Getting healthcare right; why are our politicians tone deaf to what we really need?

Getting healthcare right; why are our politicians tone deaf to what we really need?

This blog stays away from most political issues, but now that the movement to rid us of Obamacare is fully underway, we are getting some ideas from the right what their idea of a healthcare plan for the country would be.

For those who have not seen it, please look at the bottom of this blog for full details.

Most countries have a single payer system for a reason; private insurance is capitalistic and is concerned with margin and profit, as are our hospitals, our Medical Schools and our healthcare providers.  Other countries have more controls on what healthcare providers earn, what it costs for their schooling, what procedures should cost as well as what drugs should cost.

Certain fixed costs such as Medical School has left many healthcare providers with mountains of debt they struggle to pay off for years.  Many providers I know personally have been practicing for 15 years or more and are still paying off debt, while others elect to go to an under served area for several years to be relieved of the burden, while others join the reserves which will pay off a large part of it.   Perhaps, part of healthcare reform needs to investigate why it costs so much to become a physician?

Many of the countries with single payer systems either offer medical school for free, or near free.  Our country is somehow founded on indebtedness once you are out of school.  This makes it necessary to pay doctors more in the USA because of their personal overhead and the debt they carry throughout their carreers.

The truth is that many countries that are modern and expensive to live in have cradle to grave social healthcare systems where the healthcare providers make a nice income, yet, the cost of running their system is half of ours.

Too often, our current system underprices effective providers and financially rewards testing and medical procedures, many of which are risky and can be of dubious benefit.  Less is more.  Many types of holistic providers are often either not covered by insurance or patients must go out of network to access their skills.  Often, their non drug approaches are more healthy, have fewer side effects and solve the problems, rather than just the symptoms with drugs.

As we know now, chronic pain and Opioids are a management problem.  You do not manage pain, you understand the cause and address it head on using chiropractors, therapists and other specialists who understand the musculoskeletal system far better than most medical providers.  The idea of looking at a painful joint or joints, when the mechanical basis for movement is compromised and likely the cause of multiple problems needs to be rethought.  The musculoskeletal system, the neurological systems and the hormonal and organ systems are all intertwined.  The idea of super specialists looking at your parts is expensive, time consuming and often misses why your symptoms exist.  Anyone who has been from doctor to doctor without a resolution of their problem understands this too well.  This has to change.  The human body is probably much more simple than the way our healthcare system currently approaches it. If you are in pain, shouldn’t it be as simple as going to the right cost effective provider first, and not having to worry about a deductible, a network or finding the right provider? Do we really need so many people to figure out your problems, or would it make sense to take a more holistic approach, allow primary types of providers to spend the time to do it right and pay them for their time. Some doctors are moving to concierge medicine precisely for this reason, so they can see fewer patients, get paid for their time and do it right.

How to fix it; simplify

Insurance companies are a large part of the problem.  As a government with bad fiscal habits, they make changes, it costs us more and they pass it on preserving their margin of profit.  The more we spend, the more they make. They fund expensive procedures, starve primary doctors and others who are effective and would help reduce the cost of care.  They pay for tests, procedures and long term medication use that is not curative. They have over the years reinforced and changed our system into this complex organism that is bloated, less efficient than it is in other countries and has doctors worrying more sometimes about their electronic notes, being audited and wondering where their reimbursements are.  Their methods have made large hospital systems larger, providers are selling their practices to hospital systems to earn more and be burdened less and we are paying more for this too. They have outlived their usefulness.

Primary care needs to become primary again, and over specialization needs to be reversed.   Hunting for and labeling every symptom as a disease so we can recommend a pill is not healthcare.  If more specialists did primary care and paid for the time, rather than the tests, the costs could come down.    Primary doctors need to be more knowledgeable about the musculoskeletal system, and use providers such as chiropractors who are quite good diagnostically in problems such as back pain.   Recent recommendations suggest that medications no longer be used for these problems unless the patient has a long and intractable problem.  Pain is the symptom, and treating the symptom has led to an overuse of Opioids and other medications after the healthcare system has failed them, and the insurance system has restricted their access by network or by high deductible costs.

Move to a single payer system.  Too many doctors and hospitals  spend too much time calling to find out where their money is after  they send out their claims.     This is a waste of time which should be spent talking to and evaluating you.  One set of rules and removing the fear of an insurance company further reducing a hard working doctors operating budged will be gone.

Drug companies must be more transparent with their pricing and Medicare must be able to negotiate drug prices. Their model needs to be curative vs. a drug for every symptom.  Cancer must have a cure, not just an expensive treatment that gives us a few more months or a lifetime of being closely monitored.

