I need health care opinions for a school paper

MY opinion: people want good healthcare but do not want to pay for it. They want the best doctors but do not want to pay for them. They want good insurance but do not want to pay for it. They say they want healthcare for everyone but they do not want to pay for it.

Still my opinion: healthcare costs have spiraled out of control because of the insurance and pharmaceutical industries.

I don't know if this will help you with your paper but here is my 2 cents. I work in healthcare if that makes a difference to you.

Healthcare is broken, I think that most people will agree. The new guidelines tie reimbursement to performance. Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now.

I am a respiratory therapist. I deal with adults who primarily can't breath. They can't breath because they have smoked for many years and now have lung disease. Many continue to smoke despite being told by medical professionals that they need to quit. I am required on initial contact to ask them "Do you smoke?" and if they do follow it up with "Would you like information on quitting?" Most will answer the question simply and we move on. Everyday there is a least one that gets their feathers ruffled and makes a big deal out of my questioning. I remind them that I ask everyone these questions and that the hospital requires me to ask the question. It still pisses them off.

The other thing that is tied to hospital reimbursement is readmission to the hospital within 30 days for having difficulty with your breathing. Healthcare providers can not make these people quit smoking and take their medications as ordered. There are also a number of individuals that unfortunately can not afford their medications. They are doing the best they can by trying to stretch their 30 day supply of breathing meds to 60 days. There just aren't a ton of resources out there for people in these situations.

That sure is long winded! I hope you find something useful for your paper.

I wish I had to the time to reflect on each of your questions, as I could write volumes from working within one of the organizations being successful as an ACO.

But I'll just go with Lindy's post as a place for you to begin researching your answers as she put it much better than I could succinctly.

Baseline for your questions, by and large the population is used to a fee-for-service delivery model. Meaning....I'm sick...I see provider...I feel better and I move on.

That is not sustainable. That is what we had.

A very large premise of the ACA and what it demands from health-care providing entities, is evidence-based medicine practices, higher patient engagement for compliance, and quality outcome demands. It's a very, VERY big shift that is going on between what the population has been used to (liken it to I have the flu (virus) and I need an antibiotic (not appropriate treatment) to the mindset of "I have the flu...well why is your immune system such that you are succumbing to it more than others.

Shifting a population mindset, will take most certainly take, herculean customer service techniques for them to feel heard and taken care of meaningfully.

I prefer the option of paying for my own day to day health care needs in cash after having shopped my choices and providers. I would appreciate a tax benefit to doing so.

I would like to be able to participate in an insurance plan that is truly affordable, given the above, that covers only catastrophic biggies--cancer, transplants, etc.

I don't need or want a bunch of paperwork, government blah blah blah.

Simple is way better, in my opinion. But I suppose that would lessen the need for coders...so sorry about that.

WOW. That reminds me of No Child Left Behind!! That's awful!!

And as for health care it's broken all around. I just don't know it we will ever see meaningful changes because no one wants to do it. The politicians are so far up big pharmas ass it isn't even funny. Along with many other corporations.

You are very right.  I probably shouldn't post after a long day at the hospital.

This model is great on paper and will benefit many; unfortunately, there are a number of patients that will not fit into this model because of their lack of finances or their lack of willingness to help take care of themselves. 

Most practices here won't accept "self-pay" patients. If you become part of a practice and had a catastrophic event, they would have to accept financial responsibility for you. That's a big risk.

ive been a cash paying client for 18 years and have never been declined as a patient. I have given birth twice to two high-risk preemies, and had a major repairative knee surgery after a bad fall to the tune of almost a hundred thousand dollars. I have a GP and an endocrinologist.

My son has been a regular at Vanderbilt Neuro for his whole life. We always write them a check.

In the next paragraph after the one you quoted I said I would like the option to pay for a catastrophic event only insurance plan.

I'm not asking anyone to take a risk.

I'm sure some clueless practices somewhere don't accept cash pay clients but that's their short-sightedness. There are plenty who do...and it's to their benefit.

Concierge medicine. For the sick and the healthy. And those who don't want to be jacked around by insurance companies.

Exactly. This would bankrupt everyone I know.

Clueless practices? That's a laugh. We're talking the premiere practices of the entire country, if not world.

So, say you ran into a situation that would cost upwards of $300,000. Would you still be equipped to pay out of pocket? You need to have a backup guarantor (insurance) for these potential costs in this part of the country. No sane practice would knowingly incur such risk upfront. We have a major shortage of primary care docs in our state, and have for decades. It's too expensive to pay for malpractice insurance and other costs of practicing medicine.

By the way, I'm impressed that you are able to write checks for such significant amounts instead of just paying insurance premiums. Have you done a cost analysis of what you might have saved doing the latter?

There are some major initiatives happening at the primary care level that will produce meaningful outcomes-based data in the next two years. Insurance companies are engaged in one of the biggest pilots that involves statewide-span in five states of varying demographics/population models. Once the proof is shown in the data and actual lives saved (and ED visits avoided) are calculated, everyone is going to have to come along for the ride.

Medicare is starting to make the turn -- just last week they announced they would pay a care management fee for practices actively/proactively managing care for Medicare benes. Big dollars on that one. Active care management (not case management, not care coordination) is a proven winner for patients.

I regularly have contact with physicians, PAs, APRNs, QI directors, data analysts and others in health care who see the tide turning. It's going to happen. It's just going to take time because it's a HUGE undertaking.

Sadly, one of the key big thinkers behind the Triple Aim that megop mentioned is Don Berwick, who resigned from overseeing CMS rather than go through a grueling confirmation ordeal with Congress. We could be quite a few years ahead on this curve if he were still in a position to move policy at CMS.