National Healthcare System?

[pieman]

The problem with the healthcare industry is that we have eliminated a marketplace that balances cost with value.

The patient doesn't care what the procedure costs because his insurance is paying for it. The patient is merely looking for the best care they can get, because the cost is the same no matter what the level of care they receive.

The doctor doesn't care what the procedure costs, his primary motivation is to get reimbursed by the insurance company. As long as he provides the standard of care in the industry, he can avoid getting sued for malpractice and has a reason to submit it to the insurance company without hassle.

The insurance company is the only one that cares about the cost. The only problem is, they don't care if its a good value or not or if it is helpful or not. They are just trying to pay the minimum possible while still appearing to meet the basic obligations of their policy. We now have nurse practicioners at insurance companies making decisions on what get covered and therefore what the doctor will prescribe.  

None of the three entities balance cost with value.

Therefore, medical device and pharmacuetical companies are left with two conclusions:

First, before getting any return for a product they msust first do R&D and clinicals to the point where they have to prove to the insurance companies that their products are the standard of care.  

Second, they have found out that price is NOT a determining factor in acceptance and use. This is because doctors prescribe what they can get reimbursed for and patients request the best care available. The insurance company is required to pay as long as its the standard of care, no matter the COST.

The result is that healthcare companies have to continue to meet the expectations of patients for the best care as well as expend huge amounts of money for R &D and clinicals to prove that the product is standard care. Healthcare companies have found that the only way to survive in this environment is to continually improve products and charge enough to recoup R &D and clinical costs.

Is it any wonder that healthcare costs continue spiraling upward?

Universal Healthcare does not address the root problem of disconnect between cost and value. The only way to do that is to get the patient to balance cost and value.

I would propose healthcare savings accounts along with getting the insurance companies out of the medical procedure approval business. If insurance were used only for catastrophic care, it would be possible to put the doctors back in charge of deciding what is acceptable care and what is not. I would require insurance companies to pay for anything prescribed by a licensed doctor subject to fraud review.  

The new medicare law has some provisions for health care savings accounts already.

[pieman]

The marketplace always finds the most profitable solutions. If we make value based healthcare profitable, it will flourish.

We can return to value based healthcare by putting the patient (with good medical advice) back in the position of making the choices.

Encouraging High-deductible insurance in combination with 401K-like medical savings accounts would allow the marketplace to work to encourage value based decision making.


 

[pieman]

Public expectations will quickly adapt, if give the opportunity.

I am always leary of placing the government in control. Although I am not a big fan of insurance companies, at least the government can step in when needed to tweak the system. If we give control to the government, we will NEVER get it back.

Having somebody else pay the premiums just creates another layer of bureacracy. We have to face the fact that healthcare is not cheap and we have to pay for it, either directly or indirectly.

If we pay for it directly, each individual gets to choose how much we pay and how much healthcare we get.  

If we let the government pay, the government gets to decide how much YOU will pay and how much healthcare YOU will get.

There is no free lunch. Our only hope in reduce the overall cost that everyone has to pay is to support a system that encourages value choices. What we have now or a gov't paid program does not encourage value choices.