A VC - Latest Comments in Consumer Centric Health Care

Re: Consumer Centric Health Care

mbrosen — Sat, 10 Oct 2009 14:35:27 -0000

And here's an interview with the author from Dennis Miller's radio show on 9/4.

Great segment. (iTunes Podcast link. If the link expires/is expired, let me know. I have it saved and can send it your way).

http://bit.ly/uHXwz

Re: Consumer Centric Health Care

mbrosen — Sat, 10 Oct 2009 14:26:48 -0000

HERE IT IS: The one paragraph Health Care Reform bill

http://bit.ly/pVRFw

Some roughly fleshed out thoughts on #hcr and some practical solutions here (Start at the bottom):

http://bit.ly/ZoQCf

Re: Consumer Centric Health Care

Ellen — Tue, 08 Sep 2009 20:16:13 -0000

Just to be clear. Universal health care has worked so well that my $1200 premium will now be $1485 a month starting November. When everyone must buy health care then everyone is at the mercy of the health insurance companies. The reason why everyone was made to get health insurance was Mitt Romney
did not like the way the Massachusetts budget looked with all the "free care through the state." so he decided to make it illegal for poor people not to pay for insurance. So now the insurance companies can charge what they want. The "low - cost" plans of $550 a month are useless to most. I feel so discriminated against because I have to pay so much and can't even get dental because I do not belong to a group. Why can't I get a discount for lack of usage like in my mandatory car insurance premium as in good driver points.

Re: Consumer Centric Health Care

fredwilson — Sat, 05 Sep 2009 15:30:04 -0000

He proposed borrowing against HSAs for that purpose.

Re: Consumer Centric Health Care

gorbachev — Sat, 05 Sep 2009 04:17:08 -0000

I read the article when it came out. I think he diagnosed the problems of the healthcare system brilliantly.

However, he really needs to spend some more time with the common folks before he offers any more advice on how to actually fix the problems. A $50K threshold for catastrophic illness insurance coverage would bankrupt a large percentage of anyone who'd be unlucky enough to have healthcare related costs between $20K and $49,999.

I make good money, but a sudden unplanned medical bill of $20K - $40K would definitely put me in the "how the hell do I not foreclose my house" category VERY quickly, especially if combined with loss/reduction of income.

Re: Consumer Centric Health Care

Ellen — Thu, 03 Sep 2009 21:18:41 -0000

Are you nuts tort reform. First of all my doctors do no do tests so they won't get sued. They do tests to find out the cause of a bad symptom They do tests to find out answers. If we change the system where a pcp gets a lump per year to pay for tests and specialists and the pcp's income is penalized by ordering tests and gets to keep the whole years worth of money for doing nothing and then the patient isn't allowed to sue if the pcp is greedy and disallows any lifesaving tests, then I think we are going to have a problem. I lived this with medicare with my mother in 1995 and it was horrible and a nightmare. The doctor would not admit her to the hospital for a month in a half and she was presenting some very bad and life threatening symptoms. Thank g-d Fred none of your loved ones had very serious life threatening illnesses where medicare or blue cross denied hospitalization because the doctor got a bonus for keeping the elderly out of the hospital.

Here in Massachusetts you have to be on death's door before you get admitted to a hospital. If you are elderly which is 65 and you need hospitalization beyond your diagnosis related group, YOU can forget about it. You are out. No matter what. Get a stupid hospitalist who cannot diagnose properly and you have lost your one chance at life.

I don't know why people complain about $1800 for a family membership insurance premium when our 2 person family pays $2400 a month. My sister pays $1400 a month

Re: Consumer Centric Health Care

Philip — Thu, 03 Sep 2009 16:47:53 -0000

According to the AMA, (http://bit.ly/fNc4t) 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance.

So, even if you have insurance you can be right out of luck. We could try a market-based approach - but, like any other market-based commodity, you may still not be able to afford it and in case of healthcare its quality rather than price that should rule. I doubt a market-based approach would have helped the folks in the AMA study. But indeed some kind of government-supported insurance that covers 100% of catastrophic situations as a backup to a market-based approach might be interesting ...

Re: Consumer Centric Health Care

fredwilson — Thu, 03 Sep 2009 08:41:04 -0000

We gotta get tort reform as part of healthcare reform

Re: Consumer Centric Health Care

Guest — Thu, 03 Sep 2009 06:43:45 -0000

Make a living will now, while you are healthy. If everyone did this, it would be a non-issue.

