How Would You Fix the Health-Care System?

America! We're No. 1! We're No. 1!

You might not be too proud of this award, though.

A new report from the OECD provides updated data on something we've known for a while: The U.S. spends way more on health care than any other developed nation -- 141% more than the OECD average.

Source: OECD

Focus on the blue line. Most industrialized nations provide universal coverage for all citizens at a lower per-capita cost than the U.S. government spends covering its elderly (Medicare) and poor (Medicaid) alone.

If that isn't a sign of inefficiency, I'm not sure what is.

Our medical industry is the most innovative and advanced in the world. Companies like Pfizer (NYSE: PFE  ) and Intuitive Surgical (Nasdaq: ISRG  ) invent tremendous lifesaving breakthroughs. But technology is only relevant to those who can afford it. Far too many Americans can't even afford basic coverage, let alone the latest breakthrough. Just look at our health results compared with other nations. The U.S. ranks 50th worldwide in life expectancy, barely ahead of Bahrain and Libya. We're 47th worldwide in infant mortality, with a rate twice as high as France, Hong Kong, and Sweden. It's pathetic.

What's going on? And how do we fix it?

I'll ask for your help in a second. First, here are a few recommendations from various policy experts and research reports on how to put the brakes on our health-care costs.

Put the patient in control 
Most of my life I had really good employer-provided health coverage. It paid for almost anything I wanted with few out-of-pocket costs. For the past four years, however, I've purchased an individual policy with a high deductible and co-insurance.

During which period do you think I hunted for bargains and questioned whether a treatment was really necessary? The latter. Of course. With more skin in the game I became a smarter, more informed health-care consumer rather than a blind health-care recipient.

We need more of this. One study finds that, "when patients actively shared in decisions about whether to have surgery, the rate of surgery fell 23% and satisfaction and outcomes both improved." Another shows that becoming aware of probable cost-benefit outcomes "reduced the preference for the more intensive treatment by 21% to 42%."

Tone down the heroism 
"Three out of every 10 Medicare dollars are spent for people in their last year of life," said former Comptroller General David Walker last summer.

The cost of unnecessary heroisms is off the charts. It's also somewhat unique to America. Other nations seek to avoid the problem by limiting taxpayer-provided coverage for ailments with a high probability of becoming fatal. Private coverage and personal payments can take over once a limit is reached.

How this policy gets implemented is, admittedly, very tricky. It smells too much like "death panels" to many, even though private funds can still be used after taxpayer coverage tops out. Dr. Atul Gawande brings up another excellent point in his book Better: "Analysts often note how ridiculous it is that we spend more than a quarter of public health-care dollars on the last six months of life. Perhaps we could spare this fruitless spending -- if only we knew when people's last six months would be."

Make coverage mandatory 
This is about as controversial as it gets, but there's merit to it.

A minimum amount of health coverage should be mandatory.

I know. People shouldn't be forced to buy something they don't want. I get it. But the uninsured get sick. They rack up hospital bills. It happens to everyone. Those without assets are often pushed into bankruptcy. What happens to their hospital bills then? Part is covered by a host of federal and state reimbursement programs, and part is passed on to people who have insurance. It's called cost shifting. Doctors and hospitals have to get paid one way or another. You might not want to be forced to buy insurance you don't want, but I don't want to be forced to carry your weight through higher premiums, taxes, and health-care costs.

Force Medicare to say "no" 
As my colleague Seth Jayson put it, "It's not the death panel you need to fear, but the 'everything-if-that's-what-you-want' panel that already exists in government." He continued: "The solution is rationing. It has always been rationing. That's what the private insurers do already, and it's what any public insurer will have to do. Everyone can't have everything. It's that simple."

David Leonhardt of The New York Times has detailed Medicare's whatever-you-want culture better than anyone. Last fall, he profiled a $50,000 Medicare-covered prostate cancer treatment that has no evidence of being more effective than a less-complicated $10,000 treatment, among several other examples. "Genentech has not shown that its expensive vision-loss drug is better than a cheaper alternative," writes Leonhardt, "but taxpayers still pay the bill."

Emphasize prevention over treatment 
In his book Getting Better, Charles Kenny notes that, "Worldwide, there are now as many people overweight as malnourished (1 billion)."

The cost of obesity in the U.S. is nearly $300 billion a year. That's outrageous for something mostly preventable. The cure for an untold number of ailments isn't a new drug or surgery. It's a banana and a brisk walk.

You take it from here
I want your opinion. How would you fix our health-care system? Or are you happy the way it is? Let loose in the comment section below.

Check back every Tuesday and Friday for Morgan Housel's columns on finance and economics.

Fool contributor Morgan Housel doesn't own shares in any of the companies mentioned in this article. Pfizer is a Motley Fool Inside Value recommendation. Intuitive Surgical is a Motley Fool Rule Breakers choice. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.

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  • Report this Comment On April 12, 2011, at 4:43 PM, applebull wrote:

    We need basic universal coverage for all citizens utilizing the Medicare structure. A single payer plan with negotiated costs for all basic and necessary services.

    The Health Insurance Companies should have their anti-trust exemption revoked. They could then sell Additional supplementary coverage for additional coverage and added services and procedures.

    Malpractice should aim at preventing incompetent Doctor's from practicing. The thrust should not be excessive monetary settlement. Pain and suffering should be capped. Attorney fees should be capped to prevent excesses.

    We should pass a pass a law that prevents the Prescription Drug companies from charging more in the US than they do in the rest of the world. We shouldn't have to go to Canada for a reasonable price. They would be prohibited from keeping their lock step tier pricing and new drugs should go generic after five years.

    If every American is entitled to a basic education, then they are entitled to basic health care from the cradle to the grave. We should not sacrifice our Health care for the benefit of the Health Industry's profits. The Insurance Companies, the Trial Lawyers, the Prescription Drug Companies, and the rest of the entrenched entities lobby Congress and Washington with Millions of Dollars to see that they stay rich even if we don't have an affordable and dependable Heath Care system.

  • Report this Comment On April 12, 2011, at 4:46 PM, TMFBiologyFool wrote:

    The real problem is that every other country negotiates the cost of their medical care lower than private insurers in the U.S (Medicare/caid prices are based on the private insurer cost).

    Drug and medical device companies can afford to get paid less elsewhere because they make so much off the U.S. We subsidize the medical care of every other country.

    Of course if the U.S. were to lower its medical spending, innovation would stop. The only way for us to play less is for others to pay more.

    Good luck with that.


  • Report this Comment On April 12, 2011, at 4:58 PM, mtf00l wrote:

    By George I think you've got it. Additionally, those with means abroad come to America for medical treatment beyond the routine.

  • Report this Comment On April 12, 2011, at 4:59 PM, rfaramir wrote:

    A Four-Step Healthcare Solution by Hans-Hermann Hoppe

    Your "Put the patient in control" is a key agreement with Hoppe.

    Your "Force Medicare to say 'no'" is a smaller version of his ending Medicare.

    Your "The solution is rationing. It has always been rationing." is completely immoral in the direct, government controlled sense, and contradicts putting the patient in control. The only moral and efficient way to ration something is with the free market. Prices ration everything according to people's subjective valuation: those who want, need, and can afford bid prices up, those who don't need/want/or can't afford substitute down the chain of alternatives. Freeing up the market for alternatives is especially important for the poorer among us.

    Your "Make coverage mandatory" is totally backwards. No one should be forced to buy anything they don't want, ever. The only thing that is mandatory is "If you want it, you pay for it." Nothing for free, since nothing really is, anyway. If it looks like it is free, someone is benefitting behind the scenes.

    Your "Emphasize prevention over treatment" is wise as far as it goes, but each person has a different valuation of how much now versus later to spend. If they're spending their own money, it doesn't matter to the rest of us what they decide. The whole point is we only have to "get it right" if one size has to fit all of us.

  • Report this Comment On April 12, 2011, at 5:19 PM, TMFDiogenes wrote:

    "The only moral and efficient way to ration something is with the free market."

    Wow. I hope this isn't supposed to be categorical. I don't think I could afford to hire a private army, so it's not just inefficient, but actually IMMORAL for me to be protected from foreign nations.

    Listen, I love the idea of free choice, but hyperbole has its limits. The idea that Man is or should be a perfectly autonomous Heroic Individual is a fantasy.

    I personally think there's some moral imperative for the community to leverage its economies of scale to ensure its members' health more efficiently and with some kind of minimum standard, rather than leaving everyone to fend for himself.

    Hopefully we can discuss the most efficient way to achieve those aims, or at the very least discuss the limits of that imperative, rather than throw opposing absolutes at each other for the entirety of another comment thread.

  • Report this Comment On April 12, 2011, at 6:10 PM, wan2bretired wrote:

    Using WHO data for infant mortality is a farse. Most nations exclude data for all but "normal chlid birth" Non- high risk mothers, delivering at normal term. The US includes all births, high risk, pre-term and births in which major birth defects exist. Most nations do not. Other factors include the uniformatiy of the population, such as Iceland with a low infant mortality. Illegal aliens are included in our data. Our skewed infant mortality as reported by WHO is just plain wrong.

  • Report this Comment On April 12, 2011, at 7:01 PM, Heartslord wrote:

    Thousands of studies show acupuncture and Chinese herbal medicines can effectively treat post-stroke, GURDS, reflux, asthma, ADD, IBS, most chronic pain and more.

    Having performed about 75,000 treatments myself I can also vouch for it (along with WHO, NIH, etc).

    Most western medicine is terrible at treating primary medical problems like those mentioned above. They are simply fronts for the pharm industry until that particular drug is pulled from the market. As a former Pfiser chief medical officer told me in reference to Feldene "Tom you should see all the allergic deaths we've had". This while he received non-western treatment.

    In order to honor western emergency medicine (that's what really works the best) and allow for other things that work we need:

    1- Catastrophic insurance. This will protect you for emergency visits and excessive costs of treatment such as for cancer, major surgeries etc.

    2- Pay out of pocket for a "doctors" visit. This may include the acupuncturist or chiropractor or whoever you choose.

    The cost of paying out of pocket and choosing your service would be the same or less than paying those insane monthly premiums for terrible results and unecessary operations.

    Then we need to get rid of the specialists. Do you really think the human anus is so specialized it needs it's own doctor? How about the ear/nose/throat? What does a gastroenterologist do? Not much. But since your doctor knows that western medicine doesn't do much they send you to a specialist... with little or no results.

    We prove our results everyday and we also give endless amounts of free care to people who have none in a system that doesn't work. My solution is simple and will save us endless amounts of healthcare dollars and see patients get better fast!


    Tom Chi L. Ac.

    (that's not a plug, we won't get biz from this but you can see the vids of before and after often just one treatment to get the idea of what acupuncture, etc., ) can do.

  • Report this Comment On April 12, 2011, at 7:20 PM, Thaeger wrote:

    Per a recent NPR story (regarding health care insurance, gastric bypass, etc):

    "While Tennessee ranks among the nation's fattest states, TennCare's budget is stretched thin because of sagging tax revenues. Long says if paying for dietitians saved the state money, they'd do it.

    "But there's really no evidence to support the fact that providing those services would result in a decrease in medical cost, certainly not immediately, and even in the longer term," she says."


    Also, any thoughts on mandatory auto insurance? Everyone takes it for granted since it's been mandatory in most states since the 20's-30's (which has made it difficult to determine what people thought about it back then), but it seems that there'd be more than a few parallels in terms of benefits, pitfalls, and so on.

  • Report this Comment On April 12, 2011, at 8:01 PM, richsue3 wrote:

    Step 1 - Each Insurance Agency will deposit in individual state cofers as % of profit into "catastropic Fund"

    Step 2 - State run Maximums on medical fines of doctors/hospitals UNLESS grievance shows medical Malfeasance.

    Step 3 - Those not covered by insurance but with assets will have liens laid on assets to pay medical bills. Those with no assets will be taxed at yeat end against a % of their earnings untilbill is paid off.

    Step 4 - More clinic based services provided by the likes of Wlamart and other companies willing to make a SMALL % of profits from basic services offered.

    Step 5 - Medicare to fund major 85 year old + coverage over individuals ability to pay.


  • Report this Comment On April 12, 2011, at 8:15 PM, Glycomix wrote:

    According to Alan Greenspan 50% of the medicare entitlement is unfunded -not paid-for by taxes-and goes directly to debt. [source (a) or watch utube video sec 28 to 36: click link -> clip

    So medicare adds $2T to the debt each year.** That’s a little high since the total taxible income in the US is $5.6 trillion/year in according to Michael Parisi(2010) .

    The solution is to either to double the medicare payroll tax from 3% to 6%,


    eliiminate (1) the Medicare prescription plan and (2) ‘end-of-life’ benefits which may add from $200,000 to $500,000 to deaths when individuals are taken to hospitals.

    ** Amount of Medicare debt added each-year was calculated as follows: (b)$29.3T medicare debt in Feb 2005- $37.8T med*care debt in May 2009(c) = $8.5T/4.25yrs = $2Trillion/ year

    Sources: (a) 50% of Medicare unpaid by tax. ¶32 ; (b)2009_Medicare_debt ).] (c) 2005 medicare debt

  • Report this Comment On April 12, 2011, at 9:00 PM, wolfhounds wrote:

    The U.S. government has two medical systems that are so totally different in efficiency and care that most Americans (including TMF writers) aren't aware of this.

    When I worked in private industry I had excellent coverage, but had long waits to see a doctor. When a complication arose (old story) I was given a slew of tests to be sure. But when I became convinced that my thyroid treatment was over the top I decided to get a second opinion. Since I am a 100% disabled veteran I'm eligible for full treatment at any VA facility, which I took advantage of.

    The first thing I discovered was all the thyroid scans and medication weren't needed. The second was the VA had a system by which each patient is given a primary doctor. That doctor is responsible for the usual exams and blood tests, and other preventive care twice a year. At each visit the doctor checks the test results with you, monitors your alcohol and smoking habits, eating and diet, and reviews when all other exams are needed, such as, cholonoscopy, urology, eye clinic. All doctors coordinate the patient's treatment through computers anywhere in the system. While vacationing in Florida this winter I visited a local clinic for allergy problems. The examining doctor reviewed my medical history online and prescribed medication for whatever I picked up down south. My dermatologist reviews my agent orange caused rashes with my oncologist, and both of their progress notes are reviewed by my primary.

    i am sure everything doesn't go as seamless for everyone, but it sure beats the inefficiency and cost of Medicare.

  • Report this Comment On April 12, 2011, at 9:18 PM, baldheadeddork wrote:

    Aren't we overthinking this? If we really want to fix health care costs, why not start by looking at what the countries that pay half as much and get better results are doing - and do that?

    We are as much in denial as a 450-pound guy reaching for his third deep fried Twinkie. Everyone knows health care costs are out of control in a way that deserves that cliche, and our basic system of delivering health care is FUBAR. But we don't want to fix it unless the solution fits into a nice, neat description of how we want to feel about the structure of our health care system. It can't hurt anyone who's in the system now, it can't defy our worship of free markets at all costs, it can't cut profit margins for supplier companies, it can't benefit people who we don't think are worthy of care...and so on.

  • Report this Comment On April 12, 2011, at 11:01 PM, cmbourne wrote:

    "who gets the free electric scooter?"

    Until our society is willing to face that question and require every citizen-patient to take some financial resposibility, the situation is hopeless.

    Medicare is the leader in setting fees, and policies.

    Every Medicare or Medicaid patient seems to want a free scooter, a free provider ( a "provider" washes dishes and does the laundry, ie a maid) , a free MRI scan,and free meals delivered to the house.

    For years the politicians have lead them to believe that they can get anything and everything they want.

  • Report this Comment On April 13, 2011, at 6:03 AM, CaptainWidget wrote:

    as rfaramir mentioned, this article is loaded with contradiction. more patient choice, OK. Except you have no choice but to buy insurance......

    Emphasize prevention.....sure. Except who's in charge of this preventative medicine mandate? The government? Well aren't they also in charge of rationing and death panels? With the foresight of a blind newt, how does the federal government determine the difference between necessary prevention and unnecessary prevention?

    To lower health care costs competition needs to increase, and price fixing (through government regulation) needs to decrease. Done. I'll fix the national debt for my next magic trick.

  • Report this Comment On April 13, 2011, at 9:32 AM, sfureman wrote:

    For all the talk of reducing the "cost" of healthcare, I have never heard anyone actually address the true "costs" involved.

    Look at medical care like any other business. The business establishes a resale value based on costs involved to provide the product. For a doctor's office the overhead can be real estate rental or acquisition costs, human resource costs, equipment costs, etc. A disproportionate cost that no one wants to talk about is the insurance costs. The doctors have malpractice costs. The nurses and assistants have insurance costs. The equipment manufacturers have insurance costs that are added into the acquisition costs. All of these insurance costs are passed on to the consumer.

    I agree with some of the other commentators that the AMA needs to open-mindedly consider cures and treatments that have been used successfully for hundreds or thousands of years. The FDA should consider holistic treatments that do not benefit their big-pharma paymasters.

    The AMA needs to strongly police themselves to prevent unqualified doctors from practicing. The Trial Lawyers Association should be prevented from lobbying congress (although I'd bet that close to half of congress are members).

    It is my opinion and view that lawyering is adding billions of dollars of unnecessary costs to our medical system every year, while providing no real added value to the system.

  • Report this Comment On April 13, 2011, at 10:04 AM, mtf00l wrote:

    The real winners in this equation are the insurance companies. They get paid from both sides of the contract. From the patient and from the provider. If you didn't know insurance companies are in the business of making money not giving it away. Another interesting fact is the insurance industry is one of the only in existence with an unwritten agreement that they will never let an insurance company go down. That is how they keep confidence in the insurance system.

  • Report this Comment On April 13, 2011, at 10:13 AM, cmfhousel wrote:

    thanks for the comments everyone.

    <<Using WHO data for infant mortality is a farse.>>

    That's another debate, but the data is this article isn't from the WHO. It's from the CIA World Fact Book.

    <<this article is loaded with contradiction. more patient choice, OK. Except you have no choice but to buy insurance.>>

    Not sure how that's a contradiction. They aren't mutually exclusive. You can have a mandatory amount of minimum coverage (like in car insurance) and still be active in your medical decisions.

  • Report this Comment On April 13, 2011, at 11:35 AM, salrycapcasualty wrote:

    "Another shows that becoming aware of probable cost-benefit outcomes "reduced the preference for the more intensive treatment by 21 42%."

    For a minute there I thought this study was implying something was reduced by 2142% instead of by 21-42%. As we all know, reducing an expense by 2142% creates a surplus of 2042%. Health care cost problem solved! (kidding)

    Want to reduce health care costs? Live a healthier life and intentionally limit your usage of health care resources. How far does that simple observation go towards explaining the difference in U.S health care costs per capita and other countries?

  • Report this Comment On April 13, 2011, at 11:39 AM, cmfhousel wrote:

    ^Thanks, we'll get that fixed.

  • Report this Comment On April 13, 2011, at 12:08 PM, miteycasey wrote:

    How much is the spending voluntary? I think American's have a spend everything and live as long as I can attitude, where other countries have a 'it's time to go' attitude.

    American's would give their entire fortune to live one more month.

  • Report this Comment On April 13, 2011, at 12:09 PM, cmfhousel wrote:

    <<I think American's have a spend everything and live as long as I can attitude, where other countries have a 'it's time to go' attitude.American's would give their entire fortune to live one more month.>>

    What, then explains why we're ranked 50th in life expectancy?

  • Report this Comment On April 13, 2011, at 1:12 PM, wrenchbender57 wrote:

    miteycasey, Yes that is one of the reasons our health care costs are so out of control. Far too many people burn up a lot of money in order to live a few more months. Often with a low quality of life to boot. Does not make much sense. But, when someone else is paying the bill, why not?

  • Report this Comment On April 13, 2011, at 1:14 PM, slpmn wrote:

    How many of the people crying out about how outrageous it is to require people to have insurance don't have insurance? My guess is few to none because it is STUPID not to have health insurance, and even though I disagree with their opinions, I don't think the people saying you shouldn't have to buy it are stupid. The only people who don't have insurance are the ones who can't afford it. So, then, why the big outcry about this issue, and what's really behind it? I'm going to guess its really about "I don't want to contribute a dime so poor people can have health insurance." Done. Just say it. Stop barking about protecting "freedom". You're taken care of and you would prefer not having to pony up to take care of someone else. I get it. Here's the funny thing, and the whole point of the article - covering everyone, done properly (and by properly, I mean done the way ANY OTHER 1st WORLD COUNTRY ON THE PLANET DOES IT as shown on the pretty table) actually saves money! Look how much we're spending, folks! You are spending more for your healthcare than you should be, and if the system isn't radically changed, you will continue to do so. Personally, I would like to spend less, even if that means I don't have the god given right to choose whether its the government or for-profit insurance company that gets my premium dollar.

  • Report this Comment On April 13, 2011, at 1:18 PM, wrenchbender57 wrote:

    sfureman, Unfortunately the "true costs" of medical care in this country are hidden. Mostly because our current system with third party payers encourages that. Providers bill and excessive amount because they know that they will get paid much less. The insurance companies always discount what the providers bill. Also many variables depending on how much a particular doctor feels he or she should be compensated, etc.. All of these figures could be worked out though, with the variables left as negotiable. That is, if there was any real incentive to do that.

  • Report this Comment On April 13, 2011, at 1:18 PM, wan2bretired wrote:

    WHO, CIA book of facts get there data from how each country reports infant mortality.

    This link better illuminates.

  • Report this Comment On April 13, 2011, at 1:23 PM, wrenchbender57 wrote:

    Great comments slpmn, Why is it that we are SO stubborn in this country that we can't see that we are paying way too much for way too little effective medical care? Why does nobody in politics want to admit that? Pharma and insurance lobby money perhaps? Seems like the folks that scream so loudly for "free markets" may do that because their free market consists of being paid to have an opinion that profits certain companies involved in this dispute.

