Controlling Health Care Costs

[Zipp0 1]

How can we control health care costs that are spiraling out of control?

What do you think of these ideas?

1. Make malpractice a criminal issue, and eliminate any possibility of monetary payouts. At the same time, increase enforcement of medical review boards and stop bad doctors from practicing. This would remove malpractice insurance from the entire industry and reduce costs across the board.

2. Stop the US consumer financing of drug company research through higher drug prices for US customers.

3. Severely limit drug company marketing of drugs, and limit their spending in offices, and on doctors trips and speaking engagements. No more free lunches for every doctors office every day of the year.

4. Shorten the time of exclusivity on new drugs so that cheaper generics are available more quickly.

5. Allow people on the Medicaid 'cusp' to pay for a portion of their bills. Many people quit their jobs just so they will qualify for needed medical care. It's better they work and pay a portion than quit and get it all for free.

Just a few thoughts.....

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[Skyrad 0]

One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

When an author is too meticulous about his style, you may presume that his mind is frivolous and his content flimsy.
Lucius Annaeus Seneca

[rehmwa 2]

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One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

faggots are small bundles of sticks intended for burning - I've never understood how it turned into an insulting term against hs's

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Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[kallend 2,106]

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One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

faggots are small bundles of sticks intended for burning - I've never understood how it turned into an insulting term against hs's

Didn't the Nazis send a lot of hs's to the death camp crematoria?

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The only sure way to survive a canopy collision is not to have one.

[Skyrad 0]

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One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

faggots are small bundles of sticks intended for burning - I've never understood how it turned into an insulting term against hs's

fagots are also meatballs.

When an author is too meticulous about his style, you may presume that his mind is frivolous and his content flimsy.
Lucius Annaeus Seneca

[kallend 2,106]

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How can we control health care costs that are spiraling out of control?

What do you think of these ideas?

1. Make malpractice a criminal issue, and eliminate any possibility of monetary payouts. At the same time, increase enforcement of medical review boards and stop bad doctors from practicing. This would remove malpractice insurance from the entire industry and reduce costs across the board.

2. Stop the US consumer financing of drug company research through higher drug prices for US customers.

3. Severely limit drug company marketing of drugs, and limit their spending in offices, and on doctors trips and speaking engagements. No more free lunches for every doctors office every day of the year.

4. Shorten the time of exclusivity on new drugs so that cheaper generics are available more quickly.

5. Allow people on the Medicaid 'cusp' to pay for a portion of their bills. Many people quit their jobs just so they will qualify for needed medical care. It's better they work and pay a portion than quit and get it all for free.

Just a few thoughts.....

Being old, I recently had the DRE "finger" test and the PSA blood test done. My GP thought there was a "nodule" and referred me to a urologist. He did his own DRE and said there wasn't a nodule, my PSA was low, I don't have anything wrong, but COME BACK ON FRIDAY FOR AN ULTRASOUND AND NEEDLE BIOPSY".

THAT is a symptom of why health care costs are out of control.

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The only sure way to survive a canopy collision is not to have one.

[idrankwhat 0]

Ban federal funds to any company involved in direct consumer marketing of their products. And hire someone to figure out why in the hell nearly one third of each health care dollar is spent on administrative expenses.
Oh yea, almost forgot.
This is not a bill.

[billvon 3,073]

>1. Make malpractice a criminal issue, and eliminate any possibility of
> monetary payouts.

Might work, but would require serious tort reform.

>2. Stop the US consumer financing of drug company research
>through higher drug prices for US customers.

Result - no new drugs. Companies do not do things for free.

>3. Severely limit drug company marketing of drugs, and limit their
> spending in offices, and on doctors trips and speaking
> engagements. No more free lunches for every doctors office every
> day of the year.

Result - fewer new drugs. Why create a better cancer drug if no one will buy it because they've never heard of it?

>4. Shorten the time of exclusivity on new drugs so that cheaper
>generics are available more quickly.

Result - the price of the new drug doubles so the company can recoup its investment in the shorter time.

>5. Allow people on the Medicaid 'cusp' to pay for a portion of their
>bills. Many people quit their jobs just so they will qualify for needed
> medical care. It's better they work and pay a portion than quit and
> get it all for free.

Not a bad idea. Or have a sliding scale of reimbursement at the 'cusp.'

[Zipp0 1]

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>3. Severely limit drug company marketing of drugs, and limit their
> spending in offices, and on doctors trips and speaking
> engagements. No more free lunches for every doctors office every
> day of the year.

Result - fewer new drugs. Why create a better cancer drug if no one will buy it because they've never heard of it?

'

I disagree in many cases. Pepple are seeing ads on TV about drugs they probably don't even need, self-diagnosing, and then running to their doc for a script. The doc thinks it won't hurt them, and when the drug rep sees the doc writing his drug, he brings an extra special lunch to the entire office or hires the doc to speak to other doctors about the drug.

That one TV ad sent an entire chain of event into motion that absolutely did not need to happen.

"Ask your doctor about..." ads need to stop. If you are sick, go to your doctor and ask for help. Also, any incentive outside patient care needs to be removed from the prescription decision.

New cancer drugs should be prescribed because they are the best drug, not because the drug company has the best marketing. The governemtn should publish a list of drugs available for illnesses, as well as results from efficacy studies, and the doc can decide from that.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[kelpdiver 2]

you're correct in that drug marketing is a pretty big expense, but your points to lower drug prices and shorten patent time pretty much eliminate incentive to develop new drugs. That is a very expensive process with a low success rate.

If anything, patent times should be extended, esp if coupled with cost controller measures.

I'm pretty sure the administrative costs are the biggest hurdle, based on the paperwork I've seen for all my bills this past year. The best (worst) example was Blue Shield having a consultant declare that a followup CAT scan done on me at Stanford wasn't medically necessary and that they would not pay. (Results of that scan lead to a angiogram procedure the following week to seal off an bleeding artery).

First BS said it wasn't necessary, then that it was a preexisting condition (yeah, right), then they paid when I sent me my proof of continuous coverage, and months later decided it still wasn't medically necessary and demanded Stanford pay them back.

The goal is supposed to be cost control, but it certainly seems the have achieved the opposite result.

[Zipp0 1]

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you're correct in that drug marketing is a pretty big expense, but your points to lower drug prices and shorten patent time pretty much eliminate incentive to develop new drugs.

So, profit is the only incentive for curing diseases? I think there was a time when the motivation was to end suffering.

How about we remove all of the executives and marketers from the equation and just fund researchers? Paying a bunch of scientists in government labs would be better than the current system. There is no reason for marketing, advertising , and everything that goes along with it to be involved in health care.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[billvon 3,073]

>Pepple are seeing ads on TV about drugs they probably don't
>even need, self-diagnosing, and then running to their doc for a script.

Right. Then one of several things can happen:

Doctor evaluates the request, says "yes, that might help and is worth a try" and writes the prescription. Result - patient's condition may improve.

Doctor evaluates the request, says "no, that's not going to help you, what we're doing with XXX is a better approach to your problem." Result - unneeded drug is not prescribed.

Doctor evaluates the request, thinks "this will not improve my patient's condition, and may actually be a health risk" - and writes for it anyway. This is a problem with the doctor, not the drug company. If you want to solve this problem, go after the bad doctors.

>The governemtn should publish a list of drugs available for illnesses. . .

We already have such a book. It's called the physician's desk reference.

[billvon 3,073]

>So, profit is the only incentive for curing diseases? I think there was
>a time when the motivation was to end suffering.

Profit is the primary incentive for companies to fund research to cure diseases. If you want the government to do it, that's a different story. How much more are you willing to pay in taxes to switch drug research from corporations to the government?

[narcimund 0]

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Right. Then one of several things can happen:

There's a 4th option which is a more ambiguous situation:

Doctor evaluates the request and thinks "This will not improve my patient's condition but is NOT actually a health risk" -- and writes for it.

More than likely no medical harm comes from this but it costs somebody a lot of money.

I've seen it happen.

First Class Citizen Twice Over

[nathaniel 0]

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>1. Make malpractice a criminal issue, and eliminate any possibility of
> monetary payouts.

Might work, but would require serious tort reform.

Yeah, there are two routes I can see to fix the malpractice issue. One is to standardize the use of specialized arbitration services, ideally staffed with people knowledgeable about healthcare and the specific aspects of physiology in question.

The other is to do the same thing inside the court system, kinda like how we have Family Court, and some states and localities have special drug courts or traffic courts. Either way it allows the process to speed up by getting the judge and administrivia types ramped up on the same issues that crop up again and again.

I'm inclined to lean towards arbitration bodies, if a neutral hosting body could be founded, instead of special courts.

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Result - no new drugs. Companies do not do things for free.

That seems it's going to be the outcome no matter what. Most large drug co's are already slashing their research budgets, they're not able to find economies that make it worthwhile. On the small scale, venture capital and the like, things will probably continue unabated with or without advertising. So I kinda think it's moot whether marketing is restricted or not--the economy is building resistance naturally.

I am concerned that mandatory coverage without additional interventions could turn into a boondoggle, with doctors and hospitals potentially gaining incentives to overdiagnose and overtreat, hence taxing everybody through excess premiums. el Presidente's proposed taxation was at the wrong end--all income taken as healthcare subsidy should be taxed, imo.

Tax benefits, if any, should be granted to encourage healthcare that benefits society in addition to just the patient, such as preventative care, vaccination for communicable diseases, proper sanitation, etc. But not things like emergency visits, hereditary diseases, trauma care, etc. that just reflect a person's own bad luck or his own poor choices in life.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[kelpdiver 2]

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you're correct in that drug marketing is a pretty big expense, but your points to lower drug prices and shorten patent time pretty much eliminate incentive to develop new drugs.

So, profit is the only incentive for curing diseases? I think there was a time when the motivation was to end suffering.

Are you aware of how long the pipeline is from research to development to 3 stages of clinical trials to release of a new drug? (And even then you get situations like with Vioxx that cost the company even more) It takes many years and costs a hell of a lot of money. Most of those costs don't change if you do it at Cal or UCSF instead of Gilead or Genentech.

The people who work at these companies (many of my friends) do it to 'end suffering,' but it still takes considerable capital to get there.

[tonyhays 86]

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One of the simplest is to get the public healthier

Unfortunately, never going to happen. This has become the nation of couch potatoes and lard asses with no incentives to exercise.

“That which can be asserted without evidence, can be dismissed without evidence.”

[narcimund 0]

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Unfortunately, never going to happen. This has become the nation of couch potatoes and lard asses with no incentives to exercise.

That's one of the effects of health insurance.

First Class Citizen Twice Over

[Lindsey 0]

There are a few things happening that hits on these issues.

It's hard to get an insurance company to pay for a lot of the more expensive medications. Some do, but most require a PA that documents a patient has been tried on adequate trials of less expensive medications before they'll foot the bill for the more expensive drug.

Since I spend a lot of my time in the ER, here's what Medicaid's doing here to cut back on what they pay for routine care. Many, many, many people use the ER for things that aren't emergencies, and the cost for these visits is WAAAAY higher than if people just went to their own doctors during office hours. If a patient in Arkansas has Medicaid and goes to the ER for a non-emergent condition, Medicaid will pay for any evaluation done IF the physician does not give a prescription medication. This includes even more expensive studies if they are deemed necessary for evaluating the condition. However, if the condition is not emergent and the physician gives prescription medication, then they'll pay $38 for the visit, regardless of what work-up was involved.

Now, in the short-term, this isn't gonna save money, but as people with Medicaid realize that they're not gonna be treated in the ER for something they shoulda seen their own docs for, then hopefully it will change how people use the ER. I think that this will probably set a new tone for other insurance companies as well. I think it could work. There could be other issues arise if ERs aren't used as frequently, but those are bridges that we'll have to cross when it happens. Overall, I think these are some changes that could be helpful.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[akarunway 1]

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One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

Hey hey hey. Don't be jacking up the price of my vices. They're expensive enough already. Next thing you'll want a tax on my hookers

I hold it true, whate'er befall;
I feel it, when I sorrow most;
'Tis better to have loved and lost
Than never to have loved at all.

[idrankwhat 0]

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>So, profit is the only incentive for curing diseases? I think there was
>a time when the motivation was to end suffering.

Profit is the primary incentive for companies to fund research to cure diseases. If you want the government to do it, that's a different story. How much more are you willing to pay in taxes to switch drug research from corporations to the government?

I thought we were already picking up the R&D tab. So basically it would be lateral move.........to an entity........with even more overhead. Damn. Nevermind.

[Lucky... 0]

6. Deny the poor any coverage.

Oh wait, they already do that and it doesn't work.

[rhys 0]

>This has become the nation of couch potatoes and lard asses with no incentives to exercise.


And seems to be the point of the original post. Kinda?

Not only the united states of america but worldwide the economies are being ruled by multinational companies. These companies play a mighty role in the obesity and over consumption problems the world faces today.

A fat, lazy person that listens to thier ipod all day or plays on a playstation etc., eating thier well packaged (enviriomental problem), Tastey (hows ya lard ass), easily availabe (eye level at the corner store, well almost every store in the world!)products makes the particular companies eg, Nesle, Coca cola etc. very very rich indeed!

The drug companies are exactly the same they are companies that make money, and they want more money. that is the problem. Yes the emphasis has changed from providing what is needed to providing what will make the most money.

It is a huge problem but many govornments(or most likely members of the govornments) in question have vested interest in the performance of such companies.

It is not about the people anymore it is about the companies, companies basicly own the govornments through financial commitments. NO?

"When the power of love overcomes the love of power, then the world will see peace." - 'Jimi' Hendrix

[freethefly 6]

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1. Make malpractice a criminal issue, and eliminate any possibility of monetary payouts. At the same time, increase enforcement of medical review boards and stop bad doctors from practicing. This would remove malpractice insurance from the entire industry and reduce costs across the board.

Place all liability on the doctor would be a better solution. If he screws up he should lose everything.

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2. Stop the US consumer financing of drug company research through higher drug prices for US customers.

A large amount of funding for research comes from tax dollars and charities. Yet, all of the profits goes into the deep, deep pockets of the caompany and the unrealistic salaries of the top executive and CEO's. For example, AIDS meds rake in well over 1 billion dollars per month yet very little of these profits go into research and next to none is use to find a cure. The pharmetcutical companies latched onto this cash cow and cares nothing at all about finding a cure. Much like the supposed AIDS "doctor" who attend a few siminars and then call themselves AIDS "doctors". They care very little, if they care at all, about the patient. AIDS is a major money maker for those who only pretend to care while they stuff their pockets with cash. Plus, they will only see patients who have money. No money, no treatment. That in itself should be criminal as it boils done to murder.

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3. Severely limit drug company marketing of drugs, and limit their spending in offices, and on doctors trips and speaking engagements. No more free lunches for every doctors office every day of the year.

Drug pushers who push unproven drugs through the system in pursuit of the all mighty dollar. Whether the drug works or not is of little concern. It does not matter if a number of people die if the profit out weighs any payout for lawsuits that may follow.

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4. Shorten the time of exclusivity on new drugs so that cheaper generics are available more quickly.

Generics should be made available at the sametime that the high dollar version is made available. After all, your tax dollars and donations paid for the research. It should be seen as criminal to refuse to help those in need. Once again, they care nothing at all about the sick and care only about the billions of dollars that they can make before they have to allow the generic version or pull the drug due to a high mortality rate caused by the toxic crap that they call "medicine".

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5. Allow people on the Medicaid 'cusp' to pay for a portion of their bills. Many people quit their jobs just so they will qualify for needed medical care. It's better they work and pay a portion than quit and get it all for free.

On this, you are far off track as medicaid users must pay a "spend down". My spend down is $695.00 a month and must be paid monthly if I wish to use what you call "free". Oh, forget about the taxes that I pay into this system only to not to be available to me. $506.00 per month is gouging and should be seen as criminal as it boils down to murdering those who are burden with a terminal illness and cannot possibly pay such a ridiculous amount. The same with medicare. Unless you too have an illness that will kill you if not treated you may never be able to see it from my point of view. I care nothing at all about the "burden" to the taxpayer as I am a taxpayer and see the refusal of healthcare as criminal. The biggest lie in our country is that we are a compassionate country when the truth is that profit trumps caring for one another. Doctors will suck every dollar from a patient and when there is no money left you will be pushed aside to die and another cash cow will be wheeled in to take the bed. Healthcare should be given to everyone, period.

Edited due to mistake on spend down amount

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[Lindsey 0]

Place all liability on the doctor would be a better solution. If he screws up he should lose everything.

I'd be real damn picky about who I chose to treat. Difficulty with access to medical care would take on a whole new meaning.

For example, AIDS meds rake in well over 1 billion dollars per month yet very little of these profits go into research and next to none is use to find a cure. The pharmetcutical companies latched onto this cash cow and cares nothing at all about finding a cure. Much like the supposed AIDS "doctor" who attend a few siminars and then call themselves AIDS "doctors". They care very little, if they care at all, about the patient.

Okay. Get out your pencil and make a list of HIV meds available 10 years ago, 15 years ago, and now. I think there are very few illnesses that as much effort has been put into treating....with as much progress as has been made with HIV/AIDS. In my experience, the docs who treat people with HIV are some of the MOST caring of all.

Then there's Ryan White Foundation. In my area, people whose access to health care is limited get HUGE benefits from Ryan White Centers. It's not limited to medical care, but also helps with rent, utilities, groceries. Hell, they'll even pay for a social worker to help you out, cart you around, whatever you need, pretty much. Had you gotten cancer instead of AIDS I don't think you'd find as much available to you.

BTW....your bitterness is showing, and has just lumped you into that group who wouldn't get the time of day in under that plan you were talking about (above).


On this, you are far off track as medicaid users must pay a "spend down". My spend down is $695.00 a month and must be paid monthly if I wish to use what you call "free".

Most people with Medicaid don't have to pay, or only minimally, for health care. People with Medicaid spend-down are people who don't qualify for Medicaid, but whose medical bills place an unusually high burden on them, as a percentage of income (or something like that). It has to do with how high medical bills are and how much you bring in.

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail