Re-Engineering Ailing Systems

Hmm, ever wonder why it's referred to as practicing medicine?

There's plenty of wonderful curative technology.

There's very little systems integration.

Can you imagine any large corporation, using the byzantine system of record keeping utilized by doctors & health insurance companies?

According to my son-in-law and daughter, both MD's a major cost for health care is the lack of ability of doctors to transfer records between hospital systems, etc. I find this amazing, since I know that many tests performed at US hospitals ,eg radiological records, are read in India and the results transmitted back to the physicians.

My son-in-law indicates that the only hospital system that has decent record handling (via computers) is the VA Hospitals. Both he and my daughter have worked with the VA at times. I've heard similar comments from other physicians I know.

two problems with american medical business model.

1. for profit medical care. profits go to shareholders.

2. for profit medical insurance. profits go to shareholders.

the prediction is that without eliminating both of the above, that within 10 years or so, the cost of medical care in the us will consume 1/3 of the gross national product.

i have heard that social security has enough money to last until 2042 without changing anything. BUT if you bundle medicare in with social security, it will bankrupt social security within 10 years. in fact you bundle medicare with any funding source, it would be bankrupt within a few years. medicare can not stand by itself. why?

Some will argue that it is the fault of the for profit health care system and that we need socialized medicine. While it would help to bring in engineers and systems analysts and designers to modernize the methods of handling information, there is still the matter of who will pay for it.

We can do it by taxes, losing money to pay layers of civil service bureaucrats to make stupid decisions from their office cubes that never see the light of day or any bit of reality. That results in "free", but rationed, health care and extremely high taxes.

Better would be a mandatory health insurance law which requires everyone to have a Medical Savings Account and a high deductible major medical policy. I need the discipline just as much as everyone else and the best thing is that the money is mine and I will be careful how it is spent. Then let employers add tax-free up to 50% of the cost as an incentive to keep employees. Make the minimum coverage be set by law, but the insurance providers can offer better plans and set their own premiums. Make it so that the patient will watch how much is spent and question medical charges to protect his money.

Keep the freedom in health care and the government out.

There are two problems with this idea:

1. It maintains the same flawed adversarial system in which doctors and other providers benefit by billing for as many services as possible, and the insurance industry benefits by denying as many payments as possible. Every medical provider has to have at least one additional employee (bureaucrat) whose sole job is to convert the details of each medical diagnosis and treatment into billing codes in a deliberately complex system designed by the insurance industry, in order to receive payment. The insurance providers then have their legions of bureaucrats to figure out how the doctor's bureaucrat has made a mistake in a code, improperly used a hyphen, etc., in order to deny the payment. This is madness.

2. Taganan then supposes that this same flawed adversarial system that pits providers against payers will need to be transferred to the government, resulting in much higher taxes. I currently pay a 'tax' of around $1000.00 per month to my health insurance company, so that they will cover some of my medical expenses. None of the other civilized countries in the world have health care systems that cost anywhere near this much. The current system is not a bargain.

It is actually not at all necessary to continue this wasteful and unnecessary adversarial system. If doctors are salaried employes who are paid to practice medecine, rather than businesspeople who are trying to maximize profits from their medical business, then this perverse incentive can be eliminated. Then there will be no need to fund a costly army of bureaucrats in their cubicles trying to cut costs, second guessing the doctors, and making stupid decisions. Doctors are not perfect, but by virtue of their education they are the best qualified people we have to decide what medical treatment is necessary. Doctors who overtreat or undertreat patients will be detected by their supervisors (more experienced doctors) during normal hospital or clinical reviews, who can make suggestions in a collegial way, and if necessary impose sanctions or even termination.

Would a system like this solve all the problems? Obviously not. There would still be questions about how to handle medical malpractice, another huge slice of the pie. There would still be a need for a bureaucracy to order supplies, see that the supplies are delivered in a timely way, maintain patient records, etc. But it would cut out one of the most bloated, profitable, and completely useless parts of the problem.

