Health Care Law Massacred in Supreme Court

[gwb72tii]

the only way to reform health care and to control cost is to involve the consumer in cost decisions. insulating all of us with "free" whatever does nothing to make any of us consider costs in healthcare

[KenC]

the only way to reform health care and to control cost is to involve the consumer in cost decisions. insulating all of us with "free" whatever does nothing to make any of us consider costs in healthcare

I agree with you, but I don't think that begins to solve the problem. Patients are still shielded from the reality of the prices by their compays and deductibles.

If you can incentivize patients with "free" preventive care, it's cheaper for everybody (patients, hospitals, insurance companies) in the long run.

People also don't shop for health care the same way they shop for other goods or services. People don't research cardiac surgeons while their clutching their chest with an active MI. They call 911 and go to the nearest ED. Inpatients (by far the largest consumer of care) don't leave the hospital to get cheaper lab work or diagnostic imaging across town.

A bigger issue is that the "high-useage" patients are receiving fragmented, redundant, and uncoordinated care. Nearly 85% of the $2,500,000,000,000 that the US spends on healthcare per year is utelized by a small sliver of patients. These ill patients with multiple comorbidities aren't shopping around, either.


In any case, consumers should be made well aware of the cost of their treatments so that they're able to make value assessments.

[Morrison]

Honest question here - since we can all get behind the concept that the root of the problem lies in inflated costs; where is all this surplus profit going? I've heard that the insurance companies aren't necessarily getting uber rich off it. Most doctors are well paid but I think they are entitled to such pay after going through medical school, residency, etc. Yeah, I said it, "ENTITLTED". See, it's not such a bad word. Hard work entitles one to great reward, in my opinion.

But seriously, where and how do we trim the fat? I like and agree with gwb's belief in marketplace competition in theory, but like KenC pointed out, how can we practically encourage such a market to develop? And who's pockets will be the most impacted by trimming this fat? Or is the real root of the problem simply that the American people are too fat?

[z31maniac]

But seriously, where and how do we trim the fat?

Preventative care is a big one.

So is Malpractice Insurance (Hi, trial lawyers!)

KenC, what was the name of the book you had me read? Very informative.

[rwh11385]

Honest question here - since we can all get behind the concept that the root of the problem lies in inflated costs; where is all this surplus profit going?

That's an awfully strong assumption... that there is a massive surplus profit. It's entirely possible that all the companies are working with many, many people chasing their tails and not being organized, having trouble to distribute funds for coverage while enrolling customers. Profit implies that revenues are larger than cost, and as long as the status quo continues, most for profit plans could continue the same ole low quality of care (and results) for high prices but slim margins. Non-profit plans obviously are just that, but still cost money and use it through salaries, reimbursement for care, or whatever expenses may be incurred.

The other popular target is big pharma, but they spend tons on research (or the smaller firms they acquire when they make a hit do), so maybe they're not fully to blame. Medical device and equipment companies? Malpractice suits? The government? You could blame a lot of parties but the best IMO is inefficiency and spending a lot of input to not get great outputs.

http://www.hcsc.com/newsroom/questions_answers.html

Why are we spending more on health care than we used to?

There are three primary reasons we are spending more on health care than we used to:

the inefficient and ineffective use of medical services
poorly coordinated and redundant care
personal health habits that lead to poor health

What can health care providers and insurers do about the rising costs of health care?

There are several activities that health care providers and insurers can pursue, although the intensity of pursuit will vary depending on the provider or insurer. There are three general areas and at least ten specific opportunities to make improvements:

Inefficient and ineffective use of medical services
Development of an evidence-based outcomes repository or database [What Ken has been saying]
Increased incentives for health care provider use of evidence-based medicine and proven preventive measures
Increased information sharing among health care providers and consumers about best practices in terms of cost and quality outcomes

Poorly coordinated and redundant care
Development and use of a collaborative care system that links patients, health care providers and health care payers
Increased incentives for collaborative care decision making among patients, providers and payers
Integration of traditional and nontraditional systems of care along with private and public health delivery systems
Personal health habits that lead to poor health

Development of incentive-oriented, health plan member-focused programs targeting high risk behaviors
Implementation of proven, community-based programs for children, incorporating education, exercise and healthy eating [Wellness programs]
Integration of health improvement components into existing public-private community programs
Development of public awareness and education campaigns targeting at-risk populations [Health promotion / advocacy]

[herbivor]

Preventative care is a big one.

So is Malpractice Insurance (Hi, trial lawyers!)

Malpractice insurance is a very very small part of overall health care costs.

The most significant costs are mainly our ethical decisions on how we treat end of life care and our current lack of a proper system of preventative care. There is no financial incentive for any medical company really to educate individuals, regulate the food industry, or disconnect granny from the feeding tube.

