To the Editor:
The main problem with our health care system is that it is, at every level, profit-driven, from the doctor’s office to the drug companies to the hospital. And no matter how you get insurance, through the Affordable Care Act or your employer, they’re in the business of denying service to improve profitability.
No one should be getting rich off people’s misery. While doctors, hospitals and pharmaceutical companies need to get paid for their services, C.E.O.’s shouldn’t be making nine-digit salaries while patients suffer. The only solution is universal, nonprofit health care for all. Is that Medicare for All, or something different? I’m not sure, but most other industrialized modern countries provide health care as a basic right.
Daphne Case
Norwalk, Conn.
To the Editor:
My health care cost reduction ideas are:
1) Promote price transparency by outlawing confidentiality agreements between insurers, doctors, hospitals and other providers that preclude disclosure of actual contract reimbursement rates that make it impossible for patients and doctors to identify the most cost-effective high-quality providers.
2) Get medical malpractice disputes out of the hands of juries and substitute specialized health courts presided over by judges empowered to hire neutral experts to sort through conflicting claims. Also, give doctors safe-harbor protection from lawsuits if they follow evidence-based guidelines and protocols where they exist. This should reduce defensive medicine over time.
3) Find ways to increase the percentage of the population, especially among the elderly, who execute a living will or advance directive for health care. When there are no such documents and no guidance from family members, allow doctors to exercise common sense depending on circumstances instead of doing everything possible to prolong life no matter how futile or costly.
Barry Carol
Aberdeen, N.J.
To the Editor:
I am all in favor of universal health care. “Medicare for All” seems to be the rallying cry. I just want to point out one important thing — Medicare is not cheap. I’m 71 years old and have been on Medicare for several years. It is an excellent program. It has seen me and my husband through a couple of hospitalizations with little or no extra cost.
But we pay for Medicare, over $260 per month deducted from our Social Security checks plus insurance premiums for supplemental insurance and the prescription program, plus the doughnut hole for a while longer. I take a medication that is not on drug formularies because of cost and have to sweat whether I can get an exception every year.
If Medicare for All is just code for universal health care, great. If it is literally Medicare for All, be warned: It might be costly for lower-income people.
Elizabeth Fisher
Eliot, Me.
To the Editor:
The principal problems with our health care system are fairly clear: high cost, uneven access across socioeconomic echelons, poor outcomes for poor people, and lack of portability of insurance from one job to the next and from one location to another.
Here are what I think might go some ways toward solving these problems. First, allow all individuals and employers to be able to choose Medicare as their insurer, setting premiums to allow a reserve pool to cover the unemployed, disabled, working poor and indigent elderly.
Second, decouple reimbursement to providers from the volume of service provided and link it to outcomes.
Third, provide free medical training to all qualified nursing and medical students.
And finally, develop a much larger cadre of nurse practitioners to perform routine interventions for nonemergency, non-life-threatening situations.
Richard Gayle
Ventura, Calif.
To the Editor:
I am fortunate enough to have decent health insurance through my employer. However, this means that if I want to switch jobs, for a better salary or a job that better suits my career goals, I may have to go without health insurance for a risky period of time, or pay the exorbitant Cobra costs. I would also be more hesitant to work for a small company that may not provide health insurance. Wouldn’t we be served better if people could pursue their careers without having to worry about having employer health insurance coverage? This is why I support the New York Health Act.
Isabella Vitti
Brooklyn
To the Editor:
What works in American health care is the amazing technology we develop and employ. Our research hospitals are something we can be proud of.
Three things that don’t work:
1) Funding of medical education, which puts new doctors into so much debt that they are forced to choose higher-paying specialties over primary care and underserved populations;
2) Our complicated and inefficient payment system (we spend much more than other countries on overhead); and
3) Our stubborn insistence that health care is a product for sale if you can afford it rather than a basic human need.
Charles E. Bouchard
St. Louis
The writer is senior director, theology and ethics, at the Catholic Health Association.
To the Editor:
When I began my new job in 1975 as the financial manager at a primary care clinic, I was shocked at how few primary care doctors were in the community and how little money went to primary care and prevention services. As I prepare to retire, I am saddened, but not shocked, at the state of the American sick care (not health care) system.
We need to find ways, big and small, to push more money upstream to fund prevention, early intervention, primary care, affordable housing, violence prevention and so on. If done thoughtfully, we can begin to slowly reduce the number of “customers” of the sick care system — reduced emergency room visits, hospital admissions, diagnostic imaging procedures and specialist visits. This would free up a surprising amount of money that could be moved upstream, creating a virtuous upward cycle that will result in a true “health care system.”
