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I've read newspaper accounts and seen television interviews and heard people talk about their opinions and views on health care. It seems to me that most of the talk is about how to provide insurance coverage to more people or how to reduce the cost of insurance coverage for everyone.

There is much talk about how to "solve" a problem that no one seems to care to describe. I'm not saying there are no problems with the delivery of health care. I'm saying I don't know what the problems are and it is a little scarry to think - and I'm starting to think this - that very few if any of the people jumping into the fray really know what the problems are either. They just have an "agenda" item and a "goal" to pass some form of legislation so they can say "look what we did" - aren't we great!

H.R. 3200 is "A BILL" proposed for this pupose: "To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes." The bill is 1017 pages long. I wonder how many of those who are stomping around promoting this bill have actually read the entire bill. Of those who may have read the entire bill, I wonder how many actually understand it. My guess is that it was "cobbled" together by various interest groups - meaning that one section of the bill was written by and for the benefit of insurance companies, another section was independently written by and for the benefit of hospitals, etc., etc. - a mish, mash of special interest groups with lobbyists and lawyers making sure that they get their piece of the pie.

H.R. 3200 is in part suppose to build on what works and repair what does not. If that is the case, tell me what is working and why, and then tell me what is not working and why. And I mean, tell me some specifics, not just high level meaningless politically correct jargon like PROBLEM: 45 million Americans don't have health insurance. Proposed fix: "This bill will allow everyone to have affordable health care insurance". These are the sound bites we hear from politicians and there supporters.

Before we rush off to pass a "health care reform bill" so the Obama Administration - and others in Congress can claim "victory" over someone or something, it would be nice to see information about how the "system" (if we want to even call it that) we have now actually functions. I am not an expert on the topic, but it seems to me that simple logic at least raises a few questions that someone should be able to answer.

I read and hear statements to the effect that health care costs have doubled in the last ten years. No one ever has an explanation for why this has happened. Are doctors charging more? Are manufacturers of health care devices charging more? Is the field of health care losing providers and thus becoming less competitive leaving the survivors with the opportunity to increase prices? Are lawsuits, or the fear of them, driving up costs? Perhaps a contributing cause is that we have too many laws regulating the delivery of health care now! The health care costs are becoming a greater burden on the federal budget? How so?

Here is a thought - I'm sure someone has had the idea before. Patients are the consumers of health care goods and services. However, patients covered by insurance (and while there are many without insurance, there are many, many more who have insurance) DO NOT PAY the health care provider. Essentially, the patient is removed from the financial process. Thus, if the health care provider is not charging a "competitive price" or is double-billing or providing more care/goods then is really needed, the patient either doesn't know or doesn't care because the patient has no responsibility to pay the bill. It is hard for me to identify any other consumer transaction that works this way.

When people go to the grocery store (or any other store for that matter), they often shop for the best deals - they look for sales or use discount coupons offered by the seller. If the checkout clerk rang up something twice, most shoppers would probably say something like "you charged me twice for this item, please credit one charge back.". If the clerk threw in an extra gallon of milk, most people would probably say "I don't want that, and I'm not paying for it." On the other hand, if you bought groceries like we now buy health care, it is probable that most shoppers would not even be paying attention. They would pay their $20 "co-pay" and that would be it - double charge or extra milk, who cares! Or worse, even if you do care, there is no telling how you could do anything about it.

Can we focus on ways to engage the patient in the shopping and payment process? If patents could shop around and look for the best deals, and if they had some means for controlling payment based on the quality and quantity of the goods/services delivered to them, it seems to me that health care providers would be put right where we want them - in a free market system. They would have to be competitive to survive. They would have to deliver quality goods/services. They would be held accountable by the patient who is receiving the goods/services.

Maybe I'm wrong about this because of my lack of knowledge about how the "system" really works now. But, I don't understand why I never hear anyone talking about this aspect of the process.

If there is anyone out there with some insight on this, I would love to hear more about it.

