From Andy: Big Health Care Reform Should Start at the Bottom

Greetings,
As the Health Care debate around our country rages on, waxing and waning with each poll, I thought it was time to throw in some overlooked or outright discarded ideas. Bringing real access to health care to everyone without massive cost increases or symbolic coverage requires a total rethinking of how we do some things. Due to various regulations and liability issues as well as financial considerations most doctors now immediately after being in medical school go for specialty’s. Due to the cost of medical school and student loans it is not easy to make a livelihood as a doctor as a general practitioner of medicine. Now I realize that may be hard to believe due to prices that you are charged for going to a doctor but consider this first. Medical school can cost from 12-20K a year with books and other fees. This doesn’t include eating either. Now multiply that by 8 years to get a doctoral of medicine and you are looking at 96-160K in student loans cost. Don’t believe me google it and check. So you are fresh out of medical school with 100K in student loan debt. Now add whatever it costs to have a standard of living in your area. This puts most doctors out of medical school in a pretty big bind. Imagine having a house or apartment bill every month in student loans costs on top of all your bills. It doesn’t take much imagination to see why it is 50.00 or more just to see a doctor without insurance. Now add malpractice insurance to the equation. That can run from 20K to 200K depending on state and field the doctor is in. The point of all of this is we can pummel large health care companies as they are easy and in many ways justifiably part of the problem. But we are really only throwing a band aid on a gunshot wound if we don’t consider the entire system from college to hospital to managed care. So here are some suggestions or ideas for everyone to think about.
1.) Provide all or a portion of a pre-med students tuition to become a doctor up to General Practitioner with a few rules: they must maintain a suitable grade point average, depending on the level of financial help provided agree to work for a length of time at a government hospital facility or non-profit hospital for a standard wage, agree if they don’t maintain a proper grade point average or leave the position early they will be responsible for the loan or portion left that was given to them. If they fill the requirements they do not have to pay back the loan.

2.) Reform Malpractice laws. This can be done in a number of ways like setting a set percentage that lawyers can receive from winning a lawsuit while suing a doctor (in many cases lawyers take 40% area) to a realistic level, setting limits (reasonable) on how much a person could receive from a settlement ( I am in favor of this personally as long as the amount is fair and also if the injury or error causes permanent injury that the responsible party provides to have the costs of the injury for the duration of it.), reduce the timeframe that a patient can sue a doctor for an injury are all possible ways to do this.

3.) Streamline procedures involving medical practices and review them regularly with the heads of hospitals and doctors to ensure that the people doing the work are crafting the procedures.

4.) Enact Chargeback Rules. If you sue a doctor and your case is proven fraudulent or frivolous an award should be given to the doctor for the lost time and damage to his practice from the person accusing him.

5.) As lawyers have a rule that they must do a certain amount of pro bono work a year for people maybe adding in a rule of that nature may be worth looking at as well.

All of these ideas are just smaller pieces to a bigger puzzle but I haven’t read or heard of anyone in the “overhaul” of our health care mention anything close to this. We have spent so much time focusing on how big companies screw us we don’t or haven’t paid attention to how the actual doctor’s get pressured and screwed all the time. If we started with the fundamentals of health care at the bottom and worked up reforms may come in smaller packages but they would be real. Currently as it is we are trying to reform health care by replacing the board of a company not asking or listening to all the workers of that company what could be done to really change things for the better. Well writing about the entirety of the Heal care bill and debate would make a full time job I just wanted to throw in my two cents on it. See you all next time.

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9 Responses to From Andy: Big Health Care Reform Should Start at the Bottom

  1. Erick says:

    What are your thoughts on health insurance as “insurance” – defined as coverage in case something happens that you REALLY can't afford, and not simply as a medical expense account?I think there is a level of personal responsibility out there that is missing. When my oil needs changed, Allstate doesn't pay for that for me. When my tires need rotating or even worse, replaced early (because I didn't rotate them as suggested), Allstate doesn't cut me a check for that. When my O2 sensor goes out and needs replacing, Allstate doesn't pay for that. They do pay however when a light is run (either by me or another party) and my car is damaged to the tune of $3,000.In the same sense, should BCBS be paying my $50 Dr. bill because I got a sore throat or a cold? My oil changes cost more than that. What about that physical. What's the difference between a physical and a tire rotation? They're both maintenance. In fact, how much more important is my body's maintenance because I can't just drop in a new brain when it suffers a stroke due to lack of oxygen because I didn't maintain my body?I'd be interested in knowing how much insurance companies pay for “routine dr. visits” vs. “catastrophic medical expenses”. Imagine the % of costs that could be saved if insurance companies stopped paying for routine dr. visits.