It’s happening right now, supported by young people and enlightened employers who are refusing to play in the old game. I’m excited and optimistic.
Dale Jarvis
Seattle
To the Editor:
The six-year period that I spent without health insurance — long before the Affordable Care Act became law — was a frightening experience. Even after I acquired insurance upon re-entering the work force, I spent so much money on monthly payments, co-pays and deductibles that I could barely afford basic necessities.
The current law is a hodgepodge that must be grounded in a stronger, more reliable system. A program is needed to guarantee that all citizens with limited income are insured while those who are better off pay for part or all of their insurance.
I have in mind a multi-tier system. A government program would be available for anyone who cannot afford health insurance; middle-income people could choose between the public plan and a private insurer at reasonable cost; and the rich would be required to purchase private insurance at higher costs.
Bruce S. Ticker
Philadelphia
To the Editor:
I suggest that our health care system could do better in catching complications from any surgical procedure. A checklist of specific complications could be given each patient at discharge. It must be easy to read and very clear on what to do if any complication becomes apparent. This could potentially reduce the number of repeat hospitalizations for expensive inpatient second surgeries.
Gary S. Sorock
Pittsburgh
The writer, a registered nurse, is an adjunct assistant professor at the University of Pittsburgh School of Nursing.
To the Editor:
I am an educated health care provider who couldn’t keep my late daughter safe in our medical system. I learned everything I know now the hard way — by watching my daughter suffer through medical errors, misdiagnoses and communication glitches.
I honor my daughter’s memory by working as a volunteer patient advocate to provide the information that I needed all those years ago to the public. The very same issues my family faced continue to plague the patients and family members who regularly contact our organization — two decades later.
We have made little progress in truly educating and engaging patients and their loved ones to take an active — and potentially lifesaving — role in their medical care.
There are few health care strategies that are more cost-effective or empowering than asking the right questions, making informed decisions and having the skills to function as the last level of protection in the tenuous safety net for patients.
Julia Hallisy
San Francisco
The writer is the founder of the Empowered Patient Coalition and EngagedPatients.org.
Source: Read Full Article
Home » Analysis & Comment » Opinion | How to Fix a Broken Health Care System
Opinion | How to Fix a Broken Health Care System
To the Editor:
The main problem with our health care system is that it is, at every level, profit-driven, from the doctor’s office to the drug companies to the hospital. And no matter how you get insurance, through the Affordable Care Act or your employer, they’re in the business of denying service to improve profitability.
No one should be getting rich off people’s misery. While doctors, hospitals and pharmaceutical companies need to get paid for their services, C.E.O.’s shouldn’t be making nine-digit salaries while patients suffer. The only solution is universal, nonprofit health care for all. Is that Medicare for All, or something different? I’m not sure, but most other industrialized modern countries provide health care as a basic right.
Daphne Case
Norwalk, Conn.
To the Editor:
My health care cost reduction ideas are:
1) Promote price transparency by outlawing confidentiality agreements between insurers, doctors, hospitals and other providers that preclude disclosure of actual contract reimbursement rates that make it impossible for patients and doctors to identify the most cost-effective high-quality providers.
2) Get medical malpractice disputes out of the hands of juries and substitute specialized health courts presided over by judges empowered to hire neutral experts to sort through conflicting claims. Also, give doctors safe-harbor protection from lawsuits if they follow evidence-based guidelines and protocols where they exist. This should reduce defensive medicine over time.
3) Find ways to increase the percentage of the population, especially among the elderly, who execute a living will or advance directive for health care. When there are no such documents and no guidance from family members, allow doctors to exercise common sense depending on circumstances instead of doing everything possible to prolong life no matter how futile or costly.
Barry Carol
Aberdeen, N.J.
To the Editor:
I am all in favor of universal health care. “Medicare for All” seems to be the rallying cry. I just want to point out one important thing — Medicare is not cheap. I’m 71 years old and have been on Medicare for several years. It is an excellent program. It has seen me and my husband through a couple of hospitalizations with little or no extra cost.
But we pay for Medicare, over $260 per month deducted from our Social Security checks plus insurance premiums for supplemental insurance and the prescription program, plus the doughnut hole for a while longer. I take a medication that is not on drug formularies because of cost and have to sweat whether I can get an exception every year.
If Medicare for All is just code for universal health care, great. If it is literally Medicare for All, be warned: It might be costly for lower-income people.
