Healthcare Economy

An excellent article on the topic that develops the views you have expressed:

"Insurers have, in effect, control over both the supply side of the health care industry and the demand side. They are determining the demand by enlisting the majority of Americans under their policies, with terms underwritten by their employees, and they have control of the supply side by their enormous financial clout, pooled from the financial resources of the majority of American citizens, which enables them to dictate to the health industry what will be provided, how much of it will be provided and at what cost. Since there is control by a few providers, we must also allow for the great possibility of collusion between the industry and the insurers which can allow for the elimination of any competitive pricing and/or availability of services.

This enormous collective, which has been fostered and condoned by the Federal Government, is the greatest obstacle to any real "reform" of the health care industry. This embedded system is the common enemy of any free market solution or altruistic type social solution that attempts to bring necessary health care to all.

There is no solution in the cries of allowing the "free market" to work, when there is presently no free market we can allow to work. There is no chance of "affordable" health care to evolve when a proposed plan only calls for strengthening the existing conditions and positions of the status quo.

By the creation of this collective we have lost any real consumer control. Any freedoms we seem to have are rationed to us by the provider, with the cooperation and/or insistence of the medical industry. If the trend continues and the dominant providers attain an even greater market share, we will lose any choices we now have and the rest of the industry will also be forced to cave to any insurer demands. We will receive in theory "private" sector care, but the terms will be dictated more than ever by the insurer. Every step in this direction blazes the trail for that other directed health care system, government socialized care.

It is acknowledgement of this condition that can bring clarity to the issue. We do not have either a "free market" system or a "socialized" system. We have a controlled corporatist health care system. The programs and regulations of our government reinforce the insurance industry domination of health care and the collective nature of the system. We truly have a hybrid system that brings neither socialized care to all nor the choice and consumer advantages of a free market system."

I agree. It is Insurance reform, not healthcare reform. There's talk about reducing redundant tests, collaborative care, outcomes/quality reimbursement...but it doesn't show up in the bills. Stimulus is a law and will drive technology adoption faster. Healthcare reform I believe will force a reengineering of reimbursement and quality reporting. And nobody's thinking about ICD-10. I like the national debate. To watch on TV what we've been grappling with for decades is pretty darned cool.

Actually there are many providers and Health Plans actively discussing ICD10 and it is becoming an urgent issue becuase of the compliance issues. The vendors (Product Company) community while providing the transaction capablitities are not offering the services so it is up to the services providers to take advantage of this lack of attention.

Gary,

You bring out some pretty clear issues regarding the root question. In a rapidly growing majority of US citizens the fact that the "game" keeps changing names is a red flag. The fact that the "bogey man" also keeps changing is another red flag. The reaction by supporters - of this yet to be named and disclosed bill - to those who question and expect answers is a third red flag. The lack of detailed clarity around something that comprises 1/6 of the economy is a fourth red flag.

How many red flags do taxpayers need before they stop and see that this is a dead and rotting carcass that is continually being dragged around and redressed in new suits? Bury it and move on to solve the true issues.

Debate is being welcomed and in most cases demanded. What is being "stopped" is the voice of the people: Let me paraphrase:

*** Now, one side (democratic party) is doing all they can to stop any and all debate on health care reform, with the sole intent of (silencing any question and contrary point of view in order to protect their majority position and maintain their special interest and lobbyist friendships which feed greedy and power obsessive practices until the next election cycle comes around and the people once again use their vote to steer the country back to common sense)...***

Gary,

Looking at the raging debate from the outside through the peephole of LI, I am astonished how much ideology and how little fact is involved in the discussion. If you take the metrics (per capita costs, life expectancy, infant mortality, universality of coverage, etc) and compare them to the other OECD countries, it is considerably less efficient than most other systems; a fact I see rarely mentioned between all the insinuations of evil intentions.

Uli Hofer is absolutely correct. Way too much ideology involved and not enough discussion of the actual facts of the matter. The lobbying system means that the money-for-influence with lawmakers spins policy to favor specific interests rather than the common interest. These lobbying dollars are spent to obtain specific results, which is typically never the best result.

In my opinion, it should begin with Tort reform first, but apparently that's off the table. There are so many competing interests and massive lobbying efforts on both sides, that the final outcome or result will be quite haphazard and fatally compromised.

Now on to technology....

The reality is that if someone is doing something that you approve of, you are less likely to speak in favor of what they are doing than if you are opposed to what they are doing. In other words, only the opposition turns out, because they're the only ones who feel that their side of the argument is not being heard.

I guess those who have problem with the MUST idea of healthcare for all in this country have never watched that GREAT movie 'Sicko' or perhaps they have never visited any other nation in this world. Healthcare reform is a MUST in this country, there is no point in having THE best doctors, surgeons, and equipments and not having basic free care for all like any other nation that DOES have preventative measures and as a result fitter & healthier societies.Like everything else, healthcare in this country is about PROFIT and making MONEY...the system is set up to LEAD you to an expensive bypass surgery, but in EU and many other nations, you are detected and cured early on and no one goes bankrupt not being able to afford millions of dollars for insane medical costs and for insane medical conditions, most of which are preventable and curable if detected early. There is so many things wrong with this country that it is a shame we are even talking about healthcare reform a decade into 21st century....love to read some of those European headlines on American reaction to healthcare and education speech etc.....from the land of powerful and free, we have become the laughing stock of this world and for good reasons.

