Can Technology Fix the Health Care System? 570
I was surfing through my usual tech sites for the latest news when I came across an article on Wired News. It turns out Steve Case is not alone in the quest to fix the health care system. I guess I don't get what the big attraction for these guys are.... I know the US's health care system is messed up, but I'm not sure technology can fix all of the aches, pains and dysfunction in our current system. I don't get why they don't just join a major company's board or start a hip/trendy start-up....
Tech can't really fix it (Score:4, Interesting)
Besides cancers and other similar conditions, most problems facing the health care industry are caused by lack of exercise and eating the wrong kinds of food, and its a hard thing for people to change. And generally health care professionals are afraid to give definitive health advice because of the opportunity of lawsuits. How many times have doctors told patients that they should "reduce" instead of "eliminate" or "substitute" some offending substance?
There tons of evidence that most medications (some help) have horrendous side effects [medications.com] and yet people continue taking them as if there's no tomorrow. I think that no matter what doctors, tech, or the government does, its gonna take a sea change for Americans to wake up and smell the coffee and start taking their own health in their hands.
Re:The healthcare market has only one impediment. (Score:4, Interesting)
Unfortunately, although I think government regulation may well have been the cause of employment and health insurance being conflated, I don't think that deregulation will successfully disentangle the two.
In Healthcare, where does all the money go anyway? (Score:4, Interesting)
So I got the bill a few weeks later. It was astronomical. Luckily the insurance covered it but it was of course filled up with all kinds of obscure bizarre codes that only insurance billers know anything about. What I'd like to see is some auditor look very closely at how the money flows around the medical system and find the $3000 toilet seats that I'm sure are lurking somewhere in their. I wouldn't be surprised if there were a few dirty HMOs that were taking kickbacks from hospitals for over-billing. Hospital over-billing would also be a perfect way to launder money I'm sure because everybody expects the costs to be unreasonable.
I think the best course of action would be for hospitals to sell their own insurance. Having the HMO and the hospital separate creates all kinds of incentives for fraud and over-billing not to mention many different sets of books to take care of.
Socialized medicine is here already (Score:5, Interesting)
Let's say we went to a world where only private doctors existed and no one accepted insurance. The rich will be able to afford most care (although they're pretty much dead if they need something big like an organ transplant). With insurance so expensive these days, this isn't too far off from reality today.
Now, pretend that you're poor, and you come down with melanoma, despite your best attempt to avoid the sun. You can't afford care, so you wait until the last minute to get care at the ER. By then, your disease is probably advanced and much more expensive to treat, and the ER can't turn your away legally.
The ER charges you some really high price that you can't pay. They repossesses your car and foreclose on your home so you can pay for it. Maybe you can find a lawyer to declare bankruptcy. Meanwhile, the ER is still waiting for their payment, and the doctors have to be paid to pay off their student loans. So what do they do? They charge the rich people more to offset the cost.
Now you're now homeless, without a car to get to work, unemployed, and you're still in debt. Where do you go? Perhaps you turn to a life of crime and end up in prison. You definitely end up on welfare and Medicaid, probably living in a homeless shelter that is likely funded by tax-payer money.
This isn't some theoretical story. It happens to people all the time.
So, all of you who are terrified of having your tax dollars pay for "socialized health care," you're really missing the point. You're paying for it already. You're paying it in your hospital bills as cost shifting. You're paying for it via Medicare and Medicaid. You're paying for it in the prison system (which is the new mental health system). You're paying for it in terms of treating STDs by county clinics and through federally-qualified health centers.
Socialized health care is inevitable because it's already here, albeit in a horribly disorganized and inefficient state. If we kept everyone healthy, the cost of health care would drop for everyone. The question is, how can we do that while balancing quality care?
US medical system (Score:4, Interesting)
If you are in a job it HAS to pay medical insurance. People are terrified, not so much of losing their jobs, but losing their medical cover. (Yes, I do know that ruling a frightened people is much, much easier).
Why?
It isn't true in the UK, or Australia, or Europe. So it doesn't HAVE to be so.
But then the USA is one of the most unbalanced countries on Earth. By unbalanced, I mean the rich-poor gap is horrendous. Here we have the richest country in the world, and yet it has large numbers of poor illiterates, sick and dying. It is very, very sad.
I think it is amazing how the USA has gone from being perhaps the most admired country on the planet - say after the 2nd world war, to one of the least admired - say now - in barely a single generation. Quite an achievement.
I think it's time the USA started doing things that the world could admire, instead of steadfastly serving its own interests. In the medium to long term, being greedy and acting like a spoilt, petulant child tends to result in nobody liking you.
What could they (you) do?
