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Originally posted by Replaced_Texan
One of the biggest problems with our health care system is that we do not pay as much attention to preventive medicine as we should. A study came out last week that suggested that bypass surgeries and stents are relatively ineffective in preventing further heart problems, though our system insists on treating the acute problems instead of focusing on the larger issue of public health. Diet, exercise and lifestyle changes much earlier in a person's life are much more effective.
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That study, although widely reported in the lay press, is not by any means widely endorsed. There are myriad studies that show that stents and bypass are effective for preventing future problems and moreover, stents and bypass operations are done to treat debilitating angina and acute ischemia/infarction. So those procedures are necessary for the person to live and function now, not just to prevent future heart problems - they are done to treat today's heart problems.
And the diet/exercise thing is not a problem with our healthcare system. It is a problem with people.
Quote:
Originally posted by Replaced_Texan
The managed care models proposed in the 60s and 70s contemplated that an individual would be in a managed care plan for decades, and that the plan would have incentives to prevent expensive-to-treat health care problems before they manifested through educational programs, screening, and simple, inexpensive preventive care. Of course, the model got muddled, and the HMOs that came out of the model were inefficient and more importantly, easier to leave.
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The reason HMOs don't work is because there really aren't any simple inexpensive preventive measures that do much except eating a low fat, high fiber well balanced diet high in fruit and vegetable consumption without overconsuming calories, regular exercise, no smoking, only drinking in moderation, and getting plenty of rest and drinking plenty of water and taking a multivitamin.
None of those things can be done by a doctor. They all have to be done by the patient themselves. The HMO doctor can tell you about this and maybe even refer you to a dietician if you are a moron and cannot figure out what is low fat/high fiber foods or how many calories is overconsuming (hint - having to unbutton your pants is a good sign you are overconsuming).
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Originally posted by Replaced_Texan
My grandmother, for example, LOVES to go to her physician for every minor ache and pain. She’ll doctor shop until she’ll find someone to attend to her hypochondria. I can’t tell you how many ultimately unnecessary endoscopies she’s had that were fully paid for by Medicare and her co-insurance. She’s a beautiful candidate for an HMO, but she opted out after a year in a Medicare CHOICE+ plan because she didn’t like how limited she was in her health care choices. Finding the balance, where health care that is necessary is available without too much concern for cost, is probably our greatest challenge.
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This has been well studied and was the basis for instituting MSAs. If the patient does not shoulder any of the burden for their healthcare costs or only a minimal burden, they will overconsume discretionary healthcare.
This has been well studied and many workable solutions have been proposed. Read the economics of healthcare literature (it is abundant) and you will see all the good ideas out there. Unfortunately, they don't get implemented. MSAs are a really good idea. The non-discretionary care or the proven preventive care is provided at little to no cost and the consumer pays for the discretionary care up to a certain amount a year.
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Originally posted by Replaced_Texan
Ultimately, I think that we’re heading for means testing on Medicare and that the new prescription drug benefit will have to be amended to reflect income of the recipient.
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Means testing is the way to go.