Would this result in rationing of health care? Probably so, because as a society we have a large contingent of people who seem to love getting into pissing contests to see who can be the most heartless about the needs of their fellow citizens. These people will almost certainly continue to vote for representative who will try to minimize budget allocations for healthcare, errect artificial barriers to keep the 'wrong' people from getting too much care, and otherwise trying to sabotage a system that offends them ideoligically. However, the vast majority of people in our country now favor a universal system, and a significant majority are ready for a single payer not for profit system. Sounds like national health care to me.

Your idea is to force all doctors to become government employees. Then why not change all those "adversarial" positions known as free enterprise, free markets and capitalism into government positions. Why should someone have to pay outlandish charges to have their car repaired? It is well known that garages and mechanics engage in "continuing service" and resort to doublespeak when dealing with the mechanically disabled. Let's make all mechanics government employees too. Ever see the repair bills climb when the insurance was paying. Then take picture framers and art dealers, they will often use the worst materials and palm off trash as great art on the unknowing public. Come on and admit it, you are a socialist or a Democrat.

Instead of doing things which would enable a free market system to provide better medical care for less money, all you want is to make it another government boondoggle and money waster. The system needs reforms like mandating that every wage earner must choose an insurance provider. Those who do not work due to disability or other circumstances can be cared for by special programs. People should pay for their own care just as they pay for the care of their car or home. I can admit that I do not have any more self-discipline in this regard than anyone else and I wish that the government had required me to contribute to a Health Savings Account and had done something to make the insurance I had through one employer portable to the next, only suspending coverage when unable to pay premiums, rather than canceling the policy. There are better ways than just handing it over to the politicians.

I think this misses the point. The adversarial relationship between the buyer and seller is a normal and healthy part of the free enterprise system. Buyers can and sometimes do educate themselves to avoid being duped by unscrupulous sellers. They can ask friends and neighbors to recommend honest sellers. That is how free markets work. It is a great system, and I personally like it very much.

But there are two problems with this. Health care and medicine are fundamental necessities (like fire and police protection), and medicine is too demanding a subject for many people. People don't require picture frames. Even intellectually chanllenged people can become knowledgable, and even experts at auto repair.

The second difficulty arrises when third parties get in between, with their own agendas, and no particular interest in the outcome of the transaction other than to maximize their own benefit (you mention the spiraling cost of auto repairs when insurance gets involved). This grossly distorts the market.

For example, my wife recently had a series of spinal surgeries. For the first of the surgeries, the total billing from the hospital, the surgeons, anasthesia, etc came to just over $800,000. When the insurance company settled with the hospital they paid just over $60,000, less than ten cents on the dollar. At $1000 per month for health insurance that means that if we had instead banked the money in a 'medical savings account' we could have broken even in five years. Except of course that the $60,000 price would not have been available to us. We would have paid the higher price with only a token discount.

Discounts are of course a normal part of volume business transactions. But a 90% discount is something else. It is a barrier to competition.

i knew a man that used this to negotiate with the hospital over his bill. they billed him $140,000. he told them he had taken out a second on his home, and was offering to settle for $50,000 and prepared to pay today. he told them he had come up with this number by studying the actual payments of insurance companies vs the orignial bills sent by the hospitals. they accepted his offer.

I do agree that there should NOT be two prices for the same medical procedure, one low for the insurance companies and one high for the individual. That would stop if the insurance policy holder had some control over the money. The problem is that individuals are generally kept in the dark by both the medical industry and the insurance companies who make special deals, The individual never sees the itemized and detailed list of services and medications given and has no idea of the real costs. It is then easy to overcharge. The insurers know better and they can negotiate a better price.

A medical savings account helps to cover those medical costs BELOW the deductible portion of a lower cost major medical policy. It is not to replace medical insurance, but to enable one to purchase a lower cost major medical policy. The more you have in your account the higher the deductible and the lower the cost of the policy. A $2000 deductible policy with $1,000,000 coverage might cost $1000 per year, but as your medical savings increased the cost per year for the policy would drop. As long as you were healthy and did not use the MSA, so it would cover the deductible, you could reduce insurance policy costs drastically. An MSA is NOT meant to replace catastrophic major medical coverage. Your illustration of banking $1000 per month for 5 yrs equaling what the insurance company paid, $60,000, is wrong. Put $100 a month into the MSA and pay $83.33 per month for the major medical. Then you have some expensive surgeries. You pay $5000 out of the MSA as your deductible and the insurance company pays the rest. If everyone were to have an MSA and a major medical policy, more people could afford to have coverage.

