Healthcare in America is a disjointed aggregation of special interests, middlemen, profiteers, and lobbyists. It is not a system, it is inefficient, and it fails to meet the basic needs of most people. Meaningful change requires a radical new approach before it bankrupts our counntry and its citizens.
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I have so many ideas regarding how healthcare could change from an inside prospective. I have been a nurse for 30 years. I believe healthcare was patient focused for the first century I worked as a nurse. Since, it has drastically changed. It is unsafe and everyone needs a patient advocate.
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Dear Stephani: While I appreciate your thoughts I was just notified I am out of votes. Who knew??? As a retired designer of single payer systems I built the only existing MedicareForAll prototype for the Clinton Task Force in 1991. That ship has sailed for many reasons. I am working a new policy to establish a national task force on healthcare. Too your point, it will involve input from 1.000ās of sources such as yourself perhaps. It will involve a paid task force that administers questionaires of every hospital & personnel, a variety of Drs. & other providers, various employers, insurers, medicare/medicaid agencies, etc. You get the general idea. Problems will differ to some degree but there will be a number of common denominators that will emerge from which to work from. I project this will be a two year endeavor to collect enough information to architect a successful solution. This solution has to be of mutual benefit to all interests involved including the patients, I have not figured out how to locate any replies I might have. Best Wishes
The country has long been bankrupted by this as it represents 20% of GDP. There is only one way to fix this. Please see my other replies. Best wishes. Sorry I donāt have any votes left. Didnāt know there was a limit.
My suggestion is that we should switch to a cost-based competitive market system and start with experiments in small jurisdictions first. What is the cost of getting a medical opinion and a prescription. An antitrust body should monitor pricing and find out why pricing is so high and intervene.
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Do to health care what President Trump & DOGE have done to federal agencies. Clean it up and make it affordable.
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The analogy of gagging at a gnat but swallowing a camel comes to mind after reading this thread.
Yes, the medical profession has been corrupted and no longer is the best that it can be. As with most things in society, it has been corrupted by government interference and control imposed with the intent to garner and exert political power, notwithstanding the fact that you will hear high-minded justifications for government involvment. Government broke the practice of medicine; it cannot fix it. It lacks the political will and the techical ability.
As with most other services (public utilities, water and sewer, and waste disposal excepted), medical services work best subject to markeplace forces, not political forces.
Recently Tucker Carlson interviewed Dr. Richard Bosshardt. Revelations by Dr. Bosshardt are disturbing. He reports that the precepts of dei have been at work in the selection, education, training and hiring of doctors for decades with the result that physicians are too often not properly trained and qualified when licensed to practice on us.
In few other professions is meritocracy more important - and dei precepts more dangerous - than in medicine. In medicine, color, ethnicity, and race have no place in any criteria. Only merit and performance should be considered. Ever.
This thread addresses nits that alone or taken together might have small salubrious effects, but that racial quotas and dei practices have come to exist and still exist without active efforts to expunge them is the greatest fault of modern medicine. I refuse to be seen by a medical practitioner younger than 40 because I have little confidence that their training has been adequate and fit for purpose.
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Government should only ever be the last resort to address any problem.
Since the progessives who took Woodrow Wilson into office, the belief that government should largely be in the hands of technocrats who āknow whatās bestā in any given situation has been promulgated. Itās been over a 100 years since. The track record proves that not to be the case; yet the myth remains.
Government is almost never the answer. Government is almost always the problem.
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The country has been bankrupted by politicians and their technocrats. My guess is that you are both.
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Weāve all lived with the problem for well over 50 years. The causes are many, are driven by greed, and are bound by political and corporate controls. Itās a Gordian Knot that must be cut to be undone.
This collection focuses on improving the US healthcare system. Neither the public nor the private sectors have addressed the root cause because both profit from the status quo. Only āwe the peopleā suffer, so itās up to us to find a solution.
Brainstorming is a great way to generate new ideas. Iāve done a lot of it over the past 40 years but always face to face in group settings. Iām new to this social media type interaction, but it should work here as wellā¦ if I can wrap my old brain around the mechanics of it all!
