Aside from ensuring everyone has access, what other health care reforms are needed?

[hedgehog]

Here are some items on my list:

Ensuring we have enough primary care doctors: pediatricians, family doctors, internists, gerontologists

Ensuring those doctors get paid enough and maybe cutting back on the pay of the glamor specialties like cardiology.

Ensuring people in rural areas and inner cities have access to all the bells and whistles.

Ensuring that bells and whistles are used when needed, and not just to generate profit.

Ensuring we pay for medical care, and not for the leather sofa in the waiting room and the fancy fountain in the lobby.

[OHdem10]

1. Just a thought-- Access usually means---it is available if you can pay for it

Theoretically we have access now.

I suggest this point only because over the years ACCESS has been used
by GOP. It is double speak.

[Oregone]

2. I think access and affordability are the most important aspects to immediately focus on

I don't think its necessary to throw in everything including the kitchen sink the first time around, especially if it risks watering down the bill with convoluted compromise. Keep it simple stupid. Id rather see people focus primarily on the insurance reform, and then work on the medical reform once everyone has affordable access.

[hedgehog]

5. The danger is that a single bill will be seen as the entire program.

In addition to the points I gave in the OP, toss in adding nursing schools to alleviate the nursing shortage. Toss in restructuring hospital management to allow nurses to do the job they trained for!

[juno jones]

3. A guarantee that the public plan will be something that docs and clinics

outside the already overstressed low-income providers will accept. if this is only accepted by the same clinics that accept public insurance now, these clinics will only become even less availible than they already are. Even now, the waiting lists are often months long for 'non emergencies' and nothing is an emergency there because you are told point blank to go to the hospital if it is.

It is also hard to get certain treatments and classes of drugs thru these providers and even tho they assure you that they will find someone to provide the service, this also adds more wait time and anxiety to a medical situation which could be serious.


I suppose this would fall under access, but right now there seems to be medicine for the insured middle-to-upper class and medicine for the poor. One has options, choices of treatment, and medicines when you need them (or not, in the some cases of oxycodone). The other is difficult to navigate and has very limited choices availible especially when one is faced with a serious illness.

[hedgehog]

4. I know doctors who limit or refuse medicare patients because

the reimbursement is so low. Ironically, Medicare is structured to pay big bucks to surgeons to correct problems that GPs can prevent or treat more effectively and cheaply.

[juno jones]

6. Yup.

Thank you for seeing this. if the poor had preventative care, the system would benefit.

[Lars39]

7. Letting those of us with medical debts opt into the system *totally free*

until those debts are paid. No fines, no monthly charge, no patient portions.

[rvablue]

8. Medical school tuition reductions. Malpractice insurance reform, of some kind.

Both of these costs are drowning many good doctors who got into the business to heal people, which then drive up the costs on patients.

And I don't think it's fair to consider cardiology a "glamour speciality." I guess you don't know anyone who does heart surgery and what they go through and the enormous sacrifices they make -- the expense, lost sleep, zero off time -- to get there.

[hedgehog]

12. The current practice of getting an undergraduate degree

needs to be looked at, too. It was set up around 1910 to ensure that doctors had a good grounding in chemistry and biology. (See The Great Influenza: The Epic Story of the Deadliest Plague In History by John M. Barry) Today students who take AP Chem or biology in high school cover that material. It might be better to set a 2 year curriculum and then admit students to med school. Service as an intern and resident needs to be reviewed, too. Hospitals tend to look upon students as cheap labor so the hours are ridiculous.

I admit my concern here is that it is very hard for a woman to study medicine and raise children. Twelve years of study is an obstacle while the biological clock is ticking away!

[Vinca]

9. Revamp Medicare Part D.

It's nuts on 2 fronts. First, you have to find a policy that covers your particular medications. It seems you also have to see into the future and guess what you might need during the year because you can't switch to another plan until the next year. All policies offered need to cover all medications. Secondly, the donut hole has to go. You can't have seniors stuck for months on end being unable to afford the drugs they need.

[hedgehog]

11. Oh, absolutely ! The donut hole makes no sense to me at all.

What did legislators think, that people didn't really need their prescriptions and would stop spending money on them if they had to pay?

One aspect we need to get rid of is that people abuse the system to visit doctors for the hell of it! There may be some people who do that, but most people visit doctors only when they are sick. The entire premise of the co-pay is to deter people from calling the doctor. I think that's how people end up at the ER at 2AM.

[Vinca]

10. Oops - I made a duplicate. Sorry.

[Thrill]

13. Regulation. Insurance companies can no longer deny healthcare to people with pre-existing

conditions. I can't believe you forgot the most important one.

[joeglow3]

14. The biggest concern is...

How do you educate people on when to use medical services? We have a decent sized deductible that we will meet this year due to the birth of our son. One of our other boys has HUGE tonsils that are inconvenient (sleeping, breathing, etc.). The Doctor says he does not NEED to have them out (he may “grow” into them), but that he also does not have a problem removing them. Since we have to pay nothing, we are going to get them out this year.
I understand we are part of the problem, but need to stop people from running to the Doctor every time they have a sniffle (like a co-worker of mine). This taxes the system and drives up costs for all of us.
Ideally, I would like to see support for what some WalMarts & Targets are doing – providing non-urgent services for things like colds, etc.

[hedgehog]

16. If the kid has problems now, why not take care of it now?

Difficulty breathing while sleeping isn't something a little kid should have to tough out for a few years. I don't see you as abusing the system.

If a patient is needlessly running to the doctor for every little sniffle, that's for the doctor to address, IMO. Some people have pre-existing conditions that mean a minor sniffle is a problem. Otherwise, the doctor should either tell the person when to call or else dig down to find the real problem. Any doctor who routinely prescribes antibiotics for viral illnesses needs to be subjected to the same scrutiny as a Dr. Feelgood. Dr. Feelgood just screws up his own patients who are already addictive personalities. The doctor who over prescribes antibiotics is hurting everyone by helping create antibiotic resistant bugs!

[Blue Belle]

15. Ensuring that people can use the doctor they want...

like if they would rather have a naturapathic physician, instead of a lisenced drug pusher.