Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Would you like government run restaurants and McDonald's? How about government-run retail stores?
I would certainly not wish to have a government monopoly on restaurants or retail stores. But if such government stores existed, in free and open competition with private stores, I'd be enthused to try them out. Maybe they might offer inferior products and poor service, but lower prices? Who knows. It sounds like an interesting experiment to try.
Well, that's part of the problem. Why judge the hospitals based on their appearance? Why should I be paying for a gleaming lobby or fashionable architecture? I want competent care at a low price, and if that means narrow hallways with peeling paint, creaking doors and dim lighting, so what?
Why are people so afraid of a two-tiered system: private care for those who can afford it (and who choose to pay), and public care for those who do not? To reiterate my earlier point, I can afford to drive a flashy car, but choose to drive a clunker. Besides saving money, that offers me the mental peace, that a wreck would be no tragedy, and that maintenance can be skipped with impunity. The free market offers me that choice in cars. Why not a similar choice in healthcare?
Because the people who want to pay for private will still have to pay for the public as well. Health care is a service, not a right. See how fast nobody becomes a doctor anymore when they are forced to work for the government with all the government's bloated regulations and paperwork and aren't allowed to practice as they see best, but as the government dictates.
I have never worked in healthcare, so I have no first hand knowledge or experience. But I focus on your observation that larger hospitals have more clout to go up against large insurance companies.
Both larger hospitals and smaller ones employ armies of people with expertise on how to code insurance claims so as to maximize reimbursements. They must do this, because those insurance companies employ armies of people with expertise in how to cut the reimbursement to those hospitals.
It is game theoretic -- and an arms race. It takes substantial investment on the part of hospitals to keep up with the defensive tactics of the insurance companies. The insurance companies must invest to offset the aggressive claims of hospitals (and other forms of medical service providers). It is like the Cold War arms race.
None of that investment adds value to society. No patient gets better as a result. Medical doctors pull their hair out because of all the non-value-added time & effort they spend dealing with bureaucratic paperwork.
I am NOT smart enough to figure out a solution to this mess.
There have been some battles here in Northern CA...
Sutter and Blue Shied were not able to come to an agreement so those with Blue Shield found they had no in net-work options which left a lot of people scrambling.
It is not uncommon for a independent community hospital to receive only a percentage of what a large provider with many locations receives...
One small hospital struggling to serve was recently purchased by a huge provider... looking over the billing and changing NOTHING else other than reimbursement rates the small hospital would have received millions more had it had the better paying contracts of the giants...
This is the scenario being played out in many places... can't really afford to keep the doors open and then the place is taken over by a huge provider and the community loses local control and the big group makes money merely by having better contracts.
Why Not US Government Hospitals and Dental Offices?
Have you ever been treated by a government doctor?
All the ones I met - and who treated me - couldn't get a job in a weight-loss clinic, but they were just fine working for Uncle Sam because they had no liability when they screwed up.
Full disclosure: Some of the most advanced, cutting edge docs on the planet work for the US Government, and I was privileged to work with them. But they were researchers; they did not routinely treat general admission patient loads.
100% government-provided health care is probably inevitable in the US, in the long run. We spend 1/6 of our GNP on health care and have come to expect a correspondingly incredible level of technology and miracle-working; conditions that incapacitated or killed our grandparents are now routinely cured. Artificial hips and etc are a matter of routine. BUT... none of us are willing to pay 1/6 of our entire earnings for access to this kind of care, which is what it costs. Thus the public outrage, and thus the painfully apparent inability of either political party to craft a health care law to voters' satisfaction. The eventual "solution" will almost surely be to hide the true cost within general tax revenues -- ie single payer health care provided by the federal government.
But I would be surprised if this is done by closing private hospitals / medical offices and opening federally-run ones in their place. Having worked in a US military (government-run) clinic for several years, I can also unequivocally state that federally run health clinics would be a CATASTROPHE of mismanagement and inefficiency. More likely, some sort of "Medicare for all" is in our future, with care still provided by private entities but paid federally under contract to the government, and working under government guidelines. This will also inevitably lead to rationing or "managed care," for what it's worth... i.e. based on cost not all beneficial interventions that are technically possible will be made available to patients.