The problem is that in general people have little self discipline. I know, because I am one of them and got old too soon and smart too late. Social Security was started because people would not provide for their old age. The fact that the politicians lack of self discipline led them to take and spend all the money in SS and replace it with bonds that have to be redeemed through taxes is why it is in a mess now. I would have no problem with a mandatory MSA/plus insurance plan which keeps the money in the control of the individual [it is his money], but allows it only to be used for medical purposes and allows the individual to choose which insurance company to use. I am generally in favor of any plan that will work and which keeps the government out of it. As for those who do not, cannot or will not work I have no problem with providing medicines and clinics or even surgery if it will cure them and enable them to work.

I work in the Social Security area and I see the people come in asking for disability. Many of them could work if treated, but SS cannot give them treatment, they must support them in their illness [although they do get Medicaid]. I see that the system does not work, it operates by SNAFU. I see people who are probably truly disabled turned down simply because they cannot afford to see a doctor, have tests and get a diagnosis. I also see many who should win Oscars for their acting.

Perhaps making some of those discounts to insurance companies very public would help. Yet if they can get those discounts for us, it should make insurance cheaper. As the insurance companies compete to get better discounts and reduce their costs, they should also be able to keep the same profit margin and lower premiums. Could it be that malpractice settlements and insurance are too expensive and need to be limited? Could it be that becoming a doctor is so expensive that they need a greater return on the investment? Is medical technology too expensive? Can we really afford to give free [taxpayer paid] care to everyone to cure everything? Do you really believe a non-medical government paper-pushing, bean-counting bureaucrat will approve treating everyone who is sick if it will break his budget? No, he will ration care and let some die because he thinks they are not worth saving, have less value than others or he will randomize who is selected so as to avoid guilt.

As long as the present "third party payer system" remains, the interests of the three parties: doctor (provider), you (patient) and insurer remains irreconcilably different and separate for obvious reasons. Normal, sane contracts are always drawn up between two parties :seller and buyer. If one want an insurance on the top of it, it is again a sane contract: between its seller and buyer. The interests and obligations are clear, and a third party has no say in the contract.

A third party insurer has a built-in interest to say no, and to make things as difficult as possible. And neither you nor your doctor has much of a chance to escape the system. It is unhealthy, it is sick. I would like to tailor mine to my specific (lack of) needs, but no, it does not come in such flavors. It is still the 1800-1900 industrial model: one size fits all. Just look at your car insurance at the multitude of options and grades. That is this century!

Practice is still steam engine / coal industrial style. Recently, at a modern hospital I witnessed a 1/2 hour pandemonium at every shift change in the emergency room. It took them such a long time to figure out, who should be there, and which, if any patient is missing. Big stores can put radio frequency RFID tags on plain merchandise for years, to know what is coming, going and where. But a hospital - where I know, such money is no object - is "unable" to tag every person under its roof.

I also saw an inexpensive solution recently at a smaller clinic. When a person was admitted, a barcode sheet was linked to his person. All nurses visiting swiped his barcode with a wand, took blood, put the barcode on it, medication, findings, all came with the barcode on it, and the nurse gave it after swiping his barcode again. Guess what? No mixed up medications. It does not even matter, how many Jack Smith are present at the same time: different barcode. Classical KISS solution (for those do not know: keep it simple, stupid!). Cheap, simple, uniform, effective, traceable, did I say cheap? Did I see it anyplace else? Nah. It is too simple.

Then perhaps we need to figure out how to get rid of the third party and not by substituting the government. It should be the providers of medical care dealing with the purchasers of medical care and the purchasers of insurance dealing with the providers of insurance. Perhaps the insurance companies should be banned from paying directly to medical providers so they would not have conflicted interests. Most purchasers are able to handle their own affairs in such a system. within a normal legal framework to prevent dishonest practices.