How would you fix healthcare system?

[Kewl X5]

I guess Obama not used to hearing "boos?!"

Analysis: Doctors' boos show Obama's tough road - Yahoo! News

[MrLabGuy]

Here is where I would start.

Infuse...Here is that word again..."Personal Responsibility" into the system. If you smoke, eat poorly and don't exercise then you pay more or are not covered for certain vice related illnesses and conditions. I'm sorry but if you smoke in this day and age and don't know about Lung Cancer then you need to be removed from the gene pool. If however, you don't smoke, drink in moderation and live a healthy lifestyle you pay less because you cost the system less. The healthy pay as much as the stupid to balance out the risk in most cases. Medi-Caid and Medi-Care recipients should be screened and rewarded for lifestyle. If my taxes are paying for someone who weighs 340 pounds because he eats at Burger King every night I'd say he is headed for Heart Disease regardless of what we pay to keep his ass alive.

If you provide incentive for good health you will get good health because people will either change behavior or die off and the remaining citizens will live healthier and have more services and tax dollars for legitimate accidents and illnesses.

Lifestyle is a choice and has concequences...Unless you are a Progressive.

[Viperfreak2]

Make the cost of plane tickets 'per pound'.

[blondboinsd]

Originally Posted by MrLabGuy

Here is where I would start.

Infuse...Here is that word again..."Personal Responsibility" into the system. If you smoke, eat poorly and don't exercise then you pay more or are not covered for certain vice related illnesses and conditions. I'm sorry but if you smoke in this day and age and don't know about Lung Cancer then you need to be removed from the gene pool. If however, you don't smoke, drink in moderation and live a healthy lifestyle you pay less because you cost the system less. The healthy pay as much as the stupid to balance out the risk in most cases. Medi-Caid and Medi-Care recipients should be screened and rewarded for lifestyle. If my taxes are paying for someone who weighs 340 pounds because he eats at Burger King every night I'd say he is headed for Heart Disease regardless of what we pay to keep his ass alive.

If you provide incentive for good health you will get good health because people will either change behavior or die off and the remaining citizens will live healthier and have more services and tax dollars for legitimate accidents and illnesses.

Lifestyle is a choice and has concequences...Unless you are a Progressive.

100%. I'm sorry but when I had borderline high blood pressure I just changed my diet and was back in normal range in 1 month. I believe an individual mandate is the way the go with a realistic (by state) subsidy for those who can't afford the premium. I believe we need to cap malpractice lawsuits and move away from the per service billing and replace it with a pay-for-performance model. That would lower costs and reward efficient hospitals/doctors. In addition I don't believe in treating illegal immigrants without first determining their ability to pay. In other social systems (Canada, Mexico etc) if you show up from the US and want treatment you will be required to pay for your services because the system is social but only for their population. I understand that may be cruel or sound harsh but it's a reality we have to face. We can't continue to force the hospital to "eat the cost" because that drastically raises all of our medical expenses.

[Wagner]

I'm still figuring out why it is an epic problem that less than 8% of your population doesn't have health care, doesn't that mean nearly 92%+/- do?

I just look across the street at my neighbors who live in a 700K+ house and don't bother to have health care, I'm sure they are part of that 42M...along with children who can't qualify to buy health care.

Now, if you wanted to find a way to regulate costs to some extent (i.e. minimize the ability of my companies insurance costs to go up 25% in one year)...that would be something. Lessen malpractice possibilities (frivolous lawsuits) wonderful, as that would lessen dr. insurance. Great. And my number one favorite, allow me to shop for health insurance ANYWHERE in the 50 (or 57) states in the USA And for the GOLD, give small businesses (less than 50M in sales) get a substantial tax deduction if they cover health insurance, at some level, at 100% of cost.


FWIW:

This came out of the budget office in regards to the Dems 1T pkg for health care, see if this sounds worth it:

The agency estimated that the exchange and subsidies could reduce the number of uninsured people by roughly 16 million by 2015. It is estimated there would otherwise be 51 million uninsured that year.

[chile1]

Originally Posted by MrLabGuy

Here is where I would start.

Infuse...Here is that word again..."Personal Responsibility" into the system. If you smoke, eat poorly and don't exercise then you pay more or are not covered for certain vice related illnesses and conditions. I'm sorry but if you smoke in this day and age and don't know about Lung Cancer then you need to be removed from the gene pool. If however, you don't smoke, drink in moderation and live a healthy lifestyle you pay less because you cost the system less. The healthy pay as much as the stupid to balance out the risk in most cases. Medi-Caid and Medi-Care recipients should be screened and rewarded for lifestyle. If my taxes are paying for someone who weighs 340 pounds because he eats at Burger King every night I'd say he is headed for Heart Disease regardless of what we pay to keep his ass alive.

If you provide incentive for good health you will get good health because people will either change behavior or die off and the remaining citizens will live healthier and have more services and tax dollars for legitimate accidents and illnesses.

Lifestyle is a choice and has concequences...Unless you are a Progressive.

MrLabGuy you are right-on with this one - I Agree 100%. I keep fit and expect my family (including my extended family) to do so as well. I'm worse than a drill sergeant when it comes to discipline and exercise and have no patience with those living an unhealthy lifestyle and then complaining!!

And you thought we would never agree on anything..............

[Quicksilver]

Donald Berwick is a Massachusetts pediatrician and president of the Institute for Healthcare Improvement. (Donald believes he has the answer)

Ask a doctor what's wrong with America's healthcare system, and be prepared to pull up a chair. You'll hear a litany of complaints about Kafka-esque bureaucracies, litigious patients, unreasonable insurance companies, too few nurses, never enough time, too much testing and not enough talk. But complaining gets us nowhere—we need solutions. Here are my top seven reforms for health care.