That said, your post indicates that youāve done lots of thinking about the problem. Got any thoughts on a path to a solution?
āHealthcare in America is a disjointed aggregation of special interests, middlemen, profiteers, and lobbyists. It is not a system, it is inefficient, and it fails to meet the basic needs of most people. Meaningful change requires a radical new approach before it bankrupts our counntry and its citizens.ā
There is nothing in the above that makes or supports the case posited in the second sentence. Healthcare is working for the vast majority of Americans. No system can ever be all things to all people as many would have us believe. In all things there is the Pareto Principle (80/20 trade off rule). That principle states that costs and effectiveness exponentiate in opposite directions as one strives to extend benefits into the 20%. Thatās why medical treatment costs are so high. Medicine cannot be all things to all people. Some get the wrong end of the stick from medicine just as some do in every aspect of human endeavor and life. Continuing to throw political power and money at the problem is never going to solve it. It can be made better, but it can never be perfected no matter what politicians and other charlatans tell you.
The pareto principal (actually just a statistical observation) also implies that 80% of a problem can be attributed to 20% of its causes.
Their are better ways to provide basic healthcare, we just have to look past the trees to see the forest. The only folks Iāve met that think healthcare in this country just needs a little tweeking are those with money or good company paid insurance programs.
I strongly doubt that what we have works for the majority our citizens. It costs more here than any other country. Having lived and worked overseas I have found our āsystemā is no faster, no cheaper, and no better than theirs when measured based on the population as a whole.
This thread is for those who want to improve what we have. If you think itās generally ok as is then perhaps you need to join another threadā¦
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I simply challenge your statement that the American healthcare system does not work for the majority of Americans. Please, cite evidence if you make the assertion. Thatās the challenge.
āMajorityā means more than half. Your statement says that the American healthcare system doesnāt work for 50% plus 1 American. I think that statement is wrong.
If you want to qualify what you mean by āmajorityā, please do so. Unless you can cite evidence to the contrary, I accept that the Pareto principle applies in this case and that the system works for 80% of Americans. I might be wrong, but youāve done nothing to point out my error by citing evidence to the contrary. My only evidence is the established statistical inference inherent in the Pareto principle. Prove me wrong. At least cite sources that can be checked to support your assertion.
I do not posit that the American healthcare system is perfect or that it cannot be improved. But by the same token, you havenāt cited what - if any - imperfections it has that need improvement, much less how to do so.
I, too, have lived and worked overseas. I do not have company paid health insurance, but I did before retiring. I now have Medicare and medigap coverage. They suffice, but I lived for the most of my life without employer provided health insurance. I paid for private health insurance and paid out of pocket for treatments that didnāt involve hospitalization. My experience was that even that system was not oppressive unless one suffered from bad health. I was blessed with good health, generally, although I did experience 4 operations to remove masses thought to have been cancerous.
Health care costs have risen to levels that cannot be afforded under the system I described in the previous paragraph. I attribute that increase primarily to 2 factors: government mandates and insurance company profit motives. Government regulates in areas it should not and doesnāt regulate in areas it should, IMO. That the pharmaceutical industry has grown to dominate politics and media is the quintessential example of governmentās failure to regulate. The reason is obvious; politicans benefit from political funding from that industry to the point that if it were withdrawn, campaign spending would be greatly curtailed. One can argue with tongue in cheek, as did Bernie Sanders, thatthe money comes from individuals; but we all know that is untrue.
Iāll stay in this thread, thank you, if only to hold your assertions to scrutiny.