Re: Consumer Centric Health Care

Guest — Wed, 02 Sep 2009 23:08:10 -0000

I had to come back and see some of the follow up comments. Some of these names, I know them so well and respect so much that they have to say. But about healthcare? I have to say this. You need to live it to really understand what is going on. You need to be a physician or live in his home with him as his family.
We all THINK that we live it, because we see bills for our tests (totally fictional - you think BC/BS actually pays that amount?). Look at your EOB (explanation of benefits) sometime. Look what your doctor charged and what he actually got. He had no choice, the insurance company said "take our price or you can't have our patients". You see and hear about the huge amounts spent in the last 30 days of life. Do you think you would want that if it was YOUR last 30 days of life, or that it's needed? Or do you think (with a very rational thought process) that doctors fear that if they don't DO something, the family will sue them for whatever test they left out on dying granny. If we actually knew the amount spend on malpractice prophylaxis, we would be appalled. This, in my opinion, is one of the main reasons other countries can have the health systems they have. They can treat patients reasonably, with what they need. Not because they are afraid of being sued. You will not hear this. The attorneys have deep pockets, big lobbying groups, and are our government is made up of them. But this is defensive medicine, and doctors have to practice that way. Nobody wants TORT reform, but they want free medical care. This makes no sense to me.

Not to be crass. But as I posted in my last comment, my family (the family of a primary care doctor) has been suffering through this for decades. Not suffering through patients, as they are his love.

Many of you want government insurance. When is the last time you went to get a referral for a procedure? Oh, there will be referrals. How long do you think you will wait for them? Do you think the primary care doctor will be monetarily penalized for sending you for a procedure (like he was with HMOs?). Or that he will have "incentives" for "low utilization", which was also the case with HMOs. Or that he will worry about attorneys and being sued for not doing so.

How many of you have gone to the trouble of filling out a living will? A very easy step - one that expresses your wishes during those last 30 days. Possibly makes them your last 120 days or your last 10 - but regardless they are your wishes. Tests are not being done "in case I get sued". They are being done because you wanted them done, and there are no attorney problems to worry about when it's over.

I could go on and on. I understand that healthcare prices are out of control. My family pays 1800/month for health insurance. A huge number - a send a kid to college number - and nobody ever goes to the doctor!!!. There is a major problem here. But getting the government involved? Making more paperwork and layers of adminstration that costs money? And then who pays for that, the primary care physican again? Insurance companies have the deepest pockets (notice the CEO salaries of the insurance companies?? but a primary care physician average in the USA is 140k/year at his/her prime, after going to school for 7 years at minimum AFTER college with endless loans for a 5 figure starting salary?).
I do not know what the answer is, if it was easy than we wouldn't have 225 comments on this board.
But I do know that medical legal issues and insurance companies are a very large part of the problem. They also have the deepest pockets to make their interests known.
If we can somehow leave them out - and oh, just lop off some of those CEO salaries to help fund healthcare for those who can't afford it - - I will just come out and say it. With substantial TORT reform and insurance for the purpose of INSURANCE ONLY, the government would have plenty of money for the uninsured.
Nobody thinks the uninsured aren't taken care of, do they? Hopefully everyone knows that a sick person who walks into an emergency room MUST be treated, whether or not they have insurance. And it won't be any different than if they DID have insurance. And even if that person doesn't pay, and they have a bad outcome, they can sue the hospital for the outcome!

We are fortunate that my husband has never been sued, but we know what it does to the lives of those who are. There are cases where there should be compensation, but if you want healthcare like they have in other countries, then accept the compensation they give you for errors in other countries. In Australia they have set dollar amounts for each limb, body part, etc. If we did that, how this entire picture would change.

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 21:17:10 -0000

But how do you really feel kid? :)

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 21:14:02 -0000

There's a link to the netherland's system somewhere in this thread and although I didn't click thru, the suggestion was that they also have a consumer centric system

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 21:12:03 -0000

You are making the case for consumer centric health care. Pls don't think I am suggesting everyone pay for their health care. Certainly I should. But maybe you shouldn't. Maybe the government should help you shoulder the cost. That's not my point. My point is however we finance it, you and I should be incented to get quality health care for us and our families for the lowest cost

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 21:07:02 -0000

I'd take single payer or consumer centric over Obama's plan

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 21:02:03 -0000

Yeah. The discussion is always the goal. I have my views. You have yours. I learn from yours and hopefully you learn from mine

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 19:27:02 -0000

This consumer centric model exists in many parts of the world and works

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 19:25:05 -0000

I'm with you. I prefer lots of small steps to one big one. Its almost always better

Re: Consumer Centric Health Care

fredwilson — Wed, 02 Sep 2009 19:22:02 -0000

Great points druce. I can always count on reasoned intelligent analysis from you. Thanks

Re: Consumer Centric Health Care

MattCope — Wed, 02 Sep 2009 16:11:35 -0000

A lot of my peers (aged 22 - 30) are looking seriously at this option, too - but it's *complicated* if you don't have the background.