1. Make Health Care in America a Human Right

The US spends almost twice as much in health care as the next most costly nation, and our system is not even close to the best on earth. The assertion that making health care a human right isn't feasible — isn't affordable — nearly makes me mad. It's just not true; in fact, we are the only developed Western country that fails to view health care as a human right. Leadership for change must come from the President and Congress. Without the promise of health care for all, we aren't likely to muster the energy and political will we need to meet the needs of our entire population. We'll limp along, instead, with defects in care and gaps in management that we have trained ourselves to regard as inevitable.

2. Pay for the Care of Populations, Not Events

Our current system of fragmented payment — for hospital stays, office visits, lab tests, drugs, and therapists — destroys the patterns of care that patients need, and leaves them confused and, too often, simply abandoned. Funding care for people over time, instead of for specific medical events, reduces the burden of illness by focusing on high quality preventive care. We need "managed care" as it was originally intended to be — the good kind, not the evil, mutant twin that just tried to cut costs, restrict choice, and limit available care. Correctly conceived, "managed care" addresses the real needs of patients over time and place, guiding them through the technological thicket of modern medicine, and making sure that they get exactly what they want and need, exactly when and how they want and need it.

3. Put the Patient in the Driver's Seat

The more control patients have over their own care—the more they know, the more involved they are in the design of their care—the better. We haven't even begun to plumb the real potential of patients who have been taught how to become their own physicians (to the extent that they want to). Despite the rhetoric, most people can't even get access to their own medical records, and it's often next to impossible to find data on how one's own hospital or physician performs compared with others. Some people fear that, given choices, patients will not choose wisely or will demand too much. I doubt it—one study found that when patients actively shared in decisions about whether to have surgery, the rate of surgery fell 23% and satisfaction and outcomes both improved.

4. Computerize Medical Records, Once and for All

My pizza parlor is more thoroughly computerized than most of health care. It's high time to put the paper medical record where it belongs — in the Smithsonian, next to the typewriter. Proper use of modern information systems for medical records will support much more integrated care, and will allow patients to feel better supported and remembered as they move from place to place and over time. Importantly, a computerized medical record and be, and should be, accessible to patients directly, and under their control.

5. Use Modern Engineering Science to Make Health Care Safer and Smoother

The same sciences that allow airplanes to fly safely, that keep the lines moving at Disney World, and that continually reduce the costs and improve the reliability of computers and consumer goods, can help in health care too. To a large extent, health care systems were not designed with any scientific approaches in mind. Too often there are long waits, high levels of waste, frustration for patients and clinicians alike, and unsafe care. A bold effort to design health care scheduling systems, process flows, safety procedures, and even physical space will pay off in better, less expensive, safer experiences for patients and staff alike.

6. Re-Energize Primary Care and Nursing

Our current care system is hospital-centric and physician-centric. We cannot have excellent, coordinated, patient-centered, economical health care without a strong backbone of primary care, and without a vibrant, proud, and joyful nursing workforce. Yet fewer and fewer young people are choosing to go into primary care careers (instead, we are getting an oversupply in specialties like ophthalmology, radiology, anaesthesiology, and dermatology) and the average age of an American nurse is now over 47 years.

7. Give Up the "More Is Better" Myth

Good evidence now shows that the areas in the US with the highest rates of use of hospital beds, intensive care units, specialist consultations, and invasive testing don't have the best quality of care and outcomes. In fact, they often have the worst. It would be a great advance in both quality and cost if somehow the American public came to understand that "more care" is not by any means always "better care," and that new technologies and hospital stays can sometime harm more than they help. Patients need to ask more, "Are you sure I need that?" and to trust that, often, the best care is the most conservative care.

How To Fix The System - TIME

[Wagner]

Ask Citibank about how "computerized" records work and what huge security hole they open. You thought we saw litigation before, wait till the first 400K medical records are 'stolen'. Not to mention the corporations that will 'buy' those records to solicit to folks. A pizza shop doesn't have to worry about losing your SSN and all pertinent information to your existence on the planet. I'm not saying it doesn't need work but to assume this should all be 'online' is exceptionally naive IMO. I would love to see health care insurance information strung together so that once I register with a doc or the like, all my info is there and I don't have a single form to fill out. This is something I could manage online from my home or on my phone And as for having online access to medical records, how does Walgreen's do it Seems something is already in existence

It would be interesting to see a list of countries that have a "better" health care system and what factors were used to weight such an observation to remove the capacity of personal favoritism or subjective analysis. And the WHO is not an unbiased entity just look at how hard they attempted to 'pimp' N1H1 or piggy flu.

[JCL]

Originally Posted by Wagner

It would be interesting to see a list of countries that have a "better" health care system and what factors were used to weight such an observation to remove the capacity of personal favoritism or subjective analysis. And the WHO is not an unbiased entity

Leaving aside the WHO, you could use OECD, who has a lot of comparative data available online. Their criteria are fairly complete. They don't get into the value equation, more so the access rates, survival rates, and so on.

www.oecd.org/health

[JCL]

Originally Posted by Quicksilver

Donald Berwick is a Massachusetts pediatrician and president of the Institute for Healthcare Improvement. (Donald believes he has the answer) <snip>

Looks like a good list, Quick. It doesn't sound too compatible with a for-profit, event-driven system that ensures that the patient isn't in the driver's seat, and that the patient doesn't have access to records, but it would be a great start.