You are on the right track. Pricing is high in the private sector for two main reasonsā¦Medicare/Medicaid and Medicare administration. Cost and price are not the same think. The price paid by both public domains is below the actual cost of services provided. They are losses. To offset those losses providers built pvt. insurance at 340% of Medicare and avg. settlement is 200% (Kaiser Foundation), It takes 3 working people to offset 1 person on public programs. This is due to the fact that they are more frequent users of the system and their issues often both extensive or chronic. It is estimated billing depts. spend 45 mins. doing compliance paperwork for Medicare/Medicaid patients. Medicare rules & regulations comprise 273,000 pages and there are 40 agencies to comply with, Making public programs a break even proposition would reduce pvt. expenditures 30-35%. An information task force regarding the many, many issues surrounding healthcare is what is needed and what I will be proposing. A universal system must have two thingsā¦mandated participation and to your point REGULATED reimbursements, Best wishes
Well said. I have already done itā¦Twice. There are so many issues to deal with in the current system that need to be fully defined. I have always seen healthcare in this country as a socio-economic problem where everybody concerned; Drsā¦ hospitals and other providers; state/federal interests; employers; insurers; patients, etc. all attempt to serve their own economic ābest interestsā, all at the same time. The govāt plays perhaps the biggest factor in this equation. That said a new system has to satisfy EVERYBODY which makes it difficult. For example Medicare would bankrupt most hospitals and other providers in 6 months. I am proposing a national task force to undercover and define the multitude of issues before us. Facts are not opinions. I will be meeting with select legislators to try and make this happen during May recess.
Doug, like you I am older and not accustomed to this type of interface. However as a design architect with almost 40 yrs. association with this subject form the inside, I can tell you it wonāt be solved here. This is a very complex subject, with 100ās of issues to be resolved, requiring input from 1ā000ās of people if not more. Drs. have issues, hospitals different issues, employers other issues and so forth all the way down to the people. Both the people who created this mess and the people in a position to resolve it are not here. I believe it will take 2 yrs. of intense fact finding and dialogue before a something takes shape. There are many thoughts expressed here that have value but they are usually binary in focus without regard to the negative impact on other aspects of the system. An integrated approach is necessary. I have built the national prototype & blueprint (UnitedStatesUniversalSystem) but now need the facts to verify itsā accuracy. This govāt has kicked the can down the road since the eighties. Politicians are not literate enough in the subject matter to make informed decision.
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Now we have an Engineer (train driver) to steer this locomotive!
Iād love to see what you have proposed. Is it available anywhere?
Engineering seems to be one of the few professions that actually focus on the systems needed to create effective, efficient solutions to complex problems. My experience is that other groups tend to āleap to solutionsā rather than follow a logical progression that considers and accounts for multiple constraints. Every activity has multiple āstake holdersā whose needs must be factored into the solution equationā¦ sorry, my geekyness carried me awayā¦
In any case, your approach seems sound and your experience is spot on. As for meā¦ Iāve spent most of my career leading group Brainstorming, Root Cause Analysis, Six Sigma/Lean methods, and various other problem solving techniques and their application to small and large issues.
Iāve also authored many documents and coordinated their callection and organization into relatively concise operation manuals. These manuals lay out the necessary flows of information, responsilbility, and activities. Without clear definition and documentation itās imposible to assure that results will meet the expections of the organization and all those who have a stake in it over the long term. They also form the basis for the changes that will need to occur over time to keep the systems up to date .
Iād love to hitch a ride on this train of yours. Let me know what your plans are and how I can help.
Doug Brister P.E.(retired)
Wellā¦ how about a 2024 Gallup poll for starters
From Gallup poll ā¦ December 6, 2024
āView of U.S. Healthcare Quality Declines to 24-Year Low in addition to registering subpar ratings of the quality and coverage of healthcare in the U.S., few Americans ā 19% ā say they are satisfied with its cost. This reading is unchanged from last year and toward the low end for the measure, which has averaged 22% since 2001. The high point in satisfaction was 30% in 2020, during the COVID-19 pandemic.ā
Or from:
Johns Hopkins Carey Business School
September 12, 2024
"Do you trust the American health care system? Can policymakers help you trust it more?
Why it matters: Two-thirds of Americans donāt trust the health care system. There is an urgent need to focus on reversing the root causes of distrust."
Or maybe from the
Kaiser Family Foundation
Jan 17, 2025
"KFF Health Tracking Poll: Public Weighs Health Care Spending and Other Priorities for Incoming Administration
A recent KFF tracking poll shows that health care tops the list of basic expenses Americans worry aboutāeven more than gas, food, and rent."
