A Kinder, Gentler, Healthcare System

[stephL]

Sorry this is so long! According to the posts of our forum members, healthcare insurers are contacting patients with reminders and advice in an effort to control costs. One of our members reported that the case worker took a condescending approach. Ugh! Over the past few decades, insurers have taken on an adversarial role with doctors and patients with various types of interference, unwarranted denial of coverage requiring appeals, excessive amounts of required paperwork, etc. There seems to be an assumption by insurers that the public isn't concerned about controlling healthcare costs. I don't think we are as irresponsible as they fear. Doctors these days seem to be grumpy and patients aren't very content either. I think insurers need to take a more conciliatory strategy because controlling healthcare costs requires a level of cooperation and responsibility between the insurers, healthcare providers, and patients. We all have an interest in keeping healthcare affordable, so I wish they would just ask patients directly for ideas. Also, it's in the insurer's best interest  to focus on overlooked major issues like autoimmune disease so they can advocate for us. Just as with diabetes, early diagnosis and preventing complications in autoimmune disease would be cost effective. 

In my town, we have a medical 'clinic' for the uninsured. It's staffed by volunteer doctors and nurses. I visited there one time years ago while waiting for my disability to be approved. You will not find kinder people anywhere!    The clinic looked and functioned similar to a regular doctor's office, not like an impersonal clinic at all, the visit was free of charge, and they gave me free medication samples. When I was growing up, our town held fundraisers to support the local hospital, most noteworthy was a big summer carnival. Corporations, small business, and individuals supported the hospital with donations. The hospital also had the benefit of a staff of volunteers. This voluntary cooperation fostered a spirit of good will and respect between between insurers, providers, patients, and the community. Suing your doctor for medical malpractice seemed unthinkable except in the most extreme cases of negligence. Compared to the warmth that communities had toward their healthcare system decades ago, today's system seems so cold! 

Just a few of my thoughts here. So what are your ideas  about controlling healthcare costs? What do you see that can be improved, especially for those of us with Sjs?

[warmwaters]

For me the answer of how to reduce costs is to reduce the profit motive, i.e. eliminate insurers and go to a single payer system, as many large industrial nations do.  There are a variety of ways this could be done, and a variety of ways that a single payer system can be structured. If we weren't paying money to the insurers, there would be an immediate savings, and the office costs for doctors and hospitals would be reduced as they wouldn't have to navigate the systems and rules used by many different insurers.

Other ideas: use of technology to help automate many of the routine parts of the medical system (sending prescriptions, looking for drug interactions, sending information to patients, etc.)  Spare the medical staff a lot of the routine tasks, and let them spend time with patients. Increase the number of highly trained Physicians Assistants to help with "ordinary" problems like colds, infections. There are some fabulous tools out there to help doctors with diagnosis, which have been resisted both by the AMA and the insurers - make these more available.

Medical staff need more time if they are going to focus on the individual in front of them. They are often under pressure, understaffed, and frustrated with their job. And in turn that translates to them being abrupt with the patients.

And teach medical staff to communicate and to touch.  A kind hand on the arm, and the question "How are you doing?" starts the conversation off quite differently than an abrupt "Why are you here today?"

[Still in the hunt]

My healthcare provider is UPMC,, there based in Pittsburgh and the single largest employer in the area,, they bought up all the other insurance providers and they are a strick for profit company,, I wont call them a insurance provider,, they are a company, they are tehre to make money,, whenthey announced profits of 150 million the last quarter,, it had to come from somewhere,, preminums, denied testing, reducded payments to providers, the list goes on, but when you have to go into the hospital,, they rock you pretty good, for one overnight stay for my wife the bill was over 10,000 dollars,, thats insane, so i get to pay that 20% co-pay,
  its good that there are places that people can go to and actually feel like someone cares, tehre far and inbetween, I am old enough to remember house calls,, paid your 2 bucks,, and the doc usually had in his bag what you needed, if he didnt you got sent to the hospital till they found out what is wrong, your right,, doctors are pressed to provide more for less,, more patiens slipping through the cracks when it was apparent that whatever they have could have been treated if caught early, I dont know how to cut cost, a cut in cost will have the insurance companies screaming that we cant provide teh good level of care we say we provide,, I see at least 10 commercials a day about the level of care UPMC provides,, they now say we have life changing medicine,, I am not so sure its all for the good thats for sure, its a two headed monster,, money to be made,, and they dont want to give that up,, I;ll have to look and see what the ceo of upmc makes a year,, it has to be a pretty good income,,

[mshistory]

And teach medical staff to communicate and to touch.  A kind hand on the arm, and the question "How are you doing?" starts the conversation off quite differently than an abrupt "Why are you here today?"

