What is broken in the US health care system how to fix it?

Today, President Elect Obama announced former Senate Majority Leader Tom Daschle as his choice for Secretary of the Department of Health and Human Services and Director of the new White House Office on Health Reform.

In his remarks, Secretary-designate Daschle appealed to Americans to play an active role in health reform by signing up to lead a health care discussion – a series of meetings everyday people are hosting, in which they’ll gather ideas and report back to the Transition’s Health Policy Team. The team will then incorporate the results into its recommendations for the Obama-Biden administration.

We have ordered a moderator kit from the Change.gov web site, in order to facilitate the discussion. We want to gather the thoughts of the community about what is broken in the US Health Care system and how do you think it can be fixed. We will then summarize the discussion and share it with the Transition’s Health Policy Team, which in turn will combine it with other results into its recommendations for the Obama-Biden administration.

Questions:

  1. What is broken in the US health care system?
  2. How do you think it can be fixed?

Note: The link to this discussion has been submitted along with our request for a moderator kit: let’s please keep the discussion on topic without getting into partisan arguments.

P.S. Although this is a topic that most likely US members will be interested in participating in, regardless of where you live and where you were born, if you have something useful to contribute to the discussion, please do.

There was a time when people actually paid for their healthcare. If someone had a baby, they financed with the hospital, but back then, things didn’t cost like they do now. The insurance companies have trapped us into this. As medical costs rose, they did nothing to make the costs lower, they took from their customers. Essentially, you get less for more.

Can it be fixed? Well, if somehow we got more and better jobs back into the USA, it would resolve itself. More money into the economy would cycle back. But what companies are going to come back here, since they ran from this nation. They got rid of unions, then trampled on the American worker as being too expensive, so they went abroad so they didn’t have to pay people well, not pay healthcare benefits, ignore safety and environmental issues.

There was a time when almost all jobs had healthcare benefits, and you didn’t suffer having them taken out of your pay. Your healthcare benefits were included as part of your pay or salary.

I have a particular dislike for insurance companies. When I miscarried a child, I was told I should have gotten preauthorization before going to the hospital (sic), even though my doctor ordered me to go. They said they weren’t going to pay because I didn’t get a second opinion! I had good insurance at the time too. I basically told them to go jump in a lake.

From the perspective of german health care:

It is important to establish a functional and clearly defined mechanism for price fixing in health care. We germans did not dare to do that and we pay for this hesitant attitude daily. Our prices for medications are steadily rising without additional benefits. Our insurance companies are to weak or to lame to fight this tendency. In the long term this will ruin our health system. Therefore price fixing by the government is the most important step. This means the manufacturer has to declare his costs and then he will be given a fixed margin of 15% on top. If manufacturers dislike this fixing their access to the national health care market should be denied.

I know it sounds draconian but we talk about big money here. This billion euro/dollar market needs to be tightly controlled. Its negative development is very comparable to the financial market.

This is my first post here and what a sensitive subject!! In my opinion, what is wrong with our health care system is that is has a big ole dollar sign on it, it’s all about the money and the insurance companies and pharmaceutical companies have let it spiral out of control and illnesses have become tickets to profits. I’m terrified right now because I have no insurance and not enough money to pay for what I need and I think it’s sad that it has boiled down to dollar sign. As far as fixing it…I really don’t know if there are any quick fixes, in fact there are none so that’s a hard question to answer.

There are many important issues here, but this is the one I think does the most damage to people with diabetes.
What is broken in the health care system.

DRUG COMPANY DOMINATION

Medical research and doctor post-graduate “education” is almost entirely controlled by profit driven drug companies who benefit from leaving chronic conditions chronic. The money goes into expensive drugs that palliate rather than remove symptoms and which often cause side effects that require other drugs. The drug companies actively buy up patents for treatments and devices that could limit their profitability. This is why we never see blood sugar meters that don’t have $1.05 a piece disposable strips. The meter companies buy up noninvasive technologies and sit on them.

Doctors learn only about drug treatments, and their “education” is provided mostly by drug company reps of lecturers paid by drug companies who limit all treatment options to drugs. Practice recommendations are unduly influenced by drug companies because they have funnelled hundreds of thousands of dollars into the doctors who are the Opinion Leaders, like those on the American Diabetes Associations Committee of Experts which sets practice standards.

