted to become Doctors when they grew up. Now unfortunately, our brightest young minds grow up to become Lawyers. I remember someone posting a while back about how California (with a HUGE shortage of Nurses and an even bigger back log of people trying to get into nursing schools that were all filled to capacity) only approved 2 new accreditation's for programs last year yet they approved 17 new accreditation's for new law schools. THAT is a problem.

Next is the costs of regulation. I sell software for a living, the software is EAM/CMMS Software (Enterprise Asset Management and Computerized Maintenance Management software). My customer base is Hospitals and Manufacturing Plants. The cost to implement my software at FDA regulated plants vs any other manufacturing plant is 5 to 10 times Higher because of the validations required by the FDA. This for something that just tracks Work Orders and Spare parts Inventory and in no way has anything at all do with coming into contact with whatever product (Pharmaceuticals or in other cases actual medical devises) that is being manufactured. Someone has to pay for this.

Another major problem I see is the way we currently expect Employers to provide Group heath insurance. This means that vast majority of individuals do not have any real choice in who their health insurance provider is. Whatever your employer offers is what you get. This to a great degree bypasses the free market. What people that have health insurance provided by their employer quite often forget is that THEY are paying for it. It is part of their compensation package.
I personally would love to see that employers no longer provided health Insurance and see people able to go out on their own and shop for the best Insurance to meet their needs. Give the choice back to the people. Make insurance companies have competitive once again. Make people aware of the true costs of health care. This would require that Individual Policy Holders get the same rights and regulations as current Group Policy Holders.

I want to see every child in this country covered and I am more than willing to pay higher taxes to see that happen. But for Adults that are capable of working, I want to see limitations on what Working Taxpayers have to cover. Life threatening illness or Trauma, No problem at all. Restless leg Syndrome or Erectile dysfunction.. tell em to get a job.

Suggestion for improving healthcare
1. Kill all the lawyers (Just kidding, we still need a couple of em, just no where near as many as we have).

2. Find ways to reduce unnecessary and very costly FDA regulation.

3. Pass legislation requiring health insurance providers to offer the same benefits and costs for individual Policies as offered on Group policies.

4. Discourage Employers from proving health insurance. Put the choice back in the peoples hands and thus force the health insurance providers to get completive again.

5. Cover all Children under 21 with health insurance.

[NickDG 23]

>>What's it cost to get yer Ball-Sack dried these days?!
I get "half off" thank you!

Hey, Jimbo, why not let the most brilliant minds of our current generation work out the big problems.

And you just keep figuring out how not to get blown up by fireworks, and spotting . . .

NickD

[NickDG 23]

J, I understand what you're saying. But I just think it would be better to have a Bob's Doctor Shop on every corner. As for the liability thing, I would think as long as a doctor did the best they could that should be the end of it.

But, like you said, there's the rub . . .

Okay, how about this? Putting it in skydiving terms - we already have a system in place where no one can have a successful career as a AFF/TM if they are seriously lacking in the basic skill set.

No, wait a minute. Now that I think about it, maybe I haven't solved the heath care issue at all . . .

NickD

[airtwardo 7]

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But I just think it would be better to have a Bob's Doctor Shop on every corner. As for the liability thing, I would think as long as a doctor did the best they could that should be the end of it.

I dunno if that kind of 'free-market' competition in medical care is really what I want...my Dr. 'Earl Scheib' with a sandwich board out front offering 'any colon-any color' just might push my self-medicating practice to covering ALL fields.

I do like the way ya get meds in Russia though...walk up and buy 'em~!
"We don't need no stinking scripts"

~ If you choke a Smurf, what color does it turn? ~

[SpeedRacer 1]

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1. Kill all the lawyers (Just kidding, we still need a couple of em, just no where near as many as we have).

hmmm. Interesting. Maybe we should introduce a predator into the Lawyer Ecosystem to keep them under control. Only problem is: What kind of animal would eat a lawyer?

Speed Racer
--------------------------------------------------

[shropshire 0]

Quote

Quote

1. Kill all the lawyers (Just kidding, we still need a couple of em, just no where near as many as we have).

hmmm. Interesting. Maybe we should introduce a predator into the Lawyer Ecosystem to keep them under control. Only problem is: What kind of animal would eat a lawyer?

Another lawyer!!

(.)Y(.)
Chivalry is not dead; it only sleeps for want of work to do. - Jerome K Jerome

[Thanatos340 1]

Seriously.. It seem that the number of lawyers is growing exponentially each year. Our best young minds are no longer going into Science (Medicine) and Engineering. Somehow limiting the number of people becoming lawyers would be a huge help in getting this country back on track.

[shropshire 0]

Put them all on the B-Arc

(.)Y(.)
Chivalry is not dead; it only sleeps for want of work to do. - Jerome K Jerome

[TomAiello 26]

Quote

Seriously.. It seem that the number of lawyers is growing exponentially each year. Our best young minds are no longer going into Science (Medicine) and Engineering.

