Care is already rationed by the insurance companies everyday.  A transparent system is needed for that rationing.  Not everyone needs the MRI's etc they get.  I've been to the doctor 4 times in the last year and had to ask them to examine me when I had a cough and unexplained vaginal bleeding.  They just ordered tests and never touched me, never listened to my lungs, never checked lymph nodes or  never checked my abdomen.  The Nurse Practitioner did when I finally saw here but the docs just wanted to order meds and tests.  Somehow Docs in the old days could examine and diagnose what happened to that??

Here are some interesting options found on another site:

- For Medicare patients, amortize medical reimbursements over 60 months and charge the estates of patients who die within this period half the cost of their unamortized care. Currently, a third of the cost of Medicare goes to treating patients in their last six months of life, and neither the patient nor his physician have any financial incentive to save taxpayer money however dim the prognosis. If an 85 year-old patient requests hip replacement surgery, this approach avoids arbitrary, hard-and-fast rules and gives his physician some discretion if the patient is in otherwise excellent health.

- Require that health insurers charge all smokers, alcoholics and overweight/obese individuals proportionately higher premiums, just as auto insures do with bad drivers. Smoking, drinking and overeating are personal choices.

- Similarly, for those patients with serious preexisting conditions and no insurance, establish a high risk/cost pool and assign each at random to a health insurer relative to the insurer's market share.

- Offer rebates to those who sign a waiver accepting binding arbitration and caps on health care provider liability.

- Allow health insurers to write basic policies that cover only cancer, cardiovascular disease, and trauma and pay out a lump sum equal to the median cost of treating each diagnostic indication.

- Require medical specialists to charge an all-inclusive, fixed fee for treating a given diagnostic indication and post these fees online along with audited treatment outcome statistics for patients under their care. Patients could also use this forum to post their comments on the quality of care provided. Purchasing health care should be as transparent as purchasing a book on Amazon. The current opaque fee-for-service arrangement that denies patients data on costs and outcomes rewards poor, inefficient medical care

- Adopt the Oregon approach to control runaway Medicare and Medicaid spending. In this state, firm budgets are set each year which, in turn, determines the diagnostic indications treated. The state does not reimburse physicians for treating trivial cases such as the common cold, ingrown toenails or muscle aches. Nor does it reimburse futile cases where the indicated treatment makes little difference to the outcome.

Remember, one reason for over-testing (MRI's and such) is our litigious society. Physicians cover themselves by ordering every possible test, because of that one in a thousand chance that the patient has something seriously wrong that could have been detected - Then the patient will sue.

Then the physician's malpractice ionsurance pays to settle and the premiums go up. I know several physicians who have given up their areas of practice because of outrageous malpractice insurance premiums.

And don't just blame us lawyers, the average person today thinks "Lawsuit!" every time something goes wrong in their life. Altho lawyers ARE partially to blame - especially the scumbag sharks with the TV commercials...

And no, I didn't practice that kind of law - I did practice three months of it right after law school, but the whole "suing people" thing made me sick... Do you know if I had a client injured in a car accident I was told to sue everybody in the car (innocent passengers too)?

That's the kind of litigiousness that has, in part, led to ridiculous medical costs.

The lump sum is from a catastrophic plan that the individual would have paid into and if they got cance, heart disease or had a traumatic accident a lump sum would be paid out and they pay for what care they want.  No free ride since you dispise that so much Kellyj.  The waiver is for lawsuits so that their is arbitration not a trial and frivolous lawsuits are reduced.  The increased premiums for high risk behaviors are just like any insurance on houses or autos if you live in a fire zone if you live in a high density high risk driving area you pay more for the coverage.  Why is healthcare any different?  It is not discrimination except in the inner cities where exercising is difficult or dangerous in some neighborhoods so yes gyms etc would need to be provided by the insurance companies looking for wellness alternatives to decrease the risk in their pool of clients.  They could fund YMCA's.  yes there are fewer taxes on poor people I know that is hard for you to agree with but if you're living on 20000 a year or less with kids you pay less in taxes.

