|
OT - A intriguing "open lette"r on health care ...
Friend of mine, a doctor and fellow musician, came up with the
following, an intriguing plan to revamp the US health care system from a practicing physician's perspective. Be sure to read the entire plan before making any judgments, it's tricky in few spots. Open Letter Dear Mr. President, Here are the basic principals upon which a sound, sustainable and ethical health care system can and should be built:.... 1. It shall be illegal for physicians to contract with anyone other than their patient or patient's legal representative. There shall be no contracts with the government, with any "managed care" entity or insurance company, or with any other third party..... 2. It shall be illegal for physicians to receive payment directly from a third party "payor." Payment must come from the patient directly and shall be made at the time of service..... 3. It shall be illegal for third parties to request discounts from a physician for their clients. The price for various services is to be negotiated between patient and physician, as is the case with all other professions. .... 4. Each American citizen shall have a Health Savings Account established at birth. The HSA will be maintained with an investment firm or bank, the accounts being insured by the Federal government to the amount of $150,000, as are bank deposits. Increases in value on these accounts via interest, dividends or increases in investment value are not taxed, and these assets are protected from creditors, as with the usual IRA. (Regulations will need to be developed regarding the type of investment, allowing a certain low percentage to be invested in more volatile investments.) Funds in the HSA can be spent only for Health Care, but can be passed on to heirs over multiple generations, to be used for the heir's health care needs. .... 5. Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... 6. Businesses may no longer subtract from taxable income any payments to "insurance companies" for health insurance plans. They can, however, deposit money yearly into their employees' HSAs as a dedutible business expense, the yearly maximum contribution per employee to be determined after study by qualified economists. .... 7. Each American citizen shall have a catastrophic health insurance plan in place that covers yearly health care expenses over $20,000 (adjusted yearly for inflation). This plan will be sponsored and financed by the Federal Government. See below for Comments about administration of this plan..... 8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... 9. The government will mandate that each state educate its citizen about this "self-reliant" system. Every citizen must realize the need for preventive health care and a healthy lifestyle. They must realize that prudent use of these funds and maintaining a healthy lifestyle are the surest route to security. They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free “safety net” other than the catastrophic coverage..... 10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... Comments..... This plan relies on human nature to reduce costs. When payment is coming directly from funds controlled by the patient, the patient will make wiser choices. There will be less desire to obtain expensive tests that are marginally indicated for minor complaints or to obtain expensive tests when less expensive tests will do. Less expensive, but equally effective, medications will be demanded by the patient..... and so forth. With this system, the medical profession will be restored to an ethical status, it being unethical to allow outside influences to intrude on the physician-patient relationship (as contracts with third parties invariably do). .... The public will demand transparency in the pricing of services and will cease to tolerate overpriced services. .... The nation will then be pooling health risks that are in the catastrophic range, rather than simply using the "insurance industry" as a (leaky) conduit of money from employer to physician or hospital for everyday care. .... With prudent living and prudent saving, within five to six years each citizen will have in their HSA sufficient funds to cover the $20,000 "gap" in any one catastrophic year, and within ten or so years should have the funds to cover the gap for several years of catastrophic ill health. With good health and good planning, these funds can be passed from generation to generation, allowing those families with good health to become fully covered with only rare intervention by the government. .... The government can negotiate with the current managed care industry to obtain management of the catastrophic funds with minimal administrative expense, or can set up its own administrative agency (to replace the current CMS, for example) to manage and administer the catastrophic coverage program..... Physicians will now be free to concentrate on what they do best, care for patients and maintain their knowledge base, and will no longer have to waste time dealing with managed care contracts and meaningless requests from managed care companies. .... I urge you not to let the powers that be within the current managed care industry or within the established government agencies to bring pressure against the adoption of such a rational and beneficial plan..... Respectfully yours, Lawrence E. Mallette, MD, PhD, FACP, FACN April 2009 /Open Letter Once again, chew on it for a while before rushing to judgment. -- www.e-woodshop.net Last update: 10/22/08 KarlC@ (the obvious) |
OT - A intriguing "open lette"r on health care ...