  • Report this Comment On April 13, 2011, at 1:49 PM, CaptainWidget wrote:

    <<Not sure how that's a contradiction. They aren't mutually exclusive. You can have a mandatory amount of minimum coverage (like in car insurance) and still be active in your medical decisions.>>

    They are mutually exclusive. If at the base level a consumer isn't free to make the choice of "no choice" then prices will always be artifically higher than the market would dictate otherwise.

    Forcing people to have insurance will not lower prices (see Mass). Forcing people to be responsible for their OWN medical choices, however, will. I don't disagree that you shouldn't have to pick up the tab for my medical bill. But I shouldn't have the pick up an insurance tab I'll never use because you (or some government bureaucrat) says I have to.

    Free market, voluntary purchases, everyone wins.

  • Report this Comment On April 13, 2011, at 2:24 PM, Bert31 wrote:

    In the U. S., the single most expensive condition to treat is pre mature birth. It eats up more helath care dollars than any other condition.

  • Report this Comment On April 13, 2011, at 2:29 PM, Bert31 wrote:

    Yes infant mortality rates are reported in the U.S using WHO standards. Most countries do not conform to this standard, and do not report incidences where certain measurements such as weight, lenght, duration of survival outside of the womb, or gestation, are not met. So that is not a very good measure to base comparisons on, as the data is skewed.

  • Report this Comment On April 13, 2011, at 2:42 PM, CaptainWidget wrote:

    In order to be constructive (as your article asked how would I fix the problem) I'll present the same solution several doctors have presented to me.

    Allow health care costs to be 100% tax deductible at medicare rates. As one optometrist told me "If I could deduct charitable treatment from my taxes, I'd take care of everyone who walked through the door"

    Universal coverage by the free market, thanks to incentives from Uncle Sam. The government's still paying in a round about way, without the billion dollar bureaucracy surrounding the system.

  • Report this Comment On April 13, 2011, at 3:01 PM, badnicolez wrote:

    1. Remove medical insurance from the workplace (wouldn't it be ridiculous if we lost our auto insurance when we lost our job?) and have all coverage be private. Employers can provide a "health care" cash bonus if they choose.

    2. Provide a menu of coverage (much like auto insurance). If you don't want certain coverage, you don't have to buy it, but you're not getting treatment without coverage. The current mandate of "maximum coverage" for everyone is ridiculous.

    3. Remove all restrictions on purchasing insurance across state lines (increasing competition almost always lowers costs).

    4. Insurers can provide cash incentives for people to quit smoking and lose weight, beat addiction and alcoholism, and eat right.

    5. Tort reform. Another poster said we should focus on removing bad doctors from practice rather than rewarding the victims monetarily. I agree.

    6. Get drug company reps and samples of new drugs out of doctor's offices and ban advertising again. These practices have turned our doctors into pill-pushing symptom-treaters instead of diagnosticians.

    7. Force doctors and hospitals to obey end-of-life wishes, not the patient's family's wishes.

    8. Digitize medical records.

    9. No free rides, literally. Give seniors a set amount ($500,000?) of Medicare "coverage" and once they've used it up, that's it, they need private supplemental coverage or pay cash. Want to see seniors become smart consumers, make better decisions and take better care of themselves?

    10. Tax the crap out of anything and everything that is known to cause poor health (high-sugar-salt-fat-calorie foods, cigarettes, alcohol, etc.)

    11. Finally, mandate minimum catastrophic coverage after the reforms listed above bring down costs. If you "can't afford" it, the government helps you pay premiums, as long as you aren't obese, don't do drugs, aren't an alcoholic and don't smoke. Otherwise, sorry, Charlie, you could have spent the money on the premiums instead of excess food, drugs, booze and cigarettes. No treatment without insurance, ever, unless you can find a church or charity to pay, otherwise a mandate is toothless and will be ignored by most.

  • Report this Comment On April 13, 2011, at 3:16 PM, geack wrote:

    RE: rfaramir

    Having the population, as a group, say "we'll pay this much, but no more, for everyone to have access to this treatment" is somehow less moral than allowing the prices for everything to be set by the deepest pockets, thus ensuring some people can't afford a treatment at all? That's an interesting way to define "moral".

    Government rationing doesn't mean those who can afford more can't get it. Done right, it means the govt (ie all of us) agree that our collective money will only be spent on the treatments that make the most financial sense. Everyone gets treated for their heart attack (and more importantly, everyone gets the preventive care they need to help prevent heart attacks), but if you want the experimental bionic heart you pay with your own money (or more likely, with your supplementary private insurance). More money might still mean better care, but everybody gets reliable basic care, and much less tax money gets wasted.

  • Report this Comment On April 13, 2011, at 3:16 PM, Bert31 wrote:

    Medicare pays at a reduced rate of what the market price is. A procedure costs $100? Medicare pays $85. They are reimbursing below cost. So providers make up the difference (loss) by charging private health insurance companies more. So, insurance premiums are increased.

    Then, as the market price moves up (based on what providers are charging private insuracne) medicare reimbursements increase, and so on and so on.

  • Report this Comment On April 13, 2011, at 3:34 PM, trymk46 wrote:

    is all life worth milliions of dollars? is a premie worth saving? do we all need to live to be 100?

    all the diagnostic test, all the life saving measures to save one life is the basic question. Unfortunately, we will never get passed those questions in our society.

  • Report this Comment On April 13, 2011, at 3:34 PM, buddylee59 wrote:

    'Focusing on the blue line' is where the problem begins. It's a flawed comparison. Overlay the chart of blue and red lines with a chart depicting the average tax rate in each nation.

    Here are some questions:

    What percentage of American doctors belongs to the AMA?

    What would happen if we were to double the number of medical schools in the US, reducing the artificial shortage of MDs that presently exists?

    What would happen if we opened up the markets for medical devices, drugs, and ancillary services such as home care by de-funding the existing government

    structures tomorrow?

    (medicare Parts A B and D)

    How many lobbyists work in DC for the American Hospital Association?

    When did access to unlimited health care become an inalienable right?

    The comment by the veteran above is illuminating because it reveals the already-existing redundancy in the US's government-administered/taxpayer-subsidized health care structure.

    The only way a government can ever reform or improve an existing entitlement is by reducing the amount of money expended on that entitlement , and continuing to narrow the scope of the expenditure until the reform's criteria are met and satisfied.

    (See Reagan's reduction of days per hospital stay in the early 80's through implementation of Diagnostic Related Groups)

    Government-funded and operated health facilities are among the most bloated and inefficient in the country. They are the private empires of local politicians, unaccountable because the regulator and paymaster are already one and the same.

    When parasitic groups of every political and philosophical persuasion are no longer given governmental blessing to siphon revenue out of the American health economy, then we can begin to have a conversation about the structure of the system itself. But before that can happen, the moneychangers must be driven from the temple.

    (Please excuse the non-secular metaphor.)

  • Report this Comment On April 13, 2011, at 3:51 PM, PerfectlyLegal wrote:

    Everything For Sale, a book published by author Robert Kuttner back in 1997, is the book that those of you advocating for market solutions should read. His discussion of the market in health care is definitive.

    My fellow Fools are, as usual, all over the map both ideologically and factually, so I think that other than suggesting this book I will just watch this conversation from a safe distance, like I would watch fireworks.

  • Report this Comment On April 13, 2011, at 3:56 PM, MaxTheTerrible wrote:

    I agree with pretty much every point in your article. We are not going to drive medical costs down until everybody has some skin in the game. Simple solution would be to make everyone pay, say 5-10% of every treatment cost.

    I agree that universal coverage should be mandatory just like a car insurance. More importantly, penalties for not having a basic insurance coverage should be substantial (say worth 5 years of premiums), so that people would not wait to get insurance until they get sick.

    We should also encourage healthy lifestyle. So, how about redirecting portion of your medicare/aid taxes into a personal's health savings account? To go even further we could say that if a person accumulates enough funds in HSA, say $500K in today's dollars, he/she could withdraw the rest and use it as he/she pleases.

  • Report this Comment On April 13, 2011, at 6:08 PM, FPforever wrote:

    As a primary care physician, I think of many people who are unable to pay for their needed medications or treatments. I feel that the strength of any society is measured by how well they can care for the least able in that society. On that basis, if the US can no longer find a way to care for those least able to care for themselves (at least for basic needs) it shows how far our society has fallen.

  • Report this Comment On April 13, 2011, at 6:30 PM, boogaloog wrote:

    I pretty much agree with everything slpmn wrote. Why do so many of us use rhetorical soundbites to deny that we're simply greedy? And why do so many of us reject following whatever some other country is doing, even though it is clearly working so much better?

    And why do politicians spend millions of their own dollars to get elected to a job that pays 6 figures? Uhhh, because they're all corrupt and make miliions upon millions by being puppets of lobbyists from all industries.

    To those of you who make overly-simplistic statements saying each individual has to pay his own way or no treatment: what about those people who don't have a choice about getting treatment? Who are they, you ask? People taken to the hospital while unconcious. Let's say someone at Gabriel Giffords' event (call him Bob)was shot just like her. Bob goes to the hospital and no-one knows who he is or if he has insurance. (Even if he doesn't, should we as a society NOT help someone injured in such a sickening tragedy?) So Bob undergoes multiple VERY expensive surgeries while in an induced coma. He then can't function on his own for MONTHS. Should he now be on the hook for what is probably millions of dollars of medical bills? He never asked to be treated. What's your response to that?

    Simple answers ("no insurance, no treatment") are rarely adequate to solve complex problems.

  • Report this Comment On April 13, 2011, at 6:50 PM, Bert31 wrote:

    The fact is the majority of people in the U. S. are insured in one way or another. Of the 48 million supposedly uninsured (the approximate figure thrown around during the 2008 presidential election) 25% were eligible for Medicaid/SCHIP but not enrolled, 20% were not U. S. citizens, about 10% were college students, and another 20% were people who earned more than $75,000 per year. That leaves about 25% (16 million) truly uninsured with no viable options.

    College students are very inexpensive to insure. Enrollment in current programs such as Medicaid or SCHIP shoud be 95% befrore any futher expansion. If you make over 75,000, you are on your own, buy insurance or pay out of pocket and go bankrupt. If you are coming to the U. S. to work or whatever reason, you have to provide proof of medical insurance to obtain a visa.

    So what about the 16 million who fall between the cracks? I don't necessarily have the answer but before any serious discussion of a solution, the true prolbem must be identfied. Obvilously the problem is the cost of healthcare, not access.

  • Report this Comment On April 13, 2011, at 7:00 PM, Bert31 wrote:

    <<"Three out of every 10 Medicare dollars are spent for people in their last year of life," said former Comptroller General David Walker last summer>>

    I would be very interested in knowing the ages of those receiving those dollars and if they are all going to granny and grandpa as we all assume, or how much of it is going to those premies who don't survive.