Forgive me if I read something wrong but there is no such thing as free health care. Somebody will pay and pay dearly. Much of the cries for "reform" has been draped with a cloak of crisis and emergency. It is neither. The left has whipped everyone up in a frenzy with misleading statistics and rhetoric that can not be validated. Health care may need some fixes but the government must retract former policies that have perpetuated the problem and get out of the way. There is no Constitutional basis for enlarging government control and irresponsible meddling. Remove the roadblocks to free market reforms and let consumers drive the necessary change.

Get the economy growing again. Get people back to work and pass a TORT reform bill.

Bahare, the best doctors are in the US because yours is a profit-driven health care system.

All over the world, the very best doctors are getting phone calls from US universities and private hospitals, offering to triple their income. How many resist? Few. Who benefits? Rich Americans at first. Then, they teach young doctors who work in public hospitals and, eventually, the expertise trickles down to everyone.

Can US health be improved? For sure. But please stay away from universal, one-system-fits-all health care. Trust me, I am a Canadian.

Michael Porter has written a truly brilliant short essay entitled "A Strategy for Health Care Reform — Toward a Value-Based System." It addresses key structural reforms to align incentives for all parties towards delivering value to patients — something missing today.

http://healthcarereform.nejm.org/?p=467

I agree that we really do not currently have a free market system - and that's what is needed.

Insurance is interstate commerce, and should be treated as such. Get rid of the state-mandated "one size fits all" coverage, let people buy what they need from anywhere.

Tort reform is obviously required. When doctors have to pay hundreds of thousands of dollars a year EACH in malpractice insurance premiums (tell me the insurance magnates don't want to perpetuate that as well as the trial lawyers)that HAS to be a major contributer to their rates.

Waste, fraud, and mismanagement in the existing systems - Medicare and Medicaid - are the third leg of the problem.

All of these have potential solutions that don't involve massive amounts of Government spending and control.

Why don't the leftists believe in free market solutions? Because then they can't CONTROL anything. And to socialists, it's all about control. (Everybody into your predetermined pigeon holes, and by damn, stay there!)

I'm not an expert in Health Care, but I have almost 7 years of experience dealing with VA administration and Medicare providers, because doctors misdiagnosed my husband for 6 years, almost kill him.
I want reform, and a change of the point of view of health care in USA, we are a commodity!.
This is not a "health care" this is a system that "cares" more about the sickness.
Primary doctors keep patients just for money, not to cure them. Not all doctors are the same, but somebody has to do something about the medications that are killing people instead of cure.
Following are the elements to be consider according to us:
- cost of medications
- medical malpractice
- affordability of premiums
- fairness
- change the billing system.
Hospitals charge for a "package" of care that you don't receive, medication that you did not get, etc. They argue that is easier for them to bill a patient, but also, is more expensive and not fair.
I believe in technology, and I'm glad that you are writing about this issue in health care. I also believe that using technology will lower the cost of health care in the country, just keep our info safe.
I have Aetna, and they just increase my health insurance "take or leave it..." this is the system, without any tough about our economy. Also, I like Aetna, because they pay for prevention, as gym, healthy food, and some alternative medicine.
Thanks for your attention and consideration

The President of USA, Mr. Obama, is trying to bring medical insurance within the reach of the common people, but his efforts are getting blocked by the Opposition parties. Providing good healthcare and health insurance should be considered as a good practice by people, as people's standard of living will improve. In India, too many people do not have insurance cover. However, Government of India and state governments are doing their bit to help people by providing health insurance and free medical facilities. Today hospitals across the world are providing advanced and revolutionary medical equipments for diagnosis of ailments and treating of diseases. K.G. Hospital, Coimbatore, has introduced the world's fastest 128 Slice Heart CT Scanner, which can tell you if you will have a heart attack next year. It will take only five seconds. Investment in medical equipments and building hospitals as part of health care reforms will go a long way in our people having a better standard of living and increased productivity.

KV;

President Obama was elected by the people and works for the people. Addressing healthcare reform is a fundamental need to address the real issues, those that are not insured, 17,000,000 out of more than 300,000,000 americans,

Let us consider then addressing the real issues;

Make healthcare affordable for the 17,000,000 that need to be provided the same care by:

1.Addressing Torte Reform;
2.Elimination of Fraud and Abuse in those programs already in place like Medicare, Medicaid, CHIP, WIC, American Disabilities Act, Veteran Administration, others;
3.Concentrating on massive campaigns to address illegal immigration in a civil and humane way;
4 Creating additional efforts for signing that percentage of eligible Americans up for Medicaid, available plans;
5.Changing the laws that allow individuals to have portable insurance that is owned and managed individually.

Mostly, for the 85% of Americans who are happy with their current healthcare plans and flexibilities to choose, leave them alone!! Free enterprise offers competitive plans that gives us the right to choose our methods of insuring our population. Government interventions and management of our health is a dangerous option and tears at the fabric of American culture and rights we have preserved for 233 years.