What Will Finally Fix Health Care

You know what will finally fix health care?

Information.

For centuries good health care has not really been about seeing a doctor or a surgeon. It’s been about getting the right information to the right person at the right time. Okay, sure, often that person WAS a doctor or a surgeon, but often it was not. And the smarter we got as societies, the longer and better we started living. The pattern still holds.

These days we have ready, free (or as close as makes no difference) access to all the information our doctors do. (Except patient records — HIPAA says that would be a violation of privacy, and I agree…)

What we, the patient-class, the uninitiated do NOT have free and ready access to is trusted gatekeepers who will filter the good information from the not-so-good. You know, doctors who will tell us that although our Google search on these symptoms was flawed because we left out “night sweats,” or something like that.

Assuming we haven’t all succumbed to Bird Flu, Swine Flu, Nanocancer, or the Andromeda Strain in the next 200 years, I firmly believe that our descendants are going to look back at our primitive, 21st-century discussions and wonder why we wasted so much time and money when what finally fixed Health Care was information we’d been sitting on for decades.

We will probably always need a select few, skilled practitioners of the dark and arcane arts of medicine, but most of what we need to be healthy is a correct diagnosis, and the alignment of simple treatments with sets of symptoms.

That’s just information.

I’m not belittling what my doctor does. He’s worked hard to throw terabytes of information into his head so that his miraculously synaptic brain can quickly process my complaint and prescribe the treatments I need (and proscribe the things that are hurting me.)

But it’s still just information.

Okay, not when he whips out his scalpel and removes a mass from my forearm (had that done in January. Ouch.) — that’s skill acquired through years of practice. And we’ll always need somebody with that skill set to complete certain treatments. We’ll also always need other things that cost money, like new medications, fancy devices for irradiating tissue, and diagnostic tools. But those things don’t need to cost what they currently do. Not once we fix the flow of information.

I’m not proposing anything radical here. I’m not really proposing anything. I’m arm-chair quarterbacking, only instead of yelling at the television about the choice of plays, I’m yelling about how the game should really be taken into orbit and played in three dimensions by guys in armored EVA suits.

58 thoughts on “What Will Finally Fix Health Care”

  1. See, that’s the difference between a doctor and a surgeon.

    One you could replace with a decent database and halfway good A.I expert system. [perhaps backed up with a human version with intuition for the really difficult cases].

    The other you’d need a pretty good robotic arm for as well.

    1. Currently, if you replace most any human knowledge worker with a very good database and a top-end AI expert system, you get a very bad knowledge worker. Compounding this with the complexity of the human body and the fact that patient cases are not reproducible just makes the problem that much worse.

      I’m only disagreeing with the part where you make it sound easy and already attainable, however. The principle is very good, and backing up human doctors with just such systems is already starting to happen. And it’s a very good thing. See, difficult cases aren’t the problem. The problem is when a patient has a nonintuitive case, a subtle case, or even a deceptive case. It’s not a matter of memorizing the symptoms; that’s easy. It’s a matter of talking to human beings, which is actually quite hard.

      I recently went to the doctor complaining of chest pain. That was caused by indigestion caused by taking too much aspirin caused by back pain caused by a car accident years ago. All pretty much cut and dried, except that my doctor picked up on one odd phrase I mentioned–about the back pain spreading under my arm–and a minute later she found me a barely perceptible rash I didn’t even know I had. I was in the VERY first stage of shingles, and we were able to treat it with antiviral meds because we caught it in time.

      1. Alas, doctors aren’t as much better as you may think. They tend to ignore symptoms in favor of prejudices (there’s a long list of overweight folks who got into serious medical trouble or even died because the doctors couldn’t see past “fat”. Which, btw, is in many cases a *symptom* rather than a cause)

        He’ll I had a doctor refuse to refer me for sleep-testing until I started falling asleep at the keyboard and the like *in spite* of my reporting that several people (including a friend who was an LPN) had noticed that when sleeping I’d *stop* breathing regularly (which is the very *definition* of sleep apnea!!)

        Y’see I didn’t have “enough” of the symptoms.

        When I finally did get tested, and mentioned that to the doc who reviewed my test results, he just stared at me with this “Please tell me the guy wasn’t that stupid” look.

        1. My cousin’s doctor didn’t give her blood pressur3e medicine because she was skinny and in great shape. Guess what? She had a stork that would likely have been prevented if her doctor hadn’t been an idiot.

  2. The one thing you’re glossing over – and in fact, the thing that this whole debate is centered on – is, supposing we’ve determined the best course of action, how do we pay for it? Like you point out, there are things that cost money. Some of them cost a lot of money. When a guy that makes $20,000 a year needs $500,000 worth of treatment to make the difference between dying in the next six months and living another three decades, how do we as a society want to handle that situation? Managing to lower the cost of that treatment from $500,000 to $200,000 isn’t going to change the fundamental debate at hand.

    1. I’ll give you a good example of what you’re talking about. I worked for a pharmacy benefits manager for five years. I routinely put in overrides for high cost on a medication for a customer. He was getting a clotting factor as part of his treatment for hemophilia – a thirty day supply carried a submitted cost (what the pharmacy wanted to get paid) of $750,000. The contract cost (what the pharmacy agreed to accept from the company) was $350,000. His copay, each month, was $30.00. The plan paid the remaining $349,970.

      My concern is that someone with a chronic illness like this will get dumped at the first opportunity (real or otherwise). And as someone recently diagnosed with a chronic illness (diagnosed in May as a Type 1 diabetic), I have a stake in that concern.

    2. Well, stopping throwing money down a certain middle eastern rat hole would go a Loooooong way to funding universal health care,
      and funding improved education,
      and rebuilding America’s infrastructure [as in, all of it],
      and enable America to convert to green power sources,
      and properly fund manned mars & moon missions as well as replace the shuttle fleet,
      and rebuild NOLA,

      and, well, you get the idea.

    1. Sure, but what happens if they guy doesn’t work at a job that provides health benefits? Or what if he does, but the insurance company comes up with some pretext to deny the claim, or to drop coverage of him entirely?

      In the latter case, “red tape” could include years of lawsuits. With six months to live, all the insurance company has to do is wait the guy out, and in fact that’s a pretty common tactic for them to employ.

      In the former case? The guy’s just screwed.

      1. First you have to remember that, in the U.S., it is not legal for a medical provider to deny medically needy services to anyone based on their ability or innability to pay.

        So the guy you are talking about can get the treatment. How he decides to go about getting it paid for is where the red tape comes in. The guy might be Medicaid eligible. He might be able to access private charity funds. He be able to work a deal with the medical provider (a lot of medical providers that offer a $500k treatment know they aren’t ever going to get paid in full so they take what they can get).

        It’s an ugly process, but it can get paid for. It takes a lot of organization, timing, planning, and getting the right information.

        1. 1) I’ve never seen that mean anything other than “you have to treat anyone who shows up in the ER”. By the time cancer, for example, lands you in the ER, it’s way, way too late to treat effectively.

          2) Or the guy might not be eligible for any of that. Or he might be able to work a deal that has him paying $200,000 that he can’t afford instead of $500,000 that he can’t afford.

          3) Timing and planning aren’t going to be of much use when you need the treatment NOW or you’re dead within six months. And even if you embark down one of these paths, you’d need a lot of luck to make it work out.

          That’s just not good enough. That’s no more a solution than “maybe it’ll just go away, like it does for 3% of patients”.

          1. Believe what you want.

            Here is how the guy qualifies for medicaid. Having a life threatening illness qualifies him for the disability medicaid program. (The definition of disability being unable to work, imminent death, or dead). He would have to go through a medical review board to certify that it is life threatening, but because it is life-threatening with death possible within 12 months a decision can be rushed getting a result in as fast as 24-hours. Then he just has to provide verification of his income and assets. Assets need to be below $2000 though a lot of things are exempt (like many retirement funds, one home and one vehicle). If he is over he, most start liquidating their assets and paying debts or paying future expenses. Usually in about a week or less someone can be under the asset limit. Course, chances are, if he is only making 20k/year, he doesn’t have much in the way of assets. Then he has to be under the income limit (which he isn’t), but since we are talking disability medicaid, the person can take the spenddown option. This essentially allows the person to purchase medicaid for a month at a time. For someone making 20k per year on salary, their spenddown will likely be about $619.66, which is better than pay $500k. Though of course the person will likely not be working the entire month and may be losing some income, so requesting actual income being used in retroactively would probably be best. The guy can even use his unpaid medical bills to pay his spenddown. The guy doesn’t even have to be a United States citizen to qualify as long as the procedure did prevent imminent death.