I really like the alternative for the elderly where your estate is on the hook for a portion of your final illness if you seek extraordinary care you will need to payback medicare for it.  Dying the the hospital is bad, dying a quiet peaceful death at home with family and hospice is good.  We need more of this in our culture.  Less vents, and tubes and suffering more quiet grace and dignity with extraordinary pain relief and comfort.  Several in my family have passed that way and I hope I die on a beach drinking excellent champagne and taking my final opiate cocktail or in bed after mind-altering sex with my husband!

kellyj says ...

"reforming the US healthcare system is a piece of  cake!" says Harvard economist David Cutler he goes on to say there are three things that need to happen

1. promulgate a list of best practices

2. redo reimbursement ;reward for good outcomes rather than procedures

3. middle management massacre

OUCH !! one more reason to stay at the bedside!!

1.   One size fits all. It never has worked never will.

2.    Simple way to improve outcome is not to treat those with a poor prognosis. Are we sure we want to encourage this?

3.    Yep! Lets have an Army made up of only Generals and Privates.  This guy's ideas make even less sense that those of the Democrats.

I am not so sure that there is going to remain a bedside to stay at.

MaggyC says ...

There are some in these posts who are naysayers and negative about everything that is suggested as possible fixes.  Do we all agree that something needs to change?  I'm glad for those of you who feel comfortable with what you have--good benefits, good jobs, pensions, etc, but not all of us have this.  And it's not because we are slackers or poor decision makers.  Nurses, as you all know, are not known for longevity in their positions.  Many of us are single parents, taking care of elderly parents, you name it.  Nurses have historically jumped from job to job when salary was better, hours were better, benefits were better some where else.  Today I was speaking with a friend (a non-nurse) who was signing up for unemployment benefits.  she said that she was told by one of the reps that if you are over 45 years of age, you are going to have a hard time finding something.  She said there were probably 50 people in the offices with her and all appeared to be over that age except for a handful. She was advised not to include anything in your resume that would indicate age which I can't understand how you can do that.  I myself have wondered a few times about age discrimination when I sent in over 20 resumes and heard back from 2 employers.  My point is, I hope that all of you in good situations, remain in those good situations because it can be very scary when things change.  and as you know, nothing is written in stone.

To br quite honest I don't see a big need for "change" other than to get the government't out of the equation.

RNprogressive says ...

WBateley 214,

I assume you are resigning your job since according to you the government is so inept and you work for the government.  Are you leaving your jobsince it must be so terrible for you to take a paycheck from such a dysfunctional government.  Don't tell me Texas Gov is any better I just moved from there horrible schools, highest number of uninsured children and refused SCHIP funds and a govenor who wants to secede.

 

RN UnProfessional, Why do you assume WB would be quitting her job?   Assumining can be called ignorance looking for a place to go. 

This is one more instance of non productive posting, pointing fingers with disdain because this person might not agree with you.   WBatley, love your posts...........and you please keep up the posts.   It reminds me of the importance of not letting the govt into my home.  No warrant, you aint gettin in at the risk of  a 104# Siberian Husky looking for a new chew toy.  And I love the home cams my husband put in for security.  Peta is good for for something at least.

My husband was in the Air Force and overseas for quite a few months back between 1980 and 1992.  He told me that when he came back to the United States that the other countries cannot compare to the health care we have here.  Yes, the other countries have healthcare (I believe he said) for just about everybody, but the health care is substandard.  It's more socialistic.  They cannot get the kind of medicine that we have here, nor the technology needed to treat the diseases.  Also, he said that you cannot walk into a hospital over there and get the kind of care that we have (or had) here.  Where I currently work in a hospital, the standard of care that I have seen has decreased with the next generation of young people.  The generation my mother was in (a retired nurse supervisor) were caring, very efficient professionals in every sense of the word.  These younger people (and I am in my 40s) that are now working at our hospital has no sense of work ethics, work morale, or better yet, how to act and look like a professional.  Apparently they think that being friends is THE most important thing to do at this hospital, and to think that I once thought our hospital was one of the best places to work!!