2 SOLUTION: Federal funding of medical research needs to get back to where it was in the 1960s and the drug companies must be prohibited from paying off doctors using all the current sleazy dodges they use. Drug reps must be forbidden access to doctors. TV advertising of drugs must end. Doctors must be required to get academically-supplied continuing medical education not funded with drug company money.

This is broken in the Us Health care system:

  1. Medical device limits (money limits one can use in one year) create situations where for example a machine is ordered to heal a wound (Wound Vac) and the limit is so low that the machine uses the limit up; and you still owe thousands for it. You then have to wait forever after a wound is healed for a prosthetic. Then the limit is so low that you have to order a prosthetic that is low quality and creates new wounds. Therefore preventing you from walking, doing some menial things, going back to work, and looking at life in a positive manner.

  2. Insurance companies constantly denying claims that are actually covered in the policy. If you do not catch this and reply by filing an appeal for the erroneous denial in their time frame for such appeals, then you wind up battling it forever and having to pay for it out of pocket when it was actually covered in the policy.

  3. Insurance companies not providing you with the policy of coverage when you sign up for it.

The fix to this:

  1. Have insurance companies “policed” “audited” and mandated to cover prosthetics under a different category. Maybe. Just because you are healed at the stump does not mean you are able to get around safely on crutches or in a wheel chair.
  2. “Police”, “audit”, “Oversee” “enforce” Insurance company compliance with their policies.
  3. Enforce laws that entitle us to a copy of the policy we sign into.

And on another note, stop insurance companies for penalizing us for a pre-existing health condition! There is no cure found yet and yes these insurance companies have their hands in our pockets when we use the medications to keep us alive and create new complications! It is definitely a conflict when insurance companies, paid off doctors, and drug companies are involved in studies, drug research and use.

You know, I think the Insurance companies see us like cancer patients. They are cold blooded and figure, heck, if we develop complications, we will be gone. They are stingy about paying for things for us, because they think we are the problem, that we are like alcoholics who drank and wrecked their livers. They think if we had lived a healthy lifestyle, we wouldn’t be sick. We all know that is not true at all.
They don’t want to put money into anyone who has a noncurable disease. They don’t want to manage, or keep pumping money into us.
I have seen others on here post about how they have had to fight for care and coverage on things. I know what it is like, to have them tell you that they won’t pay for a monitor, or eye exams. Or diabetic education, when all you want are some specifics. I feel like I am floating out here, and cannot get help that I need. My doc is a good internist, but he doesn’t know what to tell me to eat, and the ADA wants you to eat a lot of carbs. He doesn’t know why I keep gaining weight on such few calories. He told me the educators could help me with the side effects of the Metformin. My insurance doesn’t think this is necessary. I said, “Why would a doctor order it if it were not necessary???”

I personally blasted the American Diabetic Assn. for their bland approach to patient advocacy. They claim they are helping people, but insurance companies are cutting more and more from us. I can see why you folks formed these groups online.

I won’t give the ADA one red cent.

Job-based group insurance insures that very few people will be with the same insurance group (or even the same carrier) long enough for the complications of over-conservatively untreated medical conditions to pose an economic threat to that group. Job-based insurance appears less expensive to the individual because it is backed by the employer and because young, healthy employees’ premiums subsidize the costs of care for chronic illnesses. The carriers have the size and bargaining power to negociate payments for different types of care.

If, rather than job-based group insurance, people were economically free to choose insurance plans grouped by place of residence, industry of employment (think trade union, professional society, etc.), and that these would be plans that could be kept until death, then the cost-effectiveness of preventative care and health maintenance would be more visible to the groups and carriers. Instead of health insurance per se being a benefit of employment, the health-benefits would be some sort of health savings account for the employees to use to pay the premiums and out-of-pockets based on their insurance of choice. Or, the difference could be seen as a direct increase in pay and/or ability to hire more workers and expand the business.