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There are Republican legislators, policy experts, and professionals in insurance and medicine who are articulating some very specific improvements for specific problems in the realm of health care activity. Many of these ideas are consistent with individual freedom and responsibility, free enterprise, limited government, and not increasing the need for more government funds. I sometimes listen to "Washington Journal" and "Newsmakers" on CSPAN radio and have been very impressed by some of the interviews there, especially as certain Republican legislators have spoken in detail about needed changes. Republicans in Congress have introduced bills but they do not get a hearing, nor media exposure. It helps for us to understand parts of the legislative process. Democrats are the majority party, therefore the committee chairmen are Democrats. The chairman decides which bills get heard. The majority of members per committee are Democrat, therefore because of the number of votes, a Republican amendment does not get passed unless the Dems want it to. HR 2249 Health Care Price Transparency Promotion Act and HR1468 Medical Justice Act are two bills of many by Republicans. Interested people should visit www.blunt.house.gov to find the Health Care Solutions Group of which Roy Blunt (R from Missouri) is Chairman, and www.health.burgess.house.gov to find the Congressional Health Care Caucus of which Michael Burgess (R from Texas) is Chairman. Go to the Congressional websites to see all bills which have been introduced in this 111th Congress. Also, see some articles by the policy experts at CATO Institute, Maryland Public Policy Institute, www.freemarketcure.com, and Conservatives for Patient Rights. I am including a few specific ideas here:

Rick Scott of Conservatives for Patient Rights recommends (among other things)
1. give the same tax break that employers receive to individuals
2. require a single standardized claim form
3. require providers to post prices and outcomes.

Roger Bayne, CEO of Client First, said at Cardin's Towson Town Hall Meeting that the medical service providers should have to publicize their fee in advance, so that the consumer knows what will be paid, and that individual negotiations between the insurance companies and medical providers to determine varying discounts and fees should not be part of the pricing process.

The following is taken from Rep. Burgess's Congressional Health Care Caucus site:
Problem: Many patients visiting hospitals and clinics for health care services have no idea what they will pay. This lack of transparency and up-front price listings causes confusion and discourages patients from receiving the critical care they need.

Prescription: Restaurants have menus displaying the prices of the products they offer, why should hospitals providing health care services be any different? A patient should be able to know what they are paying for and how much they will pay out-of-pocket. Rep. Burgess has introduced HR 2249, the Health Care Price Transparency Promotion Act of 2009, which aims to make health care more affordable by promoting greater transparency about the costs of health care services for patients seeking care.
The bill is supported by the American Hospital Association, and is an important step in improving our country’s health care system by focusing on patients, giving them more choices and more control over their health care decisions by providing up-front information on cost.

Doctor's Order: Real health care reform should be about empowering patients and letting them "own" their health care and medical choices. More transparency in health care costs and prices is an important step in achieving that goal, and must be a part of the national health care debate.

Problem: Today, too many doctors are forced to practice defensive medicine and face the constant threat of lawsuits and unsustainable medical liability insurance rates, which results in millions of dollars in unnecessary tests and procdeucres. Furthermore, seasoned medical professionals are retiring early because staying in practice is no longer financially feasible, further contributing to our nation's doctor shortage. This is a growing crisis that is pushing affordable health care beyond the grasp of millions of Americans.

Prescription: National, across-the-board change in the medical justice system would lower costs and improve care by lessening the threat of overzealous trial attorneys and the unmerited lawsuits they often bring about. Health Caucus Chair Rep. Burgess has introduced the Medical Justice Act , H.R. 1468, which is modeled after the successful reforms Texas passed in 2003, and would enact these commonsense reforms on a national level. The results are documented reductions in liability insurance rates, reported growth in the number of doctors licensed each year, and increased charity care, among others.

WE CAN BE THE ONES WHO FIND SOME OF THESE QUOTES, WRITINGS, AND SOLUTIONS and publicize them to the public. As the public hears from us concrete ideas for improvement, they will be less inclined to think that we're just against health care reform. As we interface with Republican legislators and Party leaders, we as grassroots can guide the rhetoric by talking about specific solutions, rather than the easier sweeping statements with which many agree, but which do not offer "do-able" changes.