            If the guy has children under 18 living with him, then there are even more medicaid options and he’s more likely to qualify. And if he were a she, then there are even more options still.

            And FYI, most people who need immediate life-saving treatments and are uninsured, typically apply for medicaid soon after getting treatment. (Medicaid can pay medical expenses for anything that happened before the time of application up to 90 days.)

            From my experience, the people who would benefit the most in a shift from the government’s current medical programs being more universal/socialized are people with chronic conditions like diabetes, asthma, or depression. These people can usually work full-time, but may not have health coverage to cover their on-going condition. Every pharmaceutical company has plans to get prescriptions free or at reduced cost to these people, but the pharmaceutical companies can be stingy. A lot of these people have middle class incomes so they can’t get medicaid and get shut out of buying private insurance for having pre-existing conditions.

  3. These are very good comments. To that I would add “prevention”, which intersects deeply with the concept of information.

    If everyone in this country could get their BMI below 25, enough long-term healthcare dollars could be saved to provide cradle-to-grave coverage for everyone in the nation. Again, making that happen is pretty pie-in-the-sky, but it’s definitely a factor.

    Thanks for the thoughts.

    1. actually, there are studies showing that BMI (at least the way it is usually measured (as a height weight ratio)) has no real connection to health. And that much of it is genetic anyway.

      Seriously. They get the fact that gaining weight is a *symptom* of some things confused with being overweight is the *cause*.

      This is one of those “everyone knows” things that studies are showing to be wrong. Only it challenges prejudices. some entrenched medical “dogma *and* is counter to the interests of the weight loss industry (dieting actually tends to result in weight *gain* in the long term)

      1. Well. I do my best not to be contrary and freely allow all their honest opinions without gratuitous gainsaying. In this case, however, the weight of experience prompts me to post one gentle rebuttal, based on years of experience as a clinical director and weight-release specialist.

        Granted, the causes of overweight are many, and there is not an “absolute” one-size-fits-all explanation. However: 65% of a nation’s population being overweight, over 30% being morbidly obese, and over 25% of children being overweight or obese is not genetics, or glands – it’s all about choices, and carbohydrate addiction.

        Granted, diets are a short-term solution to a long-term problem. If you go on a diet, you will be coming off it at some point. Americans spend $35 billion per year on weight-loss products… and most of it is wasted, because 99% of people who lose weight on diets will gain all of it back within 2 years, and usually more.

        We live in the carboyhdrate nation. 80%-85% of the carbohydrates consumed in the standard american diet (SAD – how’s that for an accurate acronym) are highly-refined and highly-processed, with glycemic indices in many cases higher than that of table sugar.

        When a person consumes high-glycemic foods, the blood sugar skyrockets, causing an outflow of insulin (the fat-storage hormone). This results in the post-prandial crash, to which the body responds by producing glucagon (the fat-burning hormone), adrenaline, cortisol (both stress hormones) and growth hormone, a pituitary precursor to ghrelin, the appetite-stimulator. These red-alert responses result in uncontrollable (addictive-level) hunger as a side-effect, which usually prompts someone to reach for another high-glycemic snack, and the cycle repeats endlessly.

        High glucose levels in the bloodstream causes arterial spasming with concomitant increase in capillary wall thickness, disabling the glucose-transport mechanism – the arteries become inflamed and scarred over time, and the body responds by producing still more insulin to hammer the glucose out of the vessels into the cells where it is needed for energy.

        Elevated insulin results in:

        • Insulin Resistance
        • High blood pressure
        • Low HDL (good cholesterol)
        • High triglycerides
        • High VLDL (very bad cholesterol)
        • Increased clotting
        • Central obesity
        • Increased risk of heart disease and diabetes

        When arteries are in a constant state of inflamed spasm, they begin to age 1/3 faster than the rest of the body. 80% of diabetics died as the result of a cardiovascular event, like heart attack or stroke, in the late 1960’s.There is no improvement in today’s statistics, despite the availability of blood-pressure and cholesterol-lowering medications. People are simply wearing out their arterial systems – in short, living too short and dying too long.