Well then, the "US Healthcare Machine" is like a badly "Machine Designed" engineered system. Private or government [like the VA], the situation is messed up both ways. You know, when a Mechanical Engineer does Machine Design, like a car, for example, you just have to have the right components together with the right design and proper control systems to make the machinery work. AND THAT THEN IS WHY THE US HEALTHCARE SYSTEM IS MESSED UP, IT'S A "MACHINE DESIGN" WITH THE WRONG CONTROL SYSTEMS.
If you don't understand me, it's maybe because I'm talking like a mechanical engineer, which I am.
Well then, the "US Healthcare Machine" is like a badly "Machine Designed" engineered system. Private or government [like the VA], the situation is messed up both ways. You know, when a Mechanical Engineer does Machine Design, like a car, for example, you just have to have the right components together with the right design and proper control systems to make the machinery work. AND THAT THEN IS WHY THE US HEALTHCARE SYSTEM IS MESSED UP, IT'S A "MACHINE DESIGN" WITH THE WRONG CONTROL SYSTEMS.
If you don't understand me, it's maybe because I'm talking like a mechanical engineer, which I am.
The problem with healthcare is the system was never "designed" at all. It just evolved into the hot mess it is today with zero planning. It is only going to get worse.
With private and employer sponsored insurance coverage the goal is always to save the employer or insurance carrier money and to shift costs elsewhere. Making sure Aetna, Cigna, UHC and BXBS make profits in the BILLIONS each year is the goal - not paying your claim.
In the 70s everyone had indemnity Plans. Then the HMO was created to control costs. That didn't work so then they tried the PPO, POS, EPO. The newest scheme to control costs is the high deductible health Plan with either an FSA or Health Savings Account.
The reason so many Plans are going toward high deductible health plans is to save money. It's like Vegas, the odds are always in favor of the house. Actuaries look at all of the statistical data and determine how high the deductibles should be set. Most people will not ever meet their high dollar deductible and will be paying for their own healthcare out pocket.
Oh, this would be a great thread to talk about those things. Because I think processes can be engineered, documented, and optimized. Actually, maybe there should be a thing like "process engineering" of the Medical Healthcare and Insurance Industries, and how they work and interrelate.
There are some, yes, I think like Stroger Hospital in Chicago. Free medical care for the poor. Instead, the US is filled with greedy "For Profit Hospitals," plus I suspect many hospitals or private practices greedily cheat the Medicare and Insurance Companies.
Now if there were a lot of US Government Hospitals taking Medicare, Medicaid, and Veterans - that would really lower costs for Medicare and Medicaid from being milked by private hospital and dental agencies...
Were US Government Hospitals once a popular thing in the past, or maybe that's something I'm suggesting now as a solution to the high cost of Medical Insurance...
In fact, with the problems of Obamacare and the uninsurable, there probably should be a lot more US Government Hospitals. Building them, setting them up, and employing people in this manner would be a good partial economic stimulus.
I lived in the Philippines for 1.5 years by now, and the Philippines has Government Hospitals to take care of the poor for free or a very low fee. Not as high tech equipment as America but they get you by.
When I was younger, Doctors were actually quite reasonable. However due to governmental involvement in the profession, it has become almost impossible for the situation of "resonability" to exist.
If it was the gravy train for Doctors that some think it begs the question is why so few American born Docs encourage their kids to do into medicine.
We have two Docs that now work as ER or Trauma Nurses... they have zero responsibility for managing an office and all the compliance issues that go with it, no personnel issues as an employer, malpractice premiums are nil compared to Surgeons and they can easily schedule time away which both do regularly... one is an avid climber and the other a runner...
I remember free clinics all back in the 60's and 70's but I believe they were all privately funded.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