  2. Andy says:

    Hey Erick, You know that is a good point. Personally i think a middle ground of sorts could be found for it. To answer one of your questions I saw a doctor recently due to a infection in my leg. My copay was 30.00/visit. The doctor I saw however bill per visit was 418.00 per visit. In this instance I would never had gotten care I needed to stop the infection for that price. There really isn't a real sense of competition for health care until you get up into wealthier patients or specialties. This in turn is caused by a combination of factors that cause a bill to be 418.00 dollars a visit. It is illegal to charge for example a different price for medicare treatments and non medicare treatments. If you check you will find out that most doctors raised their prices to match whatever a medicare disbursement is for a treatment of care for a patient. I am not knocking that medicare has and continues to be the main source of care for literally millions of people however, it is part of the problem when you work in pricing of care. Also for sore throats and colds personally unless you need a note for school or work really is a waste of a doctors time unless their is a good reason to go. i have seen people take their children to the doctor for everything and that also drives up care costs as it eats up time that doesn't need to be really used. In cases like this i personally think that professional nurses should be able to have clinics like they do in some Walgreen's that can handle runny noses and colds. There are a lot of things that we could do to really truly make changes to health care. More personal accountability, less hypochondria ( H1N1 scare? ), more effective uses of tax dollars, competition, accountability of patients, and numerous other changes. Some doctors make mistakes but medicine isn't called a practice for nothing.

  3. foxy says:

    When the doctor visits are not paid for, it has been shown that people do not go to doctors when they really should with seemingly minor ailments, to get checked out for more serious things, and then they often do become more serious, costing the patient and society in general much more. This is contrary to what a lot of people complain about; namely, that people would go to the doctor for frivolous things. Other countries who have nationalized health care do not complain about this problem. The opposite is far more harmful. My thoughts on “insurance” are that we really don't have health insurance in this country. None of us is really protected against potential financial ruin. This does not occur in any other developed country, because they all have universal systems. Here the word “insurance” is being used inaccurately. It is a national scandal that we sit by and allow this to happen to other people.

  4. Michael Koby says:

    I don't buy part of that. I have a son who has more medical issues you can name and the ONLY thing saving my family from COMPLETE financial ruin is my family's health insurance.People are quite critical of socialized health care, in fact in a previous article I wrote, you'll find links to discussions on Canada's socialized health care. Links can be found at:http://www.mkoby.com/2009/02/23/socialize-healt…A google search about Canada's health care system will even turn up stories about people being told by their doctors to go come to the United States to get needed surgeries because the waiting list in Canada is tool long.And my issue with not paying for routine doctor's visits becomes, where does the line get drawn between what's routine and what's not? And who is going to make that decision? I already have issues with hospital bills because of a disconnect between what the insurance will pay for and how the hospital is run, I definitely don't want the insurance company deciding routine/non-routine.We are definitely in need of some health insurance reform (because as for the actually doctors/care, we have great doctors here). Our government programs need work too, because I can't get assistance for my son's needs because I “make too much yearly” and I'm not even asking for them to pay for everything, just what my insurance will not cover.

  5. Erick says:

    Foxy, I think that's a mentality thing. My aunt is the director of ER for Sugar Land Hospital in Fort Bend County. She says she sees it all the time where someone comes in with $100 Nike's, lots of jewelry, high tech cell phone with the latest musical ringtones and their payer is Medicare. Another example, I was watching Pawn Stars on History Channel last night and a situation arose where the grandson bought a tattoo set from a customer, then traded it to a tattoo guy for a tattoo that he wanted. He figured that he saved money because the tattoo would've cost him more than $350.When he got back to the shop, his grandfather was PISSED while his dad was like, “you're an idiot but you'll have to make it up”.What I saw was that the older generation (his grandfather) was like, we're a business and we need to make a profit to survive. We can't just cover the cost of items cuz we have overhead to pay as well. Not only that, you took time off in the middle of a busy day and we needed your help. The grandfather was all about personal responsibility, where the father was more moderate and like, “you can't just do this stuff so you're gonna have to make it up” and the grandson was all mad with a demeanor (my impression) that he was OWED what he got. Like it wasn't a big deal and he had a right to do that because he saved money on a tattoo.My point is that we as a society (in America mainly…don't know other countries…never been there) have this mentality that we are owed the world and we should have it now. I can't say why, but can speculate that it's because 1) we're a consumeristic society with 70% of our GDP coming from people buying things (like goods, music, going to movies, out to eat, etc) and 2) the world we live in with technology makes us a “gotta have it now” because everything happens now. I mean, people who have to wait more than 10 seconds for a webpage to load don't wait, they move on (that's .011% of a day).I think in the end if we put our priorities straight and said, I need to have $50/mo set aside for car maintenance, shouldn't we also put aside maybe $100/mo for health expense beyond our premiums (that $50/mo for my car is NOT part of my $100/mo car insurance prem.)?Also, while other countries have universal systems, they do pay for those systems with 33%+ in taxes right out of their paycheck (tha'ts 1/3 of your income…no choice in finding something cheaper…just pay it cuz we say so…how is that freedom? And it doesn't address long waits, lotteries to be on a dr.s patient list, or visits to specialists which take more than year to get an appt.)Also car insurance and home insurance doesn't keep you from financial ruin, why should health? You can get into a car wreck, have a $500,000 cap on your policy for payout and then have the other driver sue you and win for add'l damages because you T-Boned his Lamborghini and $500,000 doesn't cover a new top of the line Lambo). Insurance isn't meant to COMPLETELY protect you. I think it's our job to bring more to the table in order to offset the cost (ie. drive defensively, pay attention to things around you, maintenance your car, maintain your body, eat healthy, exercise to stay healthy, etc). I don't believe a universal system is the right way because there is not 1 answer to fix all. But I guess that's just me.