        The only solution to consistent, effective weight release I have found is a three-pronged approach – eating heatlhy, low-glycemic carbs as part of a balanced diet; getting adequate antioxidant support to protect the arterial system; and increased exercise, despite the hideously misleading article that was published by “Time” magazine this last month.

        Hence I stand by my thesis. The deleterious effects of overweight are causing a huge drain on our medical system. I agree with you that it’s not completely the weight itself that is causing the largest percent of the problems – despite the fact that abdominal fat (the visible symptom) contributes hormonally to the overall problem, the greatest offender is the oxidative stress that is going on in the circulatory system, which is silent and invisible.

        1. If you compare two people one overweight, one not, it’s true the overweight person will require more medical expenses in a given year. However over the course of a human lifetime, the overweight peorson will die sooner than the not-overweight person. (Barring accidents, etc) The non-overweight person ends up requiring more health care, only because they live so long.

          Medicare only provides coverage to those 65 and older and that the part of the Federal Budget that’s threatening to break the American economy within the next 40 years. It was never designed for people to spend 25 years in the program.

          That’s the number-crunching apsect of this. The other side is a quality-of-life debate. It’s not enough to simply tell people that you have to “eat right”, not when most food being sold is not intended to be. People have been told that for at least 30 years and the problem is getting worse, not better.

          There are a lot of products that have way more sugar and salt than they really need, alternatives exist but only as a way of increasing a food producer’s market share. It would be better to convince food producers that there’s no market in what they are producing.

          At this point, I’m all for an excise-tax on non-diet sodas if it helps the public become healthier in the long run.

          However, the above isn’t likely to happen, since there is such a pro-free market bent in this country so the only option left becomes: “Well, people should make better choices.”

          1. There’s slightly overweight and there’s being 400+ lbs and type 2 diabetic at age 26 or younger. If this was a “slightly overweight” crisis it wouldn’t be a “crisis”, it’s an obesity crisis. Either there’s a serious problem with obesity or it’s media hype that’s blown the issue out of proportion. The point is the massivly overweight are going to have shorter lifespans, than the thin and slightly overweight.

            Is there money to be saved if there were less people were overweight and not diabetic? Probably, but it would take several years for any benefits to manifest and that’s if something was done beyond what is being done now.

            We live in a society of cheap, unhealthly food, and we have to reprioritize what we value as a society.

          2. The obesity (boooga booga) “crisis” actually targets a lot of people who most people would say to “but you’re not fat!” because they’re using BMI as the grading scale. So yes, I’d say it’s media hype that’s thrown everything way out of proportion, especially because the “crisis” began when the threshold for “overweight” was changed from a BMI of 27 to 25 in the late 90s and suddenly millions of people were overweight without gaining a pound.

            A great place to start is by looking at women who are actually considered “obese”: http://kateharding.net/bmi-illustrated.

            And, as noted by others above, sometimes fat is a symptom, not the disease. I am hypothyroid, for example–when my thyroid is out of whack, no amount of exercising or starving myself is going to make me lose weight.

            I agree that we have cheap, unhealthy food. That should be addressed by our food industry especially–especially because the poorest of us can’t afford to buy actual healthy food. Sometimes it’s not about information or education–plenty of people know what they *should* eat, but if cereal and pasta and other processed foods are the cheapest things to buy and you don’t have any money, why would people spend money that could go to rent or utilities on fresh fruits and vegetables? I can get two meals out of a $1 box of Pasta Roni, or five or six meals out of a 50 cent box of spaghetti (and then there’s ramen…), and only a meal or two out of $5 worth of produce, so…

          3. Depends on how much soda is involved versus how much extra food is eaten.

            If someone goes from consuming 100+ grams of highly refined sugar (in a liquid state) per day to close to zero grams, it’s not terribly likely they will consume an equal volume in other types of food. Unless you’re eating fried butter, >_<

          4. I prefer just to avoid pop altogether. Why drink something disgusting just so you can say you’re not drinking any calories? (I am one of those people who find the taste of artificial sweeteners vomit-inducing. If it’s not real, it’s not worth it to me.)

