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Thread: Covenyís plan for health care

  1. #1 Covenyís plan for health care 
    Forum Freshman Coveny's Avatar
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    This is going to be a fairly long post about what I believe is the solution to health care in America. Iím going to touch on the scientific reasons, the economic reasons, and also discuss the emotion impact. Iím going to try and give goals for each of my positions, as well as explanations on how this position is going to achieve that goal. As a for the record thing Iím not getting anyone to review this before posting it so it likely will have spelling and grammar errors, and may not be as organized as it should be, and while you are welcome to criticize those parts my hope is that you will look past them and discuss the various points and how valid you feel like they are.

    The problem
    Our current system is too costly because of regulations which prevent small at home type hospitals from operating, as well as the lawsuits against medical personal. These regulations also prevent new drugs from being brought into market, and increase the time and costs involved to bring the drug to market. On the flip side the patents or copy rights to drugs keep drug prices very high in this country because once a drug is created only that company can legally produce it for many many years. This is all designed through corruption of our state and federal government to benefit the few at the cost of the many.

    Universal healthcare cuts back much of companyís corruption, lowers medical and drug costs. It is not without its problems though as it removes much of the incentive to become a doctor, which leads to less doctors, longer wait times, or patients not qualifying for needed treatments. This again remove options of the poor to get healthcare.

    The goal
    To create a system where everyone can get healthcare, provide an incentive for people to become medical professionals, and lower healthcare costs.

    The solution
    1) Deregulate medical buildings
    2) Lower patent and copy right terms
    3) Making being a medical personal easier
    4) Regulate the amounts of lawsuits
    5) Bringing it all together

    1) Deregulate medical buildings
    Did you know that in an abortion clinic itís required to have hallways big enough to fit two gurneys side by side? Did you also know that they donít use gurneys in an abortion clinic? The point being there are many laws in place that regulate what a medical building must have, and these laws double if not triple the cost require to build these facilities. By removing these regulations, we could have doctors who saw patients out of their homes completely removing the overhead costs of having a hospital at all. Obviously, this opens concerns about infection and hygiene but if we want to lower costs and allow more people to make money in the medical profession we need to be able to treat it like any other profession. If you want to pay the extra money for a nice that is always an option, but for the poor this gives them other options to get the treatment they need. And as with everything else, as the demand in the hospitals drops, the cost of going to the nicer facilities will drop as well. This is what capitalism excels at. Once weíve done that we can setup classification of facilities by standards.

    2) Lower patent and copy right terms
    Many drugs are patented and copy righted for life, and they have a monopoly on the market so they can charge through the roof. Other companies have to wait years before they are able to make generic versions of the drugs. Companies spend a LOT more on marketing than they do on research. The government is doing most of the research. ď75% of so-called new molecular entities with priority rating (the most innovative drugs) trace their existence to NIH fundingĒ source: How taxpayers prop up Big Pharma, and how to cap that - LA Times
    Government pay for the research (as with the case of the epi-pen) and then private company buy the patient, regulated all the schools to use it, and then increased the price by 5000%. We need to break the patent/copy right monopoly sooner, and force drug companies to invest into research rather than milking whatís already been created.

    3) Making being a medical personal easier
    One of the best ways to lower the cost of something is to have a better supply. Currently to be a doctor you need over a decade of school, from which you will exit with a mountain of debt, and there are no half measures here. The closest being a nurse practitioner who is still over a decade in the making. Also letís be clear, medical malpractice is the 3rd cause of death in this country (at over 200 thousand a year) so itís not like the people who go through all those classes are providing. So, letís make it easier to break into the medical profession. Let create tiers like what we do with emergency personal. EMT is the first, paramedic is the second, ER nurse is the third, doctor is the fourth. My suggestion is to have 5 tiers for both general and surgery. The higher the tier the more schooling thatís required, and obviously testing and certification for each of level. I purpose to do the tiers in two year increments so Tier 1 = two-year degree, Tier 2 = four-year degree, Tier 3 = six-year degree, Tier 4 = eight-year degree, and Tier 5 is what we have today. Now this could mean 75% in class and 25% on the job, or whatever the industry feels is best, but the amount of time it takes to get to the point where you can see someone needs to be shortened. Also, the ability to prescribe drugs would be attached to the various levels as well.