  6. Andy says:

    Hey Foxy, You bring up a good point and i do believe a portion of people wouldn't go to a doctor with a higher initial visit cost or if they had to pay more upfront. I would personally at this time in my life be pretty hard pressed to pay much more than i do not to visit a doctor right now. At the same time health insurance is not meant to cover every cost. it offset it or brings more extravagant procedures into the realm of affordability. Also consider how it is sold, the only reason it is even somewhat affordable in its current state is they figure out the average costs amongst a group of people and charge premiums based on that. If you really want to see premiums come down get involved in school and lunch programs etc. get gym and recess and healthy more active lifestyles instilled in children early. Hell We all need to get our butts up a lot more than we do here. Our costs go up every year as we take less responsibility for ourselves and lifestyles and add to the growing costs of our own health care. I do like the idea of nationalized health care as there is good there. I just have no faith it could be implemented fairly or well in our country. Because of that i oppose national health care because it would be a joke by the time it got to everyone and with a huge bill.

  7. Andy says:

    Hey Erick, Its not just you. I wrote this article to bring another small facet up on this debate. Health care reform and overhaul is huge it touches a whole range of issues and it literally can kill if done wrong. Its not just insurance companies and government programs. Its us as a people becoming sedentary, various things we put in our foods and environments causing an increase in allergies, inadequate coverage of being active and instilling wellness when were young, costs to become a health care professional, lawsuits, its so many things. A universal health care system could solve a lot of these issues but it also creates new ones. I personally believe that a real genuine retooling of not only how care is delivered but how we as Americans do a lot of things would need to be done in order to make a true difference and still maintain the excellence of care we have now and improve it.

  8. Andy says:

    Hey Foxy, You bring up a good point and i do believe a portion of people wouldn't go to a doctor with a higher initial visit cost or if they had to pay more upfront. I would personally at this time in my life be pretty hard pressed to pay much more than i do not to visit a doctor right now. At the same time health insurance is not meant to cover every cost. it offset it or brings more extravagant procedures into the realm of affordability. Also consider how it is sold, the only reason it is even somewhat affordable in its current state is they figure out the average costs amongst a group of people and charge premiums based on that. If you really want to see premiums come down get involved in school and lunch programs etc. get gym and recess and healthy more active lifestyles instilled in children early. Hell We all need to get our butts up a lot more than we do here. Our costs go up every year as we take less responsibility for ourselves and lifestyles and add to the growing costs of our own health care. I do like the idea of nationalized health care as there is good there. I just have no faith it could be implemented fairly or well in our country. Because of that i oppose national health care because it would be a joke by the time it got to everyone and with a huge bill.

  9. Andy says:

    Hey Erick, Its not just you. I wrote this article to bring another small facet up on this debate. Health care reform and overhaul is huge it touches a whole range of issues and it literally can kill if done wrong. Its not just insurance companies and government programs. Its us as a people becoming sedentary, various things we put in our foods and environments causing an increase in allergies, inadequate coverage of being active and instilling wellness when were young, costs to become a health care professional, lawsuits, its so many things. A universal health care system could solve a lot of these issues but it also creates new ones. I personally believe that a real genuine retooling of not only how care is delivered but how we as Americans do a lot of things would need to be done in order to make a true difference and still maintain the excellence of care we have now and improve it.

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