Perhaps there's a market for health care fiduciaries...

Re: Consumer Centric Health Care

Ellen — Wed, 02 Sep 2009 12:48:57 -0000

In real life it took me 3 telephone calls just to find out what my insurance paid for a cat scan w/out dye and radiology read. I received a bill for $3616 from a Partners Hospital Newton Wellesley Hospital Newton, Ma.. I saw a minus on the bill for $3591. I knew full well Blue Cross is not going to pay that absurd price. That is the list price for people without insurance. After a half hour of telephone calls I find out that Blue Cross allows $844 and they paid out to Partners $ 814.. This was my first ever cat scan and I have been a subscriber with the best individual policy money can buy since I was born as my parents had Blue Cross for us. All the non Partners Hospitals in Ma. have been screaming corruption because Partners had a private deal with Blue Cross to get 30 % more in reasonable and customary charges on all covered services than all the other hospitals. The other hospital ceo's feel as if they were fleeced. With all the various forms of coding and bundling of services we will all need complex computer programs to find out what is a good deal at all and if you are stroking or having a heart attack you can't compare prices.

Re: Consumer Centric Health Care

nickdavis — Wed, 02 Sep 2009 10:06:03 -0000

fair point

Re: Consumer Centric Health Care

kidmercury — Wed, 02 Sep 2009 08:57:04 -0000

the healthcare discussion needs a broader perspective so that we can realize just how much govt does what they do best, which is f things up.

1. the business of practicing medicine is too regulated. you need to be board certified, AMA approved, etc. this limits alternative medicine. it limits entrepreneurial efforts. most detrimentally, it standardizes and controls the knowledge base doctors are exposed to. lots of medicines that cost nothing are not known about and utilized because of this. it also makes the process of becoming a doctor far more burdensome than necessary.

2. people get sick because they eat like crap. like all govt regulatory bodies, the FDA is bought and paid for by big pharma and big agra. the pharmaceutical companies ensure all sorts of terrible drugs get approved and labelled as "medicine," and help to create a culture where the solution for every illness is to visit a drug dealer (aka pharmacist) and develop a new habit. the FDA also wages economic war on organic and small farmers, imposing cost-prohibitive restrictions that prevent them from being able to effectively compete with the food giants. they also do things like make sure the "USDA organic" label can be used on food products that are not actually organic. wtf.

that's just scratching the surface. cancer rates are up, autism is up, STDs are up. of course government spending is up too. not just a coincidence, i assure you.

Re: Consumer Centric Health Care

kidmercury — Wed, 02 Sep 2009 08:47:59 -0000

lol, thanks for calling him bush jr boss. i really hate how he got away with being "w." wtf is up with that. he's a jr who got his job through nepotism, let's be real about it.

Re: Consumer Centric Health Care

Vladimir Vukicevic — Wed, 02 Sep 2009 08:41:40 -0000

I guess we differ on that one...

Re: Consumer Centric Health Care

rick gregory — Wed, 02 Sep 2009 01:15:24 -0000

Thanks for the link Matt, I'll check that out. I still come back to the fact that we can halve our costs if we implement the systems seen in Europe, Australia and elsewhere. Presuming this system works in Singapore that's one place and not one that's culturally similar to us. I'd like more datapoints before we anoint this the cure.

And cost isn't the whole issue - it's access to health care and quality of care as well. We overfocus on the economic aspect - who pays, what are the costs etc - but we also need to go up a level and ask the basic questions like "who gets care, what's covered, is healthcare at some level a basic benefit of being a citizen?

For myself, any system that cuts costs but doesn't address access is only dealing with one of the issues. The lack of universal access is an admission that we can't, or choose not to, provide a benefit to our citizens that every other developed nation provides. Why can't we? If it's choice, why do we choose not to? Some of the very people complaining about the cost of providing health care had no issue in spending hundreds of billions in Iraq to kill people... Let's talk about the worldviews we have and decide what we want. How to pay for that is really a secondary issue until we decide what we mean by the term 'healthcare'.

EDIT: Ok, after reading that it sounds interesting, but there's not a lot of real detail. For example, the government subsidizes a hospital stay at 80%. Sounds nice, but unless there's a sizable difference in costs between us and them, that 20% could still be a very high number here if it's not capped somehow. For elective procedures, meh. But for typical things (broken arm, appendicitis, etc) that 20% could be a very large number with our costs. And for chronic conditions (diabetes, say) or for catastrophic conditions? It could be VERY large.