On the first part, I think the reason is that it's easier to get into law school than most other "professional" programs, since there are lots of law schools with varying entrance standards. There's a huge spread of qualities in both the schools and the lawyers themselves.

I'm not sure I agree with the second part. I know lots of very smart people who are doctors and engineers.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[StreetScooby 5]

I think this may apply to this discussion. What do yall think?

http://www.nytimes.com/2009/07/21/us/21bar.html?_r=1&hp

We are all engines of karma

[Thanatos340 1]

I agree. I am just say that too many Bright minds are are being lost to law school.

And I agree that people are going into Law School instead of Med school or Graduate engineering courses because it IS easier and They will not have to worry about becoming essentially a Government employee if this "Universal Healthcare" business goes through.

Why bother with med school when the future is so uncertain for people working in healthcare. Become a Lawyer, Less hours, easier to get a Law degree, Better Pay, Less responsibility.

Also every time a Lawyer gets work, It just means someone else needs a Lawyer. It is a HUGE drain on society that produces very little in the way of contributions to society. We are going to Lawyer ourselves out of existence if this keeps up.

[TomAiello 26]

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Why bother with med school when the future is so uncertain for people working in healthcare. Become a Lawyer, Less hours, easier to get a Law degree, Better Pay, Less responsibility.

The "less responsibility" part is huge for the really good doctors. They take the responsibility very seriously, and it grinds at them incessantly. These people are working 70 hours a week and privately worry that they're not doing enough to help their patients.

It's kind of insane, actually.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[Gawain 0]

Quote

What I suggest is we don't nationalize health care, instead we nationalize health care education. In other words - we make medical school free - come one come all!

We keep the standards for graduation the same (in fact we could actually raise them with such a large pool of candidates) and open a half dozen tuition free government funded medical schools and start turning out doctors by the ton. Eventually supply and demand would level the playing field and bring down health care costs. I used to be in automatic awe (like most people I suppose) of doctors. But now that I see medical practitioners in their day to day roles I think we missed a very big lesson from 1960's television. "Dammit Jim, I'm not a miracle worker, I'm just a doctor!"

Dude...that's thinking outside the box...and that's way better than anything brewing inside the beltway. I know some doctors may not like the idea...

So I try and I scream and I beg and I sigh
Just to prove I'm alive, and it's alright
'Cause tonight there's a way I'll make light of my treacherous life
Make light!

[georgerussia 0]

Quote

What about the people who borrowed a few hundred thousand dollars to become doctors, and now need to pay off that debt? Wiping out the earning potential they borrowed (not to mention working their asses off) to attain isn't exactly fair.

Agree. That's why those who didn't go through /free/ government-based school, could keep private practice and charge as much as they want. Those who went through the government school, should work for the government healthcare for N years (with lower salary, of course).

Of course, the law should exclude monetary compensation in malpractice suits completely. If the doctor is guilty of malpractice - let DA bring the suit, and the doctor will lose the license (or even go to jail). Otherwise we all pay those monetary awards to "victims", which makes no sense.

* Don't pray for me if you wanna help - just send me a check. *

[kbordson 8]

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Of course, the law should exclude monetary compensation in malpractice suits completely. If the doctor is guilty of malpractice - let DA bring the suit, and the doctor will lose the license (or even go to jail). Otherwise we all pay those monetary awards to "victims", which makes no sense.

Ya know... THAT RIGHT THERE is one of the BIGGEST problems with medicine.

And President Obama has made it known that he has NO interest in any tort reform. "Guilty of malpractice" - are you talking gross negligence like going to the OR drunk and amputating the wrong leg OR one of the MANY MANY suits that are related to KNOWN complications of medical care: infections, bleeding, even death from an elective surgical procedure. Or suits related to "delayed diagnosis," which forces us as physicians to perform unnecessary tests and procedures to "rule out" a 1/1,000,000 chance of cancer. Or maybe suits for "pain and suffering" or "loss of wifely duties" that my sister tried to place when she broke her ankle and needed surgery....

[georgerussia 0]

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Ya know... THAT RIGHT THERE is one of the BIGGEST problems with medicine.
And President Obama has made it known that he has NO interest in any tort reform.

In my opinion the tort reform alone would not do anything good right now. In current commercial environment the prices will not go down - the price is set according to the people ability to pay, which will not change because of the tort reform. It might slow down the healthcare cost increase, but not significant either.

However when/if the government-paid healthcare is introduced, the tort reform seems to be mandatory. In fact I do not know any country in the world with "free" healthcare where a person could get any money from malpractice lawsuit when the amount would really justify the lawsuit, so if such a change is made, the tort reform is just following.

