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

There have been some great points made!

Here are three questions for you to think about:

  1. Have you or your family members experienced difficulty paying medical bills? How can policy makers address this problem?

  2. In addition to employer-based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?

  3. If you are comfortable sharing this information, how much do you or your employer pays for health insurance? What should employer’s role be in a reformed health care system?

  1. Yes. It is not an issue for government to address or not… but if government got out of the healthcare business, the market would force prices to something more mutually acceptable.

  2. Yes, if it were privately offered. Government has no business either providing or regulating healthcare.

  3. My last employer was paying about $400/month per covered employee. The employer’s role should be to provide a healthy environment and to understand its best financial interests lie in keeping its worker’s safe and healthy. Sufficient breaktime to use the bathroom and to eat (meals, snacks, etc.), facilitate physical exercise (either group exercise like in Japan, available corporate gym, etc. for desk jobs – and if desk job, schedule exercise into the work day), and if there is a corporate cafeteria, provide only healthy food options with healthy portion sizes (rather than mounds and mounds of white-flour, bad-fat-laden glop). BUT these should not be government-mandated changes – they must come from the employer’s own sense of financial best-interest.

I believe Medicare should make judgements on a case by case basis, instead of judging all Type 2’s on C-peptide results only. I meet all requirements for insulin pump approval EXCEPT ;my c-peptide results were TWO points higher than they will allow. Even with chronic kidney disease, retinopathy, PAD, and now, neuropathy, the Medtronic reseller, Diabetic Care and Education, will not approve me, because they say Medicare will refuse me. They won’t even release my claim to Medicare. If they did submit it to Medicare and I was denied, I could launch an appeal. I have 4 DR.'s, 2 dieticians, a pump trainer and the rest of the staff at the local Diabetes Education Center willing and ready to write appeal letters on my behalf. My New Year’s resolution: I will be pumping before the end of 2009, come h*ll or high water.

It appears that if one doesn’t work and has very little income, one can be on state insurance or Medicaid, but if you go above a certain amount, about 1000 a month for one person with a child, you do not qualify. Now, $1000 a month isn’t going to allow anyone to afford much, let alone health insurance, but the powers that be do not consider this. It is NOT based on whether your employer offers you insurance or not.

So, if you work more, so you can pay your bills, you are penalized for it and lose your health care benefits with the state where I live. Then one becomes a diabetic without health insurance. And, we all know that insurance companies will charge an arm and a leg (no pun intended) for insuring a diabetic.

I want the insurance companies out. They are profiting from our diseases and they only want to insure healthy people.

Oh I agree, and I work in medicine too.
All these syndromes and their drugs they created.

Ever see the commercial for Abilify, which is supposed to accelerate an antidepressant? When they say all the side effects, you wonder who the heck would ever take that drug!

I think a lot go to GP for diabetes, because there are few endocrinologists. I am on state insurance, and there are very few on my plan. I went to see one, who gave me 2 minutes of his time, wrote a script for Metformin, and left. The girl at his front desk was so apathetic when you called and asked any questions. "I dunno."
The other endo’s phone number was not in service.

The insurance companies, I think, are worse than the pharmaceuticals. They tell docs what to prescribe and what to do. Our healthcare is basically being managed by an insurance company, not a doctor.

People seem to think you can prevent diabetes. That we are lazy, didn’t take care of ourselves, ate too much, didn’t exercise. That simply is not true. You are listening to the media.
Diabetes is a genetic disease.

But you are right about diabetes education. Most insurance won’t pay for it. I would think those of you in that industry would be rallying Congress to stop the insurance companies from blocking this. If it isn’t putting a damper in your pocket, it should be a big red sign to your profession.

I have had diabetic educator, one after another, tell me “oh, sorry, we can’t see you because your company won’t approve it.” They just give up. They say a lot of companies deny it. How come no one is doing anything about this??? If you know insulin pens are more efficient, you should be attacking insurance companies and telling them this. They are simply looking to what is cheapest, not what is best for the patient.

It is the professions that can make a difference.

When you guys don’t have jobs anymore, maybe then you will. I write letters. Scathing ones too.

No, if the government got out of the healthcare industry, more people would be without healthcare.
Not everyone can afford a policy on their own, nor does every employer offer it. It would be worse than it is now. Insurance companies don’t care if you can’t afford them.

Government SHOULD regulate the insurance industry. They are denying people care based on pre-existing conditions. They are milking the healthy people and denying the sick, who need the healthcare.

Your employer gives you a lot. A lot of us do not have those perks. I am looking at the basics, getting to see a doctor, and getting Rx’s covered. There is a whole big world outside where people do not work in a corporate environment. I work in medicine, and I do traveling work. My employer does provide health insurance. My other option is to not work, and go on welfare. I will not do that. I make enough money to get by. The system tries to force someone to go as low as possible to qualify for “help.” As I was told, “Try to get what you can, file for everything.” It is that mentality that is soaking public services.

If I get more hours, I lose my state insurance. You think some insurance company is going to give me a rate I can afford? You think some insurance company will cover me as a Type 2, insulin resistant diabetes with vascular disease? They see me as a grenade!

and folks…not everyone is on Medicare. There are those of us who are not offered health insurance with our jobs, and cannot afford a policy on our own.

There are those of us who, if we even could afford something, would be denied coverage being diabetics, or they’d make the premium so high, we could not touch it.

There is a lot between those who are covered with employer provided health insurance and Medicare. Medicaid is a joke.

Hey gang, I’ve been in insurance and human resources dealing with benefit plans. I’ve come to the conclusion that employer-based plans are a big part of the problem. Here’s why:

1-Employers buy the plan. Even if they give the employees several choices, and the employees pay a portion of the premium, it still keeps the employee in a position of being a dependent of the company. This does not foster taking charge of your own health.

2-It is a source of dissatisfaction. When the employer tries to contain costs, but the employee feels a need for more services (whether or not there is a good reason to believe these services will be effective), the interests of the employer and the employee collide. The employer can’t win this battle! Nor can the employee. As a result, it is one of the most non-productive investments an employer can make in their total compensation package. AND YET, it is a minimum requirement to get and keep a reliable workforce.

3-It desensitizes people to the cost of their healthcare. When they do not appreciate the cost, they often insist on irrational things (do we all know that the biggest real risk to public health are the drug-resistant bacteria from all the use of antibiotics given to people with viral cold/flu’s)

I don’t think the government will do a better job! Just being dependent on the larger group makes us even less powerful and less likely to take control of their own healthcare. It just relocated the big brother healer from one dependency relationship to another.

The government doing it won’t save money if we remain in a situation where there is one place offering the service and a middle-man taking care of the payment. Somewhere I read that around 40% of the price we pay for insurance is absorbed by the administration of claims and only 60% goes to the supply of healthcare goods and services. Since this doesn’t involve case-management (advice on how to get the best services from the system), it only involves claims processing, I’m thinking that this is a lot to spend on something that doesn’t add any value!

What we need are sweeping changes. The problem is that too much will get broken and many people will suffer while we work this out. Fact is, that’s already happening, so maybe we should just get on with it.

I like the idea of buying groups – for the practiioners, for the clients. The ancient concept of guilds comes to mind. Masons, artisans of every kind, each had their guild. They determined the standards of practice, the standards of training, and they looked after their members. People would be thrown out of the guild if they failed to meet the standard of performance required by their profession. They helped them find work, they provided community and support. They looked out for their own if someone became sick or injured. They were generally democratic.

Seems to me like the Screen Actorss guild and Actors’ Equity might be models for us to use. There are even homes for members to go to as they become old and frail, if I’ve got this right.

Now some members of society are on the fringe, and unable to qualify for a trade/profession related guild. In such cases, there could always be church-related and university training hospital-related charities. All of the best hospitals in our region began as charities.

Another part of our problem is with the following:
Lawyers
Insurance Companies
Medical Profession failing to monitor themselves for incompetant practitioners.
Demand for high profits from medical device and supplies and drug companies

Guilds for the docs and nurses self-funding and self-regulating would get us away from middle-men taking a profit on malpractice insurance.
Guilds for the lawyers throwing out the ones who bring down the profession by filing nuisance complaints – Guild would have to pay court costs out of their coffers for all health-care filings regardless of outcome
Guilds for workers who can bargain for healthcare buying-power - as democratic societies, with accountability to one-another, there would be peer-pressure to maintain healthy habits, use services wisely
Guilds for medical clinics to purchase supplies

Note, in 1975, I worked for a company that made a little test strip for in-doctor’s office dipping into urine – it turned a color to indicate the presence of a bad thing. The test strips cost the company less than $0.00003 to produce – including all of the research that went behind it, all of the wages of the people that handled it, and shipping. We sold it to the supply house for a dollar a test strip. The supply house sold it to the doc for five dollars a test strip. The doc charged his patients ten dollars for the test. I didn’t do the math to determine what the mark-up was, but it’s gotta be about a go-zillion percent.

Want to make health care more accessible? Making it more affordable is a good place to start. Pharmaceutical companies get a big black eye because they are the obvious ones. But there are a lot of places where this happens all up and down the supply chain. Putting our heads together to bargain for better pricing on all the things we use is a good place to start

So many great points…

I have just submitted our discussion to the Transition Health Policy Team. This was the confirmation message I received:
“Thanks for telling us about your health care community discussion. Your contribution will play a pivotal role in helping Secretary-designate Daschle and the Transition Health Policy Team shape reform.”

I want to thank every single one of you who took the time to participate in the discussion so that we could come up with a number of great ideas on behalf of people with diabetes and other people who, like us, are affected by the current limitations of the US health care system.