Elizabeth Fisher
Eliot, Me.
To the Editor:
The principal problems with our health care system are fairly clear: high cost, uneven access across socioeconomic echelons, poor outcomes for poor people, and lack of portability of insurance from one job to the next and from one location to another.
Here are what I think might go some ways toward solving these problems. First, allow all individuals and employers to be able to choose Medicare as their insurer, setting premiums to allow a reserve pool to cover the unemployed, disabled, working poor and indigent elderly.
Second, decouple reimbursement to providers from the volume of service provided and link it to outcomes.
Third, provide free medical training to all qualified nursing and medical students.
And finally, develop a much larger cadre of nurse practitioners to perform routine interventions for nonemergency, non-life-threatening situations.
Richard Gayle
Ventura, Calif.
To the Editor:
I am fortunate enough to have decent health insurance through my employer. However, this means that if I want to switch jobs, for a better salary or a job that better suits my career goals, I may have to go without health insurance for a risky period of time, or pay the exorbitant Cobra costs. I would also be more hesitant to work for a small company that may not provide health insurance. Wouldn’t we be served better if people could pursue their careers without having to worry about having employer health insurance coverage? This is why I support the New York Health Act.
Isabella Vitti
Brooklyn
To the Editor:
What works in American health care is the amazing technology we develop and employ. Our research hospitals are something we can be proud of.
Three things that don’t work:
1) Funding of medical education, which puts new doctors into so much debt that they are forced to choose higher-paying specialties over primary care and underserved populations;
2) Our complicated and inefficient payment system (we spend much more than other countries on overhead); and
3) Our stubborn insistence that health care is a product for sale if you can afford it rather than a basic human need.
Charles E. Bouchard
St. Louis
The writer is senior director, theology and ethics, at the Catholic Health Association.
To the Editor:
When I began my new job in 1975 as the financial manager at a primary care clinic, I was shocked at how few primary care doctors were in the community and how little money went to primary care and prevention services. As I prepare to retire, I am saddened, but not shocked, at the state of the American sick care (not health care) system.
We need to find ways, big and small, to push more money upstream to fund prevention, early intervention, primary care, affordable housing, violence prevention and so on. If done thoughtfully, we can begin to slowly reduce the number of “customers” of the sick care system — reduced emergency room visits, hospital admissions, diagnostic imaging procedures and specialist visits. This would free up a surprising amount of money that could be moved upstream, creating a virtuous upward cycle that will result in a true “health care system.”
It’s happening right now, supported by young people and enlightened employers who are refusing to play in the old game. I’m excited and optimistic.
Dale Jarvis
Seattle
To the Editor:
The six-year period that I spent without health insurance — long before the Affordable Care Act became law — was a frightening experience. Even after I acquired insurance upon re-entering the work force, I spent so much money on monthly payments, co-pays and deductibles that I could barely afford basic necessities.
The current law is a hodgepodge that must be grounded in a stronger, more reliable system. A program is needed to guarantee that all citizens with limited income are insured while those who are better off pay for part or all of their insurance.
I have in mind a multi-tier system. A government program would be available for anyone who cannot afford health insurance; middle-income people could choose between the public plan and a private insurer at reasonable cost; and the rich would be required to purchase private insurance at higher costs.
Bruce S. Ticker
Philadelphia
To the Editor:
I suggest that our health care system could do better in catching complications from any surgical procedure. A checklist of specific complications could be given each patient at discharge. It must be easy to read and very clear on what to do if any complication becomes apparent. This could potentially reduce the number of repeat hospitalizations for expensive inpatient second surgeries.
Gary S. Sorock
Pittsburgh
The writer, a registered nurse, is an adjunct assistant professor at the University of Pittsburgh School of Nursing.
To the Editor:
I am an educated health care provider who couldn’t keep my late daughter safe in our medical system. I learned everything I know now the hard way — by watching my daughter suffer through medical errors, misdiagnoses and communication glitches.
I honor my daughter’s memory by working as a volunteer patient advocate to provide the information that I needed all those years ago to the public. The very same issues my family faced continue to plague the patients and family members who regularly contact our organization — two decades later.
We have made little progress in truly educating and engaging patients and their loved ones to take an active — and potentially lifesaving — role in their medical care.
There are few health care strategies that are more cost-effective or empowering than asking the right questions, making informed decisions and having the skills to function as the last level of protection in the tenuous safety net for patients.
Julia Hallisy
San Francisco
The writer is the founder of the Empowered Patient Coalition and EngagedPatients.org.
Source: Read Full Article