So where does that leave us?

[Rialaigh]

"I thought about this

Problem is pay to play places just won't take patients who aren't going to have good outcomes. This was the fundamental problem that led to getting paid equally regardless of outcome. ER's will become even bigger money pits because they will be forced to accept patients who are going to die on them.

The worst healthcare will be provided to those who need the best healthcare.

The best healthcare will be provided to the patients who would have lived anyways.

The linking pay to outcomes system just encourages counter productive behavior. It is basic economics and it will result in each facility in the healthcare system converging one of two ways (to either extreme). Either you will get better and better care and be more selective about your patients (only taking those who will live so you get the best reembursment) or you will provide worse and worse care forcing you to take more patients (in number) to make up for less $ per patient ultimately landing yourself in a position where you end up at one end or the other of the spectrum. "


An analogy: I needed a new engine in my Nissan Sentra. The shop dithered and ran up bill after bill and wouldn't admit they couldn't do it. I didn't pay them, I cancelled their payment through my credit card company. That is what we need. Tell the truth, do good, not dither and run up the bill then send me to a skilled nursing facility with MRSA to die.
If patients are in a lethal category of diagnosis, and it is verifiable, then they won't be dinged if proper palliative care is done instead of useless serial MRI's, lab draws, and surgeries to keep from getting sued over abandonment or under-treatmen, or wring dollars out of insurance companies.

Cherrypicking isn't hard to spot. And make health care a civil right, then it will be enforced by the FBI with the support of the IRS and other federal government. Especially appealing if they are getting federal money.

As it is, no matter how poorly you are treated, they get paid. If outcomes begin to count (and let's throw in rates of nosocomial infections, surgical and pharmaceutical misadventures, falls, etc on the side of the ledger where you lose money or get decertified), the6h will have incentives to get their act together.

ER's are loss centers because federal and state medical pays .30 on the dollar sometimes. And the departments are not run to make a profit or break even, they are set up as a chokepoint to care practicing defensive medicine to the max. If the old County hospital and clinic networks were still up and running, private hospitals would not have the ED traffic they have now.

I can see the argument for accountability and goodness knows we need it but the "pay for outcomes" system only leads to two extreme ends. It's just the way it is. Places with poor care won't have an incentive to get their act together, they will either have to run a ton of patients through. Or quit taking patients that are "high risk". I know pulmonologist that don't deal with patients who have cancer, or who are dying, or who end up in hospitals, or anything. They do chronic asthma and COPD only. From a statistics standpoint none of their patients die, they all get treatment, none of their patients get hospitalized as they are referred prior to that happening (unless it is crazy emergent). Does that make them a good pulmonologist....or just good at writing for consults for everything...

There is no good statistical way (That I can think of off hand) to keep hospitals and other health care facilities from rapidly moving towards one of the two extremes.

On a second note health care in this country is already a "civil right", thats been proven time and time again in court. If anything it reinforces the idea that everyone must get paid regardless of outcome because anyone can get any medical care regardless of their financial situation


The fundamental problem with the healthcare system in the US is not the healthcare system. It is the legal system, in several ways, primarily two. 1. Regulation and 2. Civil action (Lawsuits).

 

[Veneficus]

When I started this thread I actually envisioned a discussion on what treatments EMS would provide.

But I have noticed a rather geographically predictable healthcare debate here.

I would like to point some things out?

What place on this earth does a privately owned free market healthcare system actually provide affordable healthcare to at least a majority of the populous?

When calling federally funded healthcare government waste, is it really federal healthcare?

Afterall, it looks more like subsidized healthcare. You know, like subsidized banks, and farms, and oil companies...

Is there any place on this earth where the government subsidizes a private industry and the governed actually get a fair deal?

The VA is an extremely economically efficent government run healthcare system. Not so much on the outcome side.

One of the things I don't think a lot of antigovernment healthcare people understand is that in places where government runs healthcare, it eliminates the need for shareholder profit. When the financial goal is break even and not dividend or stock value, there is a definate shift in how the system operates.

It also shuts down the insurance problem of insurance collecting premiums when people are healthy and then turning their care and expense over to a government paid system when they are old and finally sick.

In essence, people with health insurance that don't have a catastrophic illness are paying twice, once in insurance premiums, once in taxes, for care once. How is that equitable or reasonable. Once you are out of work a few weeks, you private insurance will be gone. But they took the money you were paying for just such a circumstance and left you with medicade.

Employees have definitive salaries in government systems, they are not subsidized or fee for service. This is not without problem, as it encourages people to see less patients. But it also usually doesn't rule out a simultaeous private market. SO if you can pay for more, better, faster, you are welcome to.

Medicare/medicade is payed for by taxpayers. All taxpayers. But you recieve nothing for it and are advocating cutting what you will receive that you are paying for. I just don't understand that? What is the logic?

Cognitive dissonance?

Prior to a government mandate of no lifetime spending caps, you could actually pay insurance premiums and not recieve the care you were paying for.

An insurance company can still deny your claim until you die or go broke fighting it in court. How is that equitable for you?

Why do you pay for nothing?

That is the big bamboozle. You pay for things in the event of "just in case" but catastrophe doesn't happen to everyone. But if it happens to an individual, they are leeches and parasites on society. But what if that catastrophe happens to you?

What if it is not even your fault?

You or your family or friend become the parasite everyone else detests.

I am always amazed by people who cite that large percentages of budget are for social programs like it is a bad thing.

Doesn't that mean that you are getting something for your tax dollars?

Let's just assume for a minute that US healthcare spending was 5 or 10% of the government budget.

With social security and welfare another 5-10%

Where is the rest of that money going?

What are you getting from it?

Food for thought.

 

[mycrofft]

In America, there are people who game any system, there are people who are generationally conditioned to use public assistance as a right they have like freedom of speech; and there are people who honestly need this help (including eventually the aforementioned people) who get run over because they are lumped in with them. There is a stereotype which gets painted on all folks needing assistance, which benefits budget managers in private and public services alike, because it allows private payors to chisel and deny and delay with impunity, and it allows public services to ignore that and treat people with the concept that "any care is better than no care".

(I know, they are denied the funds to do it right, but the correct reaction is go after the insurance companies and the tax deadbeats and uninsuring employers).

Folks, you may be 21 years old and ready to take on tigers right now, but one bad patient lift or traffic accident and you too will fall off the edge and become a "leach" and a "whiner". Society shouldn't be run like an ice floe full of penguins jostling one another to the edge.

 

[46Young]

I'm trying to figure out how to protect my assets in the event of incurring expensive medical bills. It makes me absolutely sick to think that we save, do without, delay gratification to save, invest, buy a home, then see it all taken away to pay medical bills. If the creditors don't get me, the nursing home certainly will.

I'm thinking that the illegal aliens and people who take public assistance while they work off the books are on to something. They're the smart ones - they get their basic needs taken care of for free, they get free medical care, and they can spend their under-the-table pay to buy expensive material possessions. Bills and credit are irrelevant, since there's nothing for the creditors to take if they go after them. Perhaps I can request an application to apply for illegal alien status.

 

[mycrofft]

They should let people try being undocumented for about six months.