By the way, we can begin thinking of "retail" medical services like the clinics in Target, CVS, Walgreen and others, where for a cash payment (approx. $49 - $69 in some cases) a sick consumer can walk in, pay cash, and get some medical attention and written prescription. This is not a public clinic, paid for by government funds, nor an emergency room, but an entry point for uninsured to pay their own way and access care without the entanglement of mandate-ridden, expensive insurance for all medical care.
what they are proposing is not a health care package. It is a scheme to tax the american people top dollar. They preaching we need affordable health care for all. This is not affordable health care. Its another "sock it to Americans" bs.
Hi Jackie A ,

We can not expect much more from a Congress which has become , on the most part, the greatest assembly of intellectual stumble bums, political whores, and poltroonish slobs ever congregated under any flag in Christendom and Mohammedanism!
Hi Bruce,

I generally start with the premise that heath care or the care of ones own health is a personal responsibility. Naturally, the care of a minor child is the responsibility of the parent.
Access to health care is or has become a right.
Reimbursement of provider services is a personal responsibility and the manner of this transaction is a matter of personal business. The election to be self insured or to transfer all or part of this risk to a third party is, here again, a personal decision.
Government, however, is a stake holder insofar as Medicaid and Medicare is concerned. Clearly, Government is accountable with respect to its social contract with its stakeholders and, additionally, to meet all the challenges of managing its responsibilities to the citizenry in a diligent manner while using best practices such that all applicable standards which insure continuous improvement are implemented and employed.
The Executive Branch's abysmal management of the Centers for Medicaid and Medicare (CMS) with any degree of competency has resulted in an annual loss of approximately $200BB to waste, fraud, and abuse. This loss is nearly 40% of the stand alone Medicare budget!
This certainly begs the question as to the potential utilization of this waste should the Executive Branch begin to manage in a way typical of the private sector --Reduce the uninsured head count through non intervention and/or improve CMS solvency,etc.?
In keeping with my initial premise, Congress's position within this health care issue should have been restrained to the facilitation of efficiencies within the health care system by legislation to an uncontestable limit of Constitutional authorities.
Congress continues to demonstrate a total and thorough incapability of taking any pragmatic approach in the resolution of any problem. This is a result of ineptness, political prostitution, slothfulness, and cowardice.
From the very outset , questions such as "what are the working parts of the system or what system costs are increasing greater than CPI and/or what costs add little to no value to the delivery of quality health care?".
This process would continue with indentification, priortization, hearings (investigation), and relevant legislation to facilitate system (health care ) efficiencies.
The outcome would be a series of incremental legislative initiatives, occurring over several years and resulting in cost savings. I am certain that malpractice reform would be a priority legislative initiative
Here again the objective of any health care legislation should be that of the facilitation of health care efficiencies and not that of system reform or reengineering for any of the obvious nefarious reasons which may or may not be premised on the fallacious notion that health care is a right which may not rejected without a consequence.
Smart legislation will slow the growth in premium costs which will attract an increase in the number of insured ,thereby, reducing adverse selection and result in continued premium reduction.
Throughout all of this, illegal immigration can not be ignored. The social cost of each illegal is estimated at $20K and this includes their impingement upon our health care system.
With our unemployment and underemployment rate at 17% coupled with our teenage unemployment at 26%, the issue can no longer be ignored. However,in part, this is another issue.
The aformentioned are my expectations as these are an outcome of system of beliefs and rights protected and articulated in a Constitutional framework and passed down to us through the generations at great sacrifice for us to enjoy ,yet , preserve.
do our dear elected officials care what we think? i think they are part of the bailouts..
that was a VERY good point about the fact that patients currently do not pay for their health care provider, which goes against every basic market principle in capitalism! I actually saw this point brought up in last week's episode of 60 minutes, which included many criticisms of Medical Insurance. There are many "problems" that were clearly defined in that episode which include unnecessary end-of-life costs, Medicaid claim abuse (by fake companies), the fact patients aren't paying for what they are 'buying', and many others. Temporary Medical Insurance may be a band-aid option worth looking into. But it might get tricky when considering coverage (like International Travel Medical Insurance) when you leave the states!

They did not even touch on Dental Insurance Plans. A quality Dental Plan is essential and I would like some more coverage on this topic.

I'm not sure if we have a solution as of now, but I believe that solutions can surface through a logical debate.

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