Swingman wrote:
Friend of mine, a doctor and fellow musician, came up with the following, an intriguing plan to revamp the US health care system from a practicing physician's perspective. Be sure to read the entire plan before making any judgments, it's tricky in few spots. Open Letter Dear Mr. President, Here are the basic principals upon which a sound, sustainable and ethical health care system can and should be built:.... 1. It shall be illegal for physicians to contract with anyone other than their patient or patient's legal representative. There shall be no contracts with the government, with any "managed care" entity or insurance company, or with any other third party..... 2. It shall be illegal for physicians to receive payment directly from a third party "payor." Payment must come from the patient directly and shall be made at the time of service..... 3. It shall be illegal for third parties to request discounts from a physician for their clients. The price for various services is to be negotiated between patient and physician, as is the case with all other professions. .... 4. Each American citizen shall have a Health Savings Account established at birth. The HSA will be maintained with an investment firm or bank, the accounts being insured by the Federal government to the amount of $150,000, as are bank deposits. Increases in value on these accounts via interest, dividends or increases in investment value are not taxed, and these assets are protected from creditors, as with the usual IRA. (Regulations will need to be developed regarding the type of investment, allowing a certain low percentage to be invested in more volatile investments.) Funds in the HSA can be spent only for Health Care, but can be passed on to heirs over multiple generations, to be used for the heir's health care needs. .... 5. Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... 6. Businesses may no longer subtract from taxable income any payments to "insurance companies" for health insurance plans. They can, however, deposit money yearly into their employees' HSAs as a dedutible business expense, the yearly maximum contribution per employee to be determined after study by qualified economists. .... 7. Each American citizen shall have a catastrophic health insurance plan in place that covers yearly health care expenses over $20,000 (adjusted yearly for inflation). This plan will be sponsored and financed by the Federal Government. See below for Comments about administration of this plan..... 8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... 9. The government will mandate that each state educate its citizen about this "self-reliant" system. Every citizen must realize the need for preventive health care and a healthy lifestyle. They must realize that prudent use of these funds and maintaining a healthy lifestyle are the surest route to security. They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free “safety net” other than the catastrophic coverage..... 10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... Comments..... This plan relies on human nature to reduce costs. When payment is coming directly from funds controlled by the patient, the patient will make wiser choices. There will be less desire to obtain expensive tests that are marginally indicated for minor complaints or to obtain expensive tests when less expensive tests will do. Less expensive, but equally effective, medications will be demanded by the patient..... and so forth. With this system, the medical profession will be restored to an ethical status, it being unethical to allow outside influences to intrude on the physician-patient relationship (as contracts with third parties invariably do). .... The public will demand transparency in the pricing of services and will cease to tolerate overpriced services. .... The nation will then be pooling health risks that are in the catastrophic range, rather than simply using the "insurance industry" as a (leaky) conduit of money from employer to physician or hospital for everyday care. .... With prudent living and prudent saving, within five to six years each citizen will have in their HSA sufficient funds to cover the $20,000 "gap" in any one catastrophic year, and within ten or so years should have the funds to cover the gap for several years of catastrophic ill health. With good health and good planning, these funds can be passed from generation to generation, allowing those families with good health to become fully covered with only rare intervention by the government. .... The government can negotiate with the current managed care industry to obtain management of the catastrophic funds with minimal administrative expense, or can set up its own administrative agency (to replace the current CMS, for example) to manage and administer the catastrophic coverage program..... Physicians will now be free to concentrate on what they do best, care for patients and maintain their knowledge base, and will no longer have to waste time dealing with managed care contracts and meaningless requests from managed care companies. .... I urge you not to let the powers that be within the current managed care industry or within the established government agencies to bring pressure against the adoption of such a rational and beneficial plan..... Respectfully yours, Lawrence E. Mallette, MD, PhD, FACP, FACN April 2009 /Open Letter Once again, chew on it for a while before rushing to judgment. This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. |
OT - A intriguing "open lette"r on health care ...
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:
They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free €śsafety net€ť other than the catastrophic coverage..... Someone has a lot of faith in people acting responsibly. It'll never happen. And what happens to the health needs of children of irresponsible parents? Make the HSAs mandatory, deducted from earnings, and the plan has a pretty good chance of working. -- Intelligence is an experiment that failed - G. B. Shaw |
OT - A intriguing "open lette"r on health care ...
Larry Blanchard wrote:
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote: They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free €śsafety net€ť other than the catastrophic coverage..... Someone has a lot of faith in people acting responsibly. It'll never happen. And what happens to the health needs of children of irresponsible parents? Make the HSAs mandatory, deducted from earnings, and the plan has a pretty good chance of working. Just what we need, more government micromanagement. |
OT - A intriguing "open lette"r on health care ...
"HeyBub" wrote in message
... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. I know of at least on who does just that. You get to negotiate with your health insurance company and wait for them to pay. |
OT - A intriguing "open lette"r on health care ...
"Swingman" wrote:
snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan "This plan relies on human nature to reduce costs" There in lies the fallacy of the plan. Lew |
OT - A intriguing "open lette"r on health care ...
On Fri, 29 May 2009 18:39:56 -0500, Larry Blanchard
wrote: Make the HSAs mandatory, deducted from earnings, and the plan has a pretty good chance of working. Analogous to Social Security/Medicare deductions? (No judgment implied or intended) Many employers now offer optional "before tax" deductions to medical deposit accounts that are limited to payments for health care. The only one I'm familiar with had a "Use it this year, or it's gone forever" clause and too many "if, ands, and buts" about it to be very attractive to me. It was primarily intended to cover deductibles and other expenses beyond the group health insurance coverage. Sounds like a revamping of plans such as those could come pretty close to the "open letter" suggestion. Tom Veatch Wichita, KS USA |
OT - A intriguing "open lette"r on health care ...
