May 4, 2008 - 10:17am | TheSdog

Aklabwalker

Paying for the "banderheads" is a big problem. If you just socialize the system you are saying government is the answer and that is problematic for anything. You are excusing their bad behavior which is what the Dems always want to do.

We need to start injecting personal responsibility into the equation. That is what Massachusettes is trying to do. That is one of the goals of McCain's plan. Neither is perfect but there is a way to get there. We do society no favors if we continue to expand the nanny state.

I have been inside the military system as an MD. I have been inside VA hospitals as a student and seen the system up close and personal at other times. I have also have seen the results of the inner workings at ANMC and know people who work over there. The systems are not as good as you think.

The problem with all of those systems is they have the potential to turn MDs into disinterested employees. That works to some degree when you have young driven souls like myself who will still try to meet the needs of their patients. There are some of those around.

Unfortunately, you get a disproportionate number of people looking to skate with an easier time. That statement is harsh and will cause a ruckus but it is true.

The other problem which comes up is you often have some administrator trying to tell you how to practice medicine. In the military(and elsewhere), that could be some MSC officer or RN with screaming eagles on their shoulders who had no clue about what went on in most specialties.

One of the FPs at Elmendorf used to refer to the USAF administrators as the "Pediatric Mafia." This is another one that will cause a ruckus but there was a disproportionate amount of pediatricians that rose into administration in the military. The reasons are simple. Pediatrics does not pay very well on the outside, pediatricians have no real role in deployment, and administration jobs tend to be more 9-5.

We do need to tighten up laws about pre-existing conditions. Insurers are always trying to get people with bad diseases off their plans as well when they get diagnosed. There are a number of lawsuits out there right now regarding that issue.

One solution may be to do what we do with dialysis patients. They all end up on Medicare. I would actually propose tax credits or some kind of government supplement to buy health insurance for people with certain diseases. I would make one caveat, you would only be eligible if you were not one of the "banderheads" or not already covered by something like the VA.

login or register to post comments | flag this »

  May 2, 2008 - 5:36pm | akgen

okay sdoggie,

after spending hours on reading the plans...

I have to say McCains plan will totally make the employers drop the whole thing... It just wont work. Too much for more of the 'too little' comes to mind. As a small business owner, it will be easy to ax it out of the bennies provided to my employees.

Nothing looks good from my view. Except to socialize the whole system. Put limits on what doctors can be charged and hope another country becomes the mecca for medicial tourism.

login or register to post comments | flag this »

  May 2, 2008 - 6:33pm | rfn

A couple (no kids) wanting health insurance

can expect to pay $16,800 a year for it. McCain's plan would allow a tax credit for a tiny portion of that. So he expects people will be able to come up with the difference?

Oh, wait, he does! Because he believes congressmen and senators are underpaid and everybody else is making far more than those privileged folks do. Might hone his belief system a bit if, along with this scheme, all medical benefits to government workers and elected officials came to a screeching halt, too.

Of course socializing the whole system will mean the medical schools will be empty. The solution to that is already found in The U.S. Public Health Service - a paramilitary organization. All that will have to be added is a small twist on The Selective Service System. Just administer a mandatory test to all high-school seniors and any with the right skills get drafted into medical school to serve their time in The National Health Service.

But ya gotta believe McCain when he says he's a conservative, right?

login or register to post comments | flag this »

  May 2, 2008 - 7:55pm | TheSdog

Okay

You two obviousl missed the part where I said McCain's plan will not work as written.

Here are some things we could do....

1. A law that would make people take health insurance if offered by their employer or face penalties that would go into a fund to pay for the uninsured. There would be exceptions if people already had insurance through a spouse or buy their own. It may seem like a minor point but it is a problem when a young patient has been rolling the dice to have extra cash and then gets a bad disease. all of a sudden, they are uninsurable and a big time burden.

2. Allow small businesses to form conglomerates to buy health insrance. It would drop costs. A bill to do this was defeated not too long ago by groups such as the American Cancer Society. The reason? They were afraid that all the mandates for screenings and other health care at the state level would be less effective because insurances that cross state lines are not mandated in many cases.

3. The HSA/HDHP model is a good one for young patients. Most young patients need almost no care and could build up sums for future use. One change I would make would be to allow people to throw an extra $2500 in an HSA every year tax free beyond what the plan does.