          5. The secret to diet soda is usually lemon juice. Also, the splenda-based sodas are have a better taste to them.

            It’s like Nicotine gum for smokers, it takes the edge off going cold turkey.

        2. Re: BMI

          Biggest problem with your argument is that is is based on a bad assumption.
          That assumption is that the BMI is correct. The math of the BMI is bad for anyone taller or shorter than 5’4″. While the error is small for some of the average range (5’2″-5’7″) the error increases exponentially. The “adjusted” BMI used for children was made for propaganda purposes, not science. Also, the BMI does not take the type of weight into account, just total body mass.

          I am 6’3″, and the BMI number for me would make me anorexic. My children are also big. Their pediatrician was not concerned about their size to weight ratio as it put them on the skinny side of average. But the “adjusted” BMI made all my kids over-weight, if not not obese. To address my third point, I would like to add that many professional athletes, with body fat %’s below 12%, have BMI’s that make them obese. Another hidden health fact, overweight people have only one significant health risk: they might become obese.

          Most of these health numbers are to make us scared. Scare tactics are used to gain power. I always ask, “Why do they want me scared?” I have only came up with one answer: Lots of “Nutritionists”, “Scientists”, “Doctors”, “Pharmacists”, and “Professionals” want us scared so that we will accept what they say without question. They want us to use a lot of their services/drugs/diets/technologies/newspapers and pay through the nose for them.

          Obesity is a symptom of problems, not a cause. Most of your listed problems cause obesity in the first place. They are not however caused by being extremely overweight. Some can be aggravated by excess body fat, but are still not caused by it. Please stop your PREJUDICE.

          1. Re: BMI

            Prejudice? That’s a bit strong to say about someone you don’t know from Adam’s off ox. You’ll note I said nothing about people who are overweight from a judgmental place.

            If you think my suggestions, based on solid science, are detrimental to your health, you certainly need not pay any heed. But science always trumps hysteria, and I will continue to promote optimal health at every opporunity, thus helping to improve people’s quality of life and reducing the medical cost burden on society.

            שָׁלוֹם and さよなら.

          2. Re: BMI

            BMI is not the issue, really. I don’t defend the measurement as an absolute – of course there are variations from the standard, and everyone’s physiology is different. What I’m talking about is fat people, people carrying around significant amounts of abdominal fat, men with (in general) a girth over 40 and women with waist measurements over 34, people whose triglycerides are stratospheric, who have infarct-inducing levels of cholesterol, whose blood pressure indicates a stroke waiting to happen; and obese kids with type-II diabetes. All of these would benefit greatly from better eating choices and getting their bodies moving, and would reduce their overall medical expenses significantly over their lifetimes.

          3. Re: BMI

            Sure, if they can actually lose weight and haven’t spent their entire life already trying to lose weight and failing. But I think it’s far more useful to everyone’s time not to judge people who are fat and assume they must be lazy, gluttonous pigs who don’t already eat healthily but just happen to have more body fat than you. I have a friend who eats the most nutritiously of anyone I know, who works out every day, rides her bike everywhere, and who will probably never weigh less than 220 lbs. That’s just her body. She’s asked her doctor about it, and her doctor–knowing her health habits far better than any random judging stranger on the street–said she’s just fine. Her cholesterol is fine, her triglycerides are fine, and you know what? She’s the happiest person I know.

            I think that fat people are just the easy targets nowadays, honestly. Because people can target them in the name of “health.”

  4. Paying for the big, expensive treatments isn’t an issue if the system isn’t clogged with diagnosis and prescription. And yes, hypochondria and placebo, addiction and abuse.

    The “information” solution assumes that we’ll all get better at using the available information. We wash our hands more often, and don’t drink from pools of poop-water anymore. There’s still hope for curing stupidity.

    1. Don’t forget stupidity among the other failings. I have a sister who is a nurse who sees the same patients time and time again because they don’t take their medication for diabetes. They are regulars in the ICU not for lack of information but for lack of implementation.

  5. Segway :

    Armoured EVA suits??? MEH! Armour is for weenies! 🙂

    (See Australian Rules Football.)