Swingman wrote in
: Friend of mine, a doctor and fellow musician, came up with the following, an intriguing plan to revamp the US health care system from a practicing physician's perspective. Be sure to read the entire plan before making any judgments, it's tricky in few spots. Open Letter Dear Mr. President, Here are the basic principals upon which a sound, sustainable and ethical health care system can and should be built:.... 1. It shall be illegal for physicians to contract with anyone other than their patient or patient's legal representative. There shall be no contracts with the government, with any "managed care" entity or insurance company, or with any other third party..... 2. It shall be illegal for physicians to receive payment directly from a third party "payor." Payment must come from the patient directly and shall be made at the time of service..... 3. It shall be illegal for third parties to request discounts from a physician for their clients. The price for various services is to be negotiated between patient and physician, as is the case with all other professions. .... 4. Each American citizen shall have a Health Savings Account established at birth. The HSA will be maintained with an investment firm or bank, the accounts being insured by the Federal government to the amount of $150,000, as are bank deposits. Increases in value on these accounts via interest, dividends or increases in investment value are not taxed, and these assets are protected from creditors, as with the usual IRA. (Regulations will need to be developed regarding the type of investment, allowing a certain low percentage to be invested in more volatile investments.) Funds in the HSA can be spent only for Health Care, but can be passed on to heirs over multiple generations, to be used for the heir's health care needs. .... 5. Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... 6. Businesses may no longer subtract from taxable income any payments to "insurance companies" for health insurance plans. They can, however, deposit money yearly into their employees' HSAs as a dedutible business expense, the yearly maximum contribution per employee to be determined after study by qualified economists. .... 7. Each American citizen shall have a catastrophic health insurance plan in place that covers yearly health care expenses over $20,000 (adjusted yearly for inflation). This plan will be sponsored and financed by the Federal Government. See below for Comments about administration of this plan..... 8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... 9. The government will mandate that each state educate its citizen about this "self-reliant" system. Every citizen must realize the need for preventive health care and a healthy lifestyle. They must realize that prudent use of these funds and maintaining a healthy lifestyle are the surest route to security. They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free “safety net” other than the catastrophic coverage..... 10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... Comments..... This plan relies on human nature to reduce costs. When payment is coming directly from funds controlled by the patient, the patient will make wiser choices. There will be less desire to obtain expensive tests that are marginally indicated for minor complaints or to obtain expensive tests when less expensive tests will do. Less expensive, but equally effective, medications will be demanded by the patient..... and so forth. With this system, the medical profession will be restored to an ethical status, it being unethical to allow outside influences to intrude on the physician-patient relationship (as contracts with third parties invariably do). .... The public will demand transparency in the pricing of services and will cease to tolerate overpriced services. .... The nation will then be pooling health risks that are in the catastrophic range, rather than simply using the "insurance industry" as a (leaky) conduit of money from employer to physician or hospital for everyday care. .... With prudent living and prudent saving, within five to six years each citizen will have in their HSA sufficient funds to cover the $20,000 "gap" in any one catastrophic year, and within ten or so years should have the funds to cover the gap for several years of catastrophic ill health. With good health and good planning, these funds can be passed from generation to generation, allowing those families with good health to become fully covered with only rare intervention by the government. .... The government can negotiate with the current managed care industry to obtain management of the catastrophic funds with minimal administrative expense, or can set up its own administrative agency (to replace the current CMS, for example) to manage and administer the catastrophic coverage program..... Physicians will now be free to concentrate on what they do best, care for patients and maintain their knowledge base, and will no longer have to waste time dealing with managed care contracts and meaningless requests from managed care companies. .... I urge you not to let the powers that be within the current managed care industry or within the established government agencies to bring pressure against the adoption of such a rational and beneficial plan..... Respectfully yours, Lawrence E. Mallette, MD, PhD, FACP, FACN April 2009 /Open Letter Once again, chew on it for a while before rushing to judgment. Once upon a time I needed surgery to remove an excessive portion of my uvula (the thingy hanging down in the back from the roof of your mouth - it caused excessive snoring). The ENT said I needed Vioxx for pain relief (that's how long ago). I asked why not Celebrex, and he said Vioxx is better. End of discussion. Is that how you will be negotiating prices? -- Best regards Han email address is invalid |
OT - A intriguing "open lette"r on health care ...
"Lew Hodgett" wrote in message ... "Swingman" wrote: snip Lawrence E. Mallette, MD, PhD, FACP, FACN plan "This plan relies on human nature to reduce costs" There in lies the fallacy of the plan. Lew I recall a company that wanted to reduce their expenses for sales and service people with expense accounts. They had company credit cards and cell phones. They took away the company cards and phones and instead, had them use there personal cards and phone, but also paid their entire phone bill, not just the company portion, and gave them some extra on other expenses. Once the people handled the money themselves, saw the bills, saw the waste, they reduced the overall expenses considerably. I may work. |
OT - A intriguing "open lette"r on health care ...
Han wrote:
Once again, chew on it for a while before rushing to judgment. Once upon a time I needed surgery to remove an excessive portion of my uvula (the thingy hanging down in the back from the roof of your mouth - it caused excessive snoring). The ENT said I needed Vioxx for pain relief (that's how long ago). I asked why not Celebrex, and he said Vioxx is better. End of discussion. Is that how you will be negotiating prices? God! I first read you sentence as having a need to remove an excess vulva! Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my request for Vicodin, (or if he insisted on Vicodin when I requested Morphine) I'd ask for a referral to a more patient-friendly physician. |
OT - A intriguing "open lette"r on health care ...
"HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. |
OT - A intriguing "open lette"r on health care ...
"Larry Blanchard" wrote in message ... On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote: They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free "safety net" other than the catastrophic coverage..... Someone has a lot of faith in people acting responsibly. It'll never happen. And what happens to the health needs of children of irresponsible parents? The "Right" thinks that the "Left" can learn this responsibility. |
OT - A intriguing "open lette"r on health care ...
"Leon" wrote in message ... "Larry Blanchard" wrote in message ... On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote: They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free "safety net" other than the catastrophic coverage..... Someone has a lot of faith in people acting responsibly. It'll never happen. And what happens to the health needs of children of irresponsible parents? The "Right" thinks that the "Left" can learn this responsibility. The "right" more often than not, is wrong. |
OT - A intriguing "open lette"r on health care ...
