My friend Sandy has been involved with health insurance as a proprietor. My series on community health care has spurred some thoughts on her part that she as agreed to share. There are some really good points here.
1. I do believe in a mandate but I don’t like the fact that insurance companies make a profit. Get rid of the middle man. Many people argue that the govt doesn’t have a good track record running big departments but, in my opinion, that doesn’t justify insurance companies unless they are regulated and the CEO pay is somehow capped. At least, now with Obamacare, they have to use at least 80% of revenue (and I think it is 86 or 87% in MA) for actual health care or give a rebate.
2. I think everyone should pay something (except the very poor) including co pays. I do think when people have to pay out of pocket they think more about whether they really need to go to the doctor or not. Some people go for every little cough or scrape…let them pay a little for that.
3. I have had this idea for at least 10 years – tax junk food – anything without nutrional value. The money would go into the health care pool. This way, people that make bad choices are at least paying more into the system. A little like a value added tax but I guess this is really a penalty for bad choices. It does bother me that my rates are somehow connected to how unhealthy people are because of these bad choices.
4. I think there should be clinics that are easily accessible in city locations for the poor. Maybe even have them connected to hospitals to move people out of emergency care when someone comes in because they don’t have a primary care dr and their kid has strep throat. These clinics should offer services on a sliding scale.
5. Educate and promote hospice care and end of life options. Obamacare wanted to do this and got blasted by the republicans as a death panel. I think many people don’t know that you can chose to die with dignity. My father (had alzheimer’s) and father in law (had brain cancer) both died at home under hospice care and I have to say it was the best experience for the situation at that point.
6. Tax as income any health plan over a certain amount – the cadillac plans.
7. Promote and make very affordable all preventive care.
8. Dr’s Pay? That’s another issue that many people complain about. I have mixed feelings since my daughter and her husband are both MD’s. I know what they spent to put themselves through med school. I know the hours they put in studying. I know the hours they spend (80/week) now in their residency programs. 4 years of undergrad, 4 years of med school and anywhere from 3 to 7 years of residency depending on the field they go into. My daughter has 4 years and her husband has 3 years (both starting 3rd year). One reason there is a shortage of primary care dr’s is because of the expense and loans students have, so they chose fields that pay better. There are programs for loan forgiveness if you go into primary care or obgyn and work where the govt sends you. And of course, there is the military to get a free education. I don’t think people want a dr that is not very well educated and trained. Dr pay is nothing compared to the wall street and ceo people and dr’s provide a valuable service!
9. Lawsuits. Many of the tests Dr’s order are to protect themselves from lawsuits. I think only the very over the top cases – removing the wrong limb or something like that should qualify for a lawsuit. I don’t know how much that adds to the overall cost of health care.
10. Rationing. This is hilarious. People against Obamacare and any changes to the current system, always say we are headed towards socialism and rationing care. We ration care now…if people don’t have insurance or if they have bad coverage, their care is rationed by the insurance co.
Here are some other situations I have heard about from my daughter and her husband.
1. Keeping someone’s elderly parents hooked up to machines when there is no chance of a good outcome so the kids can still get the parents pension. I’m not making this up! Dr’s can recommend a treatment plan but the family has the last word.
2. Many Dr’s, when faced with a terminal condition, choose not to undergo treatments. Instead they choose to spend that time with a better quality of life instead of in a hospital hooked to machines.
An issue I faced this year had me speechless! My husband’s dr recommended a treatment (standard procedure) that was optional so I called the dr’s office to find the cost since we have a deductible. The dr couldn’t give me a price, said they don’t know till the insurance co bills them. ok…..I called the insurance co to get the price but they couldn’t/wouldn’t give me the price until they get billed by the dr and know the code! Where else do we “buy” something and then months later, get the bill? I contacted my state rep and asked that question. They listened to my story, asked me to write it down and send it in to a committee working on overhauling the health care in MA. They also told me that there is a law that says insurance co don’t have to give a price! outrageous. How can you even try to make a responsible decision when you can’t get the information?!
I think much of the expense in the health care field happens at the end of life. (I have read the statistics but don’t remember what they are). Of course we don’t want to be “killing” people because they are a financial burden but I do think the treatment somehow has to be evaluated in terms of quality of life. But who makes those decsions? Should the family always have the last say? I guess in some cases, the insurance co has the last say if they refuse to pay for a treatment. Wouldn’t it be better for Dr’s, who really know the problem, be the ones making those decisions?
I do think there is a place for the community health care you talk about but there’s so much more that needs fixing!