    Health System : I don’t get how the US system can be so bad. (I know it is) its not Brain Surgery… okay.. maybe it is. I see it and compare it to the Australian system and the NHS system in the UK and I just don’t GET IT…

    1. Re: Segway :

      In a nutshell, it’s bad because the health insurance companies are businesses whose prime directive is to make a profit, *not* to keep/make people well. Thus, if you cost them too much – if you exceed your “lifetime maximum expense” or you develop a chronic disease at some point when you aren’t already covered by group (not individual) insurance – you will not have insurance anymore. And even the simplest and most routine medical procedure – say, an X-ray (and really, it’s not like X-rays are in limited supply) – is prohibitively expensive for anyone who isn’t rich to pay for themselves. So, to sum up, the sickest and poorest people are the ones least likely to have health insurance.

      1. Re: Segway :

        How would it be any better if the government were footing the bill? The money has to come somewhere, even in cases where profit is not the motive. Under nationalized health care systems, those deemed too sick or too old tend to be denied treatment that goes beyond prescribing another pain pill.

        I’ve paid for x-rays out of pocket before (and I’m by no means wealthy). You can make payment arrangements with hospitals, and as I’ve written elsewhere they’ll cut you a break if you’re in financial distress.

  6. This doesn’t take in account that it’s just not a simple matter of symptoms and answers. If that was it, then we’d only need Dr. Google.

    The thing is, physical examination is needed, and tests, and x-rays, ultrasounds, palpation, and even surgery.

    It’ll probably take centuries to perfect our robots enough for them to perform all the doctorly duties, but if that happens then no job will be too complex for a robot to perform.

    1. “I’m sorry Sir, RoboSurgeon Beta2 appears to have accidently sliced your big toe off whilst it was removing your ingrown toe nail. have a coffee on us”

      1. Given that human doctors make mistakes like amputating the wrong leg (or in one famous case managing to destroy a male baby’s penis with the electrocautery during a circumcision) your scenario isn’t that big a deal. As long as the robots do it less often than the humans things will be an improvement.

  7. You know, as cliche as it is, I really do think that the Information Age will greatly impact and improve society over the long term. Especially now with the proliferation of smart phones that give people almost limitless access to untold amounts of information anywhere they are. And as methods to effectively search, sort and filter that information improve the effect is going to become even greater.

    Or maybe I just read too many transhumanist/futurist/singularity articles.

  8. re: information

    Agreed. And IMNTHO a big part of the information that will fix healthcare is the information that will enable healthcare consumers to become more engaged in the process, e.g. “how much does this procedure/treatment/what-have-you cost?” and “will it be cheaper if I pay for it out of pocket?”. One of the largest factors in driving up healthcare costs is that people don’t know or care the cost because they aren’t paying for the bulk of it themselves. I’ve learned from experience (mainly from losing my employer-provided health insurance) that if you arrange to pay out of pocket for doctor’s visits they will charge you less than they would if insurance was picking up the tab. The doctor’s office we go to even allowed us to apply for “hardship billing” (my term, not theirs) which gives us an even larger discount on our doctor bills. Knowing the costs also allows healthcare consumers to “shop around” and find the best value for their money.

    So yeah, I agree with the points of your post in terms of “preventive care” and home remedies and the like; I just think the “information spigot” needs to be opened up on the fiscal end, too. :o)

    1. Re: information

      Yes, I recognize that some procedures/medications/etc. are too pricey to be paid for out of pocket by most people. Those are the things that health insurance was traditionally intended to help with prior to HMOs got everyone into the mindset that health insurance should pay for every doctor’s visit and prescription. Again in my not terribly humble opinion, health insurance should cover only catastrophic health events (i.e. the ones that would utterly ruin one financially if one had to pay it themselves). Limiting what insurance companies have to pay out would go a long way toward making it more affordable.

      1. Re: information

        >>health insurance should cover only catastrophic health events (i.e. the ones that would utterly ruin one financially if one had to pay it themselves)< <

        I would agree with you in theory, but in practice, most people who don’t have insurance that covers office visits, prescriptions, and routine checkups just don’t ever get them. Which is fine from the perspective that it’s their choice, but not fine given that it means they’re more likely to end up with a serious illness that could have been diagnosed and prevented if they had simply gone for regular checkups. Which is a lot more expensive.