"HeyBub" wrote in
m: Han wrote: Once again, chew on it for a while before rushing to judgment. Once upon a time I needed surgery to remove an excessive portion of my uvula (the thingy hanging down in the back from the roof of your mouth - it caused excessive snoring). The ENT said I needed Vioxx for pain relief (that's how long ago). I asked why not Celebrex, and he said Vioxx is better. End of discussion. Is that how you will be negotiating prices? God! I first read you sentence as having a need to remove an excess vulva! Anyway, if a doctor offered me Vioxx (or Celebrex) and declined my request for Vicodin, (or if he insisted on Vicodin when I requested Morphine) I'd ask for a referral to a more patient-friendly physician. For reasons unknown to me he is not at the hospital anymore. That's all I can say. The procedure worked as advertised - something like 5 days of pain, but tolerable under the medications provided. I ate a lot of soft food (Singapore Mai Fung(spelling??)) which provided beneficial capsacain (hot pepper). Snoring was almost eliminated, but after 5 or more years is returning somewhat. In my professional opinion there should not have been much difference between the 2 COX-2 inhibitors, but I am not a physician. -- Best regards Han email address is invalid |
OT - A intriguing "open lette"r on health care ...
"Ed Edelenbos" wrote in message ... The "Right" thinks that the "Left" can learn this responsibility. The "right" more often than not, is wrong. Yeah, you are probably right, the left should be handled by the government and the right should take care if it self with out having to help the government take care of the left. |
OT - A intriguing "open lette"r on health care ...
I agree that changes are needed in our current system, but it scares the
heck out of me to think that the government would be more involved. These are the same democrats and republicans that have sent our economy into a tail spin. I have witnessed our own insurance company dictating the course of treatment for my wife's breast cancer over the last three years. We have had to fight to get the proper drugs and treatment over the cost saving path the insurance company would prefer. We have also been subject to huge co-payments on drugs. Three years ago we had a co-payment of $65 per pill for Anzemet! I like the basis of the letter, but by the time our government gets through haggling over it we may be ****ed again. cm "Swingman" wrote in message ... Friend of mine, a doctor and fellow musician, came up with the following, an intriguing plan to revamp the US health care system from a practicing physician's perspective. Be sure to read the entire plan before making any judgments, it's tricky in few spots. Open Letter Dear Mr. President, Here are the basic principals upon which a sound, sustainable and ethical health care system can and should be built:.... 1. It shall be illegal for physicians to contract with anyone other than their patient or patient's legal representative. There shall be no contracts with the government, with any "managed care" entity or insurance company, or with any other third party..... 2. It shall be illegal for physicians to receive payment directly from a third party "payor." Payment must come from the patient directly and shall be made at the time of service..... 3. It shall be illegal for third parties to request discounts from a physician for their clients. The price for various services is to be negotiated between patient and physician, as is the case with all other professions. .... 4. Each American citizen shall have a Health Savings Account established at birth. The HSA will be maintained with an investment firm or bank, the accounts being insured by the Federal government to the amount of $150,000, as are bank deposits. Increases in value on these accounts via interest, dividends or increases in investment value are not taxed, and these assets are protected from creditors, as with the usual IRA. (Regulations will need to be developed regarding the type of investment, allowing a certain low percentage to be invested in more volatile investments.) Funds in the HSA can be spent only for Health Care, but can be passed on to heirs over multiple generations, to be used for the heir's health care needs. .... 5. Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... 6. Businesses may no longer subtract from taxable income any payments to "insurance companies" for health insurance plans. They can, however, deposit money yearly into their employees' HSAs as a dedutible business expense, the yearly maximum contribution per employee to be determined after study by qualified economists. .... 7. Each American citizen shall have a catastrophic health insurance plan in place that covers yearly health care expenses over $20,000 (adjusted yearly for inflation). This plan will be sponsored and financed by the Federal Government. See below for Comments about administration of this plan..... 8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... 9. The government will mandate that each state educate its citizen about this "self-reliant" system. Every citizen must realize the need for preventive health care and a healthy lifestyle. They must realize that prudent use of these funds and maintaining a healthy lifestyle are the surest route to security. They must be made aware that contribution yearly to the HSA must come before purchase of consumer goods, a new car, or a vacation, for example. There will be no free “safety net” other than the catastrophic coverage..... 10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... Comments..... This plan relies on human nature to reduce costs. When payment is coming directly from funds controlled by the patient, the patient will make wiser choices. There will be less desire to obtain expensive tests that are marginally indicated for minor complaints or to obtain expensive tests when less expensive tests will do. Less expensive, but equally effective, medications will be demanded by the patient..... and so forth. With this system, the medical profession will be restored to an ethical status, it being unethical to allow outside influences to intrude on the physician-patient relationship (as contracts with third parties invariably do). .... The public will demand transparency in the pricing of services and will cease to tolerate overpriced services. .... The nation will then be pooling health risks that are in the catastrophic range, rather than simply using the "insurance industry" as a (leaky) conduit of money from employer to physician or hospital for everyday care. .... With prudent living and prudent saving, within five to six years each citizen will have in their HSA sufficient funds to cover the $20,000 "gap" in any one catastrophic year, and within ten or so years should have the funds to cover the gap for several years of catastrophic ill health. With good health and good planning, these funds can be passed from generation to generation, allowing those families with good health to become fully covered with only rare intervention by the government. .... The government can negotiate with the current managed care industry to obtain management of the catastrophic funds with minimal administrative expense, or can set up its own administrative agency (to replace the current CMS, for example) to manage and administer the catastrophic coverage program..... Physicians will now be free to concentrate on what they do best, care for patients and maintain their knowledge base, and will no longer have to waste time dealing with managed care contracts and meaningless requests from managed care companies. .... I urge you not to let the powers that be within the current managed care industry or within the established government agencies to bring pressure against the adoption of such a rational and beneficial plan..... Respectfully yours, Lawrence E. Mallette, MD, PhD, FACP, FACN April 2009 /Open Letter Once again, chew on it for a while before rushing to judgment. -- www.e-woodshop.net Last update: 10/22/08 KarlC@ (the obvious) |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. But what do you do for critical care wherein costs can easily run into the $100's of K numbers--a friend had heart valve replacement at roughly $300K recently. The routine office visit is simple; the costs are in the high-dollar items that are less frequent, high liability (tort) costs and the costs for unreimbursed care that have to be picked up by those who do pay. The "competition" between physicians for expert medical care is a fallacy -- in general the consumer has insufficient expertise to judge quality or to know how to select alternate care options for the highest efficacy. When forced to make difficult decisions on perhaps life-or-death issues, in the end its not likely that the overriding concern will be the cost. Easy enough to hypothesize that's what the so-called rational consumer SHOULD do, but just as the markets are as much or more emotion-driven, health care choices are as well. -- |
OT - A intriguing "open lette"r on health care ...