The other issue is the relationship between the FDA and Big Pharma. The FDA puts up a series of roadblocks that make it all but impossible for medical treatments not developed by Big Pharma to be approved, and the level of drug safety is unevenly applied to candidate treatments (again, favoring Big Pharma). The length of time and the amount of paperwork and kickbacks needed to get FDA approval greatly increases the cost of drug development, which is passed along to us as higher prices, greater co-pays, and higher insurance premiums. Get rid of the FDA and let people (aided by doctors, local pharmacists, and such) read the information for themselves and make informed decisions based on something other than a corrupt Federal agency.

I agree. People think insurance companies “care” about us, but their sole aim is to make more and more money. I have seen some physicians start their own pay-for-fee plans, because they know how insurance companies dictate medical care. Your medical care is managed by your insurance company, not your doctor.

I had a friend who was a dentist, and she said after all her years of medical training, she was told what she could do by a clerk in an insurance company. I corrected her, it wasn’t the clerk, it was a bean counter above her.

Manny: Thank you for leading the effort to get our voices heard. You will no doubt spend many hours trying to summarize the views of this community. Here is one person’s opinion (mine) about what needs to be fixed and how to fix it (unfortunately, all it needs is money, in the right places):

  1. Research and Development: NIH needs to get into the lead on the funding of r&d. It should be done on a governmental and academic basis – having the drug companies fund research results in incremental steps that keep patients on drugs that maintain their reliance on the drugs, as opposed to treatments that will actually result in a cure (imagine the impact on the medical industry if a cure were suddenly discovered and we no longer needed insulin, syringes, test strips, pumps, infusion sets, etc.).

  2. Education/Long-term Treatment: Until we can achieve a cure, we need a change in the focus of treatment of patients. Patients need to be educated about how we can control our diabetes. People at risk for diabetes need to be educated so they can take the steps to delay onset. This costs money today, with benefits unseen for many years into the future. There is no immediate profit return to paying for education with nutritionists, CDEs and the like.

  3. Health Insurance: Health insurance should not be a for profit enterprise, as it will always put the interests of the shareholders and the executives ahead of the patients. Should my health insurance pay for me to go see a doctor that costs twice what a local doctor should? No. There need to be limits. (Perhaps if I want some kind of gold plated coverage, I should be able to get it, but I should have to pay extra for it.) But, health insurance should provide a reasonable and extensive coverage to help patients better take care of themselves.

  4. Coverage: Every person in the United States must be provided with access to a minimum level of medical care. This should include pre-natal care, regular doctor visits for children, annual physicals for all adults and certain other agreed procedures, such as mammograms for women over a certain age, colonoscopies for adults over a certain age, etc. If people can get basic medical care, diseases are more likely to be caught early, saving costs of treatment later and lost work days. This coverage should also include catastrophic illness/injury care.

  5. Prescription Drugs:

(a) FDA Approval Process: The FDA approval process has to change. Not only must there be controls to make sure that their is no corporate bias in the approval process, but drugs should not necessarily be approved unless they show an improvement over an existing medication. There are too many stories out there (I cannot vouch for veracity, just what I read) about drugs that have a new formulation but do not provide materially different results from an existing drug that is coming off patent protection. Too often, doctors want to prescibe the newest medication, even if it does the same as an old one or is just a combination of two different drugs.

(b) The Prescriptions: Drug companies should be limited in the benefits they give to doctors for prescribing a particular medication. My old CDE said that there was a difference between Humalog and Novolog in certain patients and thought Humalog might be better for me. My doctor preferred Novolog and had parts of his research funded by its manufacturer. Led me to wonder whether the decision to stay with Novolog was based on the best treatment for me or the doctor’s loyalties. Doctors must be completely loyal to their patients. No exceptions.

© Medical Advertising: Should be banned. There is a comedian (name escapes me) who does a routine about all of the various disclaimers he hears on drug advertising. It is very funny. But, it points to the issue that patients do not know what drugs are right for them and what are not.

  1. Paying for it: Health insurance in the U.S. costs a fortune. My family coverage in 2009 will cost about $20,000, including the deductible, even though the coverage is not that extensive (thankfully, prescriptions are covered). And I am happy to have it and grateful to have the ability to afford it. I often wonder, though, how much insurance we could provide across the country if all the health insurance paid by or on behalf of every insured person were pooled, if all of the redundant overhead of the many insurance companies were eliminated and if all of the profit and excessive executive compensation were redirected back to the patients, through either lower premiums or coverage for more people. Could we do it? I do not know, but would love to have one of our government wonks give us an answer. Would it be possible? Don’t know, but someone should do the research.