* clean up your own backyard
* Institute a decent national medical system. Increase taxes to pay for it. Kill off the medical insurance companies, push back the tide of wealth in the medical profession
* Fix the schools. Put money into the system (gosh, there's tax again) especially in the poor areas. You NEED those scientists and business folk who drive you economy - and if they don't get a decent education because they were born poor, black, Hispanic, Muslim, female (or any of the other sins of America), you won't get them
* stop messing up the world. Stop starting wars (USA has started more than any other country since the 2nd world war ended). Try to do some good - but not with soldiers
* start doing thing that need to be done. How about really, really investing in sensible power generation (and stop giving tax breaks to oil and coal companies - maybe that would save you some of the tax). Do some decent research. Put some people on the moon. Make the world proud! You've done it before - do it again
Mind you, a good start would be just stop driving those horrible little trucks (called truck so they can break their own rules on fuel consumption - I mean really, guys).
Sweden is a far easier country to admire. Finland
And getting a fair and equitable medical industry would be a good start.
Re:US medical system (Score:3, Interesting)
Externally, looking in I agree with this statement. I think that the systemic problems in the US right now stem from the fact that the US has begun moving away from a free market system such as it was originally founded upon. The US has begun moving away from personal liberties upon which it was also founded. And finally, the political system in the US is structured to realistically allow for only a 2 party system (as no other parties can compete effectively) and because of this, it is difficult to enact any real change.
The sad irony is that the "patriots" in the US should be wrapping themselves in the constitution, and not the flag. I am disappointed as a Canadian, where I live in a non Constitutional Republic, and I feel that I have more freedoms than my neighbors to the South. Realistically, it should not be this way.
Re:Expectations (Score:3, Interesting)
Try and get that across to the American people. Just try.
"How do we do that while balancing quality care?" (Score:5, Interesting)
Now many people reading what I just said are probably thinking, "That's inhuman." These are people's lives, not cars. Well, I'm sorry but this is exactly why health care costs are spiraling out of control. Just like the United States being a debtor nation because people cannot say, "No."
I worked in health care as an analyst and application developer for 3 years. For one: it's a nightmare to use technology to do anything because the systems are hugely complicated and entangled in an enormous amount of rules, regulations, qualifications, exceptions, and so on. For two: we have all the statistical information necessary to classify diseases and injuries by cost and come up with a budget that says, "We can treat that, but the cost is too great given the statistical occurrence of the problem, so we can not treat you."
The outcry against that would be tremendous. But I can tell you for a fact that this is exactly what happens on a battlefield. Any battlefield: a corporate takeover, war between nations, etc. People make brutal choices that have a huge negative impact on peoples' lives all the time. A company buys another because it is expedient and then they let go of 50% of the workers. We don't like that, but we accept it.
But if someone says to most people, "I'm sorry but we cannot treat 30% of these problems. We have the money on hand in the short-term, but in the long-term it will break the system for all of us." People are not altruistic. People will not accept the fact that they have cancer and are going to die because the treatment is available but too statistically expensive. People will not accept the fact that they need some expensive heart surgery because they have been pouring fat and sugar into their bodies for years and now it's time for someone to pay for that abuse.
Many people don't take responsibility for themselves, because we don't have a system that requires it. We put people in prison and relieve them of the responsibility of food and shelter and making adult ethical choices. We provide expensive treatments for people that need emergency treatment because an emergency has occurred as a result of years of abusing themselves. And so on.
We're not going to fix a damn thing until we get better at saying, "No" in the short-term when it is absolutely necessary for a sustainable long-term. And that's true in all aspects of society. Health care, the environment, economics, education, whatever. It's all the same single cause. Most people can't make personal short-term sacrifices for long-term gain. Debtor nation. The one's that can, don't spend much time talking about these things because it goes nowhere. They can't solve other people's problems. People need to take responsibility for themselves or the few that already do have to carry everyone else.
Re:The healthcare market has only one impediment. (Score:1, Interesting)
I have seen first hand what they do and how they abuse the "basic medical care". Any normal person with common sense enough not to be to poor to have medical would just get a bottle of something over the counterand save $150 or so. But then it does go to how smart people are. You don't see idiots taking home $50,000 + a year but you do see idiots with a medical card or complaining that they are the working poor and cannot afford insurance while on their way to drop another $50 at the bar to brag about the boat or motorcycle they just bought that costs them only $250 a month.
Actually, I would say that everyone who wants coverage can afford it is they made adjustments to their lifestyle. And if someone still couldn't afford insurance and didn't qualify for the free government shit, they are very few and far in between. What some people pay for insurance alone on their brand new car could cover the costs of medical insurance let alone getting rid of the new car and stick with the 5 year old model that is perfectly fine.
The problem in America isn't that people cannot afford medical insurance, It is that they cannot afford it and still maintain their lifestyles. And because of their greed, they want to tax me more to pay for it. And that is depressing.
Getting the government out of the medical industry will do more to fix any perceived problems then having them work on it.
Ban Lawsuits against Doctors -- Arbitration? (Score:3, Interesting)
Current system, we do not award damages based upon merit, but based upon jury awards. While jury awards are a reasonable way of dealing with many torts, they also introduct tremendous unfairness and confusion. If a medical treatment has an 80% success rate, and yours failed, you should not have a tort... sometimes there is bad luck. If you want to protect people from bad luck, then let's pool risk and do insurance. Create a mandatory "tax" on medical services, based upon percentage failure rates and damages for treatments (we already have the billing codes) and let those that lose life's lottery collect from the pool.
