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(former member)

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Posted: Jun 28, 2009 - 4:07pm

Went to a lecture last night by a guy named Christensen, who's supposedly the national expert on health care economics and stuff. Here's something by him.

Fascinating discussion of this topic. Began by talking about steel and rebar and how the market shifted drastically when larger mills got too set in their path and then were swallowed by mini-mills. Not bad management, just an inexorable trek to obsolescence.

Then, a discussion of health care premiums as a percent of the family income. was 7 percent, then 14, and in about 6 yrs will likely be about 30+%. This is, like the large steel companies, a predictable march towards unsustainability.

In fact, the only way to keep costs down is to develop cost-effective and routinely efficient strategies for health-care delivery. Any discovery process has three stages: intuitive discovery -> generalities that allow for comprehensive discussion of the problem -> specific rules for addressing the issue. There are medical problems that fall into those categories: Type 1 diabetes requires intuitive care, not strict rules. But, treatment of a sore throat has been honed to a set of specific rules that are patient-friendly and cost-effective. Those rules must be implemented to be efficient and cost-effective in situations where care is properly defined. It isn't, generally, because doing more results in more billing, doesn't it?

And, hospitals have positioned themselves as extremely expensive situations. Rather than a streamlined, efficient, cost-effective method of delivering a small cluster of products, they insist on a setup that is inherently hyper-expensive so that it can provide "anything." Small clinics geared towards, e.g., hernia repair, are about 1/3 the cost - for the same product. They are the only way to keep health care costs from skyrocketing.

Unsustainable skyrocketing care costs are also the result of inefficiencies in variations in ordering lab, prescribing medicine, and the general multi-site runaround that seems to be common. 

However, the way to keep costs under control and avoid the unsustainable price rise is anathema to fee-for-service medicine. If the provider makes money by ordering or providing a service, then preventative care is against their financial interests, no? They make less money if they recommend fruits and vegetables and more if they do an angioplasty. It's just how the FFS world is.

So, this gentleman predicted that fixed-pre-payment is the only reasonable method of keeping our culture healthy and preventing the current rise in health care costs. This is different from HMOs. It's a system wherein patients pay a fixed amount per month, and the health care system receiving those premiums knows that it is in their best financial interest to keep the patient from unnecessarily utilizing services, so as to be good stewards of the premiums paid (and that includes giving high-quality care so as to not lose premium dollars to lawsuits, right?).

And therefore he predicts that in the next 6 years, we will see the collapse of the FFS (fee-for-service, the old steel mill model) medical system as we see it today, and a move towards fixed-pre-payment services (the more efficient mini-mills for steel) across the country, competing to keep patients healthy (quality data are readily available as advertising attractants to subscribers) while providing a personable experience and integrating their providers, lab, imaging, etc. (Services in separate locations increase inefficiency/waste and drive up costs, and so are automatically less favorable.) He names a few medical care systems across the country that are already doing this. Those that aren't (the fee-for-service world) are about to have the rug yanked out from under them as they figure out integration, cost-effectiveness, integrated services, and the electronic medical record.

May we live in interesting times... 


starcloud

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Location: Geo Update: 35.568622, -121.10409 you're close enough
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Posted: Jun 19, 2009 - 7:39pm

 manbirdexperiment wrote:

what a bunch of oxymorons 
 
not intended, but thank you anyway
Manbird

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Location: Owl Creek Bridge
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Posted: Jun 19, 2009 - 7:30pm

 starcloud wrote:
haven't had health insurance for uh . . . 10 years, and my latest client is health care for all (imagine that) how ironic!

 
what a bunch of oxymorons 
starcloud

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Location: Geo Update: 35.568622, -121.10409 you're close enough
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Posted: Jun 19, 2009 - 7:27pm

haven't had health insurance for uh . . . 10 years, and my latest client is health care for all (imagine that) how ironic!


n4ku

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Posted: Jun 18, 2009 - 9:37pm

The Daily Show With Jon StewartMon - Thurs 11p / 10c
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Inamorato

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Location: Twin Cities
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Posted: Apr 14, 2009 - 8:04am

In case there is any question about the priorities of the American health care system...