I donāt want a debate here so I wonāt ask you for your evidence. The above was all found online in 30 minites or so, but I readily admit that my opinion is based primarily on āanecdotal evidenceā. I also know that you can find support for just about anything online. I still trust my own collection of experiences and those reported by to me by folks I know more than the often biased āresearchā of academics and article authors who must āpublish or perishā.
For now Iāll just close with an often heard phrase I believe relevantā¦
āI may disagree with what you say, but Iāll defend to the death your right to say it.ā
That said, please do stay in with us here. Your comments will help keep those of us who think improvements ARE needed in healthcare grounded. āGroup thinkā is real and always a threat to effective problem solving. For this online brainstorming effort your input is both appreciated and solicited.
After all, us old retirees need all the mental exercise we can get!
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In my view that is a complaint about costs, not about quality of or quantity of care.
Iām 83 years old. Iāve received health care in every decade since the 1940s starting with surgery and post surgical care for a fractured skull before I entered elementary school. Iāve had surgery in every decade since (about 15 in all) the most recent being in 2023. Iāve been treated for GI, ENT, orthopedic, opthalmic, respiratory, and cardiac issues. Iāve observed nothing but improvements in healthcare. I am not now nor have I ever been wealthy or even in the top tier of households in the US. I live on retirements savings and social security benefits. My position is in no way based on elitism.
Iāve also witnessed costs increase far faster than the CPI or COL indexes. I believe that a significant portion of those costs arise from a) government regulations, and b) intrusive insurance regulations. The former, IMO, were all caused by technocrats in government interfering in a situation at the behest of politcians seeking votes. The latter was caused by providers wishing to remove themselves from the commercial side of medicine thus assuring their revenue streams without their effort and making it impossible for patients to hold them fiscally accountable (which is also a sort of litical move without government). All of the above is anecdotal, personal experience. I could add similar testimony for care my wife received over the last 6+ decades.
I donāt think any rational person can argue that medical techniques, procedures and practices have steadily improved. One can argue that access to them is not democratic, but access to medical care is not a right; itās a privilege just like driving a car or buying million dollar home is. God forbid that it should ever be democratized or we will get what Canada and England have . . . people dying while waiting their turn at the teat. Show me, if you can, any evidence that people are dying or suffering extreme adverse consequences because they lack access to care. I donāt doubt that it happens in some few cases, but making access a democratic right will ruin medical care in this country. It would be throwing the baby out with the bathwater. Democratize it and the illegal entry problem will turn to a torrent that there are not enough bullets being made that could stop it.
The debacle that was the COVID-19 scare is the only circumstance Iāve observed over 70 years that reduced my confidence in medicine, and that was not based on patient care but on the willingness of providers to succomb to political pressure, especially those administering hospital and clinical care. That is due directly to the fact that the government can withhold reimbursements for Medicare and even take away access to the Medicare payment system for political, not medical reasons. I still damn providers for their weakness.
I cannot refute that medical costs are out of line, generally, with the economy. I agree that they are egregiously high, but itās a logical fallacy to conflate that with declining health care.
I agree with you that the issue isnāt
qualityā¦ itās cost. Unfortunately even the best quality is immaterial if itās affordable only by the rich, those with corporate or civil service paid insurance benefits or (to a lesser degree) medicare/medicaid.
Most of us old folks know from experience that āAināt nuthinā freeā. All benefits are eventually rolled into the total cost billed. Insurance (both private and public) adds significant cost for administrationā¦ paperwork back and forth multiple times between patient, doctors, specialists, hospitals, insurance companies, government regulatorsā¦ and then it must be recorded, filed, and tracked. After all this non value added cost is put on then profit get added to the pile. In the end itās the regular working folks who must carry the load both through higher taxes and higher cost.
The are lots of other areas associated with healthcare that add cost but little benefit. Looking back on your comments I suspect part of our misunderstanding lies in the topic title. A better one might be āReducing healthcare costā. That might help steer folks more in the desired direction.
Thanks for the response. I think it helped align the topic toward the resl issue with healthcare. Iāll see if I can get the topic title changed.
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