However, medicine by jury is HORRID. My wife's delivery was all messed up by overeager Doctors and our need to fight back to stop unnecessary interventions. Unfortunately, "high risk" in medicine is anything over 1%, and as a result the masses suffer to protect the outliers. So little of medicine is based upon statistical evidence, and more about what is the standard procedure so I can defend my actions in front of a jury.
Back to the cost issue, even trial lawyers defending the practice like Sen. Edwards (D - N.C., retired) claim that malpractice is only 1% of the costs, but that seems unusually low. My father who has a successful practice had several years where his malpractice insurance and his takehome were roughly equal, so that's a huge burden. However, defensive medicine, NOT malpractice is the problem.
For example, a pregnant woman can take OTC vitamins that are good enough, cost? $10/month. That same pregnant woman will likely get a perscription for vitamins (my wife did) for $55/month (co-pay, $15/mo.). It only cost us $5/month difference, but the "medical costs" increased over 5-fold.
Likewise, often the new drugs are only slightly better than the old drugs, where they are statistically similar for most cases but slightly better in some. in addition, the generic may cost $2 - $4/pill, while the new perscription pill may cost $200 - $800. Now, I would personally be happy to cough up some money to avoid the low-risk change of complications during surgery, but is that reasonable that you get those drugs for everyone? Would it be better that most people take the risk of complication (which is usually already under 1%) than run up costs?
The problem isn't the costs, but that is you go with the cheaper option, 99% of your patients saved money, but 1% now have a tort against you.
That's why pediatricians perscribe anti-biotics for ear infections, despite the OVERWHELMING majority of them being viral and the anti-biotics have no affect.
Defensive medicine combined with everyone being entitled to the newest, most expensive drugs results in the current out of control medical costs increases.
Re:What about Canada, UK? (Score:1, Interesting)
I believe that surveys show most people in the UK who use the National Health Service (NHS) are very happy with it, and a heck of a lot more money has been spent on it since Blair came to power so that our spending is closer to other European countries. Of course our tabloid papers always manage to highlight one problem or another the NHS has but you have to understand that it is a truly _huge_ organisation - this is probably where anti-"socialized" medicine campaigners get their silly scare stories from.
From what I've read here whether you believe the US system is broken or not seems to depend on whether you believe comprehensive health care for your fellow man is akin to a basic human right - in the UK we do and any politician who suggests otherwise would be considered either nutty or evil. The problem I'm seeing in this US debate is not that it can't be done (there are plenty of developed countries with better systems than the US), certain people just don't want to do it for a variety of what would seem rather strange views in Europe or the UK.
Re:The healthcare market has only one impediment. (Score:2, Interesting)
And the "free government shit," as you so colloquially put it, is near impossible to qualify for thanks to the bureaucratic road blocks put in to buy votes from narcissists like yourself, when all these blocks do is increase the bureaucracy, increase the cost of the programs, while stupendously increasing the pain and suffering felt by people who have no better option than to deal with "government shit." It's a lose/lose/lose!
One last thing. Any person who is capable of navigating through the system and successfully acquiring "free government shit" deserves to be given a high paying job on the spot, because that takes the kind of managerial/HR/PR/accounting talent that cannot be taught.
Re:The healthcare market has only one impediment. (Score:3, Interesting)
So, the question remains open: How do you get government out of healthcare, yet ensure that the poor sick/wounded are not left to die ?
Will not happen. Once government gets into it, then it becomes a political lever on the people to increase taxation into perpetuity. People become complacent, dependent and scared to loose it so they pay up. Which is really the problem, who is going ot pay and how many tax increases will be used to pay for it.
If the US does go government health care, do it wisely. Make the government flat tax a percentage on all income, no deductions, so everyone feels the pay pain. Deduct it separate from other taxes, say a flat 16% to start. The government then turns these into credits that must be spent on free enterprise insurance and given out equally to only those that are legal citizens or residents. If you don't file your taxes, or are an illegal, too bad so sad. If not spent, they can get the lower quality government care. Keep deductibles, it prevents abuse. Year over year, the program cannot run a deficit. Neither can the government use excess for general revenue. Prevents political "dipping" in the cash cow.
Also set limits, liability limits if you will. With enough cash anyones life can be extended. Is $1M too much, or $50M? Sorry, 300 years ago it was far more simple but in todays society this has to be addressed.
One last item to get past the lobbyists. Health care insurance companies of any kind must offer their rates equally to all that apply. No hiding behind group rates to avoid individual applicants. Simplify the legalese, if a Gr 12 can't understand it, it is too complex. They must take all that apply, but have the right to deny for 1 year. This is to prevent convenience hoping and deny for avoiding insuring. Legislate single billing/deductibles for a single incident issues. Finally, vigorously enforce existing fairness laws and levy heavy fines for non-compliance.
This way you don't get sucked too far down the tax rabbit hole.