4. Any medical expenses over 3K a year would become tax credits and I would allow that credit to be carried over for at least 5 years. Notice, I said credit and not deduction. Hence, any money you spend over 3K would directly lower your tax bill by that amount and you could carry a balance over to the next year if it made your tax liability zero. This would help take the sting out of a medical disaster for someone. I would even allow HSA money spent to also be counted in the credit.

5. Mandates must for the most part go away. There need to be some basics but mandates force things into plans that drive up the cost. There needs to be a wider variety of plans on the menu and eliminating many of the mandates would help.

6. Medicaid should be expanded to allow people of somewhat greater incomes to buy into it. In other words, they pay somewhat of a premium to the state instead of being completely uninsured which costs the system too much money. This would take some serious thinking but it could close the gap for many people.

7. We need to get back to basics. There is bias in an allopathic physician such as myself but every little piece of "therapy" does not need to be covered. Nor does every piece of medical equipment. One of the biggest problems with Medicare is as they have expanded what they cover the pie is split more and that has driven down the reimbursement.

8. We need to learn when to stop. There are many times in the medical world where we keep brain dead people alive for no reason except guilt felt by family members or religious fanaticism. At least 2 or 3 times a year I see a Medicare patient that should have been allowed to die and instead hundreds of thousands of dollars are being sucked out of the system to keep them alive.

9. We need to have a plan for the self-destructive. Many of the people that stiff hospitals and doctors on bills are alcoholics, IV drug abusers, or others who simply after a while are unsavable. They suck unbelievable amounts of money out of the system.

10. We need to pressure other countries to not price- control drugs and force consumers by default here to pay more. We also need to increase patent times and start the clock with approval and not application. People will say Big Pharma will not charge less but longer time to recoup expenses and a better worldwide situation might help.

11. We need to simplify medical billing. It is complete gamesmanship right now. It also still favors surgery and procedures more than it should. Many people on all sides of the fence are paid a lot of money to fight battles over billing and it costs the system billions.

12. We need tort reform in a big way. It really should be #1 instead of #12. Some of the things above will never happen unless the lawyers are controlled. They file frivilous suits which cost time and money to defend even though the vast majority get dropped, dismissed or won by the medical entity. Fear of lawsuits guides medical record keeping more than actually communicating with peers and defensive medicine runs rampant.

There are other things and details to be hammered out. One thing is for sure, nothing that has been presented by the current candidates will get us anywhere.

login or register to post comments | flag this »

  May 3, 2008 - 12:05am | akgen

can the health insurance ...

they are like the American doctors middle man...

login or register to post comments | flag this »

  May 3, 2008 - 9:16am | TheSdog

AKG

It may break your heart but sociallized medicine is a collasal failure. People with means in Europe, Canada and elsewhere come here if they really needs something done.

login or register to post comments | flag this »

  May 3, 2008 - 9:25am | rfn

Yet people from "here"

regularly and increasingly go to other countries for superior medical and dental care at considerably less cost. Admittedly, not to Canada, eh?

login or register to post comments | flag this »

  May 3, 2008 - 10:35am | TheSdog

Don't believe the hype

People going on these medical trips are getting into trouble.

login or register to post comments | flag this »

  May 3, 2008 - 10:43am | rfn

And The Japanese

cars were made from recycled beer cans. Scrape the paint off and you'd read "Budweiser" or, if it's a higher-priced model, "Coors".

At least that's what a lot of folks said about them when they were frightened out of their wits and trying to encourage "Buy American" in an era where the wheels fell off American made cars before they cleared the dealer's lot.

login or register to post comments | flag this »

  May 3, 2008 - 12:05pm | TheSdog

Go ahead

and have your surgery done elsewhere.

Just remember you get what you pay for.

login or register to post comments | flag this »

  May 3, 2008 - 1:15pm | rfn

Until people figured out

those Japanese cars were actually much better than those produced in Detroit they sold for much less. Now that the quality has been recognized, the prices are premium.

I believe that will happen as regards medical care as well.

Meanwhile look forward to increasing numbers of Medicare patients since the paying ones will, more and more, be combining vacations with "doctoring".

login or register to post comments | flag this »

  May 3, 2008 - 4:57pm | TheSdog

Not worried

Already had to clean up a couple of patients that went elsewhere for procedures.

People will figure out that it is not necessarily a good idea to get medical care in a country where the cab drivers make more than the doctors.

login or register to post comments | flag this »