As an aside, I do believe we all need health care, but I certainly don't want to be paying for everybody else's health care, just because they can't (or is it won't?) work.  I'm not a nurse yet but am working to become one.  Universal health care means we'll all be receiving health care, which is good, but then what happens to the quality of care?

CaptainEricRN says ...

Remember, one reason for over-testing (MRI's and such) is our litigious society. Physicians cover themselves by ordering every possible test, because of that one in a thousand chance that the patient has something seriously wrong that could have been detected - Then the patient will sue.

Then the physician's malpractice ionsurance pays to settle and the premiums go up. I know several physicians who have given up their areas of practice because of outrageous malpractice insurance premiums.

And don't just blame us lawyers, the average person today thinks "Lawsuit!" every time something goes wrong in their life. Altho lawyers ARE partially to blame - especially the scumbag sharks with the TV commercials...

And no, I didn't practice that kind of law - I did practice three months of it right after law school, but the whole "suing people" thing made me sick... Do you know if I had a client injured in a car accident I was told to sue everybody in the car (innocent passengers too)?

That's the kind of litigiousness that has, in part, led to ridiculous medical costs.

I don't fully blame the lawyers for this, it is the contingency fee system that encourages it. If a person had to pay the lawyer a hourly fee up front instead of looking at it as "free if you lose and millions if you win". The person who sues pays nothing but the doctor or hospital being sued must pay huge legal fees.

regarding healthcare being a social issue...how so?? what does that mean social issue? isnt it a people issue a health issue why would it be a social issue.  its a private issue your issue and yur families issue.  making it  a social issue is pretty much saying that your health or the lack of it is everyones issue.  Not true.  The government is fabulous oh excuse me WAS fabulous at one thing keeping us safe from people who want to kill us. now putting them in charge of healthcare is a whole nuther thing.  Don't really want a group of people telling me what kind of access that i can have to my doctor when they won't allow us to use air support in Afganistan (new rule ..look it up) not good don't feel like joining up anymore and i can say that with gusto.  Volunteerism is good if you know someone has got your back just like caring for people who you know can give you some disease you cannot get rid of ...nice to know i have access to the best healthcare in the world and i don't need a pass from some politician or some cost benefit analysis board!

what is the use of going into a war if you don't plan on winning it? what is the point in being friends with people who obvioiusly don't want to be friends?  i'm sure that one would like to believe everything the gov is telling them is true but its not and they lie and will continue to do so if people keep looking the other way and don't hold the politicians accountable.  If one loses their health insurance and job that is terrible but society does not owe them a leg up that's the way it is and has been in this country since forever.  we have lost more men in afgani than in iraq in the last 6 mon and this new rule on air support is stupid and i wish that a few people would be more critical of the decision to manage it this way. just as the idea that everyone is owed healthcare is not condusive to a free society.  no one is taking my right away for healthcare they are just funding the crazy idea that society is owed healthcare on MY back and i don't like it.

I CHALLENGE ALL OF YOU, to talk to some of your doc's that have trained in G.B., Ask them, about care for ALL.   Ask them if those over 65 have equal access to the ICU, ask them some hardcore questions.   A lot of Indian (from India) MD's actually trained in GB, and can give you some insight into the care that you WON'T be getting.

I'm not blaming the 'VICTIM'.  I know enough people that have played ROULETTE with healthcare, passing up on health insurance, because 'they couldn't afford it'.  Yet these same people are taking vacations (that I can't afford), have bigger houses, or one in particular that I know drives a Cadilac.  Another that didn't have health care, had over $50,000 invested in his HOBBY of racecars.   I'm saying these people ARE NOT VICTIMS, and they don't deserve a DIME or  a FREE RIDE.

I don't want a revamped version of MEDICARE FOR THE MASSES.  If you think that we will be able to keep our 'private healthcare', they will be driven out of business, and we will wind up with no other option. 