There are more things to consider. I do not know about other countries but at least in Russia/ex-USSR DAs know that medicine is not bullet-proof and there is virtually no guarantee, so to lose the license the doctor should do something really malicious in nature, like doing brain surgery while being drunk. If the doctor prescribes a valid pill and the patient gets disabled or dies after taking it, usually DAs don't even take those cases. This, of course, has its consequences - occasionally doctors get murdered because the people basically have no other recourse, so they believe they "deliver justice" this way. Another one is that every life insurance or disability policy I've seen there either had exclusions for medical mistakes, or cost zillions if they do not.

So the tort reform is not something simple which could be done overnight. I'd start with requiring govt-sponsored healthcare recipients to sign a release of liability type waivers. Wanna sue a doctor if something goes wrong? Pay more, but do it yourself. Don't force other taxpayers (who're paying for your healthcare) to pay more for your right to sue.

* Don't pray for me if you wanna help - just send me a check. *

[nerdgirl 0]

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Seriously.. It seem that the number of lawyers is growing exponentially each year. Our best young minds are no longer going into Science (Medicine) and Engineering. Somehow limiting the number of people becoming lawyers would be a huge help in getting this country back on track.

Concur for lots of reasons on the problems of lack of interest and incentives to pursue science, math, and engineering. Multiple reasons, some of which you’ve cited.

Do you have any data to suggest that the number of individuals interested in pursuing medical degrees is declining?
It’s my understanding that is largely controlled by number of medical schools. From a business perspective, it's a smart business model: flooding the market would hypothetically lower cost (salaries). There are few incentives to change that model. It's also worked well for most of the 20th Century.

Do you have data on number of lawyers versus number of folks pursuing business or economics degrees?
The latter two seem to me to have been the primary shift.
And frankly, why not? It’s arguably easier than a degree in science or engineering. While I’m sure one can find anamolous examples, how many folks go from b-school to electrical engineering? The vector is overwhelmingly in one direction. Make more money … or appear to over the last 10-20 years … than most scientists or engineers. Appear to have more job options than declining science, math, and engineering jobs.

American kids aren’t stupid … okay, the subset who might be likely to go into a science or engineering field aren’t completely stupid. They see and hear about “off-shoring,” labs closing, how much work you have to do compared to a business degree, etc.

There’s also a question in my mind of how valid is the rhetoric that there aren’t available young scientists and engineers? (Maybe not available at the price Bill Gates, et al. want to pay.) I disagree with Gates; more H1-B visas is not the answer to “How to Keep America Competitive”.

Before globalization, the market would have adjusted (hypothetically) to raise the prevailing wage. One result of globalization is the wages can remain low if there is an available workforce to fill them.

A few folks recognized the connection between lack of available decent-paying jobs and decline in one subset of engineers when the Southern California aerospace industry seemed on the verge of collapse, e.g., #’s of jobs “decline[d] from 370,000 in 1988 to slightly more than 160,000 in 1996. Despite some modest gains since 1996, aerospace employment remains below 170,000, less than one-half the level of a decade ago,” (from Trends in the Southern California Economic Region). In 1987, aerospace engineering-related jobs accounted for 10% of the US manufacturing jobs (see Chapter 2 Life After Cutbacks: Tracking California's Aerospace Workers).

More recently, the National Academy of Sciences report Rising Above the Gathering Storm recognized the jobs connection.

The declining American science and technology workforce is a *major* issue for many of the federal agencies, including the DoD. In 2005, the Under Secretary for Acquisition, Technology, and Logistics (USD(AT&L)) charged the Defense Science Board (DSB) with looking back to the Cold War and the “technologies” (i.e., capabilities in DoD-speak) that gave the US strategic dominance and technological advantage over adversaries (i.e., precision, speed, stealth and tactical ISR) and identifying equivalent technological capabilities for the 21st century: 21st Century Strategic Technology Vectors

In addition to identifying 4 critical “capabilities,” the DSB found that there is a lack of career science and technology development – a “crisis” – for DoD activities. This is exacerbated by the decline in math and science education, which was seen as creating a national security problem. A major theme of the DSB study was that revitalizing human capital is essential for the DoD to realize the technology needed to dominate over adversaries of the 21st century. The last three USD(AT&L)’s and the current one, a physicist by training, have spoken about this repeatedly, including acknowledging the lack of reasonably well-paying jobs as an issue.

In December 2007, Steve Forbes spoke about his review on the decline in scientists and engineers and investment in technology research at the Forbes/Wolfe Nanotechnology Forum: “technology is the critical piece.” One of his prime concerns is that America’s declining investment in science and decline in training of new scientists and engineers is creating a situation in which America will be “buying” new ideas and innovation from foreign sources (like China) and becoming clients rather than selling them on the global marketplace.

While a lot of folks of talked about it, imo, the decline in S&T capacity remains a strategic blind spot with respect to action. Ignoring it is not going to make it go away. President Bush put together the American Competitiveness Initiative (ACI) that emphasized the importance of science and engineering education of innovation.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying