I'm thankful that healthcare consumers are finally becoming aware that our healthcare system is seriously ill. But few are aware how broken the system really is, how incredibly complex the problem is, the many shortcomings of the predominant solutions being proposed, and the strategies & tactics that hold real promise for fixing the system.
We see the U.S. healthcare system as being on the verge of collapse: Millions cannot afford health insurance; care quality is inferior compared to many other nations, while our costs are highest by far; there is little incentive to deliver cost-effective treatments and little knowledge of what constitutes high-value care; healthcare providers are squeezed financially and are unable to spend adequate time with their patients because arbitrary rules control costs without regard to quality of care; the insurance and payment models are seriously disturbed; emergency rooms are over-crowded; many of our veterans don't receive adequate care; competition between providers is misdirected; new health insurance plans put consumers at serious risk; medical malpractice suits are rampant and professional insurance is through the roof; and so on.
Bottom line is that our healthcare system is widely acclaimed for its technological hardware, yet ranks embarrassingly low in performance, access and fairness. Can it be reformed to benefit all stakeholders?
We believe the answer is yes.
My associates and I—who include doctors, nurses, counselors, patients, researchers, policy makers, economists, and others—have spent many years studying these problems and creating a sound blueprint for solving the healthcare crisis. The strategy we propose offers 20 useful tactics for changing broken healthcare policies and practices by focusing on such things as wellness, value creation (i.e., care quality improvement and cost control), consumer/patient empowerment, reforming current economic models, delivery of personalized medicine, interdisciplinary collaboration, conducting better research to develop practice guidelines and identify dangerous medications and procedures, changing the way providers compete, supporting first responders in emergencies, understanding the mind-body connection, understanding the benefits and risks of complementary and alternative approaches to care, and using innovative information technologies to aid decisions.
We present all this on our Wellness Wiki at wellness.wikispaces.com. It starts with an in-depth review of the current situation and then describes the “knowledge void.” It then discusses the pros and cons of three possible solutions to the healthcare crisis currently being discussed: (1) high deductible health plan with health savings accounts, (2) disease management with pay for performance, and (3) rationing. Then it presents a comprehensive plan for solving our healthcare crisis.
We wish to offer our work to Unity08 to assist in the development of a national healthcare policy for reforming/transforming the current system. And please also feel free to visit my Curing Healthcare Blog at curinghealthcare.blogspot.com
I look forward to any questions and comments and ask for the opportunity to offer something useful to the noble Unity08 cause.
Be well,
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Could we have a summary or is this a "pay to play" thing?
A Democrat seeks complex solution to simple problems
A Republican seeks simple solutions to complex problems
A reasonable person seeks simple solutions for solvable problems
Your question about "pay to play" appears to be an attempt at understanding my motives; I appreciate it. So, let me start with a brief overview of my background and ideals.
I'm a clinical psychologist, practitioner, researcher, software inventor, and founder of a small health IT company. Twenty years ago, I made a conscious decision to focus my life on collaborating with others to help make this world a better place for our children and future generations by helping transform our healthcare system in fundamental ways. I'm currently involved in activities devoted to consumer empowerment and wellness; continuous improvement of care quality and efficiency using evolving evidence-based guidelines and clinical outcomes research; bettering the health and well-being of the elderly, infirmed and impoverished; developing cost-effective technology that enables collaboration and secure data sharing between clinicians, researchers and consumers; protecting populations through better biosurveillance; and supporting first responders and trauma department staff in disaster situations.
We wrote the Wellness Wiki (and I write the Curing Healthcare blog) to share our knowledge and understanding. This is all done "on our own dime" (we don't charge a fee for it), and we make a sincere effort to remain objective, fair and balanced in what we write.
You also asked for a summary of our strategy, which follows.
We contend that the only possible way to achieve sustainable gains in the quality of healthcare, and control costs in the process, is to remove most waste from the system, foster wellness (e.g., through prevention, self-maintenance, lifestyle change, and compliance to evidence-based treatment regimens); minimize errors and omissions; supply useful decision support, education and guidance; bring greater transparency into the system; and deliver the best possible care for the least cost and with the least risk to every patient. Doing this requires many fundamental changes to the way things are currently done, and, as discussed on our wiki, we've identified the following 20 tactics to do it, (with links to the Wellness Wiki for the details):
Focus on Consumer-Centered, Universal Healthcare
Deliver Personalized Care
Collaborate
Increase Healthcare Fidelity
Improve Care Quality with Evidence-Based Practice Guidelines
Offer Consumer Education and Wellness Programs
Integrate Sick-Care with Well-Care
Reform Current Economic Models
Redirect Competition
Provide Case Management
Implement the “Advanced Medical Home” Model
Utilize Home Care and Telemedicine
Support Decisions with Diagnostic Aids
Protect Populations with Biosurveillance
Use Evolving Health Information Technology (HIT) Tools
Utilize Knowledge Services and e-Learning
Deliver Biopsychosocial Healthcare
Provide Case Management
Establish Multi-disciplinary Diagnostic and Referral Centers
Research Complementary and Alternative Medicine and Human Genetics and Genomics
PS: May I suggest you change your last tag line to: A reasonable person seeks cost-effective solutions for solvable problems
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Steve,
your post is obviously a result of a lotta work.
it is a bit overwhelming for me........yes, difficult issue(s).
could you scope y'alls position for me a bit ?
is what you're suggesting....
~ before, after or without universal health care ?
as proposed by kucinich HR # 676 ?...which obviously is my preferred starting point..... lnk ~ preference
in 25 words or less.......ok ?
OK, germanicus, our strategy in 25 words ... how's this:
Universal insurance is essential, but inadequate. Instead, we need universal healthcare within a system that promotes wellness and the consistent delivery of high-quality, cost-effective care.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I'm listening... The most important question is: How do you propose this program is funded? Who oversee's this UHC program? How is it regulated? Can a person still select their own doctor/specialist/surgeon? What happens to the Doctor's/Nurses/Specialists/Surgeons, etc. that will not participate in this program? Are they forced to participate or lose their license? Plenty more questions....just trying to understand some basic issues. Thanks.
Thanks for you excellent questions, Wes.
While I’m not talking about a universal healthcare (UHC) “program,” I am presenting a comprehensive strategy for making fundamental changes to our healthcare delivery system, of which UHC is an important component.
The reason we developed this strategy is to stimulate dialogue about crucial issues that are often missed in the debate on healthcare reform. Our expertise focuses on development and deployment of economical health information systems and on the importance of research and knowledge management to improving quality and controlling costs.
We fully recognize that the issue of oversight, regulation, funding, etc. must be addressed for fundamental changes to happen. I believe the answers to you questions will emerge from this kind of conversation, and I see my as helping to keep the discussion centered on how to deliver value to the consumer. We also realize that many have a stake in maintaining the status quo and will resist any meaningful transformation in this direction.
We contend that any UHC strategy must promote higher care quality and control costs (i.e., increase healthcare value) or it will fail in the long term. Plain and simple. If anyone disagrees, please make you case.
Continually increasing value healthcare requires leadership, commitment, a focus on growing and using evidence-based knowledge, embracing wellness, an open mind to alternative approaches to care, innovation, etc. This costs money, requires effort, and necessitates changes to the way many things are currently done.
While we haven’t answered all your questions, following are links on our Wellness Wiki where we discuss some of the barriers and drivers to implementing the strategy:
Problems Relating to Provider Motivation and How to Solve Them
Problem of Consumer Ignorance when Selecting Providers and How to Solve It
Problems with Current Practice Guidelines and How to Solve Them
Problems with Today’s HIT Systems and How to Solve Them
As to your other questions, I found the Porter and Tiesberg book, Redefining Health Care: Creating Value-Based Competition on Results a good place to start. It makes the case that providers (clinicians) would form clinical practice units that integrate the talent and facilities required to deliver coordinated care over the entire care cycle (i.e., each episode of care), including all providers treating a patient and all services delivered by these teams, from diagnosis to treatment to rehabilitation and long term management, and even prevention. These practice units focus on particular health condition for which they have expertise enabling them to demonstrate superb clinical results and efficiencies. Both risk-adjusted outcomes and costs would be measured over the full cycle of care, not for discrete interventions or procedures. Teams who have better outcomes at lower costs, i.e., deliver greater value, have a competitive advantage and receive more referrals, as well as financial incentives. These comparisons would be made at regional, national, and even world level, not only locally within their own healthcare system; patients would be given incentives to travel to the best providers. Successful clinical practice units would, therefore, gain ever greater experience treating particular conditions and would develop ever greater expertise and efficiencies, thereby continually improving the quality and lowering the cost of care delivered.
I hope this will lead to fruitful debate!
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Thanks for you excellent questions, Wes.
While I’m not talking about a universal healthcare (UHC) “program,” I am presenting a comprehensive strategy for making fundamental changes to our healthcare delivery system, of which UHC is an important component.
The reason we developed this strategy is to stimulate dialogue about crucial issues that are often missed in the debate on healthcare reform. Our expertise focuses on development and deployment of economical health information systems and on the importance of research and knowledge management to improving quality and controlling costs.
We fully recognize that the issue of oversight, regulation, funding, etc. must be addressed for fundamental changes to happen. I believe the answers to you questions will emerge from this kind of conversation, and I see my as helping to keep the discussion centered on how to deliver value to the consumer. We also realize that many have a stake in maintaining the status quo and will resist any meaningful transformation in this direction.
We contend that any UHC strategy must promote higher care quality and control costs (i.e., increase healthcare value) or it will fail in the long term. Plain and simple. If anyone disagrees, please make you case.
Continually increasing value healthcare requires leadership, commitment, a focus on growing and using evidence-based knowledge, embracing wellness, an open mind to alternative approaches to care, innovation, etc. This costs money, requires effort, and necessitates changes to the way many things are currently done.
While we haven’t answered all your questions, following are links on our Wellness Wiki where we discuss some of the barriers and drivers to implementing the strategy:
● Problems Relating to Provider Motivation and How to Solve Them at wellness.wikispaces.com/Problems+Relating+to+Provider+Motivation+and+How+to+Solve+Them
● Problem of Consumer Ignorance when Selecting Providers and How to Solve It at wellness.wikispaces.com/Problem+of+Consumer+Ignorance+when+Selecting+Providers+and+How+to+Solve+It
● Problems with Current Practice Guidelines and How to Solve Them at wellness.wikispaces.com/Problems+with+Current+Practice+Guidelines+and+Quality+Improvement+%28QI%29+Programs+and+How+to+Solve+Them
● Problems with Today's HIT Systems and How to Solve Them at http://wellness.wikispaces.com/Problems+with+Todays+HIT+Systems+and+How+to+Solve+Them
As to your other questions, I found the Porter and Tiesberg book, Redefining Health Care: Creating Value-Based Competition on Results a good place to start. It makes the case that providers (clinicians) would form clinical practice units that integrate the talent and facilities required to deliver coordinated care over the entire care cycle (i.e., each episode of care), including all providers treating a patient and all services delivered by these teams, from diagnosis to treatment to rehabilitation and long term management, and even prevention. These practice units focus on particular health condition for which they have expertise enabling them to demonstrate superb clinical results and efficiencies. Both risk-adjusted outcomes and costs would be measured over the full cycle of care, not for discrete interventions or procedures. Teams who have better outcomes at lower costs, i.e., deliver greater value, have a competitive advantage and receive more referrals, as well as financial incentives. These comparisons would be made at regional, national, and even world level, not only locally within their own healthcare system; patients would be given incentives to travel to the best providers. Successful clinical practice units would, therefore, gain ever greater experience treating particular conditions and would develop ever greater expertise and efficiencies, thereby continually improving the quality and lowering the cost of care delivered.
I look forward to any follow-up questions and comments.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
[deleted: duplicate]
The problem with our health care system is that more money is made by people being sick than by their being healthy. As long as drug companies and insurance companies control the government no solution will be found. Insurance for all is not the answer. A stronger less dependent citizen is. The only difference between communism and capitalism is that under communism government owns business. In a capitalistic country business owns the government.
I'm sorry Steve, but that comes across as very "pie in the sky" to me. What are the actual programs you want to implement and how much will each cost? There's a big difference between saying "Make xxx better" and saying how you would do it and what it would cost to do. For instance, the bullet point "Collaborate" or "Increase Healthcare Fidelity". To me, this sounds like, instead of an expensive, bloated UHC waiting to happen, a VERY expensive, bloated UHC waiting to happen. You can't build a healthcare plan on "make things all better". What part of the plan actually *makes* collaboration and increase healthcare fidelity (what *is* that?!?) happen?
I'm going to post back on my MRSA idea and how I manage to avoid most of your concerns, but I can also show you how a policy leads to change also. You're going to need to do this if you want to sell your idea.
A Democrat seeks complex solution to simple problems
A Republican seeks simple solutions to complex problems
A reasonable person seeks simple solutions for solvable problems
What kind of back door scam are you trying to pull off? This site is not for your free advertising.
I find it sad that our society is so jaded by deception that it’s often wise to distrust. I’m taking a great deal of time engaging in dialogue with people I don’t know, but trust they are here to help improve our country!
We have extensive knowledge about the healthcare crisis and are sharing it in an open forum. We’ve asked for nothing in return and only want to be heard. But I understand people’s skeptism.
What do you think we are advertising? Where do you believe a scam is being perpetrated? I’d be happy to reply to your concerns so you better understand our motives.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I briefly glanced at your wiki site and it seems to me if Unity08 or any organization was to back your program. There would be plenty of lucrative consulting fees to spread around. Who best to consult with but the author of the program. Since I don't follow the intricate details of all these programs I really can't give an ups or down on your plan, except it is your plan. That is why I am skeptical. There is a down side to everything. The unintended consequences are usually the killer. Like who pays for this.
I do understand your point and you have every right to be skeptical!
The fact is, we all have to eat, and if I was hired as a consultant for Unity08, I would consider it an honor to work with this fine organization. But I am sharing my knowledge now out of a sincere desire to help change our healthcare system through grass-root efforts, no strings attached!
Actually, what I'd love to see is "my plan" be transformed through ongoing dialogue and feedback into "our plan." There are still plenty of unanswered questions for which only a community of honest, open collaborators can answer. That community, in my mind, in Unity08.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
No need to feel sorry, John. We all want improve the healthcare system and this kind of critical dialogue is necessary. I thank you for your feedback and reply below.
When we wrote the transformation strategy presented on our wiki, we started with the understanding that cost, quality and accessibility problems must be addressed seriously and powerfully. We concluded early on that two main factors should be priorities.
First, we must address the healthcare industry's lack of knowledge about the most cost-effective ways to prevent and treat illness, which results in incredible waste and poor outcomes.
Second, our country's payment model--which is based on a "pay for it once then pay again to fix it when it breaks" mentality--encourages healthcare providers to do as many sick-care (i.e., allopathic) procedures as possible, rather than (a) getting people well as quickly and inexpensively as possible and (b) keeping them well as long as possible, both physically and psychologically.
We then investigated ways to do it by pulling together different models presented by smart people and competent organizations, which became our 20 tactics. We all realize that implementing those tactics will take time and money, and we have examined how to make it economically feasible.
You ask for an explanation of the parts of the plan that actually makes collaboration and increased healthcare fidelity happen. Consider the following from our wiki.
Collaboration focuses on enabling and encouraging cooperative efforts between networks of healthcare stakeholders across the globe for decision support, research, and knowledge gain:
Also as discussed on the wiki, there are already models of this kind of collaboration in actions, including several practitioner-researcher networks, regional health information networks, and health information exchanges. A form of collaboration also exists between primary care physicians and their networks of specialists to whom they refer their patients. There is even increasing collaboration around joint decision making between patients and their doctors. Furthermore, there is a recent effort to establish "continuity of care records" (CCRs) to facilitate communication between multidisciplinary teams treating the same patient. And finally, there are low-cost methods for fostering such collaboration. But more has to be done and it need not be expensive.
As to the issue of "healthcare fidelity," here's a quote from our wiki:
Healthcare fidelity is a term used to describe how well systems delivering healthcare enable providers to give patients the precise interventions they need when they need them - nothing more and nothing less. Fidelity exists only when healthcare systems enable:
A high-fidelity healthcare system:
Fidelity of care in America, unfortunately, has suffered because we currently spend huge amounts of money on developing new drugs and devices that deliver only modest improvement in the quality of care, as well as spending vast sums on administration and competition for patients that have no beneficial impact on quality. By consuming resources that could be used for increasing fidelity, this misalignment of priorities and focus may cost more lives than it saves and ultimately causes health outcomes to suffer. A strong case can be made, therefore, for spending less on these activities and more on systems for improving the fidelity of care, which would:
Here there would be the need for increased spending on information systems and clinical outcomes research to develop and use (a) evolving evidence-based guidelines; (b) decision-support tools aiding in diagnostic and treatment decisions; and (c) rational economic models.
Simply focusing on lowering insurance rates and increasing coverage fails to address the issues of poor care quality and high cost, which can actually put consumers/patients in a worse situation by (a) having to make decisions for which they are ill-prepared, (b) encouraging the continuation of "assembly line medicine" (10 minutes with the doc and then out the door), and (c) fostering the delivery of unnecessary, inappropriate care, or inadequate care.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Hi Steve,
Thanks for that. I didn't see that stuff on your previous links.
It seems to me you're going after *how* to provide the healthcare while I'm thinking of how to fund it. I'll do some reading on your suggestions as soon as I find a free moment or two.
The only thing I see is that government is *lousy* at implementation, so I would only advise caution that the amount of money it might take to make this happen could be absolutely enormous, whereas it seems like a bunch of good guidelines that should be followed voluntarily.
A Democrat seeks complex solution to simple problems
A Republican seeks simple solutions to complex problems
A reasonable person seeks simple solutions for solvable problems
No disrespect for Steve position because efficient and quality care always require effort and vigilance. But we do have abundant healthcare in this country, even enough for our health impoverishing life styles. The problem today is funding efficiencies to deliver it to everyone as needed. We need boundries on 'as needed' somewhat less than 'as wanted'. We need a revenue gathering and distribution systems that does not intervene between service provider and patient on 'as needed' care. Gathering and distributing funds is a banking function not an insurance or healthcare provider function. Even government has no role other than underwriting legislatively determined contribution to such bank for the cost of the impoverished and catistropical ill as needed for thier constitutional duty to 'general welfare'.
Bill"for what we are together"
bill713.unity08@sbcglobal.net
You get no argument from me, Bill, about the need for funding efficiencies. I am open to whatever works, as long as it promotes value for the consumer.
Defining "as needed" vs. "as wanted," however, is not always easy. For example, it's not unusual for a patient to get different recommendations from different doctors for the same condition; each one saying the patient “needs” something different. This “practice variation” problem occurs when different healthcare providers, even major academic medical centers, treat similar patients in vastly different ways and for significantly different costs. This research shows that more care and higher spending are not associated with better outcomes, and may, in fact, result in worse outcomes. A patient could be hospitalized for nine days in one part of the country and three in another for the same diagnosis, and those differences would have no impact on outcomes. No other industry handles the same situation in so many different ways when these differences don’t yield better results, and even result in worse outcomes. In other words, more expensive care isn’t necessarily better care. So, who’s to decide what a patient really needs?
BTW, an interesting approach is using the quality-adjusted life year (QALY) metric in determining if particular healthcare interventions are worth the cost by considering both the quantity and the quality of life generated by such care.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
"particular healthcare interventions are worth the cost by considering both the quantity and the quality of life generated by such care". This is nothing more, or less, than rationed health care, if imposed by the state.
The state can't even bring it's self to give employees, who do not have health coverage at work, an off the top tax break for their health insurance premiums.
This demonstrates to me that the state has no desire, or intention, of improving the healthcare system in this country. They only wish to increase their control over it.
Yes, QALY is a form of rationing used, for example, in the UK. I'm not an expert on QALY, but as I understand it, the metric, though imperfect, does provide a means for determining what type of care is worth funding. It seems they figured that when you have finite dollars to spend on healthcare, it's not possible to pay for every possible procedure and medication requested. Some may be more cost-effective than others in terms of the amount of longevity and quality of life relative to cost. So, they came up with a way to determine where the line is drawn based on this risk-benefit analysis.
Again, this is just my understanding and I am not advocating QALY-based rationing.
On the other hand, don’t we actually ration care in the U.S. in a non-obvious way? For example, there are ceilings, exclusions, co-pays and deductible on insurance policies, and millions are uninsured. Someone who can’t afford the care, and it’s not an immediate life a life-or-death emergency, doesn’t get it (unless, of course, you’re incarcerated). Unlimited care is available to the wealthy, but not for the rest of us. That’s a form of rationing.
I can certainly understand your doubts about our government’s desire to transform our current healthcare system in a way that benefits the masses, although I don’t think they'd be motivated to use QALY simply to increase their control over the system. Instead, what concerns me is the relationship between lobbyist activity and the types of corporations receiving the greatest financial benefit from the current system, i.e., pharma, insurers, and medical device manufacturers.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I think the necessary funding is already availably, but it is being squandered in excessive admin costs and obscenely top heavy Management. The disastrous cost containment strategies employed by self-serving Managers are extremely detrimental to effective quality healthcare. The exploitation of fatigued, overstretched, overstressed Medical staff has caused a dramatic increase in serious errors and super-bugs; these preventable problems are a major financial drain on the Healthcare budget. This toxic work environment caused a "Nursing Exodus," not to be confused with the now infamous, but totally contrived "Nursing crisis." This is the feeble excuse still used to justify Deliberate Negligent Understaffing. We must Control Understaffing Today: see the C.U.T! Campaign on my Blog: Transparency for Equal Accountability in Medicine: http://medteam.wordpress.com .
If we fix the current grossly disproportionate imbalance of power then many of the Nurses who once deserted our Hospitals for temporary Nursing Agencies will return to permanent employment: this will save money by cutting out unnecessary Nursing Agency commission fees. Better staffing means safer, more vigilant care with fastidious cleaning resulting in fewer costly mistakes or virulent infections. How do we cope with smaller Management? By encouraging absolutely everyone in the workforce to participate in developing better solutions to the multitude of issues and minor frustrations we face everyday. To find out more about this read my Wiki input on the Kaleidoscope of Innovative Momentum: http://kim-team.wikispaces.com/
I am passionately committed to Universal Healthcare, but for me that is every person on earth rich and poor alike. I have no vested interest in communicating my ideas except possibly to regain my damaged self-respect after being vilified, banished and ostracized for blowing the whistle on Deliberate Negligent Understaffing. I had to leave the US after I lost my home, but I am still determined to expose and help resolve the issues that proved so destructive to my career. I want to know that my personal sacrifice finally accomplished lasting positive changes in a deeply flawed system, even if in future my own energies are redirected towards working as a Medical volunteer in far more needy places in the developing world. There are too many Medical professionals like me, whose conscientious patient advocacy trying to promote safe quality care has cost them dearly. The Healthcare industry desperately needs much stronger Whistleblower protections for all employees, with reliable Compliance Hotlines and radical reform of “Bad Faith Peer Review.” Silencing whistleblowers and stifling innovative ideas just eliminates the potential for identifying expensive errors or creating cost effective strategies. Go To:
http://medteam.wordpress.com/tag/compliance-accountability/
We must stop the morally reprehensible practice of using the third world as a cheap labor source by scavenging Medical staff from impoverished countries that can ill afford to train them. We could make all levels of Medical training more affordable by creating high quality teaching Hospitals in poorer nations and sending our candidates to train alongside local people in places where the cost of living is relatively cheap. That way, not only do we put affordable Medical training within the grasp of talented candidates in the US who cannot pay for their own tuition, we actively participate in improving the quality overseas care and sharing our huge resource of advanced Medical knowledge with the developing world. While we decry their regime for human rights violations we pretend do not exist in the US, Cuba has done a fantastic job contributing to global healthcare; it is time our government followed this remarkable example.
Americans need to realize that they share this planet with people equally deserving of health, wellbeing and respect; in traveling beyond US borders one becomes less intolerant and dismissive of other cultures and less inclined to accept needless foreign intervention, overseas aggression and preemptive wars. War itself has a price, not just in the deployment of forces, but in the unnecessary burden it places on our Healthcare facilities with the ongoing treatment of wounded and disabled veterans.
A new emphasis on the preventative and wellness approach, early detection with rapid intervention at a stage where treatment is simpler, less toxic and more affordable, will also help generate the funding for universal access to care. This would require some time to take affect due to the huge backlog of uninsured, untreated citizens who have neglected their ailments because of past financial constraints. This postponed care with a last ditch commitment to treat expensive complications at the final stage of the disease process is a massive drain on current resources. Medical facilities today pass on the cost of those who do not pay their bill to all other patients who are capable of paying for care, so in essence we are already paying for the uninsured. What will make this burden more affordable is the shift to early detection and treatment. There are further benefits to creating a healthier population in that healthy people are better equipped to work, gain full time employment and resume their place as regular tax payers contributing to the system.
Can we really afford not to have UHC? The working poor, the uninsured, the homeless or our migrant communities, all those who are ineligible for healthcare represent a deadly potential breading ground for infections capable of devastating the general population. This is Americas Achilles heal; a massive epidemic would be a really expensive oversight to try and fix! Why does the current lack of universal access to Healthcare and so called “business friendly” laws leave us so vulnerable? Go to: http://medteam.wordpress.com/tag/disaster-preparedness/
We must remove the vested interests that drive an industry that thrives on perpetuating sickness. Big Pharma needs serious reform initiatives to encourage the development of drugs we desperately need, like new antibiotics to treat infections that have become resistant to our current drugs. While antibiotics represent only short term drug profits, our pharmaceutical industry would rather concentrate on investing in creating or just tweaking maintenance type meds for long term profit. There is no incentive at all to develop low cost drugs to treat diseases that primarily impact those who live in the third world. We need to make sure that all alternative treatment modalities are very thoroughly explored to guarantee that a potentially promising low cost alternative is not ignored simply due to reduced profitability. I would like to surgically detach the Drug Companies from their unhealthy political involvement and unethical abuse of power.
Last, but not least, the misdirected malpractice millions! Every single patient must pay for this warped system of unfair, indiscriminately punitive, lottery style awards that discourage or penalize transparency. All patients who do not respond well to their treatment require financial aid to cover the real cost of additional care. We need to place an entirely different emphasis on insuring patients to cover Medical risk or bad outcome, without regard to fault, so that Doctors do not need to obscure the truth or resort to defensive Medicine to protect their careers. Genuine negligence or wrongdoing should be handled by Medically trained lawyers in dedicated Medical courts. Go to: http://medteam.wordpress.com/insurance-covering-medical-risk/
I am confident that the money needed to provide quality Healthcare to everyone in the US and expand our Medical knowledge to benefit those overseas is already within our grasp. It will not take a super tax, a generalized lowering of standards or unacceptable restrictions and limitations. It will require more conscientious proactive participation and acceptance of personal responsibility for wellness from everyone. Mostly it requires us to remove the major obstacles that have become so entrenched by greed and the manipulation of power to the detriment of mankind as a whole. I think the Wellness Wiki is a terrific way for us all to find innovative ways to make Universal Healthcare a reality that offers a shining example to the rest of the world and also helps to heal those less fortunate around the globe.
There's a great deal of truth in what you wrote!
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I'd appreciate reading any other thoughts you wish to offer!
Note that I have two other replies being reviewed by the moderator before posting (since they include a number of hyperlinks, they are flagged as suspicious); one is a response to your previous questions, the other is to Wes52's questions.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
HI Steve,
I'm not a physician, so I can't say, but most of the physicians I've spoken with really lay much of the problem with regulation, legal BS, paperwork, insurance companies, etc, everyone getting in the way of providing good care. I can't say how best to treat patients, but I really doubt UHC funded by taxpayers, but controlled by the government is going to help you establish your system as well as an MRSA program would and certainly couldn't do it as efficiently. That's about my only quibble, that the government can barely tie its own shoes. If you've seen some of our "splendid" government organizations at work, deep inside - police, INS, etc, it frightens me what they would do with it. I have a lot of work to do still, but I'm going to do a point by point on the MRSA program and what makes it different from an HSA type system.
A Democrat seeks complex solution to simple problems
A Republican seeks simple solutions to complex problems
A reasonable person seeks simple solutions for solvable problems
I can certainly understand your concern about having the government controlling a healthcare system like the one I'm proposing, John. Someone suggested to me that a "Medicare for All" type financial model might work. I don't know, but am keeping my mind open to all possibilities. Maybe a taxpayer-funded government-controlled model would work IF there is adequate oversight, transparency and accountability? But non-partisan oversight, true transparency and honest accountability have not been our government's strong suit.
I would be interested to see how your MRSA program overcomes the serious shortcomings of HSAs and see if it helps enable consumers to get better care at lower cost with less risk.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I read a little deeper into your planned proposal and from what I understand, basically your plan is to stream line some current operations, increase preventive medicine from birth and add some type of planned wellness initiatives (exercise, nutrition etc.). It also seems to be part of proposal to add more electronic record keeping and other “new fangled” info gathering techniques. All laudable proposals, however as others have commented “Who is going to pay for this?”.
I have a suggestion for good or ill depending on how you perceive it. Despite the naysayers and Bush haters the prez had a plan several years ago that was dropped like a hot gall bladder. His plan called for all business employee healthcare deductions removed from the tax code. Any monies employers give to employees as a benefit would be included in income. Start a healthcare subsidy for all Americans that would be added to employees income. Then install a healthcare credit to the tax code. This credit would be used to offset any health premiums and costs, co-pays etc. and new subsidy. Basically this would make healthcare costs a wash. Any cost above credit would be paid out of pocket. The theory would be Americans would shop for better plans and better services if they had some thing to gain or lose. This may also reduce costs due to the “ large number theory” used by most insurance companies (large number theory says the more policies in play spreads the risk over a large population, should lower individual costs). This would work as a privatized universal health plan. The naysayers do not want insurance companies involved but the only way this or any system to work is to remove government intrusion.
Decent summary of our proposal, but I'd add better use of science and knowledge management to find out the most cost-effective ways to treat health problems and use this knowledge to drive decision aid tools available to providers and patients/consumers.
Anyway, it would be interesting to hear others opinion of your plan to pay for it. Actually, what I'd love to have is a compilation of all reasonable fiscal/economic models, both public and privatized, that are able to fund the strategy I propose, so we can examine and compare them side-by-side in terms of (a) the problems each model addresses and the implications for different stakeholder, (b) what's needed to make the model work, and (c) the benefits it will likely deliver. This means we would need talented economists who would crunch the numbers of each model and present the results in a manner that enables clear comparisons. We'd have to know how each model would, for example:
And while I agree in principle with the "large number theory" you mention, only after examining each model as described above would I feel confident and competent in taking a position.
I'd like to comment on "the theory would be Americans would shop for better plans and better services if they had some thing to gain or lose." I believe you are referring to the moral hazard idea, which assumes that insurance encourages risky and wasteful behavior by the insured person since the cost of consumption is paid by someone else. Many, however, considered it a myth by some when applied to healthcare because, unlike other consumer goods, insured people don't go to healthcare providers just because it's free; in fact, most people don't like to go to the doctor or take medications. Here's a link to where I discuss on the the moral hazard myth on my Curing Healthcare blog.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Actually the reference to gain and loss is in reference to tax credits or deductions. If a policy holder's cost for medical care for a year is say $5000 and he has a credit of $7000 the policy holder could apply the balance of $2000 to his other income. If the policy holder could cut costs by shopping for better plans or lower cost deductibles, co-pays etc. to say $3500 that would allow $3500 credit to be applied to his other income. It would be smart economics for a policy holder to cut personal costs if he would gain an advantage on his taxes. It would also be an incentive to private insurance companies to lower cost and improve services to keep a client base intact. As it stands to day employers are paying for insurance and the patient has no skin in the game therefore there is no incentive to change the status quo.
I also have a problem with how the system is set up as far as coverage, for instance I need to purchase a family plan to cover myself and spouse. My children are over 21 and are not eligible but their cost is included. I am also required to pay for maternity coverage even though my wife is beyond the age of having children. This is also part of a large number theory, by spreading the cost of maternity over all policy holders, cost for children bearing women could be reduced. If not these women would be unable to afford premiums. Gotta love that large number theory.
As for the moral hazard question, I believe people with lifestyle hazards should be required to pay more. Back to the large number theory their cost cannot be offset by raising premiums to all because the average policy holder would jump ship for better rates and insurance companies would sell their policy to reinsurers, eventually the pool of bad risks would need to be covered by a government plan probably medicaid. The insurance companies could be required and would still cover these people but as their health and lifestyle improved their premiums could be reduced. sounds like a wellness thing to me.
Good points. You seem to be describing the HSA model. It can save you money if (a) you have a job and you earn enough for the tax credit to be meaningful; (b) you have the knowledge you need to select the doctors and treatments delivering the best value (high quality care rendered efficiently), which is unlikely; (c) you are able to determine the best combination of coverage, copays and deductibles; and (d) you are not one of the many “working poor” who cannot afford insurance and earn too much for Medicaid. Otherwise, you’re in trouble! These are some of the reasons for arguing that it’s not a good global healthcare delivery model.
The issue of holding people responsible for lifestyle hazards is complicated. For example, should a drug addict, alcoholic, overweight person, depressed individual, or diabetic be charged more for insurance if they fail to follow doctors’ orders? If so, would it help them stop taking drugs, drinking alcoholic beverages, reduce their calorie intake, improve their mood, or control their blood sugars. More often than not, I doubt it. In fact, increasing the cost of care for these folks is likely to keep them from getting regular check-ups and likely impede their ability to purchase the medications and make the lifestyle changes they need. Anyway, this falls into the realm of “compliance/adherence,” for which a great deal has been written. There are many reasons for non-compliance, ranging from emotional factors, self-deception and lack of family support issues such as cost, transportation, and complicated self-management regimens. Here’s a link to myths about compliance. Anyway, regardless of the reasons, if we fail to provide affordable care to people whose lifestyles are likely to make them (or keep them) sick, then society ends up paying for their emergency care when they arrive at the ER.
So, instead of focusing on punitive action, I suggest we focus on creating effective, innovative wellness programs that foster positive lifestyle change and compliance to reasonable self-care routines. This will require a good deal of research and out-of-the-box thinking.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
After reading your response to my comment, I came to the conclusion that you either did not read it, misunderstood or are trying to change the subject. My suggestion is not primarily about HSA accounts but revising the tax code and providing subsidies to the “working poor” lower income families and individuals not covered by an employer plan. The ability to shop and choose a plan in the free market would provide the catalyst for change.
1) Most individuals would be covered by employer plans.
2) Lower income persons would get subsidies to purchase private insurance instead of government plans
3) Elderly, unemployed. under employed, disabled would still fall under Medicare/Medicaid umbrella.
4) Chronically ill, end of life, long-term care, high risk individuals would also fall under Medicare/Medicaid.
As for “moral hazards” a majority of these individuals would also fall into the high risk pool. Most of these people are gaming the system. They may already be covered by Medicare/Medicaid. They know they could walk into any ER and get the best FREE care in the world. I draw the line when a drug addict spends his prescription money on crack or a 25 year old person that is 200 lb. overweight demands a gastric bypass, on the taxpayers dime, and whose lunch time choice is 10 or 12 Big Macs, while sitting on the couch watching the Price is Right. Stop eating! Stop Drugging. This may sound cruel or mean spirited but maybe denial of care or rationing is appropriate “cure” for these people. I don’t believe we would be punishing these people by charging them more for healthcare, I believe we are just cutting our losses.
I view some of your comments to be typical professional snobbery. You assume that the average American is too stupid to figure out the best and most economical choice for their medical plan. These are the same people if they had five cell phone plans in front of them could pick the plan that saves them money. They know the active ingredient in $10 bottle of Tylenol is the same as the $2 bottle of acetaminophen or a glass of club soda a couple of Tums and an aspirin is virtually the same as Alka-seltzer for one tenth the cost. I may be out of line but this being America, free speech and all that stuff. A word of advice from a guy in the trenches. While you are up in your ivory tower don’t let your education get in the way of your brain. Never underestimate a human being’s power to game the system. We as a species are the “Great Manipulators”. That is why we are at the top of the food chain
To stumpylarue - In response to the Personal Responsibility post
We agree on some things and disagree on others.
Thanks for the clarification of your plan …We agree that “providing subsidies to the ‘working poor’ lower income families and individuals not covered by an employer plan” is very important!
We also agree on the issue of personal responsibility, though our focus and understanding of people differs. For example, we agree that someone trying to “game the system” for personal financial gain ought to be help accountable for their actions. To me, this includes things like insurance fraud, such as submitting a false claim. And yes, as a species we are “Great Manipulators.”
But when it comes to the kinds of people in your example, things are not as obvious as they might appear. Let me elaborate on each example:
1. You say some people, who may already be covered by Medicare/Medicaid, know they could walk into any ER and get the best FREE care in the world. No argument from me. But I doubt that anyone with the financial means would purposely choose to sit for hours in a crowded ER for a relatively minor health problem that could have been treated in a primary care physician’s (PCP’s) office for a $40 co-pay. You have to be in a heck of a financial crunch to choose the ER!
2. You say a drug addict who spends his prescription money on crack, or a 25 year old person that is 200 lb. overweight who demands a gastric bypass on the taxpayers dime while choosing to eat 12 Big Macs in front of the TV, are also gaming the system.
Well, I’m not so sure about that. There are powerful biological (e.g., genetic, brain chemistry, etc.), psychological (e.g., emotional, habitual, etc.) and environmental (e.g., social) reasons why these kinds of self-destructive behaviors are so difficult to change for many people.
Simply saying they should be “strong enough” to change despite these factors is unrealistic. And making healthcare more costly isn’t anywhere enough to motivate them (case in point: Even the threat of jail doesn’t persuade an addict to quit using, and social rejection and the risk of death is rarely enough for the obese person to reject the Big Mac and TV for a salad and exercise). Instead, we should be putting more effort into discovering and delivering effective methods of behavioral change and compliance. Otherwise, they, too, will increase overall healthcare expenditures through ER visits, as well as the cost of jail for the addict.
Bottom line: I agree that personal responsibility is very important, but charging them more for healthcare may actually make things worse. Anyway, this issue is worth continued exploration.
3. You presume that I assume that the average American is too stupid to figure out the best and most economical choice for their medical plan. As case in point, you indicate these same people could select the best cell phone plan that saves them money. Problem is, I don’t see cell plan selection as being equivalent to choosing a health plan. I don’t know if you’ve ever tried to compare different health plans in an effort to select the best, but here are some of the things you’ve got to do: Gathered lots of data on dozens of on each plan, including the deductibles, premiums, co-insurance, co-pays, covered treatments and wellness programs, ceilings on coverage, estimated tax-savings and other details. Then you’ve go to estimate how much you’ll be spending on different healthcare services and medications over the next year. With all these numbers, you can make a guess on what health plan makes the most sense for you (and your family). And believe me, it’s a real challenge!
But it doesn’t stop there. When you need help for a health problem, health plans that have you “put skin in the game” put pressure on you to select the best doctors and hospitals, i.e., the ones that provide the best value (cost-effectiveness … quality / cost). In principle this makes sense. The problem is that means you must know what they charge and what kind of results they get. And you had better be sure if you need care; wait too long and your condition will worsen …go to the doc too soon, and you are wasting precious money on unnecessary care.
Unfortunately, even the brightest, most educated and motivated consumers, who do a great deal of research and get tons of information, typically end up with no clear-cut way to determine the best health plans, providers and treatments. This is due, in part, to the lack of transparency of care costs and quality, as well as to the knowledge void (even the professionals often don’t know what’s cost-effective care). So, before consumers are expected to put skin in the game, they should have information that doesn’t yet exist; getting this information and making it available to the consumer is one of the things my proposed healthcare transformation plan addresses.
4. And finally, you say consumers know the active ingredient in $10 bottle of Tylenol is the same as the $2 bottle of acetaminophen or a glass of club soda a couple of Tums and an aspirin is virtually the same as Alka-seltzer for one tenth the cost. I’m sure some do, but effective advertising by big pharma convince people to pay more for the brand names than they would have to paid for generics.
I suppose you’d say “consumer beware” is appropriate here; but my point is that the system is loaded against consumers making wise decisions. It is not an issue of intelligence.
Bottom line: Few people realize how badly broken our healthcare system is. It's a true crisis and our country has continually failed to focus on some of the most important issues. Instead, we tend to seek simple, short-sighted solutions to incredibly complex, multifaceted problems.
I believe we should start with a deep understanding of the underlying problems and then propose comprehensive solutions that are consumer-centric, evidence-based and value-driven.
I think we both agree that John's MRSA proposal is an admirable attempt to deal with one issue: How to pay for healthcare for everyone. I suggest we work on developing his core concepts (which address the issue of "accessibility") and adding provisions for funding clinical research aimed at developing practice guidelines promoting cost-effective care delivery; establishing systems of transparency (making clear quality and cost data); promoting use of economical health information technologies to help reduce errors & omissions and to build better knowledge bases; and rewarding high-value (high quality and efficiency).
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
The problem with Healthcare in this country rests between the Doctors & the Insurance companies. Example I am diabetic I see a endrocrinologist who employeess 3 med. assistant nurses. Mty bill is the same wether I see the DR. or nurse. Considering the fact that the Dr. has more training why do is the bill the same? I see the Dr. every 6 months. I see the assistant approx. every month. The Dr. quadrupled his number of patients thus his income. Then the insurance company & the Dr, disagree on their agreement. The result is I am told that the Dr. is no longer authorized, find a new one. Who looses, just the patient. Same thing happenes with the bills. The insuurance company pays what they consider is fair & reasonable leaving the balance soley to the patient. Is this right? I do not thing so. If our goverment had stood with the original principles whereby competition was a key factor to success we would have manye 3 times the number of insurance companies we have today. Corporate Ins. CEO's making 650 million plus per year. The greed has to stop. What happened to We the people, for the people & by the people?
Thank you Steve, you are one of the first people who have actually expressed the real problems with health care and you are not blaming the people for all that is wrong. You are not taking the Moral High ground meaning that people will be people no matter what and no one is perfect like some think themselves. If they look deep enough or objectively at themselves, they will find that they too have faults and would not like to have their faults singled out when it comes to health care treatment or cost.
The mind is a complicated place and we know so little about it. Anyone who has dealt with a person with mental illness or drug addiction (which in many cases go hand in hand) would know that making things more expensive would do nothing to change their behavior, believe me they are already expensive enough with few treatment options and even fewer treatment centers. In addition, if one has not had to deal with mental illness they would not know that there is little to no help available to all but the rich. Take it from someone who has a love one with mental illness (diagnosed at 8 years old)and since he turned 18, drug addition, that was 8 years ago. He has Overdosed several times, been in and out of drug treatment centers, however, the one thing missing is that they are not treating the underlying problem, mental illness. Without treating this problem he will continue to relapse and I am helpless to do anything about it because I cannot afford to pay for the treatment he needs. And believe me, I would need a great deal of money because no insurance would cover this type of care and if they do, it is extremely limited, much like drug addition treatment.
People need to be aware of many aspects of human behavior and what the reality is for people dealing with a variety of problems, whether it be physical or mental. The government does have a role to play in this issue. Take drug addition treatment, there has been a number of studies which prove that 30, 60 or 90 days is almost a guarantee that the person will relapse, if you give them at least one year of in house treatment with behavioral modification aspects to the treatment they are 80% more likely to succeed in staying clean. However, no insurance, not even Medicaid, will pay for more then 90 days, most will only pay for 30 days. The same holds true for mental health which include bipolar disorder, depression, learning disabilities, PTSD, etc. We need research on how the brain works and what treatments work best for what disorder. We cannot fix what we do not understand and that includes health care.
I have read most of what you have posted on other sites and find that you have a better understanding of the problem then most anyone else to date, and believe me, I have read a great deal on this issue. While I have pointed out some problems with why health care cost is skyrocketing, you have put a human face, so to speak, to the problem and this is the one thing most people either ignore completely or worse, deliberately distort the human side.
I really wanted you to know that your work is appreciated and is the reason I have responded to your post. Of late I have not responded to many post because it is more of the same, no new ideas or the ideas are extremely critical of one group of people or another, at least when it comes to the health care issue. I have found that people are rarely willing to even try and understand the world outside theirs which, IMHO, will always limit their knowledge of an issue. As my grandmother use to say, "wear another's shoes before judging them".
Betty McLeod
PA 06
Betty327@ptd.net
I sincerely appreciate your comments, Betty. Hopefully, together, we can help shift the direction of nation toward greater openness, compassion, understanding and humanitarianism -- moving from "ME-ness" to "WE-ness." This would not only help transform our healthcare system, but would also transform our society in a very positive direction. Thanks again for your support.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
You are welcome Steve but good luck in that endeavor. I have tried on several occasions to bring some consistency to the discussions but have failed, the human mind, go figure.
However, I think most of the world has the mentality to be selfish and that is an extremely hard mind set to overcome. There is a void in people that makes them unable to put themselves in another's shoes and so they judge. In your line of work I am sure you know that it is always easier to judge others then to judge ones self. I also believe this is one of mans' biggest faults and the hardest to overcome. This is the reason why so many bow to the rhetoric of the MSM and politicians. The MSM and politicians know this and that is the reason they use words like socialism and liberal or Conservative, people will respond to those words. Fear is a strong emotion that is used against the people on a regular basis in this country and is the same reason we are so divided as a country.
I have no idea how to overcome this obstacle.
Betty McLeod
PA 06
Betty327@ptd.net
You seem to be a wise woman, Betty, with a good heart. I admire that.
Yes, people are easily manipulated, especially when fearful. And I agree that the "me & mine" mind-set is very difficult to change. It requires a degree of enlightenment that is largely absent from our society. In fact, the "me generation" is now in power. We tend to judge people by their material wealth (e.g., it's shameful to be poor ... you're worthless if your homeless ... the rich are to be admired). We give an embarrassingly small amount of our GNP to needed countries. Many American believe that they are "more deserving" than other peoples simply because we live in the U.S. These are just a few of the things so fundamental to our cultural mind-set, and so basic to our economic model of conspicuous consumption, that I sometimes find it difficult to be optimistic about the future because these things are fatal flaws in human nature. But how can we give up when future generations will inherit the world we leave them? I feel a deep responsibility to make a better world for the children of today and tomorrow ... although it's awful tough to make a living that way.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I may be covering old ground
We agree and disagree about some things but before I site the problems with current healthcare system, from a consumer’s point of view. I think a comment about “moral hazard” is in order. We see this problem from different sides. As a medical person you feel a “calling” to save these people. Granted there are some who due, to no fault of their own, are ill and deserve help. A noble cause, and I admire anyone with the strength of character and commitment to jump in. Good luck and God’s speed. I would be the first one to help someone who asks for it or attempts to help themselves. I on the other hand feel no obligation to help anyone who is self-destructive and continues their behavior. I feel by nursing these people back to health, feeding, clothing, and putting a roof over their head is enabling them to continue their self- destructive behavior. I’ m from the tough love school of rehabilitation. Enough said.
As for problems, over many years I have noticed several items that if marginally corrected would go a long way to improve the system
1) The medical community has a secret, clubby, demeanor. It is very virtually impossible to get an opinion of the qualifications of another doctor or facility from their colleagues. Without a qualitative or quantitative opinion of the medical prowess of most professionals the consumer is in the dark.
2) The CYA syndrome. More transparency. I need not elaborate on which body part is being covered. Most medical personnel cover for each other, as in any job, covering for others in the medical profession can cost lives and in all things mistakes can be deadly. Chronic mistakes and doctors who repeatedly make the same mistakes need to be sent packing or the public gets it in the pocket (malpractice suits, needless tests, higher rates, second and third opinions etc.). If a plumber is a screw up it gets around and he is out of work but a doctor screws up nobody ever hears about it. The lawyers get the big bucks and the patient loses.
3) Standard Practices. Most jobs have a standard procedure as a starting point whether is changing your car’s oil or heart surgery. It seems most medical people fly by the seat of their pants a majority of the time. You go to the doctor, he sends you for blood work blood, work comes back he sends you for an x-ray, x-ray comes back he sends you for more blood work. Agreed a diagnosis may be tough and require more info however it has been my experience that he could have done the all tests at one time and it would have been cheaper all around.
4) Lack of communication. Doctors talk down to patients like they are idiots. There are people that lack intelligence to understand medical jargon. They need to speak english (or language of choice). Answer questions and not ignore the patients concerns.
5) Publish malpractice suits. This is a double edged sword a large number of doctors are sued because they are perceived to have deep pockets but like the plumber scenario above if he was a screw up he would not have a practice.
6) Education. The public needs to be educated about what is available. I have found the best and worst educator is actually an insurance salesman. They know the ins and outs of every plan and know how to explain it in english. However a fair percentage of them are a bit unscrupulous so clients need to shop around for the best company. Insurance companies are forced to make all their literature conform to state statutes that is the reason they seem to be in greek.
These are only a few of the things I have noticed. I guess I need to let a cat out of the bag … I know a lot more about insurance that the average shmoe.
You will not get an argument from me. I agree with you assessment.
Betty McLeod
PA 06
Betty327@ptd.net
Several of the problems you've identified, stumpylarue--the lack of transparency and accountability--are not at all unique to healthcare; they are indicative of many systems in our society, from government to business to military to education to sports ... you name it. I think the reason has to do with human nature. That is, for some it's fear of punishment (loss of income, lawsuit, bad reputation, etc.); for some it's ego ("It will make me look bad ... I'll be embarrassed" or "I'm a professional with a degree and license, so my judgments should not be questioned," etc.); and for some it's manipulation for financial gain (an issue of power and control). But you're right, it's a problem that must be addressed.
I think you're also on target about problems with communications between patient and provider, and the lack of patient education. Although these issues seems to be getting a bit better, we need a lot more collaborative decision-making and, as some call it, "information therapy" (you can Google it). I believe these things can be facilitated by a third party who acts on the patient's behalf to foster patient-provider communication, and who empowers the patient with good, understandable information. In fact, I'm working with a group of people in an innovative international project that focuses on these issues.
And practice standards, in the form of evolving evidence-based guidelines, is a critical piece of the solution.
I, too, have mixed feelings about publishing malpractice claims. And I'm not too fond of some of the doctor and hospital rating systems out there because they fail to assess the most important information, i.e., care value--whether their results for particular types of patients are superior to the results of other providers in terms of symptom reduction, complication avoidance, error avoidance, quality of life improvement, and the efficiency/cost-effectiveness of care.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Excellent article about Redicare clinics in Wall street journal opinion section pg. A-11 thurs 8/2/07. Most clinics are in malls and pharmacies. Check it out
I'm quoting parts of a provocative post about waste in the form of "over-treatment" in our healthcare system posted on June 29 on The Health Care Blog at http://www.thehealthcareblog.com/the_health_care_blog/2007/06/policy-the-dart.html
It is written by Maggie Mahar, an award winning journalist and author whose work has appeared in the New York Times, Barron's and Institutional Investor. Her post follows.
In its June 2024 report to Congress, MedPac (the Medicare Payment Advisory Commission) highlighted one of the dirty secrets of our healthcare system: as a nation, we are currently spending billions on drugs, devices, surgical procedures and diagnostic tests without having a clue as to whether they are effective. The reason, MedPac explained: we have very little comparative-effectiveness research that provides head-to-head comparisons of various treatments for a particular malady.
Meanwhile, the Medicare commission observes, Many new services disseminate quickly into routine medical care without providers knowing whether they outperform existing treatments, and to what extent. For example, a recent study showed that inexpensive diuretics may control hypertension as effectively as expensive calcium-channel blockers (ALLHAT 2024).
One might think that the FDA would require that a manufacturer show that its new drug or device is better than existing treatments---at least for some patients. After all, new medical technologies are almost always more expensive, so wouldn’t you think they would have to be improved in order to be approved?
Think again. That’s not the FDA’s job. The FDA exists simply to decide whether the benefits of a particular treatment outweigh its risks. Thus, in order to pass FDA scrutiny manufacturers need only test their product against a placebo”which, as MedPac notes, is what most do. In other words, they demonstrate their treatment is better than nothing.
Of course in order to peddle their product to physicians, some companies do conduct research which purports to show that their breakthrough is better than the competition. Unfortunately, in these cases drug-makers and device-makers tend to lie.
…Medicare is running out of funds--in large part because as much as $1 out of every $3 that it lays out is spent on over-treatment. That money is squandered on unnecessary, often unproven bleeding-edge procedures, over-priced drugs and devices that are no better than the products they replaced, and diagnostic tests that don’t extend lives.
Research done for more than two decades by Dr. Jack Wennberg and colleagues at Dartmouth University has proven that over-treatment is the second biggest problem in our healthcare system: While some Americans (the uninsured, the underinsured and those on Medicaid) receive too little care, others (the well-insured and many on Medicare) receive too much care. And more care is not always better care. Dartmouth’s research shows that over-treatment isn’t just a waste of money”it can be hazardous to your health. … There is a stark correlation between reduced utilization and better outcomes. …
Finally, it is important to understand that Wennberg is not talking about patients overusing the healthcare system because they don’t have enough skin in the game. He is talking about doctors and hospitals providing more care than is needed, in part because the economic incentives of a fee-for-service system encourages doing more, in part because both health care providers and insurers are worried about being sued if they don’t offer or cover the newest treatments”and in part because they just don’t have the information they need to know which treatments are most effective.
In many ways, the Dartmouth research provides a roadmap for reforming our health care system. And the fact that both MedPac and CBOE are so enthusiastic about Dartmouth’s findings suggests that in the next few years, Medicare reform may help pave the way for national health insurance. Establishing an independent institute that compares the clinical effectiveness of the treatments that Medicare pays for would be a very good place to start.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Good stuff, Steve.
I hate to toot on the MRSA thing again, but here's where I think the advantages come in - overtreatment would instantaneously screech to a halt. Why? Because the doctor would have to convince the person spending the money that the drug or procedure that costs more is better. Why do statin drugs if you can lower cholesteral just as well for free through diets? Why buy expensive, problematic drugs for nausea if marijuana is cheap and effective? Most ailments begin with bad diet and no exercise and that is cheap or free to fix. Given the choice between paying for a drug or eating/exercising, I think most people will be more motivated to start taking care of themselves. I think it would also stifle the problem we have with feeding people way too many drugs at the same time with their complex interactions. Most drugs on TV have food/common equivalents. Shy? Drink a beer! Constipated? Have some pork and sauerkraut! Feeling nauseaus, can't eat? Smoke a joint! I found that stuff like Claritin didn't work any better for alergies than cheap generic drugs. And I also only use those on very severe days, rather than all season and found that my allergies have become progessively milder. And that's about the only medicine I'd take unless it was seriously needed. It's easy to prescribe "free" drugs, it's much harder to convince someone to spend their savings on them.
A Democrat seeks complex solution to simple problems
A Republican seeks simple solutions to complex problems
A reasonable person seeks simple solutions for solvable problems
John, I like your creative mind! Since there are so many UHC plans being offered, of which your MRSA is a contender, I suggested another post [here's the link] that Unity08 create a plan comparison chart so the different models can be evaluated and discussed in an organized manner.
Steve Beller, PhD
i appreciate analytical data as well and seeing the funding methods described side-by-side would be great. But considering the variables of transition cost, human judgement in impementation, and legislative entanglement modeling would not predict a very certain result. I don't think any group of Unity 08 delegates could pull a whole picture together objectively, but we might be able to find a broader consensus on a broader principle. I think that starts with accepting 'for profit' health services through 'non profit' financial management. Then fight for the particular implementation in the legislatures where the battle must ultimately go anyway.
With that principle in place we can reconstruct the role of entitlements until we are confident in the legislators constitutional requirements for 'the general welfare'. Just getting to that point in the next administration would be a monumental undertaking.
Bill"for what we are together"
bill713.unity08@sbcglobal.net
While I agree, Bill, that this would be difficult and precise analytics impractical, I believe it would be very useful to start by identifying the factors that go into each model, the proposed methods for addressing each factor, and the assumptions associated with those factors.
These factors may include, for example, ways to encourage and reward quality improvement and waste reduction, ways to make good care accessible by all, ways to promote wellness, ways to deal with widespread medical catastrophes, ways to conduct real-world outcomes research, ways to do better biosurveillance and post-market drug and device surveillance, ways to promote compliance to effective self-management regimens, ways to coordinate care among multidisciplinary teams treating a patient, what to do about entitlements, etc. I bet we can identify all the key factors!
Different models will propose different strategies and tactics for each of the factors. The assumptions upon which the strategies and tactics are based can be debated, and the likelihood of success evaluated. This all seems doable to me. And your point about accepting 'for profit' health services through 'non profit' financial management would a general financing method likely to be endorsed by certain models. The problem is, at this point, I don’t even know which models currently proposed endorse this approach, or even what it means in detail.
I also agree that determining the precise cost and funding mechanisms for each of the factors of each model may very well require expertise Unity08 delegates don’t have. And that’s OK for now since there’s still much that can go into chart. In fact, any missing information would be identified by a “to be determined” notation in the chart. These TBD’s would then help focus us on what information we still need to obtain.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
Bill,
There are several ways to create charts for comparing, evaluating and discussing UHC options in a collaborative forum.
The one we're leaning toward is to create a grid in a wiki and allow people to insert their ideas into the appropriate cells, as well as edit existing content. Along the top (in the first row of cells) there would be the names of different proposed plans. Down the left column would be the key factors each plan must address.
In the intersecting cells people will enter the information explaining how each particular plan addresses each specific factor. Many of the cells can be pre-populated by the moderator based on information already offered in U08's ShoutBox.
For each factor across all plans (i.e., each row of cells) we would have a corresponding wiki discussion page where people can ask questions and have ongoing dialogue about the answers. This can be made simple by having a hyperlink in each cell to the appropriate discussion page.
We're examining possible alternatives, though this one seems to be the easiest solution. I'll offer our WellnessWiki, but it shouldn't be difficult for U08 to create one for us.
I'll post other options if they appear to be better than a wiki chart.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
I will be looking for it.
Bill"for what we are together"
bill713.unity08@sbcglobal.net
But you have now entered into the turbulent and ofttimes chaotic would of politics. We need you to state, preferably in the form of a motion, just what it is you want the delegates of Unity08 to support. Be precise, please
ex animo
davidfarrar
OK, David. I'll do my best, but I'm no politician!
I have a pretty clear vision of how this comparative chart can be created and managed. The greatest challenge, imo, is the time commitment. Following are particular things that have to be done. I'm not sure how best to put them in the form of a motion, so I look for guidance to make this post “properly political” for efficient action.
1. Selecting a wiki. While I offered my WellnessWiki, which is from wikispaces.com, there are others out there. So, an initial step is to have someone review the different wiki platforms and select one for Unity08 to use. Finding that person would probably the first step; having our delegates
review the person’s choices is second, and obtaining the wiki is third; which may involve a modest cost to the wiki vendor. For this step and the subsequent ones, it would be helpful to have a paid, experienced moderator to keep things organized and flowing. So, this issue should also be discussed and voted upon.
2. Create the basis structure of the Comparison Grid (CG) on a page of the wiki is the next step. While a grid is easy to create, populating it with the appropriate contents can be a challenge, which requires the following:
(a) Selecting the UHC plans we will compare in the CG. I think we ought to start by identifying the plans offered in the Unity08 Healthcare forum.
(b) Defining the key categories we will use in the CG to compare the plans.
We can do these things through discussion on the wiki or even in this forum.
3. Populate the CG’s cells with initial UHC plan information that is summarized from the Unity08 Healthcare forum discussions (or other sources). We have to decide who will do this and if that person will be paid.
4. Create other wiki pages with links to each category for discussion of the different ways each plan addresses each category. These discussions will focus on examining the assumptions built into each plan and evaluate the likely impact of the plans on different groups of people. And they should be actively moderated to organize and facilitate the flow of dialogue.
5. Establish and use a voting mechanism by which the main aspects of each plan are judged. We have to decide who will do this and if that person will be paid.
6. Disseminate the results of the voting process and compile a (possibly hybrid) UHC plan (platform) for Unity08. We have to decide who will do this and if that person will be paid.
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog
The lack of response to my suggestion to compile a UHC Comparison Grid concerns me. There are a great many ideas expressed in different topics on this forum, but unless we construct a means for organizing it all in a way that allows us to compare, integrate, discuss and vote on different alternatives, we're not going to be able to make any meaningful collaborative decisions.
Is there someone in Unity08 who is responsible for taking all the creative UHC ideas expressed by our members in the healthcare forum Shoutbox and constructing proposals our delegates and other members can vote on? Or are we doomed to have endless conversations that branch out in all directions and fail to coalesce something we can all digest and evaluate?
Steve Beller, PhD
Wellness Wiki
Curing Healthcare Blog