As far as legislation goes, YES we need legislation to put a lid on the pharmacy industry.  We Americans are paying through the nose, while other countries pay far less for the same drugs.  IT IS a CRIME what they charge us for drugs.  We also need a lid on all the excessive lawsuits in healthcare, that would bring the overall cost down.  Lawsuits require hospitals, DR's, NP's, and PA's to do unnecessary tests and carry expensive insurance to protect them.  These two measures alone would probably bring healthcare costs down by 25-50%.

kellyj says ...

the price of drugs recieved in the hospital is a compilation of many different charges. if you get your bill you will not see a charge for the housekeeper the nurse the medical aide the engineer the central supply specialist the iv therapy rn the dietician the wound care rn the concierge the lvn transporter the lift team ...i could keep going...you will see 3 main charges the lab the drugs and radiology these are the cost centers that drive and pay the hospital.  Healthcare here in  America is the best in the world simply because we have made it so.  We could charge 75 cents for tylenol and buck 25 for the antibiotic but you would have to get up and get it yourself and give yourself CPR if you have a reaction.  Everyday the care becomes better. There are many instances where the care exceeds the benefits of continuing to administer it.  This is a big problem and should be decided privately between the ones involved. ie ethics Do not be misled there are the facts and those of us who have worked in this industry for a while know what they are.

You are so correct. Well said Kelly

RNprogressive says ...

Not really nonproductive posting as according to his profile he works for Texas Veterans land trust which I may have wrongly assumed has a government paycheck involved.  If you all dislike our government so much don't take anything from it.  Many of you here want a decrease governmentn involvement in your lives and yet some of you post on the abortion forum about government limiting access to care and other resources for women.  Which way do you want it government involved in social issues like healthcare, regulation of abortion etc or no interference at all. Do you want your states involved?  Would you feel more represented if this was a state by state initiative for healthcare as in Oregon, Washington and Massachusetts?

Its extremely nonproductive.       I havent disliked our government until this last administration.   I have posting til Im blue in the face over abortion. Its evil and its murder.    The only thing that I can see as something that could help this administration is to fire all of them.   They stink, corrupt, dishonest and dont deserve my respect, which I do not have for this administration.   Look back the through  history books covering the French Revolution, looks creepy.   Im sorry for those who dont have health coverage, but Im sorry I cant afford to pay for it.   I cant afford their mortgage payment, and the cap and trade thing is a scam.  What good is that crap going to do except cause more debt for the middle class, there is No Way China and India will do anything about going green............they told that to nobama a few days ago that they would not participate like the US is being forced to do.   HIstory has a way of repeating itself given enough time.  Rome fell too, the comon man knew their government was guilty of wasteful spending and changed the world.  Its a way to get more money out of us.   Funny thing is Al Gore is making a mint over global warming which is fake...........the globe is actually cooler than it use to be.   BTW, Al Gore's wealth has increased by a bunch.........he's worth over $50million now.  

RNprogressive says ...

WBateley 214,

I assume you are resigning your job since according to you the government is so inept and you work for the government.  Are you leaving your jobsince it must be so terrible for you to take a paycheck from such a dysfunctional government.  Don't tell me Texas Gov is any better I just moved from there horrible schools, highest number of uninsured children and refused SCHIP funds and a govenor who wants to secede.

The governor who wants to secede is the BEST part, now if the rest of the state would go along. The terrible schools and great number of uninsured children could be solved very simply by deporting those residing in the state contrary to our immigration laws, it would do a lot to solve the jail overcrowding problem as well.

I do work indirectly for the state, and rest assured if and when they start abusing their Constitutional authority 1/1,000 as much as the federal government does on a regular basis I will be on theiir case with equal fervor.

RNprogressive says ...

Not really nonproductive posting as according to his profile he works for Texas Veterans land trust which I may have wrongly assumed has a government paycheck involved.  If you all dislike our government so much don't take anything from it.  Many of you here want a decrease governmentn involvement in your lives and yet some of you post on the abortion forum about government limiting access to care and other resources for women.  Which way do you want it government involved in social issues like healthcare, regulation of abortion etc or no interference at all. Do you want your states involved?  Would you feel more represented if this was a state by state initiative for healthcare as in Oregon, Washington and Massachusetts?

State control would at last be constitutional, Federal involvement on any level is not. Read Amendment X sometime.