        Limiting what insurance companies have to pay for to catastrophic/chronic trauma/illness would in practice result in more of those expensive sick people, and people using the expensive ER as a clinic because they don’t have the money to see a doctor – exactly what we have now.

        1. Re: information

          “I would agree with you in theory, but in practice, most people who don’t have insurance that covers office visits, prescriptions, and routine checkups just don’t ever get them.”
          It’s hard to argue with an uncited generality, so I’ll accept your statement for the sake of argument. In any case, I look at that as more of a case that people are less likely to indulge in a doctor’s visit if they’re responsible for the bill (or rather, are aware of what they’re actually paying for it). When people live under the illusion that they’re only paying a co-pay for doctor’s visits (after all, employer-provided health insurance essentially is paid for out of employees’ paychecks), they’re more likely to go to the doctor every time they get the sniffles. More visits = more health care expenditures, irrespective of any hypothetical “sicker due to going to the doctor less” population.

          “Limiting what insurance companies have to pay for to catastrophic/chronic trauma/illness would in practice result in more of those expensive sick people, and people using the expensive ER as a clinic because they don’t have the money to see a doctor – exactly what we have now.”
          Only if people are as uninclined as you say to avoid doctor visits and the like if insurance doesn’t pay for it. I think if people came to realize how much cheaper it can be to pay for non-catastrophic care out of pocket many if not most would be inclined to do so.

      2. Re: information

        Except that just getting my asthma medicine every month, for me, is catastrophic. I’m sorry, $750 a month for medicines just to be able to breathe is TOO MUCH MONEY. It’s more than three times my car payment.

        1. Re: information

          “Yes, I recognize that some procedures/medications/etc. are too pricey to be paid for out of pocket by most people.”
          Thanks for reading thoroughly. ;o)

          In a serious vein, have you tried writing the manufacturer of your asthma medicine? Despite a lot of vilification in the media, drug companies will often help people who cannot afford medications.

          1. Re: information

            I did read thoroughly, thanks. I have done the whole go-to-the-manufacturer thing. You have to make under a certain amount of money each year, and I make just slightly over that. But I’m self-employed, so it actually comes out to a whole lot less after taxes. But that doesn’t count.

          2. Re: information

            My condolences on your situation. I asked about the go-to-the-manufacture thing to better establish what your situation is. And sorry if my “thx 4 reading” remark came off as snark; I had intended it to be read in a light-hearted tone. The reason I said it, though, was to underline that I think situations like yours are catastrophic and should be fair game for coverage under medical insurance. The ones I think should be excluded are those which are readily affordable, especially those on the “Walmart $5 list.”

  9. The fundamental problem with the current health care system is that it is money-centric, not patient-centric. Insurance and pharmaceuticals care more about their bottom line and stock prices, than they care about their patients. Doctors are also guilty of gaming the system, to milk out more dollars. All the information in the world won’t help you if it is pushed aside to make a buck.

    So the resulting system must result in keeping the corporations honest. Both through incentives, and regulations. Move the focus from money to the patient, and the flow of information will improve.

    If you ask me, ‘do you want the government making your health decisions’? If the alternative is a stock price driven insurance company or a doctor lining his pockets with pharmaceutical money, then definitely, yes the government is the better choice.

  10. I suspect the final solution for this will best be described in our current familiar terminology as “open source health care”. I don’t know exactly what form it will take yet, but it seems like a likely long-term possibility.

  11. Given the trouble I’ve had with my health care this last year and my inability to pay the huge premiums necessary to be covered–and my inability to pay the money required to get my medicines to cover my relatively mild chronic condition, I can’t see how better flow of information would make any of these things more affordable. I don’t need more information–I *know* that I have asthma. I just need to be able to afford the medicines I need to be able to breathe on a regular basis.

  12. I couldn’t read through all the comments, but I’m sure you pissed off several people just by being smarter than them with you. Part of the health care problem really is that we are charged much more for treatments than we should be. This is coming from the woman who recently had to beg for help with perscriptions that are literaly sustaining my life because I can’t pay $700 a month out of pocket when my husbandis making too much on unemployment for me to get medicade.

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