I agree with the general thesis of this post, and also that the AMA survey has to be taken with a large grain of salt because it was purely self-reporting and not data-based. However, no matter what healthcare reimbursement system is in place, it is a simple fact that costs must be controlled - funding is not, and never will be, infinite. The 3 major components of making expenditures reasonable will be: (1) Eliminate private insurance, and thereby cut out the current 20% or more of premium payments that go to exorbitant administrative overhead+executive salaries+ profit, rather than to patient care. In its place, implement a national single payer program - - which would NOT!! take over the *delivery* of healthcare, but would simply re-channel the collection & disbursement of healthcare dollars. With single-payer (think re-vamped Medicare covering all ages, and with improved/more equitable provider reimbursement), there would be no profit motive, executive salaries, or stockholders, and the overhead would amount to roughly only 5%. [For those who want to learn more about single-payer, check out Physicians for a National Health Program.] (2) Mandate drug price negotiation - just like Medicare is now beginning to do. (3) We must be clear-eyed and acknowledge that not all care recommended by a provider or desired by a patient is appropriate and necessary. And that more care is not always better care. I can attest to all of that as a physician who during my career saw a substantial amount of unnecessary or duplicative testing, procedures and referrals - mainly, I think, because providers are too pressed for time to do what we should be doing, which is to think and consider rather than the fastest and easiest route, which is to treat/order/refer. In addition, what we were trained to do in residency is not always (or does not always remain) best practice based on hard outcomes data. What will ultimately be needed are *physician*-devised and -managed, evidence-based, flexible guidelines. I had experience with these as a practitioner and executive at Kaiser Permanente for part of my career, and they can be successfully implemented and effective.
AI has accelerated this problem. People setting the rules for AI are not using data to support their denials. They simply "think" that this shouldn't be covered versus using scientific data supporting the denial.
I, too, have observed the shocking similarity of Republican health care policy to Death Panels. I'm old enough to have lived when kidney dialysis was earned based on your CV. Here's my blog on that time: https://www.healthrageous.com/post/who-shall-live-who-shall-die
Way too simplistic to blame "evil insurance companies" for healthcare problems. Since the end of WW2, demographics have warned of babyboomers retiring and having more medical claims as they age.
The US stood by and let the AMA and state regulators restrict the number of doctor and nursing students which has not nearly kept up with with retirements and burnouts. This could have been prevented or reduced by building more schools and class sizes.
And value-based compensation rules were promulgated by CMS, and providers and insurance companies alike were happy to utilize machine learning and ai in their risk adjustment models in order to maximize income and return on investment.
But as important as these elements are, the US is the only country where triage is not a fact of life/death when it comes to rationing healthcare.
So blame evil insurance companies, yeah, I get it. But let's blame CMS and federal policy makers for being asleep at the switch for almost 80 years.
I have a medical insurance client who likes to tell anyone that will listen to him that the biggest problem facing the world is overpopulation, and the older I get the more I understand it.
The birthrate in most developing nations, including the US, is not keeping up with deaths. So a younger population cannot support the extremely expensive healthcare ecosystem that we US citizens see as a god-given right.
Rx costs continue to climb, accounting for about 25% of healthcare spend.
Oh, and at least 75% of healthcare spend is a result lifestyle decisions -- diabetes, coronary/heart, cancer, etc.
Theee are any number of other reasons for rationing care, but these are top of mind.
The Private For Profit Health Insurance Companies serve no purpose other than getting in the way and driving up the cost of healthcare. No other country has a Private For Profit Healthcare System.
I agree with the general thesis of this post, and also that the AMA survey has to be taken with a large grain of salt because it was purely self-reporting and not data-based. However, no matter what healthcare reimbursement system is in place, it is a simple fact that costs must be controlled - funding is not, and never will be, infinite. The 3 major components of making expenditures reasonable will be: (1) Eliminate private insurance, and thereby cut out the current 20% or more of premium payments that go to exorbitant administrative overhead+executive salaries+ profit, rather than to patient care. In its place, implement a national single payer program - - which would NOT!! take over the *delivery* of healthcare, but would simply re-channel the collection & disbursement of healthcare dollars. With single-payer (think re-vamped Medicare covering all ages, and with improved/more equitable provider reimbursement), there would be no profit motive, executive salaries, or stockholders, and the overhead would amount to roughly only 5%. [For those who want to learn more about single-payer, check out Physicians for a National Health Program.] (2) Mandate drug price negotiation - just like Medicare is now beginning to do. (3) We must be clear-eyed and acknowledge that not all care recommended by a provider or desired by a patient is appropriate and necessary. And that more care is not always better care. I can attest to all of that as a physician who during my career saw a substantial amount of unnecessary or duplicative testing, procedures and referrals - mainly, I think, because providers are too pressed for time to do what we should be doing, which is to think and consider rather than the fastest and easiest route, which is to treat/order/refer. In addition, what we were trained to do in residency is not always (or does not always remain) best practice based on hard outcomes data. What will ultimately be needed are *physician*-devised and -managed, evidence-based, flexible guidelines. I had experience with these as a practitioner and executive at Kaiser Permanente for part of my career, and they can be successfully implemented and effective.
I appreciate your insight
AI has accelerated this problem. People setting the rules for AI are not using data to support their denials. They simply "think" that this shouldn't be covered versus using scientific data supporting the denial.
We can’t let the market fix this problem. Free market economics don’t apply here. It’s a fixed market.
I, too, have observed the shocking similarity of Republican health care policy to Death Panels. I'm old enough to have lived when kidney dialysis was earned based on your CV. Here's my blog on that time: https://www.healthrageous.com/post/who-shall-live-who-shall-die
Way too simplistic to blame "evil insurance companies" for healthcare problems. Since the end of WW2, demographics have warned of babyboomers retiring and having more medical claims as they age.
The US stood by and let the AMA and state regulators restrict the number of doctor and nursing students which has not nearly kept up with with retirements and burnouts. This could have been prevented or reduced by building more schools and class sizes.
And value-based compensation rules were promulgated by CMS, and providers and insurance companies alike were happy to utilize machine learning and ai in their risk adjustment models in order to maximize income and return on investment.
But as important as these elements are, the US is the only country where triage is not a fact of life/death when it comes to rationing healthcare.
So blame evil insurance companies, yeah, I get it. But let's blame CMS and federal policy makers for being asleep at the switch for almost 80 years.
I have a medical insurance client who likes to tell anyone that will listen to him that the biggest problem facing the world is overpopulation, and the older I get the more I understand it.
The birthrate in most developing nations, including the US, is not keeping up with deaths. So a younger population cannot support the extremely expensive healthcare ecosystem that we US citizens see as a god-given right.
Rx costs continue to climb, accounting for about 25% of healthcare spend.
Oh, and at least 75% of healthcare spend is a result lifestyle decisions -- diabetes, coronary/heart, cancer, etc.
Theee are any number of other reasons for rationing care, but these are top of mind.
The Private For Profit Health Insurance Companies serve no purpose other than getting in the way and driving up the cost of healthcare. No other country has a Private For Profit Healthcare System.
I am more than happy to share the stories of fighting for my MS medicine to be covered ALL THE TIME.