 

Nurse called out of surgery and laid off


Associated Press 
Updated: 04/14/2009 09:44:08 AM CDT
MADISON, Wis. — A Dean Health System nurse was called out of surgery so a manager could tell her she was being laid off. 

Dean Health said the surgery was minor and the patient wasn't affected, but the manager who summoned the nurse from surgery violated medical protocol. 

Dean Health spokesman Paul Pitas said the incident happened at Dean's West Clinic in Madison on Wednesday or Thursday. 

Pitas said there was a period of time in which a nurse wasn't present during the procedure. He said while there were other clinical staff present, the absence of a nurse is a violation of patient care procedures. 

The Madison-based health care provider announced Wednesday that it planned to "immediately" lay off 90 employees. 

Pitas declined to name the employees involved or what type of surgery the nurse was attending when she was called away.


AliGator

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Posted: Nov 21, 2008 - 10:59pm

I've referred to health care in France on several occasions here at RP. I lived there for 13 years (read: one-third of my life and most of my adult life) and had my babies there. I cannot say enough good things about health care in France, but the most important thing I can say is that I never worried about it.

NPR has done a series about health care in Europe; here's a link to the bit about France. I realize that this is a few months old, but it just came across my radar.

The US could do worse than to imitate the French model. And yes, I knew the system over there was running a deficit before I read this article, but still, it works. If the price of a GP visit rises from 20 euros to 25 or even 30, it's still affordable.

It's not a perfect system, but it sure beats what we currently have here.
Servo

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Posted: Oct 31, 2008 - 10:09am

 OlderThanDirt wrote:
Just curious.  Those started around here about 5 years or so ago, and a lot of people we know had to find new doctors.  I've wondered how it is working out for the doctors that went that route.  My guess is probably pretty well.
 
FYI it hasn't gone very well at all for several specialties.  I've heard way too many (true) stories about OB/GYNs who have had to stop practicing medicine because the malpractice insurance was bankrupting them, quite literally.  More than a few were left so in debt that they couldn't even afford to retrain for another specialty.  Their decades of medical training and practice went to seed, possibly permanently. {#Sad}


OlderThanDirt

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Posted: Oct 31, 2008 - 12:23am

 BlueHeronDruid wrote:

She's struggled. Had her own health issue in the midst of it. Decided to only practice what she likes about medicine. Took a few years, but the practice is growing. By no means a rich woman, nor one wanting or needing to be.
 
I really don't know how the "Boutique" docs are doing, but I see a good possibility that the Pebble Beach/Carmel patients could make it quite profitable.  Until the docs overpopulate themselves.  The next level down are the "we don't accept Medicare payment" docs, who think (maybe rightly so) that Medicare does not pay them enough.  I don't know of any but the "boutiques," though, that don't accept any kind of health insurance.

Hey, past my bedtime.  Talk to you later.  {#Hug}{#Sleep}

Alchemist

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Location: San Jose, CA
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Posted: Oct 31, 2008 - 12:06am

 Alt-Ctrl-Tom wrote:

I'm with ya.  I quit my soul-destroying corporate senior management job 20 months ago, and continued the insurance out of my pocket for 18 months.  Then, while going through a budgeting exercise a few months ago to see how I could stretch my dwindling savings further and continue to avoid/postpone returning to a "career" that I had come to despise, I decided to cease being insured. 

The primary reason: my monthly insurance cost me more than my mortgage.  It was the single largest expense: more than shelter, more than food, more than utilities, more than transportation, more than entertainment (cable tv, DSL internet, music purchases) - more than any two of those combined.  The singular ridiculousness of that fact - mostly just in case I get horrifically ill/injured - caused me to cease my insurance coverage.  I only wish I had done so sooner.