My rheumatologist does this - he always comes in the room, gently shakes my hand and asks me how I'm feeling. It really does make a HUGE difference because it immediately puts me at ease and makes it feel more like having a conversation rather than being "examined."

[brook]

If you look at Medicare, I think there is more waste there than any other insurance company.. Medicare spends money to audit hospitals and soon doctors offices to be sure they aren't billing fraudulantly. Rules and more rules. More and more ways to pay the provider less. The providers have to hire people to be sure they are following the rules and to meet with auditors. Increasing costs of healthcare. I don't think a government run program will work in the United States. Are the programs in other countries created and run by politicians? How much input by medical community?  I think some people will benefit if we move forward because they will have coverage they never had, but many of us will have to learn to live with less. It has to balance out somehow. Just my thoughts.

[rnathans]

Fraud is a problem anywhere. That said studies have shown that Medicare is one of the most efficient health insurance systems in place with more of it's money going to actual health care. Many doctors will also tell you that it is easier to get approval for treatment from Medicare than private insurance and that the appeals process is easier. Medicare rules are established by the government but it is not run by politicians.

Medicare is not perfect and costs need to be reigned in everywhere BUT I would rather not have decisions on my care dictated by a private insurance company whose only motive is profit.

[Skylar]

My healthcare provider is UPMC,, there based in Pittsburgh and the single largest employer in the area,, they bought up all the other insurance providers and they are a strick for profit company,, I wont call them a insurance provider,, they are a company, they are tehre to make money,, whenthey announced profits of 150 million the last quarter,, it had to come from somewhere,, preminums, denied testing, reducded payments to providers, the list goes on, but when you have to go into the hospital,, they rock you pretty good, for one overnight stay for my wife the bill was over 10,000 dollars,, thats insane, so i get to pay that 20% co-pay,
  its good that there are places that people can go to and actually feel like someone cares, tehre far and inbetween, I am old enough to remember house calls,, paid your 2 bucks,, and the doc usually had in his bag what you needed, if he didnt you got sent to the hospital till they found out what is wrong, your right,, doctors are pressed to provide more for less,, more patiens slipping through the cracks when it was apparent that whatever they have could have been treated if caught early, I dont know how to cut cost, a cut in cost will have the insurance companies screaming that we cant provide teh good level of care we say we provide,, I see at least 10 commercials a day about the level of care UPMC provides,, they now say we have life changing medicine,, I am not so sure its all for the good thats for sure, its a two headed monster,, money to be made,, and they dont want to give that up,, I;ll have to look and see what the ceo of upmc makes a year,, it has to be a pretty good income,,

Hi Still in the hunt, UPMC is theoretically a Non-Profit hospital that is clearly run by a maniac who wants to own the world and make us all pay through the nose. If anyone is interested, just google what's going on here between UPMC and Highmark Insurance - lots of people are being hurt and will be hurt in the community thanks to UPMC. Ugly, cruel, mean etc. And UPMC does have their own insurance program for the few who can afford it or if you work for the institution. I used to work for UPMC and I can tell you that most people do not like working there and even the doctors are treated like dirt. Sad for Pittsburgh community.

Okay, health care is BIG BUSINESS - $$$$$$$ is the goal. Now it's only fair that the health care industry make some profit - but it's out of control. And the sad thing is that when it comes to acute care - the type you need if you're in an accident and broke your leg or collapsed your lung for example - the health care really works so well to save our lives. But chronic care, the kind most of need for sjogrens etc. - well - care is very poor, there are no cures, no magic bullets that can make us whole again.

However, most of the chronic diseases that we suffer from in the West are all self inflicted by our diets - things like type 2 diabetes (not type 1), most heart disease and even some cancers are all related to our poor, extremely rich diet. According to government records in near the beginning of the 20th century we ate about 120 pounds meat and now we eat over 222 pounds, In 1913 we ate 40 pounds of processed sugar and now 147 pounds and in 1090 294  pounds of dairy products and in 2006 605 pounds of dairy per person - well all this excess meat, diary and sugar has taken a real toll on our health. I'm an example of someone who changed their diet and no longer need a pile of medication - no longer have a laundry list of doctors that I have to see regularly, no longer need tons of testing etc. If most people changed their diet to eat a lot of fruit and veggies and very little lean meat and small amount of sugar - well there would a huge impact on health care expenses and we'd put tons of doctors, hospitals, health professionals, big pharma etc. out of work.