On Sat, 30 May 2009 08:02:12 -0700, cm wrote:
I agree that changes are needed in our current system, but it scares the heck out of me to think that the government would be more involved. These are the same democrats and republicans that have sent our economy into a tail spin. But yet the SSA administers Social Security with an almost negligible amount of overhead. A government program can work efficently, but the devil is in the details. For example, Medicare offers way too many opportunities for fraud just because of the way it is structured and administered. And the fraud is coming from the private sector part (i.e. patients, doctors, hospitals, and insurance companies) not the government part. -- Intelligence is an experiment that failed - G. B. Shaw |
OT - A intriguing "open lette"r on health care ...
Larry Blanchard wrote:
On Sat, 30 May 2009 08:02:12 -0700, cm wrote: I agree that changes are needed in our current system, but it scares the heck out of me to think that the government would be more involved. These are the same democrats and republicans that have sent our economy into a tail spin. But yet the SSA administers Social Security with an almost negligible amount of overhead. A government program can work efficently, but the devil is in the details. .... Yeah, so efficiently they have thousands on the roles that have been deceased, some for decades (GAO investigation I heard reported not long ago)... -- |
OT - A intriguing "open lette"r on health care ...
"dpb" wrote in message ... Leon wrote: "HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. But what do you do for critical care wherein costs can easily run into the $100's of K numbers--a friend had heart valve replacement at roughly $300K recently. The only reason that the procedure cost that much is because insurance companies probably only pay 30% of that cost. Eleminate the insurance companines and you get the better pricing because every one is paying their fare share and the medical industry does not need nearly as many on staff whose only job is to "try" to collect what is owed them by the insurance companies. The "groups" that I referred to so surgery also at a dramatic reduction in cost. The routine office visit is simple; the costs are in the high-dollar items that are less frequent, high liability (tort) costs and the costs for unreimbursed care that have to be picked up by those who do pay. The "competition" between physicians for expert medical care is a fallacy -- in general the consumer has insufficient expertise to judge quality or to know how to select alternate care options for the highest efficacy. When forced to make difficult decisions on perhaps life-or-death issues, in the end its not likely that the overriding concern will be the cost. Easy enough to hypothesize that's what the so-called rational consumer SHOULD do, but just as the markets are as much or more emotion-driven, health care choices are as well. -- |
OT - A intriguing "open lette"r on health care ...
"Nova" wrote in message ... Leon wrote: "HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Do you really think the medical profession would keep the cost low or would they continue to keep jacking their price up to match the ones that are charging the most? Competition drives down prices. With insurance paying for your care there is no competition. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. That's because they feel the "usual and customary" charges, agreed to by those practicing and accepting the payment amounts the insurance companies have negotiated, are too little and they don't like being questioned when they overcharge. I suspect it is because they make more money and have lower costs extcept for the extensive advertising. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. How do they handle payment for the expensive things like surgeries, cancer treatment, child births, hospital stays, etc.? A patient that is a member of one of the Houston area groups had a daughter than needed arthroscopic knee surgery. He shopped the price and got quotes in the $15,000 range. IIRC his group did the surgery for less than $3,000. There will probably still be insurance for catastrophic needs if you feel that living an extra year or two is woth having insurance for. |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"dpb" wrote in message ... Leon wrote: "HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. But what do you do for critical care wherein costs can easily run into the $100's of K numbers--a friend had heart valve replacement at roughly $300K recently. The only reason that the procedure cost that much is because insurance companies probably only pay 30% of that cost. Eleminate the insurance companines and you get the better pricing because every one is paying their fare share and the medical industry does not need nearly as many on staff whose only job is to "try" to collect what is owed them by the insurance companies. The "groups" that I referred to so surgery also at a dramatic reduction in cost. .... Do they do the difficult surgeries or are they like the private heart clinics and others I'm aware of that "cherry-pick" the routine cases w/ high probability of success and low probability of complications and leave the rest to the others thus driving up average costs drastically. Again, _there's_ where the rub is. I'd wager it's the latter--every one of those groups I've ever seen have very selective membership criteria. I don't understand the 30% example--typically insurance carriers are covering 80% or "standard and normal" for any particular procedure. I'll agree there is some overhead in processing claims but I'm yet to be convinced it is a preponderant fraction of costs--rate it compared to liability cost and uninsured/uncompensated care costs and I'd wager it's the tail of the dog. Just as I'm totally unconvinced electronic records will have any discernible effect on actual costs--it may help in some cases w/ precision, add errors in coding in others and every large data-processing implemented I've ever seen simply transferred one group of overhead costs to a different set to implement/maintain/operate the system. -- -- -- |
OT - A intriguing "open lette"r on health care ...