So, I'm now marginally employed in a part-time job that has the beauty of an absolute lack of management responsibility, corporate bullshit, corrupt impossible and  irrational executives, and dishonest self-interested ladder climbing weasels - though unfortunately it has me not making enough to cover the cost of living - and now I'm among the uninsured. 

Sure, if something horrific happens, and I'll be wiped out - but if I'd continued to purchase my own health insurance to address that risk, my complete insolvency would've have been a certainty.  So, I'm uninsured and fine with it.  Fucking crooks.
 
Though if you're wiped out then you'll have free health care - rather a perverse system!

I knew a guy once who was an adrenaline junkie - hang gliding, motorcycle racing, you name it.  He made over $100 an hour (20 years ago) consulting but couldn't see any reason to buy health insurance - he knew the hospitals had to treat him if he darkened their doorstep.  Which he had occasion to do on more than one occasion.  I think of him when someone claims 47 million Americans have no "health care", rather than "health care insurance".
BlueHeronDruid

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Location: planting flowers


Posted: Oct 31, 2008 - 12:05am

 OlderThanDirt wrote:

Just curious.  Those started around here about 5 years or so ago, and a lot of people we know had to find new doctors.  I've wondered how it is working out for the doctors that went that route.  My guess is probably pretty well.
 
She's struggled. Had her own health issue in the midst of it. Decided to only practice what she likes about medicine. Took a few years, but the practice is growing. By no means a rich woman, nor one wanting or needing to be.

OlderThanDirt

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Posted: Oct 31, 2008 - 12:01am

 BlueHeronDruid wrote:

Nope.
 
Just curious.  Those started around here about 5 years or so ago, and a lot of people we know had to find new doctors.  I've wondered how it is working out for the doctors that went that route.  My guess is probably pretty well.

OlderThanDirt

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Posted: Oct 30, 2008 - 11:56pm

 NoEnzLefttoSplit wrote:



exactly, who needs doctors?

 
{#Lol}  Actually, it was in a small hospital about two blocks from where we lived, L was born in a larger hospital about 12 miles away.  Her mom remembers the bill being somewhere around $50.  No one we knew had health insurance in those days, so the medical providers were limited to whatever the traffic would bear.

Yes, we can cut our insurance costs by choosing higher deductibles and co-payments.  That usually makes a lot of sense, but many people want their insurance to pay for every little case of sniffles, every scraped knee, every bottle of medicine.  That raises the costs considerably, usually more than the "nickle and dime" medical costs would warrant.  Everyone needs to  cost it out, choose a level of coverage that suits their needs most economically.

BlueHeronDruid

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Location: planting flowers


Posted: Oct 30, 2008 - 11:56pm

 OlderThanDirt wrote:

Does she also charge an annual "subscription" fee?  The "boutique practice" I referred to earlier works as you describe, also charges an annual fee of up to $15,000, depending on the level of service desired.  Hospital and prescription costs are not included.
 
Nope.

NoEnzLefttoSplit

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Posted: Oct 30, 2008 - 11:33pm

 OlderThanDirt wrote:



(and that was one of the more expensive vets.
{#Lol}

 


exactly, who needs doctors?


NoEnzLefttoSplit

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Posted: Oct 30, 2008 - 11:31pm

 Alt-Ctrl-Tom wrote:

I'm with ya.  I quit my soul-destroying corporate senior management job 20 months ago, and continued the insurance out of my pocket for 18 months.  Then, while going through a budgeting exercise a few months ago to see how I could stretch my dwindling savings further and continue to avoid/postpone returning to a "career" that I had come to despise, I decided to cease being insured. 

The primary reason: my monthly insurance cost me more than my mortgage.  It was the single largest expense: more than shelter, more than food, more than utilities, more than transportation, more than entertainment (cable tv, DSL internet, music purchases) - more than any two of those combined.  The singular ridiculousness of that fact - mostly just in case I get horrifically ill/injured - caused me to cease my insurance coverage.  I only wish I had done so sooner.