  • Report this Comment On April 13, 2011, at 7:56 PM, a1juice wrote:

    So happy that CMBourne mentioned the Scooter! Since my husband turned 50, we both get at least 4 e-mails a week telling us we can have a "hover round, Scooter, diabetes testing supplies, wheel chair, etc " for free!! I would love to know how many millions of dollars are spent on these items when they aren't even needed. On top of that, My Grandmother needed a wheelchair, so we bought her a pretty good one for around 650.00. I later saw the company charged her medicare account $750 (and was paid) for that same chair we bought with our money. We called the company to ask why they billed for the chair we bought. They said it was for "insurance" in case it needed to be replaced! Now why would the insurance cost more than the cost of replacing the chair??

  • Report this Comment On April 14, 2011, at 12:17 PM, varney wrote:

    Not surprisingly, Morgan uses statistics to denigrate the US healthcare system that don't aren't directly related to health care.

    Life expectancy isn't solely dependent on the health care system. The US has the highest rates of murder and accidental death in the world, and many of those deaths occur to people who are relatively young; this drags down life expectancy significantly. Analyses which have been done to try to adjust for this have found that US life expectancy is the highest in the world.

    Similarly, we have far more low-birth-weight babies because we have a much higher rate of teen pregnancy than other industrialized countries. Again, this isn't an indictment of the health care system! If you look at infant mortality for low-birth-weight babies, you'll find that the US has the lowest; again, a result of our BETTER health care system.

    The most amusing part of the fact that liberals like to trot out our leadership in per-capita healthcare spending is that those same folks want to sweep our leadership in per-capita education spending under the rug. At least with healthcare we have a superior result. In education, we spend more than any other industrialized nation, but rank dead last.

  • Report this Comment On April 14, 2011, at 12:23 PM, varney wrote:

    <Also, any thoughts on mandatory auto insurance?>

    Apples and oranges. You have to have liability auto insurance to cover your victim's costs - you are not required to maintain comprehensive or collision coverage (which pay your costs).

  • Report this Comment On April 14, 2011, at 4:17 PM, drborst wrote:


    Maybe I've seen the stats Morgan used enough that I've started to believe them but really don't know any better. I'd be interested to know where the analysis including the murder rate and accidental death come from (it sounds like interesting reading).

    I'd also be really interested to know about this teen pregnancy thing you mention. It doesn't sound righ to me. All the girls from my high school who had babies early had healthy ones , while the two who had their first following the 20 year reunion had other problems. I don't think low birth weight babies correlates with age of mother, it is more correlated with things like the mother smoking and drug use. Along those lines, I don't find your claim that the US accidental death rate is the among the worlds highest credible. And we all know there are more suicides per year than murders, so the suicide rate would be at least as relevent.

    And really, is Morgan denigraating the US health care system using data? I know we tend to think of health care as hospitals and people wearing scrubs, but aren't the rate of smoking and obesity and murder and suicide and accidental death all public health issues. I tend to think it is right to include those things. (and it would also be a good idea to include some kinds of public health spending in the comparisons, like the amounts we spend at OSHA for example).

    In short, I'm not sure I believe your claims, but would love to see data.

    Oh, and your second post. Kinda wrong. In an auto accident, my victim is a specific party. But if I don't have the means to pay my medical bills, then the victim is everyone else who uses the service and has to pay more. Some kind disaster coverage being mandatory isn't that different from the auto insurance that is required.

    By the way, I don't disagree with your main conclusion on education (that we spend ineffeciently), but I really don't like the consequences

  • Report this Comment On April 14, 2011, at 4:26 PM, cmfhousel wrote:

    There are several papers arguing that studies adjusting life expectancy for murder that put the U.S. in first place are statistically flawed. Email me @ and I'll shoot you a copy.

  • Report this Comment On April 14, 2011, at 4:57 PM, yarp55 wrote:

    1 the insurance companies should only write catastrophic policies for health care and drugs that cost very little if everybody buys one and make it mandatory.

    2 the government should buy catastrophic policies for for the the very poor.

    3 make doctors have menus like restaurants for every service they provide let them compete .

    4 write off on your income taxes what you spent before your insurance took over.

    very simple too simple for the lawyers and health insurance industry.

  • Report this Comment On April 14, 2011, at 5:46 PM, daliya wrote:


    We older sicker debilitated nearly dead people can offer to die before millions are spent on non essential and non effective tests etc and procedures that make doctors and hospitals rich but do not improve our lives. These end of life non essential procedures cost the country a lot of money and do not get us to heaven happier.

    If we are unable to get weller and will die anyway don't allow doctors and hospitals and labs to get rich doing procedures and tests and surgeries-like chopping out the stomach of someone that has no legs or lungs of chance to live- already half dead but still have insurance to pay for this. .

    This is criminal waste of money and is practiced in hospitals to make them rich and not improve our last days on earth.


  • Report this Comment On April 14, 2011, at 8:39 PM, teddipoo8699 wrote:

    We want the same health plan benefits that these 535 men and women receive as lawmakers . Nothing less.

  • Report this Comment On April 14, 2011, at 9:51 PM, Bert31 wrote:

    <<The U.S. ranks 50th worldwide in life expectancy, barely ahead of Bahrain and Libya. We're 47th worldwide in infant mortality, with a rate twice as high as France, Hong Kong, and Sweden. It's pathetic.>>

    Is this a win at all costs prospect? Most of the top ten countries in the list are either ridculously small populations (Monaco 30,539), or have an incredibly homogoneous population which make it much easier to deliver health care solutions. The many ethnic differences in the U. S. cause a great deal of health care disparities, which in turn effect life expectancy. To take these simple types of data points to say the health care in the U.S. pathetic, is, I think, pathetic. It makes a very nice headline, and you get alot of comments on your column, but it does nothing to educate or enlighten, though I am sure some folks find it amusing.

    TMFBiologyFool absolutely hit the nail on the head. The U.S. finances health care innovation for the entire world. The U.S. has to decide whether we will continue to innovate for the benefit of the entire world or not.

  • Report this Comment On April 15, 2011, at 2:05 AM, Rowants wrote:

    How about starting with cutting the BS paperwork. I have a stack of papers here from one friggin doctor visit. The doctor charged $120, the agreed charge is $103, which I paid immediately, yet here it is, almost a year later, and I am still getting statements that show $17 insurance pending. I've called both the doctors office and the insurance company, to no avail. If I am having this much trouble for this, I can't imagine what is going on with people who actually have a complicated bill.

  • Report this Comment On April 15, 2011, at 11:13 AM, CluckChicken wrote:

    I find two problems with putting patients in more control and there really are little to no solutions for these.

    The first is the shopping around for the best service for ones medical needs. For those that have major illnesses that require constant treatment the options are already very few, and cheaper services tend to be relative (is 500k really any cheaper than 515k and is the cheaper option even accessible to you?). The other issue is that the 2nd most expensive time for medical cost come from emergency services, in which case one doesn't have either the time or the option to shop around.

    Second problem are the patients themselves. History has shown time and time again that the majority of the people are not very bright. Most people have a difficult time understanding their prescription drug coverage let alone what they may have to deal with for major medical issues. Also such an environment invites fraud, just look at what happened in the mortgage industry, which is complicated but far less so then the medical industry.

  • Report this Comment On April 15, 2011, at 11:18 AM, EBerg13 wrote:

    A recent article I read suggested retiring in France because the weather is good, outside of the big cities the cost is low and "France has the best health care in the world." Whomever noted we should see what other countries are doing is right. Take the best and emulate them.

    I think a single-payer system would have been on the table when reform was passed if the economy had been better. Right now, this country can ill-afford to put health insurance workers on the streets. On the other hand, what a boon for small business a single-payer system would be. Talk about innovation! When people with ideas big corporations don't want to hear about start walking to work on them, we'd see some real economic growth ... and with that benefit off the backs of industry, some real competition with the rest of the world.

  • Report this Comment On April 15, 2011, at 12:52 PM, daliya wrote:

    How to save medicare costs



    We older sicker debilitated nearly dead people can offer to die before millions are spent on non essential and non effective tests etc and procedures that make doctors and hospitals rich but do not improve our lives. These end of life non essential procedures cost the country a lot of money and do not get us to heaven happier.

    If we are unable to get weller and will die anyway don't allow doctors and hospitals and labs to get rich doing procedures and tests and surgeries-like chopping out the stomach of someone that has no legs or lungs of chance to live- already half dead but still have insurance to pay for this. .

    This is criminal waste of money and is practiced in hospitals to make them rich and not improve our last days on earth.

  • Report this Comment On April 15, 2011, at 1:03 PM, shruggered wrote:

    The biggest problem with the discussion of medical costs is that nobody addresses the medical costs. All the discussion is centered around how to pay for something that has no incentive to become value based. We never ask how much should something cost, we just worry about how we are going to pay for it. How much should the chest X-ray cost, how much is the blood work, how much is this operation, are all irrelevant to the current discussion. Until there are incentives to compete on price and quality, all solutions are doomed to failure. Claiming we have anything approaching a market system for medicine is obscene. We have a mountain of regulation which leads to higher costs and less efficiency which in turn turns up the volume on the demand for more regulations. What if a doctor could compete based solely on price and quality? What if there were no restrictions on medicines and a patient could consult with a specialist about which to use, but could then purchase whatever drug they wanted with no prescription? Why is it illegal for me to open a surgery center to provide operations for a fraction of the hospital cost with significantly better outcomes? I'm glad high deductible insurance policies exist, but I can't shop for services because there are no incentives for doctors to provide price based services. Until the model is changed completely, I can predict the natural history of the health care disease-more cost and less productivity.

  • Report this Comment On April 15, 2011, at 1:30 PM, apachelark wrote:

    Perhaps is we did away with all the many frivolous programs we have it would make a difference. And unless you were totally disabled or very elderly you would work for free to pay for health care cleaning up parks or other jobs to benefit the public. By giving away health care free we are enabling people to live off our tax money. There are people that know how to milk this system more than you or I could ever comprehend. It's not fair to those working or those retired that have paid in to the system for decades.

  • Report this Comment On April 15, 2011, at 1:35 PM, enzo1012 wrote:

    1) Get rid of the Lobbyists! These add a lot of costs to medical products and insurance costs

    2) Can we have affordable health in this country? Yes, but not run by the govt.

    3) Publish rates for all services in Doctor and Hospital offices at the front door. These should not be hidden costs. Different rate exist with every insurance provider. People would shop, and insurance companies would reduce rates.

    4) I pay for my health insurance, and I'll bet most people do not know dental insurance costs more than paying out of pocket. How do I know this. My dentist pulled out his published rates, and shared my last 3 years out of pocket expenses, and said add this to the annual premium. He then said knock off 15% off the published rate and see if paying me cash, credit, or credit card saves .....$850/year savings over my insurance, plus deducts!

    5) I have heard every Doctor and Dentist tell me their premium costs are driven by a number of items....force this industry to do what automotive did, and Microsoft....Focus on Process, Lean Business (most readers will not understand Lean), Single IT software solution. Doctors and Dentists pay staff or outside agencies to keep them up and running with interfaces. Have staff on board tracking down monies owned by insurance. Redundant costs.

    6) I would like the Motley Fool to contact me. I just completed a major project out of the country, helping a major govt reduce their health care costs. This same effort is needed here. But egos in hospitals and health insurance are too big, and they know best. If the Fool wants details, they have my e-mail. I would be happy to provide more data.