Doctors must be educated for a much lower cost.  This will eventually reduce the cost of hiring them. The diagnostic tracts most doctors use must be rethought, to embrace health rather than illness and we must redefine health and wellness and the role a doctor plays in our lives.  Doctors need to question what they are told to believe; there is always room for healthy skepticism and being a pioneer with a different point of view must be embraced, rather than ostracized by the medical community, when a provider finds a different non mainstream method that may actually solve a healthcare problem.

Transparency on the costs of hospitals, hospitalization and doctor visits.

Tort reform, so healthcare providers and hospitals can no longer use this as an excuse for over testing and over treating.

What we don’t need.

  • More complexity.
  • Higher costs for care.
  • Multiple tiers, that are confusing and frustrating for patients, and EPO plans that restrict your access to the people who will help you the most.
  • Economic rationing through high deductibles that has people waiting because of the cost.  This leads to more chronicity, higher costs and in the case of the musculoskeletal hormonal and organ systems, more injuries and joint damage over the years.
  • A solution that creates huge health care monopolies such as the Barnabus and Robert Wood Johnson merger.  We need competition.
  • A simpler healthcare system that is more holistic, looks at helping you stay healthy at a much lower cost.

Many of todays diseases are from how we eat and the types of food we consume.  Years of sweet drinks contributed to diabetes being the number one cost driver in healthcare today.  If we treat this part of the problem with better food, better farm to table organic vitamin rich foods, perhaps many of todays diseases may not even exist.

Managing your health on the medical side comes with costs, obesity and vitamin deficiencies.  Managed them on the dietary side may offer better overall health.  Fitness must also be a priority.  It is not ok just to talk about it.  It must be a priority that begins in school and is reinforced throughout our lives.


Summary of GOP Plan to Repeal and Replace Obamacare

by Jon Bombardieri
House Republicans on Monday released a detailed proposal to replace the Affordable Care Act. The following is a quick recap of some of the highlights from the proposed legislation:

The bill does not call for eliminating the Obamacare provision that bars insurers from denying coverage to, or from charging higher rates, for people with pre-existing health conditions;

The bill would not eliminate the popular ACA provision that allows adults under age 26 to be covered by their parents’ plans;

The proposed legislation would dismantle much of the 2010 law known as Obamacare and create a new tax credit tied to an individual’s age and income, aimed at helping Americans buy insurance if they don’t get it at work. The refundable tax credits would be tied to age, with people under 30 eligible for a credit of $2,000 a year, increasing steadily to $4,000 for those over 60. The size of a tax credit would grow with the size of a family, but would be capped at $14,000. The credits would be available to wealthy Americans, the tax credits would start to shrink for individuals making more than $75,000 or households making more than $150,000. For every $1,000 in income over $75,000, the tax credit would be reduced by $100;

The proposed plan would end the requirement that most Americans have health coverage or pay a penalty, a provision long derided by Republicans, and a mandate that larger employers provide health insurance to workers. It also would repeal most of the health law’s taxes starting in 2018 and freeze funding in 2020 for the 31 states that expanded Medicaid under the law;

The proposal wouldn’t eliminate the ACA’s exchanges where people can obtain insurance, but far fewer people are expected to use them because the subsidies that reduce premium costs would no longer exist. Those subsidies are only available now to people who obtain coverage through the state and federal ACA exchanges;

The bill also maintains the ACA’s Medicaid expansion temporarily;

Beginning in January 2020, the federal government would transition into a system in which a set amount of funding would be sent to the states each year. The move is expected to save the federal government significant money over time but could result in fewer people having insurance coverage;

The bill would expand health savings accounts aimed at helping people save money for health costs. It also would nearly double the current allowable contribution levels for Health Savings Accounts. By 2018, the limits would be $6,550 for an individual and $13,100 for a family;

The proposal would also end a special executive compensation limit that the 2010 law applied to health insurers. That law prevented companies from deducting more than $500,000 in pay to executives. Other companies face a $1 million limit, but that cap doesn’t apply to performance-based compensation;

The bill would eliminate the Affordable Care Act rule that requires employers with 50 or more full-time workers to offer them affordable health coverage or pay a penalty;

The proposal also would remove the $500,000 cap on the amount of executive salaries that insurers can deduct from their taxes as a business expense. Under the bill, insurers could deduct the executives’ full pay;
Insurers would still be required to include 10 essential health benefits in their plans. And insurers would continue to be barred from setting maximum limits on benefits paid out for a customer; and

The bill likewise would not kill the so-called Cadillac tax, which under Obamacare would by 2020 impose an excise tax on the value of employer-based health plans that exceed a certain value threshold, but would bar that tax from taking effect before 2025 at the earliest.