dpb wrote:
Leon wrote: "dpb" wrote in message ... Leon wrote: "HeyBub" wrote in message ... This plan does not rely on "human nature" to reduce costs - it relies on government setting rules on how health care contracts should be negotiated and enforced. There is nothing that would prevent, today, a physician from demanding payment up front from the patient and refusing all third-party involvement. Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Already there are groups of doctors, clinics, pharmacies, and hospitals that will not accept insurance. You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. But what do you do for critical care wherein costs can easily run into the $100's of K numbers--a friend had heart valve replacement at roughly $300K recently. The only reason that the procedure cost that much is because insurance companies probably only pay 30% of that cost. Eleminate the insurance companines and you get the better pricing because every one is paying their fare share and the medical industry does not need nearly as many on staff whose only job is to "try" to collect what is owed them by the insurance companies. The "groups" that I referred to so surgery also at a dramatic reduction in cost. ... Do they do the difficult surgeries or are they like the private heart clinics and others I'm aware of that "cherry-pick" the routine cases w/ high probability of success and low probability of complications and leave the rest to the others thus driving up average costs drastically. Again, _there's_ where the rub is. I'd wager it's the latter--every one of those groups I've ever seen have very selective membership criteria. I don't understand the 30% example--typically insurance carriers are covering 80% or "standard and normal" for any particular procedure. I'll agree there is some overhead in processing claims but I'm yet to be convinced it is a preponderant fraction of costs--rate it compared to liability cost and uninsured/uncompensated care costs and I'd wager it's the tail of the dog. Just as I'm totally unconvinced electronic records will have any discernible effect on actual costs--it may help in some cases w/ precision, add errors in coding in others and every large data-processing implemented I've ever seen simply transferred one group of overhead costs to a different set to implement/maintain/operate the system. More to the point, even if the actual cost is only 100K and not 300K, that's still more than most people can afford out of pocket. |
OT - A intriguing "open lette"r on health care ...
"Leon" wrote: Competition drives down prices. With insurance paying for your care there is no competition. Reading the above brings a question to mind about another industry. How much competition is there among auto body shops for insured accident repair? Lew |
OT - A intriguing "open lette"r on health care ...
J. Clarke wrote:
.... More to the point, even if the actual cost is only 100K and not 300K, that's still more than most people can afford out of pocket. Yet even more to the point, even $300K is a mere pittance for many treatment options... :( -- |
OT - A intriguing "open lette"r on health care ...
Lew Hodgett wrote:
"Leon" wrote: Competition drives down prices. With insurance paying for your care there is no competition. Reading the above brings a question to mind about another industry. How much competition is there among auto body shops for insured accident repair? Quite a lot here, actually, anyway. All insurance companies I've dealt with pay only the lowest bid w/ confirmation work is required either by own inspection for really high-$$ jobs or simply photographic submittals for lesser amounts. I still say one's viewpoint of costs when dealing w/ major health care isn't generally focussed on lowest bidder. For maintenance care such as long-term medications, etc., sure, but for (say) cancer are you going to the local GP or Hutchinson or Mayo or other specialty clinic? -- |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"Nova" wrote in message ... Leon wrote: Precisely, and that is the beauty. Once again competition between doctors and their services would keep costs low. Do you really think the medical profession would keep the cost low or would they continue to keep jacking their price up to match the ones that are charging the most? Competition drives down prices. With insurance paying for your care there is no competition. The competition comes into play with the insurance providers. When I choose my medical insurance plan one of the major considerations is which doctors participated in each of the plans that are available. The lower priced plans had fewer participating doctors and specialists. snip You have to join their group for well under $100 per month for your whole family but a typical office visit costs around $35. How do they handle payment for the expensive things like surgeries, cancer treatment, child births, hospital stays, etc.? A patient that is a member of one of the Houston area groups had a daughter than needed arthroscopic knee surgery. He shopped the price and got quotes in the $15,000 range. IIRC his group did the surgery for less than $3,000. I don't know that I'd always want my medical treatment to go to the lowest bidder. There will probably still be insurance for catastrophic needs if you feel that living an extra year or two is woth having insurance for. It doesn't take a catastrophe to end up with astronomical medical bills. I don't foresee any major reduction is the cost of medical care regardless of who foots the bill. As proposed in Swingman's original post: "Each American citizen shall be able to exclude from taxation the amount of $5000 per year (adjusted for inflation) for deposit in his or her Health Savings Account, with catch up contributions allowed if the prior year's expenses exceeded this amount. There shall be no limit to the total amount of capital the citizen can accumulate in his or her HSA. .... " How does this work for a hypothetical married couple with three young children and one wage earner making minimum wage? Obviously they won't be able to put $25,000 per year into their HSA. Then there's: "8. Citizens with income below the poverty level will be provided yearly with a "tax rebate" from the Federal Government, deposited directly into their HSA..... " A "tax rebate" would indicate the citizen is paying federal tax. A family of five earning $13,624 per year ($6.55 per hour x 40 hours x 52 weeks) does not pay federal income tax. And there's: "10. Citizens who become ill before they have accumulated sufficient funds in their HSA to cover the "gap" (whose HSA balance falls below zero in a given year) will be LOANED the needed funds by the Federal government, to be repaid with interest in the future. This loan will show up on their credit report and will influence their ability to borrow for other purposes until it is repaid. .... " Let's bury the hypothetical family in debt and take away all incentive to work. Tim and I can cover all their expenses with out tax dollars. -- Jack Novak Buffalo, NY - USA |
OT - A intriguing "open lette"r on health care ...
"dpb" wrote: I still say one's viewpoint of costs when dealing w/ major health care isn't generally focussed on lowest bidder. For maintenance care such as long-term medications, etc., sure, but for (say) cancer are you going to the local GP or Hutchinson or Mayo or other specialty clinic? It is the market forces at work regardless of the industry. When the talent pool is limited and the demand high, price reflects this whether you are dealing with show business talent, lawyers, or the medical profession. Quality, perceived or otherwise, has it's price. Lew |
OT - A intriguing "open lette"r on health care ...
"dpb" wrote in message ... ... Do they do the difficult surgeries or are they like the private heart clinics and others I'm aware of that "cherry-pick" the routine cases w/ high probability of success and low probability of complications and leave the rest to the others thus driving up average costs drastically. Again, _there's_ where the rub is. I have heard nothing to make me think that they would not. It would be as ignorant to assume that they would not as it would be to believe that they would with out checking the details. Same goes for AMU insurance company or HMO. I'd wager it's the latter--every one of those groups I've ever seen have very selective membership criteria. Have you seen them all? I don't understand the 30% example--typically insurance carriers are covering 80% or "standard and normal" for any particular procedure. I see my medical bills and what portion that is actually paid by the insurance companies. Often the insurance companies cut up to 90% off and often will not cover a procedure. The doctor writes that off, I don't get billed for the difference. I'll agree there is some overhead in processing claims but I'm yet to be convinced it is a preponderant fraction of costs--rate it compared to liability cost and uninsured/uncompensated care costs and I'd wager it's the tail of the dog. Just as I'm totally unconvinced electronic records will have any discernible effect on actual costs--it may help in some cases w/ precision, add errors in coding in others and every large data-processing implemented I've ever seen simply transferred one group of overhead costs to a different set to implement/maintain/operate the system. |
OT - A intriguing "open lette"r on health care ...
"J. Clarke" wrote in message ... More to the point, even if the actual cost is only 100K and not 300K, that's still more than most people can afford out of pocket. but a far greater amount of people can afford 100k vs. 300k. You are not going to be able to please all the people all the time. |
OT - A intriguing "open lette"r on health care ...
"Lew Hodgett" wrote in message ... "Leon" wrote: Competition drives down prices. With insurance paying for your care there is no competition. Reading the above brings a question to mind about another industry. How much competition is there among auto body shops for insured accident repair? When I was in the business, there was basically no competition, in Houston or Corpus Christi, in the 70's, 80's, and 90's. Because 99% of the cars being repaired were covered by an insurance company. Basically we never had to worry about a customer turning down an estimate. Additionally we did not accept payment from insurance companies unless it was MIC insurance sold by GM. We charged every one the same price whether the insurance company was involve or not. When we had to accept MIC insurance we had to discount parts $30% and give a hefty discount on labor. We stayed busy. |
OT - A intriguing "open lette"r on health care ...
"dpb" wrote in message ... Lew Hodgett wrote: Quite a lot here, actually, anyway. All insurance companies I've dealt with pay only the lowest bid w/ confirmation work is required either by own inspection for really high-$$ jobs or simply photographic submittals for lesser amounts. The insurance company "wants" to only pay the lowest bid. Read your policy, there is generally no mention of where you have to get the car repaired. If you choose to have the car repaired at a more expensive place the insurance so is liable to pay for the repairs up to the value of the car. Basically the lowest bid could still be thousands higher than the next guy down the street. It is a game that the insurance companies play. They try to make you and are very often successful at getting you to shop for cheap repairs. |
OT - A intriguing "open lette"r on health care ...
"Nova" wrote in message ... A patient that is a member of one of the Houston area groups had a daughter than needed arthroscopic knee surgery. He shopped the price and got quotes in the $15,000 range. IIRC his group did the surgery for less than $3,000. I don't know that I'd always want my medical treatment to go to the lowest bidder. Agreed and these guys are probably makin more off of the procedure than those having to collect from an insurance company. Remember insurance companines get deep deep discounts and often don't pay. Basically HMO's and insurance companies are more like agents for many doctors. I think I would probably have more faith in a doctor that does not rely on an insurance company to bring in it's patients. There will probably still be insurance for catastrophic needs if you feel that living an extra year or two is woth having insurance for. It doesn't take a catastrophe to end up with astronomical medical bills. I don't foresee any major reduction is the cost of medical care regardless of who foots the bill. Don't for get the major point here, insuranc companies make more than the health care system does and what overhead does an insurance company have other than an office for record keeping? Take the insurance company out of petty coverage and every one saves, except the insurance company. |
OT - A intriguing "open lette"r on health care ...
Same goes for ANY insurance company or
HMO. |
OT - A intriguing "open lette"r on health care ...