    4) Regulate the amounts of lawsuits
    If we put tiers in place then there needs to be an understanding that the less you spend on a doctor the less you can sue them. This could be regulated based on the tier of the individual who saw you or the amount of money you spent to receive care. For instance, if you saw a tier 1 then you couldnít sue him for more than 10k, tier 2 30k, tier 3 100k, tier 4 200k, and tier 5 unlimited, or it could be something like 100 times what you spent so that if you had a $20 doctor visit then the most you could sue that doctor for would be $2,000, but if you spent $300 then you could sue for 30k. Accidents are going to happen, and if you want to take a higher risk to save money then the person trying to provide you care needs to have the incentive that one mistake isnít going to bankrupt him.

    5) Bringing it all together
    Once we have a system in place where medical care is much cheaper and more available we can cheaply subsidize it. For instance, it wouldnít be expensive to cover 100% the cost for tier 1 medical professions in a tier 1 building, 80% for 2/2, 60% for 3/3, 40% for 4/4, and nothing for 5/5. Insurance companies could easily adapt to this system, and allow for MUCH more flexibility in healthcare plans that cover the difference, and work on top. Making it affordable to even see tier 3 medical professionals. Doctors have the freedom to build their own practices without having to worry about the regulations of the facilities, and our society would likely even have doctor house calls again. If we can stop trying to remove risk, and stop trying to force people to work for less I think we can easily provide healthcare for everyone.


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  3. #2  
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    Not sure a lot of your facts are right.

    1) The abortion clinic example one is a poor one, the laws are politically motivated by anti-abortion legislatures trying to force all clinics that provide abortions to close down. Most medicine in the nation is now done in clinic--and while they more by hard to meet standards, at least in WA state, they don't seem too onerous.

    2) "Many drugs are patented and
    copy righted for life," My understanding is most drugs are patented for seven to twenty years, with most between 7-12 years. The real problem I think is the market is so chopped up between states private and public agencies that only a relatively small part of the US health industry truly has leveraging power to bring parma prices down.

    3) Don't think it's how long it takes to become a doctor, but the excessive tight control of mostly doctor run
    RUC that controls the number of graduates and residency programs. American medical programs reject the majority of well-qualified applicants by a huge margin.
    https://well.blogs.nytimes.com/2011/09/22/how-one-small-group-sets-doctors-pay/
    http://www.motherjones.com/wp-conten...hool_grads.jpg

    4) Tort reform in more than half the states has already reduced the number of lawsuits from something like 20,000 to something like 12,000 per year. But it's not really the lawsuits driving things--malpractice insurance has never been more than a less than one percent of the medical cost. Overly aggressive testing is much more of a problem--which I don't think your recommendation would put a dent in. I think continued tort reform, especially of the type to limit "pain and suffering" claims so only actual harm and cost is recoverable would go much further. (I'm an EMT/IV tech).





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  4. #3  
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    Quote Originally Posted by Coveny View Post
    This is going to be a fairly long post about what I believe is the solution to health care in America.

    The goal
    To create a system where everyone can get healthcare, provide an incentive for people to become medical professionals, and lower healthcare costs.

    The solution
    1) Deregulate medical buildings
    2) Lower patent and copy right terms
    3) Making being a medical personal easier
    4) Regulate the amounts of lawsuits
    5) Bringing it all together
    1) I don't think this is a significant healthcare cost issue.
    2) This is an area that needs review. Especially in regards to the university (and mostly government funded) discoveries.
    3) Easier or cheaper? I am not sure going easier is beneficial to future patients.
    4) There are frivolous lawsuits in every aspect of civil law. But I think the 'amount' of lawsuits is irrelevant, its the merit. And who decides that? There are (I assume) many of these settled out of court without the benefit of an actual determination to save time and money - and that works both ways, people who were greatly wronged will settle for less just to get it over with and doctors/hospitals who didn't cause the harm (the disease/injury did) who will settle to get it over with.

    There are sooo many problems with the ACA, I slide towards full repeal and start over rather than a patchwork of 'fixes'.

    Before this site went down, we had a discussion on healthcare. One of the posters was an independent contractor who for years has been unable to afford insurance, or found shopping around when something was needed was cheaper for him than carrying an additional health insurance policy. For his examples (and I am going from memory) one was shopping around for a certain imaging procedure (not x-ray but I cannot remember which). His prices in his location varied from $3400 (?) to $800. We were discussing why as an insured person, we cannot shop around for a cheaper price without being penalized for going out of network, such as this money spent at the out of network clinic would not count towards the insurance deductible.