So, I'm now marginally employed in a part-time job that has the beauty of an absolute lack of management responsibility, corporate bullshit, corrupt impossible and  irrational executives, and dishonest self-interested ladder climbing weasels - though unfortunately it has me not making enough to cover the cost of living - and now I'm among the uninsured. 

Sure, if something horrific happens, and I'll be wiped out - but if I'd continued to purchase my own health insurance to address that risk, my complete insolvency would've have been a certainty.  So, I'm uninsured and fine with it.  Fucking crooks.

 


Is it possible to get health insurance with a high deductible in the States? I have to foot any bills up to a cumulative total of €800 p.a. myself before the insurance kicks in. As a result my premiums are down to €350 a month (still quite high but a lot lower than most). Lately, I've been thinking about raising that deductible.

What I like about the idea is that it avoids a huge amount of paperwork for all concerned and that is what saves money.


Servo

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Location: Down on the Farm
Gender: Male


Posted: Oct 30, 2008 - 11:13pm

Alchemist wrote:
My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.
 
My PCP is leaving private practice for a hospital job.  He is citing similar reasons.  The main difference is that where you wrote "government mandates", he's saying "insurance company antagonism".

The only new government mandates that I can think of from the last decade is HIPAA.  In this age of personal information for sale, HIPAA is well worth the extra work.  But since deregulation, insurance companies seem to serve nobody but themselves.

I want assurances that Medicine is being practiced by skilled, qualified people, and not hacks and poseurs.  I want insurance to be an equitable business relationship, not a hostage situation.  I want my practitioners to see Medicine as a higher calling, and not as the road to riches.

I know that a freshly-minted MD who isn't independently wealthy has a huge tab to pay off.  Maybe that's part of the problem too.  IMHO education is the single best investment that any person or nation can make.  I believe that the society that makes access to knowledge proportional to one's ability to learn, and not one's ability to pay will see a return on investment that far beyond the monetary amount.


OlderThanDirt

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Posted: Oct 30, 2008 - 10:31pm

 BlueHeronDruid wrote:

This is why my physician (and friend) practices without a net. No insurance accepted. Meaning: she can spend time and attention with her patients (who can afford to pay up front) and have only an office assistant. Her practice is growing - but not among Medicare recipients, as you'd imagine. One schedules appts. with her by the quarter-hour or more. Our insurance pays a bit towards this. But her attention is priceless. 
 
Does she also charge an annual "subscription" fee?  The "boutique practice" I referred to earlier works as you describe, also charges an annual fee of up to $15,000, depending on the level of service desired.  Hospital and prescription costs are not included.

BlueHeronDruid

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Location: planting flowers


Posted: Oct 30, 2008 - 10:24pm

 Alchemist wrote:
My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.  She says if she had known back in college how bad things would get she would have chosen a different field (and this is from a tireless patient advocate).  She read Hillary's entire health care reform screed and noted not a single clinician (a doctor who sees patients) contributed!  

The government has screwed up medicine, and it will only get worse if they seize more control.

 
This is why my physician (and friend) practices without a net. No insurance accepted. Meaning: she can spend time and attention with her patients (who can afford to pay up front) and have only an office assistant. Her practice is growing - but not among Medicare recipients, as you'd imagine. One schedules appts. with her by the quarter-hour or more. Our insurance pays a bit towards this. But her attention is priceless. 

OlderThanDirt

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Posted: Oct 30, 2008 - 10:17pm

 Alchemist wrote:
My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.  She says if she had known back in college how bad things would get she would have chosen a different field (and this is from a tireless patient advocate).  She read Hillary's entire health care reform screed and noted not a single clinician (a doctor who sees patients) contributed!  

The government has screwed up medicine, and it will only get worse if they seize more control.

 

It kinda makes you long for the good old days, like 1941.  My mom told me my birth cost my parents $14.

(and that was one of the more expensive vets.
{#Lol}
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