  • Report this Comment On April 15, 2011, at 1:41 PM, catoismymotor wrote:

    Soylent Green fused with Logan's Run.

    Of course that means I would be dead by now and in your cereal bowl.

    So be it.

  • Report this Comment On April 15, 2011, at 1:48 PM, puckjohnl wrote:

    Want a solution? Why not start at the very macro level and understand that the majority of stakeholders in the healthcare debate first and foremost don't even understand the intrinsic MODALITY of healthcare as a business or public entity. If I were to list an entitie's attributes as universal coverage, fundamental public need, 24/7 coverage, rural/city access, satisfaction driven, significant environmental and social consequences, etc.- the overwhelming response from an educated and thoughtful public would be Surprise - PUBLIC UTILITY! We have PU modalities in this country that, for decades, are and have been very successful in providing cost-effective goods and services with fairly responsible oversight at every government level. And the last time I looked, most of them were pretty solvent and still often classed as "widows and orphans" investments with long-term staying power. Restructuring healthcare delivery in this country using cost-effective analagous PU strategies might go a long way to improving service, focusing on true delivery costs, upgrading customer satisfaction, and fostering true innovation. Perhaps we need fewer "caring and sharing" medical types and more systems engineers who truly understand large-scale systems integration, economies of scale, marginal analysis (best use of last spent dollar) and a host of other structural changes that would truly make Healthcare delivery and its attendant costs a "national system."

  • Report this Comment On April 15, 2011, at 2:12 PM, BBRAF wrote:

    .I believe that every body is entitled to medical care at the basic level.This sould be covered at the goverment level and the rest sould be the responsibility of individuals.We essentially do the same for food.

  • Report this Comment On April 15, 2011, at 2:36 PM, chitownjester wrote:

    I agree with one commenter above who stated just go copy the system (or best parts of multiple) of other countries who spend less and get more.

    For everyone who thinks you shouldn't be made to buy healthcare by the govt' - why then am I made to buy advanced weapons systems and support bases around the world? I have no say in that either. I also have no say in getting an education, but no one is peddling a dogmatic "you shouldn't be forced to be educated" mantra - because dogma aside it is a completely non-practical, non-workable notion which flies in the face of the obvious: better education provides better life options and higher income (in the aggregate).

    Truth is this- big business is behind both decisions - a less efficient, private-run, fee-for-service medical system employs more people, guarantees simpler money-making formulas for higher-paid speacialists, and cannot be held to account for outcomes. Big business also benefits from socialized defense (socialized loss, privatized profit) and again, is not held to account for outcomes. How are three wars making me safer? What statistics are used to demonstrate this? If I am acutally safer, at what cost? Is the expenditure worth it, or would it be better to fund other priorities such as education? Can't hold the military/defense establishment accountable, because as soon as anyone does the chorus of "we have to support the troops!" and "weak on defense / missle gap / Al Qaida / Lashkar-e-Taiba / etc." jump in and make sure the debate is cut-off through emotive arguments which serve only to maintain the status quo.

    America prior to WWII had no standing army. Now we spend more on military than all other countries combined. Defense and health care will drain this country.

    Prior to WWII there were no (or few) employer-provided healthcare plans. They were added post-war when companies had fewer dollars to give raises, and providing healthcare was a cheaper way to increase total comp (yes, healthcare once cost so much less employers wanted to pay in benefits!!!) The employer funded system is inefficient, opaque and enables a system which again is not held to account for patient outcomes.

  • Report this Comment On April 15, 2011, at 3:04 PM, Excusemesir wrote:

    To reduce the cost of medical care in the US, I would take away the regulatory and enforcement powers of the FDA, leaving them with a certification standard, much like Underwriter's Laboratory.

    FDA approvals are so arduous and expensive that it is impossible for any new inexpensive treatments to be brought to market, simply because the return on investment is not there. Take away their regulatory powers, and treatments would be able to say either that they are "Approved by the FDA", or "This treatment has not been approved by the FDA."

    Nutritional approaches, Complementary and Alternative Medicine, and many other treatments that cannot be patented are available. Under the despotism of the FDA, however, there are individuals in prison for trying to help people with treatments that worked, but that they could not afford to push through the FDA approval process. And there are thousands of others who have been bankrupted by FDA lawsuits, just to keep their relatively low-cost treatments from threatening the profits of the drug companies.

    And while some may worry that this would allow the use of treatments that might harm people, it has become evident over the last decade that the FDA approval process lets a lot of treatments through that still cause extensive harm, and evidence of that harm does not necessarily get the drugs off of the market. Given the number of Big Pharma executives who take sabbaticals to work for the FDA, or who move back and forth between the FDA and industry, it appears that the primary function of the FDA has become that of protecting profits for the pharmaceutical industry.

    Certainly there are many other steps that should be taken as well, but eliminating the regulatory and enforcement powers of the FDA would make a big difference.

  • Report this Comment On April 15, 2011, at 3:08 PM, wrenchbender57 wrote:

    IF health care coverage is NOT mandatory then many people will wait until they have a need before they start paying premiums. When that happens then all the people pay for their health insurance on a regular basis get the shaft. No way has been shown yet to prevent that except for some kind of mandatory system. Why should the rest of us subsidize those who game the system?

  • Report this Comment On April 15, 2011, at 3:11 PM, wrenchbender57 wrote:

    The combined waste from the current system should more than pay for a system that treats everyone without the overhead and beuracracy Is that not evident to most of us?

  • Report this Comment On April 15, 2011, at 4:03 PM, justtired2 wrote:

    I agree, the combined waste from the current system could pay for a more workable system..We should evaluate other systems.

    We should take a good look at our Medicaid and Welfare systems as well. Why should I work all my life, have two children (anyone hear of birth control)! And put both through college, on my own dime...sometimes working 3 jobs! While, and this story is true...A woman that I know, has six children (by different men) children about 2 yrs. apart...she recevies around $450.00 each per child...along with free housing, heat and ult..medical care and food stamps for all...and to top it education! You figure out her take home pay...and noticed...the spacing between children...adds up to about 28 years of free stuff, out of my taxes! I know, people can make mistakes, but should I be responsible for six of them??? Ok...then let's allow one.....and, it takes two to tangle..split the years for child support payments....9 for 1 parent and 9 for the other....I bet this would put a stop to this!

    I've worked in the health care industry...I heard entire families discuss how they fraud the medicaid family cut holes in the kitchen walls so that each bedroom had access to the kitchen in order to receive Medicaid benefits (each family group had to have a kitchen available in order to get benefits)!

    Believe me, the doctors are in it too....I've had doctors order tests just because it was covered, not because the patient needed the tests!

    I know I sound like I'm ranting...but, just when are we really going to take a good look at the issues and fix seems like all we do is wait for the next elections and listen to same old stuff!

    We need business people in our government rather than the politicians who are so busy running for office while in office and who are too afraid to say or do anything to spoil their free ride! I say, if they don’t do their jobs…We The People terminate them and hire someone who will get the job done and let’s all have their benefit package!!!!

  • Report this Comment On April 15, 2011, at 4:16 PM, MrMikeS wrote:

    I am a small business. I do not like the government to tell me and my business to have to cover my employees with health insurance. I leave this choice up to my employees. I pay them extra each month for a health plan offered by BCBS. They can decide to buy insurance on their own. This was they are in charge of which insurance company gets the funds or not.

    I truly believe that our insurance costs would not be as high as they are if the Lawyers did not get into this business. I bet the business that has the most lawyers is the insurance business. After all if the insurance company has a lawyer then sometimes the customer has to hire one also just to defend himself from the insurance company. This is a great country.

  • Report this Comment On April 15, 2011, at 4:29 PM, ROGERADAMS wrote:

    I've been a Fool Premium member since 1998 and this is my first comment. I have had an HSA insurance plan for 7 years, prior to very high deductable insurance. I'm 61 and have been mostly healthy all my life. As of today my HSA has paid 0 dollars in 7 years. I learned early on to ask for alternatives to the expensive treatments. My Doctor knows my situation and we always talk about cost before anything is done. I believe we could cut health care costs in 1/2 or less if everyone was responsible for the first $2500 per year. This is based on my own experience. My Dad died last May, 2 bouts of pneumonia back to back. Medicare paid over $100,000 his last 2 weeks of life. I love my Dad but it was all to no avail. There is a point in quality of life we just gotta let go. I could give countless examples of situations where I have gotten medical treatment at less than half price by asking questions. I would not bother to keep the cost down if I had no deductable. It's really just that simple.

  • Report this Comment On April 15, 2011, at 4:29 PM, Jfrvw wrote:

    Look at our "NonProfit" hospitals. New Buildings & Equip,....expansion.....expansion! And how about some of the Dr.'s Fees! I waited 1.25 hrs in the waiting room, when all I wanted was my meds renewed. Then, another 20 minutes in the room, waiting for the Dr. When he finally arrived, he began telling me all his problems. After 15 minutes, I told him I had to leave. By-the-way, he did say he would renew them. Then, the bill came in the mail.....$145.00!!! I called, but could receive no satisfaction. I don't have any insurance & trying to make it on tough!

    There should be a set charge POSTED, both in Hospitals & Dr's. Offices. It sure would stop people from going in. Especially, indingents, (druggies) waiting in the Emergency rooms, etc.

  • Report this Comment On April 15, 2011, at 6:14 PM, fromthecenter wrote:

    Nicely done. This was the endless comments page.

    I would suggest that a start to a better health care system would be an informed discussion of the kind of medical system that this country would like to have. We like to think of the US as # 1, what sort of medical system could we create that would merit that designation. This must be noisy and national.

    Dealing with the problem peacemeal, which is what probably will happen, tends to run into problems of whose ox is getting gored, or rather who will lose money if any particular solution is adopted. For instance, a national health insurance program will obviate the need for state insurance commissions, eliminate the protection from competition that smaller insurors enjoy and lower payments to physicians and hospitals. So these people will oppose such a plan if presented alone.

    Perhaps the prescription for health care reform would best be taken in one dose. "ObamaCare" certainly hasn't been well received, particularly by those it most benefits.

  • Report this Comment On April 15, 2011, at 6:15 PM, mike2153 wrote:

    What does insurance do? It just takes another slice out of the pie. There should be one payer- the Government. Yes, that will require more taxes. But you get what you pay for and we're paying for a huge mess as it stands now. I don't have health insurance, nor could I purchase it if it was even close to affordable - pre-existing conditions means they wouldn't even sell it to me if I could afford it. What is government for? To me it's to provide essential services that its citizens are unable to provide for themselves. There's nothing more essential than a persons health and this country could provide that basic necessity for its citizens at less cost than we could individually. I don't understand why more people aren't up in arms at the insane system we have. Look at that chart up above; there's no third world countries on it. Those are all our equals, our peers, and they've figured out that our system doesn't work. Let's fix it.

  • Report this Comment On April 15, 2011, at 7:24 PM, williamjacobs wrote:

    The cost shifting could be greatly helped if we removed the requirement for hospitals to treat patients. After uninsured people die on the doorstep, folks will get insurance (or lobby for a public program of some kind.)