On Fri, 29 May 2009 18:03:59 -0500, Swingman wrote:
Friend of mine, a doctor and fellow musician, came up with the following, an intriguing plan to revamp the US health care system from a practicing physician's perspective. Be sure to read the entire plan before making any judgments, it's tricky in few spots. Open Letter snip Why don't we just buy ourselves a doctor? Let's say you belong to a builder's association with one hundred members. Each of the members has been spending $1000.00 per month on family medical insurance. That creates a theoretical maximum pool of $1,200,000.00 per year. Let's say an internist earns an average of $200,000.00 per year. His salary would cost each member $2,000.00 per year. Since he only has a patient group of four hundred people, he can do his own damned paperwork and he doesn't need an office because with only four hundred patients everything would be a house call. Alright, if you're gonna bitch about medical equipment and other expenses, let's throw in $50,000.00 a year for that. So now we have a medical subcontractor at a total cost of $250,000.00 per year divided by one hundred members for a cost of $2500.00 per year. That's $208.33 per month for primary medical care for a family of four. That leaves $791.67 per month to pay for catastrophic coverage. At a cost of $3500.00 per year for that coverage that would be another $291.67 per month. Total cost of primary and catastrophic coverage is about $500.00 per month. I haven't looked into the cost of buying an actual hospital yet but, what the hell, we're talking about a builder's group. I'm thinking $200.00 per square foot including the Chiwanese medical gear we'll get from Grizzly. I don't know why my son thinks that math isn't fun. Regards, Tom Watson http://home.comcast.net/~tjwatson1/ |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"J. Clarke" wrote in message ... More to the point, even if the actual cost is only 100K and not 300K, that's still more than most people can afford out of pocket. but a far greater amount of people can afford 100k vs. 300k. ... Out of pocket w/o insurance I'd say the percentages are about the same--miniscule. -- |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"dpb" wrote in message ... ... Do they do the difficult surgeries or are they like the private heart clinics and others I'm aware of that "cherry-pick" the routine cases w/ high probability of success and low probability of complications and leave the rest to the others thus driving up average costs drastically. Again, _there's_ where the rub is. I have heard nothing to make me think that they would not. It would be as ignorant to assume that they would not as it would be to believe that they would with out checking the details. Same goes for AMU insurance company or HMO. They might; then again they may not. Most likely the selection criteria were made when you were enrolled in the group. What if you had been 70+ and in need of serious heart care when first applied? Think you'd still have been accepted? I'd wager it's the latter--every one of those groups I've ever seen have very selective membership criteria. Have you seen them all? Of course not--but I've seen enough to have a pretty good understanding of their business model. It's quite selective, not universal. I don't understand the 30% example--typically insurance carriers are covering 80% or "standard and normal" for any particular procedure. I see my medical bills and what portion that is actually paid by the insurance companies. Often the insurance companies cut up to 90% off and often will not cover a procedure. The doctor writes that off, I don't get billed for the difference. .... That's doctor's choice then--I've seen some that do, some that pass the cost on and some that are in between. Some carriers have contracts that say what is/isn't passable; some physicians choose not to accept patients with those carriers. There is no one size fits all, but if there's one of the sign-up monthly fee groups that doesn't have a fairly tight acceptance criteria policy I've yet to see it. -- |
OT - A intriguing "open lette"r on health care ...
Lew Hodgett wrote:
"dpb" wrote: I still say one's viewpoint of costs when dealing w/ major health care isn't generally focussed on lowest bidder. For maintenance care such as long-term medications, etc., sure, but for (say) cancer are you going to the local GP or Hutchinson or Mayo or other specialty clinic? It is the market forces at work regardless of the industry. When the talent pool is limited and the demand high, price reflects this whether you are dealing with show business talent, lawyers, or the medical profession. Quality, perceived or otherwise, has it's price. Sure, but... :) The point I was making was that imo there isn't much pricing competition brought to bear in the selection of treatment process by most people in search of medical care--in general they're more concerned about whether they think they're going to find an effective treatment whatever the cost. Thus I don't think competition is particularly effective in holding down health care costs because I don't believe it's the driving force in most decisions. -- |
OT - A intriguing "open lette"r on health care ...
Leon wrote:
"dpb" wrote in message ... Lew Hodgett wrote: Quite a lot here, actually, anyway. All insurance companies I've dealt with pay only the lowest bid w/ confirmation work is required either by own inspection for really high-$$ jobs or simply photographic submittals for lesser amounts. The insurance company "wants" to only pay the lowest bid. Read your policy, there is generally no mention of where you have to get the car repaired. If you choose to have the car repaired at a more expensive place the insurance so is liable to pay for the repairs up to the value of the car. Basically the lowest bid could still be thousands higher than the next guy down the street. It is a game that the insurance companies play. They try to make you and are very often successful at getting you to shop for cheap repairs. I didn't say anything about _which_ estimate you have to submit; only that they will only pay the amount of the lowest that is submitted that covers the required work. Most body shops I've dealt with will come to within a few $$ of any other; they all use one of a few software packages for estimating so their labor estimates are all within a few tenths of hours/task and they all use the same or nearly after-market parts markets as well. The biggest differences I've seen is finishing but the highest here will tell you when he makes the estimate it's higher than most other shops in town because of that and he'll knock it down when the insurance company balks (as they always do). If it's a chromed piece I'll make it be OEM; otherwise anymore I can't see any significant difference in the aftermarket parts of significance. Just been thru it w/ Mr Buck that couldn't stay on the side of the road where he belonged... :( -- |
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