    Why is my crappy health insurance premium 100% deductible for my employer (as I understand the deductions) but not for me? I don't get much choice in what they offer, my options are decline healthcare (and be penalized by the gov) or find another job. And that changes every year (the employer offered healthcare).

    Why are clinics not required to post procedure costs for easy access to consumers? In my state, before obamacare, a law was written requiring hospitals/clinics to charge the uninsured the same price as their cheapest negotiated insurance price. This went nowhere because there was no way to prove an individual was over-charged; proprietary information. Unless you hired a lawyer to fight for you. While waiting for my state insurance to go thru, I got a bill for $200. The ONLY thing I had going for me was a side job working with an elderly couple who had insurance. Guess what the insured person was charged for a clinic visit at the same place? $125. That is just the clinic visit and not procedures taken. So right there I am 100% sure this major provider was not following the law. My state insurance went through and guess what the state insurance was charged. $75. My state insures low income via insurance plans. This is not directly from the taxes paid, taxes do pay the insurance premiums for the low income in this state (hope that makes sense). So who exactly was the lowest negotiated premium?

    For the last 3 years, I have been actively working the system to stay on my state healthcare insurance. It's GREAT insurance based on income. I quit jobs because I was nearing the point of having to accept crappy employer offered insurance, not because of my income, but because of the stupid way obamacare is handled. $25 to $61 per month via the state vs $42-$100 per week via employer offered (and allegedly affordable) healthcare. At $11 per hour, thats 22K per year (50 weeks of work) which via income qualifies you for $61 per month healthcare via the state, at $11 per hour via an employer offered qualified healthcare, your premium (at 9.69%) is $177.62

    $61 per month via the state vs $172 per month via the allegedly affordable health care. And that is not even getting into the deductible differential, which is substantial.

    At $14, that $400 per month premium is 20% of your (before taxes) income. Pay $400 per month for health insurance with a $5k deductable is $9K yearly liability. And at $14 per hour working full time 50 weeks, puts you out of the most excellent state plan by $3.8K, exactly the difference you will pay to the insurance company. You lose 3.8K income to the insurance company. 20% of your income going to fund private companies; mandated by law.

    Oh, and those federal dollars to help poor people pay for employer offered crap? Does not qualify if it is a bronze plan (the most common I see and the one being offered by the $14 job). Meet the Press (cbs) a couple weeks ago had an excellent guest who was talking about exactly this. Working people being screwed by the current system.

    edit to add:
    Another quarrel with the ACA. Taxing good insurance policies [i think it was called Cadillac tax] and medical devices is counter-intuitive to providing quality and affordable healthcare. There just seems to be an incredibly flawed logic applied here.
    /edit

    Employers should have a tiered deduction for offering employees bronze care plans with employees being able to reverse deduct. Say the employer bronze plan is 20% deductible for the employer, the employee gets to deduct 80% of their premium/out of pocket expense. If the wage of that employee meets the federal guideline for existing medicare type plans via wage, then an equal amount is deductible at tax time. But that is not how it works. From IRS (a 74 page document to figure out if you can get tax credit):

    Under the health care law, certain health coverage is called minimum essential coverage (MEC). You generally cannot take the PTC for an individual in your tax family for any month that the individual is eligible for minimum essential coverage, except for coverage in the individual market, defined below. Minimum essential coverage includes:

    ... lists multiple state/fed insurance for poor/elderly...

    Most types of employer-sponsored coverage.
    https://www.irs.gov/pub/irs-pdf/p974.pdf

    Fed tax allows for medical deductions. hahaha. Must be over 25% of your tax year income, must be fully paid off in that tax year and does not include premiums or deductibles paid. You get 30% of your yearly income as a medical bill? The first 25% is not deductible, only the 5% above that threshold. The lie is 'affordable'.

    So, in closing, ALL aspects of healthcare should be deductible based on income alone above 10% of your wage. Could even be a tiered deduction so those who make the most and have the fewest dependents get less of a deduction. Employer healthcare deductions should be based on quality of healthcare offered/number of employees - wages paid / net profit (or something like that).

    Drug companies and RICO. Why are drugs cheaper in Canada and Europe than here in the USA unless there is collusion to keep prices higher here, or the US citizens are funding European/canadian drug costs. Take your pick.
    Last edited by JaneD; October 10th, 2017 at 10:27 AM.
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