    Our current system treats people when they are dying and VERY expensive, then ships them out the door as fast as they can hoping they become another hospital's problem. This may lead to relapse where inexpensive follow up care would prevent that.

    Our emergency room is cruel, expensive socialized medicine. Anyone who says the status quo makes sense is a liar or a moron.

    Either treat people early, on the cheap, or let them die. This in-between crap is financially ruinous.

  • Report this Comment On April 15, 2011, at 8:51 PM, clc57 wrote:

    There should be a higher deductible and higher copay on all medical treatments. I agree with the author that when more of your own money is at stake you become a more selective consumer.

    Another place to cut health costs down: someone needs to look at the companies that provide medical supplies and medical equipment. Their prices are outrageous. Some of the suppplies that we are required to buy from favored vendors costs many times more than the same item at a hardware store!

    I also suggest that there be national catastrophic care insurance to cover medical expenses over a certain amount, say, $50,000. A person would be responsible for paying expenses up to that amount. This policy should also cover well baby checks, prenatal care, immunizations and annual checkups. That's all. If someone wants more than this skeletal coverage they can get private health insurance. If there is an upper limit to what an insurance company will be liable for, then their rates will fall and become more affordable.

  • Report this Comment On April 15, 2011, at 9:00 PM, Tadlarra wrote:

    Single payer is the only long-term solution!

  • Report this Comment On April 16, 2011, at 12:13 AM, MCrawley1970 wrote:

    In his book 'Multiple Streams of Income' wealth management expert Robert G. Allen pointed out that while the United States has 5% of the world's population, but files 94% of the world's lawsuits. Furthermore, frivolous lawsuits (many of which relate to medical procedures) cost the US economy about $230 Billion per year.

    It wouldn't be a panacea, but a major improvement in health care cost containment would to adopt the 'loser pays' legal stipulation that exists in Canada, the UK, Australia and many other countries. In short, when two parties litigate in civil court, the loser pays the legal bills of the winner, and such costs are assessed by the courts. It is because of the threat of civil lawsuits (and lawyers willing to work on a contingency basis) that US doctors are often forced to practice 'defensive medicine' of various sorts: procedures that are not really necessary, but protect the doctor from liability if a lawsuit is filed. Doctors are also forced to buy copious amounts of malpractice insurance as a consequence of this state of affairs.

    I also think there should be a cap on the amounts awarded for various wrongs in litigation, and the cost of filing a lawsuit should be a function of the desired amount of damages. Right now, it doesn't cost any more to file a $100 million lawsuit than it does to file a $100 one. It gives people an incentive to file 'moonshot claims'.

    If a single-payer medical system is the desired outcome, a 'loser pays' legal system will be essential.

  • Report this Comment On April 16, 2011, at 12:14 AM, organjess wrote:

    Start reducing healthcare costs in each specialty:

    Obstetrics: First do no harm. All the evidence points to more low-birth weights, more bills, more cesarean sections, more recovery time, more costs for drugs and doctors, more bills for sick infants, etc. Why? Because women are urged to induce their labors, augment their labors with dangerous drugs like epidurals and pitocin, and then end it all with a cesarean section when the induction fails or the baby goes into respiratory distress from the drugs. All because the doctors aren't patient enough to let nature take its course. The average homebirth costs $3000 with a professional midwife and produces as good or better outcomes for low-risk moms and babies. Even emergencies that happen at home can be quickly transferred to nearby hospitals before it is too late because emergencies that happen at home have warning signs. (Emergencies that happen at hospitals, on the other hand, are nearly always caused by the procedures at the hospitals and are very often immediate and life-threatening.) Also homebirth mamas are more likely to take charge of their medical care: eat right, exercise, ask questions, not have expensive medical procedures, etc. They also take responsibility for their choices. They are educated on the possible risks and outcomes, unlike the hospital where everyone is promised a perfect baby and a perfect birth until suddenly it doesn't happen. (Sometimes babies aren't meant to survive and if they're born in a home environment, they are allowed to expire in the natural way instead of artificially sustained for months or "saved" in the NICU at whatever cost.) Average hospital births cost $12,000 and up and we're quickly heading towards cesarean rates of 40% at a cost of $30-$50K each. Not to mention the ban of Vaginal Birth After Cesarean (VBAC) that most hospitals enforce which force women to have expensive c-sections for their following babies as a matter-of-course (even though evidence for VBAC is that it produces better outcomes for moms and babies as long as they aren't messed with, i.e. induced with drugs that might cause uterine rupture, etc.) And then there's all the babies put in the NICU because of bad reactions to the epidurals or pitocin or being induced too early or other traumatic birth experiences.

    I'm not saying every woman should have a homebirth. But if more midwives were in the hospitals and were allowed to practice according to what they've been taught (using non-invasive techniques, supporting the mom, waiting and watching while the body does its work, and only getting involved when it was evident and necessary), the cost of birth in this country and the outcomes that lead to lots of preemies in the hospitals, etc would come way down. But since birth is most hospitals biggest money-maker, it is highly unlikely that hospitals would encourage methods that produce better birth outcomes but do not bring in as much income.

    Yet, if births had better outcomes, more mothers would succeed at breastfeeding.....which would also bring down the cost of healthcare.

    In other specialties: I read this week that if doctors are given a choice of treatments for themselves, they often take the less expensive and more productive route. Yet they recommend to their patients the more expensive route because they are afraid of being sued or think the patient wants that. Most patients do not know that there are more than one way to treat conditions or that many conditions can be treated with inexpensive solutions (nutrition, more vitamin D/sunlight, etc.) Doctors that I've worked with often assume (since they only have 5 minutes to spend with me, they can't take the time to explain anything anyways...) that I want a drug or treatment and my current primary doctor derides many of my questions. (I'm a woman and I couldn't possibly know as much as he does. Needless to say, we're not seeing him for much these days if we can help it. Why are we still with him? He's one of the few who doesn't force vaccinations on us......and there's another thing: If vaccines are so great, why not make everyone pay for them themselves? Maybe then we could finally get the conclusive evidence we need of vaccinated populations vs. unvaccinated populations and which are actually having better outcomes with fewer health problems. Because if vaccines ARE causing autism, how much money could be saved by using catastrophic insurance to cover treatment of the few bad cases caused by not vaccinating while saving all the money on autistic treatments?)

    Not to mention all the evidence that points to more vitamin D and sunlight preventing or healing most cancers and many other conditions/diseases. Instead we slather on chemicals in sunscreens and wonder why we get sick.

    And recently my state has enacted a "truancy" law which means that parents who do not get a medical release from their doctor will get reported to child protective services and the state for allowing their children to miss school when they were sick. I'm sure the only good to come of this law will be more parents forced to take their children to the doctor so that the doctor has more business.

  • Report this Comment On April 16, 2011, at 3:21 AM, ironstone44 wrote:

    there are many good and bad comments included above. let me suggest some things that could have been done without a major healthcare bill from congress and the president.

    Before I do that, why does the president and congress have better health care than is provided for everyone else? It appears that George Orwell's 1984 has arrived. Some pigs are in better positions than others.

    In any case, let me outline some changes that could be very effective.

    1. why do Americans pay two or three times as much for drugs than Mexicans or Canadians? Could it be the paid lobbyists?

    2. Why do hospitals allow insurance companies to get 75% discounts but charge those without insurance or the poor the entire amount? (is it beccause teh government pays?)

    3. do private doctors not treat those without insurance so that they are sent to public hospitals and the costs of emergency room visits are three to four times as costly?

    4. How many foreign doctors and nurses are there within our systems? Is there a limit on medical positions in schools so that we are producing fewer doctors so that doctors salaries are higher than in almost any other country??

    5. Why is it that if you go to a doctor for some type of medical device, Medicaid or Medicare pays significantly more than if you order the exact same device over the internet?

    Some devices are about 30 percent of what doctors bill medicare? is that because of thee added costs of doctors doing things.

    6. In some countries, people do nto have to go to a doctor to get drugs. Mexico has pharasists who sometimes perscribe drugs - so there is no cost associated with a doctors visit that we pay for as citizens.

    7. the legal system is outrageous. In most states lawyers who take on medmal cases take 33 percent if a case does not go to trial. they also get reimbursed for all costs before settlement - this usuallyt eats up about 40-50 percent of the benefits that insurance companies pay out.

    7a if there is a trial, then lawyers get 40% plus costs (that includes medical experts, and reports) This is requierd so that a person cannot bring an action unless they have an attorney who pays for the costs of the doctors.

    7b. How tightly are the doctors who do IME indepenant medical examinationns controlled. You have heard of dualing experts. Which expert is more believalbe?

    another alternative would be to have the judge select a medical expert and let the parties pay for that expert - and any other person who they want to to refute that expert. - (again, this may not work since the best, or highest paid - donot want to work for a court system.

    How frequently do people settle because they are not working and cannot afford medical care. tehn when there payment or win is spent, we the taxpayers have to support them.

    How many unlawful immigrants are being cared for in our system? i am tired of them being called undocumented aliens instead of those who have violated our law and reap the benefits.

    let us get rid of the anchor babies - many other countries have already done away with this archaic law.

    Realize that doctors may get paid a small fortune - I had surgery and the doctor was paid about 3500 for about 1 hour of work. someone else opened me, and someone else closed me, a nurse put me under, and each of these individuals was paid by the hospital. The doctor who worked on me had seven other surgeries during the day. you figure out how much he made? i know that he takes 3 or more months off to go to his horse ranch in North Carolina.

    The legal profession can charge a lot less, but choose to charge the maximum that is considered appropriate by the state courts. (sometimes there is a discount based upon professional courtesy (25 percent for the families of other lawyers, or for other lawyers.

    I know that in some installations, expensive equipment is used 24 hours a day to defer costs. those who choose to have catscans, or mri's during hours where teh machines are not busy get deep discounts. If these approaches are used, the costs go down. Another thing that has occurred is the many members of the dental and medical profession now do not update some of their equipment. they may not need all of the bells and whistles so that the equipment is amortized over a longer period of time and th patients should pay less.

    You are having more people having medical or dental vacations because care overseas is just less expensive than in this country. Other issues with the medical profession is that some installations are not using the newest technologies since it would require doctors to take months off to train, and they don't want to lose the income - so some foreign countries have more up to date techniques than we have in our country.

    Other issues relate to politics related to many areas of law and medicine. show me a lawyer who is on a legislative body who passes a law that woudl hurt his profession (many states allow part time legislators so lawyers continue to practice in areas where they impact legislation. )

    i wnet to a lecture where a very well known speaker was talking about things that are wrong in our country. His first comment related to corporate influences in almost all areas of our lives. and then he mentioned, where else but in Florida do you get a governor who has taken the fifth amendment how many times. is this the types of governments taht we want?

    t hat are obbiests?

  • Report this Comment On April 16, 2011, at 3:34 PM, ultimatewarrior wrote:

    A terrible article. The author should be ashamed of such a terrible article. If I wanted to spend 5%, 25%, 75% or all of my money on health care, so what.

    You Lib hack of an author.

    You fail to mention that most of these countries ration care. Maybe you should move to one of these back bencher countries. Like any Libtard, you will be happy there.