Just one person’s views on the subject.

I love the discussion that is going on!

We have received the participant guide. I am attaching it here as a reference for everyone to download and read, as we keep the discussion flowing.

Here are the goals of this discussion:

  1. To discuss health care reform and draft a submission to the Transition Health Policy Team;
  2. To use a process to do this that respects and empowers attendees; and
  3. To identify stories that exemplify the need for health care reform.

I think we can thrive on all three!
8061-HealthCareCommunityDiscussionParticipantGuide1.pdf (95.6 KB)

BTW, in the participant guide you will find a survey: if you can copy it and paste it into a private message sent to me through TuDiabetes with your answers, that would be great!

The main problem with U.S. Healthcare is that it is only designed to address acute illnesses, not chronic illnesses. Consequently, the U.S. scores about 17th on a worldwide basis (below Cuba and Jordan) in terms of the care provided to people with any chronic illnesses.

If we continue with the system as is, for profit pharma companies, for profit medical care industry, and for profit insurance companies, I see no answer. Not that I am saying do away with the above but they are businesses in a capitalist society (which I am not arguing against,) and I am not sure how we can dictate how they do business.

If we want to make medical care available for all, perhaps the middle man (insurance) needs to go away. Costs will regulate themselves to what the market will bear i.e what we can afford. If no one is buying something because it is too expensive, the cost will come down. Are docs, hospitals, insurance and pharma execs, willing to make less? The lobbyists will make a fortune fighting for things to stay the same.

Well I think we can all see right through it, the insurance companies and drug companies are ruining health care in America.
I work in health care and it is easy for me to see the problem!

Many Docs are quitting medicine because their malpractice insurance is so high they just cannot afford it.
Many patients cannot go to the dr because they cannot pay their insurance costs.
We have kids without insurance, they can’t even get their required inoculations, god forbid they might have a chronic illness!

That needs to be fixed.

The drug companies, well don’t get me started, they are inventing illnesses to treat and the drugs they sell us cause permenent complications…don’t worry they have a drug for that!
No more ads on TV for drugs, just for starters.

The materials that are used in hospitals cost more from the vendors than they do at Costco, why is that?
Perhaps all the hospitals can form co-ops so that they can buy at a lower cost. There are 3 large hospitals within 5 blocks in the neighborhood I work. Can we become a co-op? All buy the same drugs/sheets/scrubs etc together?
We cooperate when we have mass disaster drills, this is a mass disaster!

The idea that Diabetics are going to their GPs for care is insane. Diabetes is an epidemic in our country educate the GPs in it. No one even tested me for it so when I accedentally discovered that I had a BGL of 450 and a 14.5 A1C I was suprised…and so was my GP.

It took me three messages to get the answers through… the first set of questions required more input than the message length would allow.

The topic is “What is broken in the US health care system and how to fix it.”

  1. Greed exists all over the world, not just in the US, so that one word comment adds nothing here.
  2. Obama was a US Senator for a short time, and the US health care system has been broken for a very long time. Whether you like Obama or not, this comment is totally pointless.

The main problem with the US health care system is that we have a middle man that adds nothing in the way of improved health products or services yet skims billions off the system. That middle man is insurance.
There are other problems, but that is one great difference between the US and most other developed nations.

Sort of like Wall Street!

I’m a nurse. I work in the diabetes education field. I’m also the mother of a diabetic child. My biggest barrier to education is insurance companies/ medicare. My education is directed by what insurance a person has. For example, people with only medicare have to be taught vial/syringe insulin administration. Insulin pens are not covered by medicare. The pens are easier to see unit markings and use in most cases, however they are expensive. Another obsticle is the fact that diabetes requires one take ownership of their disease. It can be very challanging to actually help people to want to be well with diabetes. How can we fix this? People need more education and support. Put more dollars into wellness promotion. Preventivie care is key. We should teach people how to be well with whatever ailments befall them, not wait until they are patients in the hospital with complications from that illness.