5 Replies Latest reply on May 25, 2011 1:12 PM by JerryD

    The racket we call health care

    JRR

      I work in communications for one of the nation's foremost health care associations.  Recently I convened a group of colleagues to start a discussion group on how we might respond to the various incentives to control health costs under the Affordable Health Care Act; the directive from the top management was clear - "we won't discuss costs because one person's idea of waste is another's bread and butter."  I also wanted to start a discussion on end of life care issues, since Medicare spends somewhere about 75% of the money on 5% of the very sick patients in the final months of their lives.

      Well, friends, ever wonder why Congress won't really do anything about health/Medicare costs?  Any other industry with similar practices would be subject to criminal prosecution under RICO - but the health system is run by people in white coats pledged to uphold the Hippocratic oath!

        • Re: The racket we call health care
          JerryD
          I have been communicating for a couple of years with my legislators about this and other health issues . I strongly believe that we need to have "best practices" defined by a non-political and peer reviewed committee structure. Some significant improvements have resulted from just installing standard procedures to eliminate hospital infections at little cost.  Other issues that you point out such as very expensive procedures with very short term improvements need guidelines. Is a $100,000 procedure to gain 3 months more life a good decision? I don't know but experts should render a decision that affects standard application, no?
            • Re: The racket we call health care
              ldgpangeo
              Are not most end-of-life procedures approved by a family member?  It's very difficult to let go of a loved parent, but it is clearly an area where there needs to be more family discussion and planning. 


                • Re: The racket we call health care
                  JerryD
                  I believe that your living will or health advocate step in here.  Without either, the family will probably try to extend life as long as possible. Who wants to say stop treating mom or dad? Mon and dad need to think that through and decide how it should be handled and then talk to the family.
                   
                   By the way wasn't there a big political stink when they tried to include coverage for letting a doctor review one's options? Called it a death panel or something like that, no? It's probably best to start talking to the family and the doctors when things seem to be slipping and you still are in control and before you reach the edge and probably don't have sufficient ability to discuss. I know that I was greatly offended when my Mom's healthcare providers withheld IV fluids when Mom stopped eating and drinking (purposely in my mind). I guess that was her choice to make but I did NOT like hearing it put so bluntly by a nurse.
                   
                  We nee to treat the kids and family like adults!
              • Re: The racket we call health care
                alicyna
                The reason Congress can't control health care costs is because their campaigns are funded by (among others) the private insurance industry which was able to spend $1million a day to get the Health Care Act to contain the provisions they want: individual mandates so they get the whole enchilada, NO public option so they don't have to compete with lower priced plans, medical loss ratio (% of premium paid for claims) of 80 to 85%, and rigged oversight. Medicare would see better savings if managed by an independent board instead of Lobbyist-led Congress. I speak from my experience as a primary care physician and later Medical Director for Part B in Ohio. Medicare operates efficiently, and introduced all the innovations in claims processing and fraud control which were later adopted by private insurance companies. The medical loss ratio was around 95% in the 1990's. European countries have insurance companies but they have to be non profit. Blue Cross and Blue Shield, originally non profit are being bought out. Useful reading: "Deadly Spin" by Wendell Potter, former spinmeister for Cigna. Also go to PBS.org and view TR Reids documentary about capitalistic systems: "Sick Around the World
                  • Re: The racket we call health care
                    JerryD
                    Alicyna, I totally agree with the concept that health insurers should be non-profits. When the recent health care "reform" was in process, I felt that I knew very little about the overall topic so I ordered and read the book by T R Reid entitled "The Healing of America". This book surveyed the major health care strategies across the world and also put into perspective the fact that the strategy in America is not one but is many with almost every one that exists in the world depending on the program you are looking at: Medicare (Canada), VA, private insurer, etc.
                     
                    After thinking about the various approaches and thinking about what Americas would tolerate, I personally rejected all of the government run programs since they seem to suffer from those receiving the benefits running wild with their usage resulting in cost containment and provider abuse issues. The German approach really hit me as a good compromise that saved significant funds over our current private insurer approach that results into too much going into the insurers pockets resulting in only 80% of the premium dollar going to actual services. This approach mandates that all insurers operate as non-profits resulting in as I recall over 90% of the premium dollar going to actual services. Bang! Instance cost reduction and increased health services. Another benefit is that those covered tend to stay with one of the 100's of insurers for very long periods. This provides a great benefit in that the insurer becomes much less reluctant to push preventive and best practice long term procedures which have a long term cost lowering effect. Everybody wins!!!!