  • Report this Comment On April 16, 2011, at 4:33 PM, mike2153 wrote:


    It's rationed here, too. The insurance company rations it out to you. Cost them too much, you're out of luck. No insurance, no rations. One more thing: civility costs nothing.

  • Report this Comment On April 16, 2011, at 6:42 PM, alzbeta wrote:

    This commentary has caused me to reflect on a personal incident. I was working full time at a minimum wage job. My employer did not offer health benefits. I elected to pay $4000/year for catastrophic care that kicked in after a $7500 deductible.

    I went to the emergency room with severe abdominal pain. After observing me for 5 hours, I was given a CAT scan. My appendix was on the verge of rupture. They gave me my scans and had my husband drive me to another hospital two hours away, where my appendix was surgically removed. Recovery swift and uneventful.

    Bill from first hospital about $4500. Bill from second hospital and surgeon about $15500. Because I was insured, sum of bills magically reduced to $13000. Our share: $7500 deductible plus 20% of remainder =$8600. Sigh of relief. If I had not been insured, I would have had to pay the entire $20000. On top of this, hospital #1 offered a 10% discount if we paid in full within 30 days.

    10 months take-home pay gone in 4 days.

    Is this unfair, or do I deserve this for being poor?

  • Report this Comment On April 16, 2011, at 8:04 PM, summerfield101 wrote:

    There should be no health insurance industry. It's waste of a way too much money. Advertising, CEO salaries, lawyers to figure out how to legally deny care, etc. That money should be transformed into a government system like Medicare or VA that provides free care to all. Substantial salaries, incentives, rewards for health care workers should be based on how well patients are taken care of, how positive treatment results are, etc. Conservatives are always prone to blaming somebody else. Accusing them of being scam artists. Like those people who want a free electric scooter. Yeah, I would sure love to lose the use of my legs just so I could get a free scooter! Being able to walk is so overrated! And people "scamming" the Medicaid system to get the minimal services that Medicaid provides... one previous commenter mentioned that they overheard families talking about cutting holes in the wall from bedroom to kitchen so they could qualify under some Medicaid stipulation for more assistance.... Would YOU like to be in a position of having to cut a hole in the wall so a family member, a loved one, could get at least some crappy, minimal level of care that they need and can't get any other way? Yeah, right, that sounds like such a great deal. Gee, I wish I was poor and desperate so I could rip off hard working tax payers! Conservatives can't stand to hear that there may be many people who, through no fault of their own, but just the vicissitudes of life, end up or are even born into circumstances where they could really use a little humanitarian consideration, Christian charity, Buddhist beneficence, whatever, in the form of financial or medical help. Didn't somebody once say that the greatness of a nation is shown in the way it treats the least among us? There are too many Americans who want to prove America is not a great nation.

  • Report this Comment On April 17, 2011, at 1:02 AM, nightbrightener wrote:

    not sure where to start, i work as an er nurse and find some of these comments intelligent, some scary and some amusing. the most truthful statements center around the concept of how much is grandpa worth. you saw the fervor of the unwashed public at the "death panels" with the assist from fox news lol. that exchange right there is why the messed up medical system will continue to stagger on like some blind old dog. we as a society think we can find a way to make anything work, regardless of the evidence. it won't happen but in a perfect world we could make the following changes.

    ration care based on clinical guidelines from independent studies that are peer reviewed, if it isn't effective, you're paying out of pocket.

    cap litigation awards as other posters mentioned, loser pays court cost, public record of Dr's loss of privileges and reason.

    all persons required to file copy of advanced directives with their taxes, central database accessible 24/7 and that is the ONLY guide to advanced care used unless person brings in own papers.

    VA style preventative care and gatekeeping by NP's and PA's for all but specific complaints such as chest pain, shortness of breath, LOC or traumas which can be seen immediately in the ED.

    and this is a personal pet peeve but... hospitals are not hotels, they are where very sick people go until they get less sick and go home to recover. they are not places for window views, private rooms and press gainey scores. part of the reason that aspirin cost 80 dollars is the tv in every room and the fountains in the lobby. if you want to know a good hospital ask how many patients each nurse and patient care assistant has, not which has the friendliest front desk. you people are shooting yourselves in the foot complaining about things that have NO effect on your care except detrimentally. you may spend 2 months out of 65 years in an acute care setting, cheap and good matter, not style.

    as far as some of the hyperbole in these comments, there is some truth to it. we see about 25% or so of people who literally come in because they "ain't payen" ala medicare and caid. we are talking about head colds, throwing up once, period 2 days late, to get MOTRIN because then it's free, want narcotics, etc...

    yet we are mandated to "provide care" and if you want the truth that is why they get antibiotics and vicodin, so we can get them out the door and see the next person who may actually be ill. we coddle some of the laziest mofo's on this earth at your expense and will continue to do so because it is the path of least resistance. remember that the next time you read about opioid abuse or antibiotic resistent illnesses or the spiraling cost of insuring the poor. personal responsibility died on the tragedy of the commons and we aint bringing it back anytime soon

    end result, if we change the rules some poor kid/ grandmother is gonna die who might/would have lived with another system and that is on us, now you tell me if it's worth it and if it can happen when network news gets a hold of that story, real or hypothetical.

  • Report this Comment On April 17, 2011, at 11:35 AM, cmfhousel wrote:

    My aunt is having trouble posting (our comment section's spam filter gets a little aggressive.") She writes:

    "Morgan, thank you for providing much food for thought here.

    I understand the appeal of free-market healthcare, driven by consumer choice. A difficulty with this might be underscored by the differences between how tests and treatments are billed. It’s more likely that the cost for a medical test can be easily

    quantified. However the costing for medical procedures becomes more complicated. Billing is often done from a myriad of sources: the hospital, surgeon, anesthesiologist, lab, etc.

    I’m concerned that the average consumer will not have the level of sophistication needed to accurately determine ahead of time what costs will be. Seeing that medical billing offices aren’t always sure themselves how total costs are determined makes this task look even more daunting. Add to this the difficult circumstances around emergency care, and the complexity becomes more daunting still.

    Americans often believe that universal health care can only be achieved if it’s totally run by the government. But a look at universal health care systems across the world reveals a

    very different story. There is every possible combination and permutation of delivery system imaginable, from single-payer options to Germany’s system in which insurance companies play a

    large role. The common denominators?

    1) Most have developed a sophisticated system for making patient information easily available to all healthcare providers.

    2) Providers adhere to set pricing (established any number of ways) so all consumers know up front what costs to expect.

    3) In return for limits on pricing, most health providers go to medical school on the government’s ticket, so they emerge debt free.

    For anyone who shudders at the thought that this scenario looks like pure socialism, some countries also allow physicians to establish a private-payer practice on the side and charge whatever the market will bear.

    The important thing to remember is that each country has molded its universal health coverage system to make its adoption more practical and acceptable for that particular society. I would hope that ingenious Americans could do the same."

  • Report this Comment On April 17, 2011, at 12:11 PM, Bert31 wrote:

    The insurance companies are they way they are precisely because of government interference.

  • Report this Comment On April 17, 2011, at 8:48 PM, jackpursell33 wrote:

    We need more doctors and nurses. We are not graduating enough; as a result they cost more.

    If we would have free med school with a 6 year mandatory assignment after school we could use these new doctors for Medicad and wellfare care--

    just like West Point or Annapolis. Doctors now face up to $300,000 in student loans after graduation. But these pre-paid doctors need to be a part of several new med schools so that there is a increased number of doctors in the USA. More doctors less rationing!

    The same idea for nurses. Offer free trainining with a 6 year mandatory assignment for Medicad and wellfare care. In addition we should expand nurses treatment limits; so that more things can be covered without a doctor. These people are called Nurse Practitioners. More nurses equals lower costs and less ratioing.

  • Report this Comment On April 17, 2011, at 10:14 PM, Ctyp wrote:

    Re DannyBoy31 - let me paraphrase what you wrote:

    The insurance companies are they way they are precisely because they control the government. And they make sure that the government doesn't interfere with them making money.

  • Report this Comment On April 18, 2011, at 12:19 AM, DrGizmo wrote:

    Have been working in medicine for 30 years. My take:

    1. Make doctors and hospitals charge the same fees to everyone they serve - no more sweet deals and discounts for insurance covered patients. This is the essence of our country's problem - the folks least able to pay get the highest prices for equivalent services.

    2. Ban all media advertising for prescription drugs. We do it for cigarettes, etc., why do we allow direct-to-the-public marketing of premium priced, cost-driving medications? And don't give me the "public awareness of a critical disease" stuff - most drugs are marketed not for their originally designed intent, but for statistically proven side effects, that then must have a disease made up! (Remember, Viagra was supposed to be a heart medication but gave people priapus.... then along came ED!)

    Groundshaking? No. But very powerful first steps.

    Your thoughts welcome.

  • Report this Comment On April 18, 2011, at 9:00 PM, foolisme1018 wrote:

    1. don't require employment to obtain health insurance.

    2. Unemployed under the age of 65 should be part of a pool that get competitive coverage. Their premium will be based on their financial situation.

    3.A Medicare like entity would handle the level of coverage and reimbursement to providers of services.

    4. All adults not covered by Medicare or Medicaid would be required to pay a percentage of the premium cost.

    5. The percentage of the premium would dictate the level of care available. This level would be made clear to the insured.

    .6. Catastrophic coverage for the unemployed would be available for an additional cost.

    7. By insuring the now uninsured there should be savings to insurance companies and providers of services. A percentage of these savings should help pay for the difference between the premium paid and

    the actual cost of the services provided .

    8. Insurance companies should concentrate on paying for treatments in prevention of illness and not experimental treatments.

    9. All insured should be informed of the realistic level of their insurance coverage in a easy to understand format.

    10. Finally their should be a fund set up to help pay for patient with exceptional need.

  • Report this Comment On April 18, 2011, at 10:08 PM, CRACKTACTOR wrote:

    The notion that a profit motivated middle man standing squarely between the doctor and patient (i.e., the insurer) can control costs is pure fantasy.

    Example: My radiologist bills $50 for two X-rays, Anthem Blue Cross pays $7.50, after a three month period of "determining the medical necessity".

    Health care is not Budweiser: I have yet to find a doctor who will give me a price for any procedure without an examination, which I have to pay for, so the idea of "shopping around" is even more laughable.

    What an insult to those who dedicate their own lives to saving others'...

  • Report this Comment On April 18, 2011, at 10:29 PM, PETPOE wrote:

    Lots of good thoughts.

    liked the ER nurse 'nightbrightener' refreshing (and honest) view.

    combine that with a better curb of litigation and equal pricing for drugs and treatments and the US can cut costs big time.

    Also focus on rationing healthcare spending in last month of life. Should go hand in hand with better eduction/counseling (palliative care vs heroic medicine), instead of 'death panel' directives.

    I am a life science professional. I lived most of my live in Germany and Denmark, now 10years+ in US. Had my fair share of accidents and sickness. Had good medical insurance in all places, got well served all places. Have further inside cause spouse works as hospitalist.

    Discussion is way too polarized in the US(Morgan has a good hand to pick these questions). That extends into congress. As long as the politicians only yield to lobbyist and political activists (on either side), there wil be no solution. Instead, establish expert panels with good mediators.

    regarding the opposition to mandatory healtyhcare: most people accept to buy car insurance even though we don't want to get into an accident. Why not accepting health insurance ? Its quite likely that allmost all of us need to vist the ER at some point.

    And afterall, any changes can be reevaluated and changed if needed. Together with the existing models (other countries, different US states) one should be able to come up with a compromise IF ONE WANTS IT.

    btw 'ultimatewarrior' seems to be a poor frustrated soul, need anger management. or maybe visit one of those 'socialist' countries to learn (a life long exercise).

  • Report this Comment On April 18, 2011, at 11:43 PM, newageinvestor wrote:

    I agree with applebull. Universal medicare where the governmet can negotiate lower drug prices. Letting patients have more control over medicalEdecisions makes sense since it seems to improve outcomes, but I see this as a cultural issue that has to start at the medical school issue - we need fewer doctors with God complexes for starters.

    Private insurers should not be in the business of providing health insurance, since they are much more expensive than Medicare in terms of administrative costs (12% vs 4%). Perhaps they could just help the govt administer medicare. They would kick and scream but still stay in business.

    I'm overall glad that people on this thread are having intelligent discussions on this topic.

    One more thing - "the market" only really works when both parties have the same amount of information. How often in the real world does this actually happen? This is another argument in favor of patient education and empowerment.

  • Report this Comment On April 19, 2011, at 10:00 AM, tsmit2h wrote:

    The problem with health care is that it is an unbounded need. Providing "basic coverage" is tricky, as democracies hate to see some people denied care that others get. Not financially convenient, but tough to get away from.

    The bigest problem is the insurance model itself. It provides no incentive for people to weigh the cost of their care. The catastrophic coverage model is the best I've heard of for introducing this sensitivity.

    Catastophic coverage has another advantage: when small bills are paid directly, there are NO administrative costs. And these constitute most transactions.

    Prescription drugs: drugs cost magnitudes more in the US because single payer systems in other countries use their clout to negotiate down prices. But rather than have the government negotiate prescription drug prices, allow importing from foreign countries. It would have the same effect, only preserve market forces.

  • Report this Comment On April 19, 2011, at 10:51 AM, Unclelouie11 wrote:

    First of all, we need to get the insurance companies out of the healthcare business. The states would be required to oversee various Healthcare groups which are run by Hospital personnel. All US citizens would be covered and required to pay into their choice of Healthcare groups. Profits go directly to these groups instead of the insurance companies. Hospital personnel would be covered under their Groups insurance plans. Doctors who choose not to be part of these Groups would pay their own insurance. Doctors will actually decide what is best for their patients.

  • Report this Comment On April 19, 2011, at 11:31 AM, wrenchbender57 wrote:

    I agree with the person who said to look at other countries that have a successful model and copy that. Limit malpractice suit rewards. Everyone should have access to at least minimum health care. The system we have now is not working very well. Look at what we spend vs what we get. Pretty clear that we are not getting true value for our health care dollars. Yet the conservatives want more of the same. Makes no sense.

  • Report this Comment On April 19, 2011, at 11:57 AM, JohnOt wrote:

    I almost agree completely with applebull, but I would deal with drug prices differently.

    Until the day comes when we will turn the uninsured away from emergency rooms to die on the sidewalk we have every right to force people to obtain medical coverage. Healthcare is not just another insurance product because we have to come when they call. It is just taxation, what is the difference between being taxed to provide a policy and requiring you to go buy one?

    A single-payer system delivers the health care dollar for much less than the private sector, a Medicare model is best. We should determine what the average American can afford to pay for health insurance, set that limit on coverage, then tax and pay for the best policy that can be negotiated within that limit. For example a policy with low deductions, visits but a lifetime cap of $500,000. The average person uses about $250K of medical care in their lives.

    This would cover all but a few percent of the population before reaching policy limits, But private insurance could supplement this basic policy, if people want better coverage or with higher limits then they can buy it.

    This system provides basic coverage for all at an affordable rate and with freedom of choice. It also assures that hospitals will be reimbursed.

    With respect to drug companies, let's get rid of patents on pharmaceuticals. Patents are to reward innovation and there is no need to. Most of their products are based on NIH government and university research anyhow, its an open secret that the taxpayer pays twice. Have the government expand drug research, you just don't need the mechanism of the free market to motivate scientists to do research. They have been doing this for years and, again, most new drugs are based on government or university work anyhow.

    Drug companies would then be in the business of delivering new drugs at the lowest cost, rather than trying to monetize medical research and advertise marginally better patented drugs to boost sales to satisfy shareholders.

    Many problems but I believe this is As Good As It Gets.

  • Report this Comment On April 19, 2011, at 12:04 PM, wrenchbender57 wrote:

    Insurance company involvement in health care seems to add more layers of paperwork and cost with little real benefit to the consumer. Seems like this capitalist system is not working out very well. It needs to be drastically modified or replaced.

  • Report this Comment On April 19, 2011, at 12:08 PM, wrenchbender57 wrote:

    JohnOt, where is the data that shows the the government or universities provide the research for new drugs? My impression is that most of this is done in the private sector. Would like to see the data that backs up your views.

    IF the private sector is doing the research then return on investment is a real incentive. Maybe there is another way to do it that is more cost effective?

    If so, would be great to hear it.

  • Report this Comment On April 19, 2011, at 1:44 PM, sOnTheIsle wrote:

    How about Tort reform? How about allowing people to buy insurance across state lines? How about not forcing insurance companies to cover things most patients don't need or want?

    i.e more competition and more choice instead of a one-size-fits-all approach.

    Also, your car insurance doesn't cover oil changes or tires. Patients should pay more for basic services and medical insurance should be used for big ticket items.

    Finally, before praising the health systems of other countries, it might be useful to examine the level of care in those countries. e.g. the wait for procedures such as a MRIs in Canada is several months. Survival rates for cancer are significantly lower in the UK, etc.

  • Report this Comment On April 19, 2011, at 3:07 PM, jweissman wrote:

    Very few mention this:

    When my ma and pa, 25 years apart passed, both were in the same. Every day a doctor would come in, take a pulse, look over the paper on the clip board, chat a moment and charge Medicare 350$. No care provided, no benefit gain, except to the doctor. In my mother's stay, a doctor came into her intensive care unit with an entourage of 5 interns. She was on life support, in a coma. She could gain no help from a bunch of young doctors peering down at her, and the arrogant shyster "teaching" them what all I don't know. This happened twice in one week, the shyster charging Medicare 250$ for each visit.

    I had no personal expense for these fraudulent "treatments"--which I have to bet are endemic-- but I complained to Medicare. The rep there told me to fill out a complaint form, which I did, but she said she could do nothing. I reminded her of the difficulty we all face as Obama, at the time, was trying in install his doomed-to-fail healthcare system. This post should explain why I said, and still say, the president's system is doomed to fail--unless REAL reform is made BEFORE the system is "off and [not] running.

  • Report this Comment On April 19, 2011, at 3:18 PM, Ironbob wrote:

    Health care wasn't broken until the government got a hold of it.

  • Report this Comment On April 19, 2011, at 3:55 PM, Chippy55 wrote:

    The health care system was NEVER BROKE, ergo there's nothing to fix. I could name a dozen people who smoke ($16 a day), who drink every day, who drive SUVs, who have cable TV AND WHO HAVE DECIDED NOT TO GET THEIR OWN Healthcare! It's a choice. SO, why should they have to pay a fine if the CHOOSE to not get something? IT'S UNCONSTITUTIONAL, as are all 2,900 pages of the monstrosity, which among other things, allow AGENTS OF THE FEDERAL GOVERNMENT TO ENTER YOUR HOME, and interrogate your children as to whether you are raising them properly. WHo comes into your home? Hillary? Openly homosexual Barney? Kathleen the liar? Irrational and wild-eyed Pelosi? Alleged Homosexual President? Joe Bite Me? Tax cheat Rangel or Geithner? Who? A democrat like Bill CLinton? IT'S IN THE 2,900 PAGES!

  • Report this Comment On April 19, 2011, at 5:40 PM, wantingtoretire wrote:

    I think your aunt gave the most intelligent response.

    As for fixing the problem, it is clear from the majority of respondents that they have no idea. All you seem to get is the same old same old......."it must be free market" "you can't force people to have insurance" "if only this one little detail is fixed it would be perfect" "if there wasn't a government there would not be a problem".

    The reason your healthcare is the way that it is, is because this is America. You make everything too complex. You are also an ill-health nation. The paperwork has to be seen to be believed...I still cannot believe how much there is of it. The system is very inefficient, not the actual delivery but everything supporting the delivery. Because it is America, everyone in the long long long chain to provide anything to the sharp end wants enormous profits. This is the creed America lives by. The complex, fragmented "healthcare system" is ripped off right left and center by everyone wanting to make money. After all this is how the American military works and whose costs are also astronomical, but in the case of the American military most people do not have any contact with it and do not experience what a dollar munching machine it is as well.

    In short, fix America.

  • Report this Comment On April 19, 2011, at 7:26 PM, daliya wrote:

    save money from medicaid and welfare


    Someone should put the word out that usa cannot have any more increase in population. One can enjoy sex even with tubes tied.

    Families that cannot feed , hous or educate their families should stop having children voluntarily to help the usa survive.

    If one has a history of perversions, criminality, psychiatric illness , AIDS or some other inherited disease that will cost the government millions one should be encouraged and educated towards sterilization as a patriotic act. If one is penniless and on the street or homeless and one does not have a means to provide for a child can we not educate towards being patriotic and not bring more children to burden society.

    If ones wealth was created by clever and crooked deals and clever accountants so you paid no tax - should one not help usa and pay ones due and much more.

  • Report this Comment On April 19, 2011, at 10:38 PM, Oldfool103 wrote:

    I know this will be discount because I am not an American, but I am a 66year old Canadian male who smoked for 30 years, drank for longer than that, have a number of chronic conditions, and control everything with supplements that I pay for myself. I see my doctor a couple of times a year, for routine adjustments, take no drugs, and happily pay my taxes for health care that someone else needs. If I need a bypass or chemotherapy, so be it, I have paid my share. If I avoid that, lucky me. I have gotten way more out of this life than I probably deserved; and I sure don't have any resentment for those who have had it tougher.

  • Report this Comment On November 14, 2011, at 12:11 PM, basilwhite wrote:

    Give people who don't qualify for Medicare the option to pay for it at a rate that breaks even on overall Medicare costs per person. This encourages the market to compete against Medicare for cost and quality, and puts everyone in the Medigap business as every American has a vested interest in the national debate on what Medicare should fund and what people should buy on their own. Medicare can also achieve economies of scale by funding wellness and nutrition programs that reduce costs by keeping people healthy before they reach 65 and start getting Medicare for free. Adding the buy-in option to Medicare also encourages a portable health record for all, as the Federal government can mandate that providers store all their health data in the portable health record in order to get Federal reimbursement for health care.

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