The only way to bring health care costs down is if every person took the incentive to self-educate and try and live as healthy as possible and then negotiate the terms of their end of life care (before the time comes) so as not to impose extraordinary costs with the expectation that earlier death may result. But since all of that is highly unlikely, then in my opinion, the government has some responsibility to educate and regulate (provided it doesn't restrict our personal liberties), since as I said, no company has an incentive to do so. A person's ignorance in living a healthy life shouldn't have to result in me having to pay higher premiums, but currently it does.

[mrsleeve]

^

You disgust me

[Kershaw]

mrsleeve, i cant believe im saying this, but...

i think you're being an idealistic bleeding heart liberal.

herb's approach is pragmatic. it's something we really need to consider. is it worth spending a million dollars a month to prolong someone's life 3 more months when they're barely alive?

next thing i know you're going to be signing up for greenpeace.

[rwh11385]

http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx

What is driving health care spending?
While there is broad agreement that the rise in costs must be controlled, there is disagreement over the driving factors. Some of the major factors that have been discussed in cost growth are:
Technology and prescription drugs– For several years, spending on prescription drugs and new medical technologies has been cited as a primary contributor to the increase in overall health spending; however, in recent years, the rate of spending on prescription drugs has decelerated.[1] Nonetheless, some analysts state that the availability of more expensive, state-of-the-art medical technologies and drugs fuels health care spending for development costs and because they generate demand for more intense, costly services even if they are not necessarily cost-effective. [6]

Rise in chronic diseases – Longer life spans and greater prevalence of chronic illnesses has placed tremendous demands on the health care system. It is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [7] In particular, there has been tremendous focus on the rise in rates of overweight and obesity and their contribution to chronic illnesses and health care spending. The changing nature of illness has sparked a renewed interest in the possible role for prevention to help control costs.

Administrative costs – At least 7% of health care expenditures are estimated to go toward for the administrative costs of government health care programs and the net cost of private insurance (e.g. administrative costs, reserves, taxes, profits/losses).[1] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending.[8]

As previously mentioned, inefficient administration... expensive but not highly more effective technology... and chronic obesity and related issues.

[rwh11385]

http://www.nytimes.com/2012/03/31/op...for-death.html

Yeah, we went through this the past fall. Grandma (my last surviving grand parent) had a brain tumor and was treated over the summer and seemed to recover well. However, when the fall came, she deteriorated quickly and there was nothing that could be done to return her to previous health. Her and her children's wishes were to make her comfortable as possible. She was moved from the hospital to a hospice and then to home hospice care.

Although it's challenging to accept a loved one's coming passing, it also is very selfish to try to prolong infinitely their lives (of very low quality of life) for selfish reasons (wanting them around still). I think that people ought to be responsible and make their intentions for their own end of life care apparent, but that would require many to face the reality that they too have a limited mortality.

[mrsleeve]

^

Thats basically just what I was going to say in response to kershaw.


Not that I think we should spend shit piles of money on those that are about to leave us, with little chance to recover. BUT that said I do think that should be left more to the individual than some govt bureaucrats and bean counters dictating to us what should be done based purely on dollar value. Like heater says, people need to be responsible and proactive with these kinds of things on their own. To be honest I dont know that many people that are over 35 that have not had this talk with their families and made their wishes clear at least in an informal verbal kinda way.


With my self and with most of my family, there are very specific instruction when it comes to long term/end of life concerns. Its well known in my family that there are not to be any extreme measures to be taken to prolong or save one of our lives, unless there is a very very good chance that we will recover to what the person involved would consider a reasonable quality of life

[Kershaw]

trusting that everyone is going to pitch in and do their part?

sounds like communism.

[rwh11385]

trusting that everyone is going to pitch in and do their part?

sounds like communism.

The freedom of people to choose what to do with their lives is greatest thing but greatest weakness of liberty in terms of efficiency. But personal responsibilty is a crucial and underlying concept of personal freedom.

The government deciding what citizens will do according to the administrations wishes is communism (one child policy) versus citizens choosing how many children to have.

Anyone seen Logan's Run??

[z31maniac]

Malpractice insurance is a very very small part of overall health care costs.

Heeter's graphic on the past page shows malpractice, and the defensive medicine practiced to avoid it, accounts for 10% of costs.

Hardly trivial when total healthcare spending is $2 Trillion + per year.

[herbivor]

^

You disgust me

I'm sure because I said "government should regulate" made you throw a little bit in your mouth, but I think that's just a reaction you have to the statement versus a pragmatic thought of the situation. I'm not saying government should be involved in making personal medical decisions, but I don't see anything wrong with perhaps requiring a class in nutrition and health in primary education, or regulate the food industry in a way so we don't have to worry about eating things like "pink slime" and other chemicals and poisons.
How can that be an attack on personal liberties and medical decisions? In fact I would argue it's a protection of them.