d*****s
发帖数: 5610 | 1 其实都是光看电视，不看数据，不自己分析的。
吃福利最多的是主流人种的低收入的那些，但是这都不是太大的问题，只要经济增长了
，吃福利的人就会下降。关键是经济增长问题。
把眼睛老是往某些少数民族盯，真是没出息。
但是美国政府开支中最大问题是medicare，这个是67岁以上医疗全包，很多费用是在临
终前3个月上面花费了巨大金钱，这个和什么种族根本没有关系。美国政府其他开销不
是大问题。所以Obama的Obamacare方向没有问题，就是timing有问题。
以下是一个doctor的建议，如果cut 美国medicare cost by 50%，他说的不见得全对。
http://www.oftwominds.com/blogaug12/cut-healthcare-in-half8-12.
Some time ago I told you how I could cut health care costs in half and
provide every American with the healthcare they need (not necessarily the
healthcare they want!). Here goes. Some of my points might seem drastic, but
we are facing a drastic problem.
1. Immediately introduce national healthcare for all Americans ( and ONLY
American citizens and H1B visa holders ) which will be paid for by an
immediate TAX INCREASE.
2. Like Canada, this will cover all doctor's office, E.R., clinic, hospital
etc. visits. Unlike Canada (the biggest mistake Canada made), there WILL BE
co-pays for routine office visits and visits to the E.R. that are NOT
serious emergencies.
Here is why Canada's no co-pay system is wrong. A family physician friend of
mine in London, Ontario had a family in her practice. The little girl got
an ear ache, with a low-grade fever on a Saturday. The mother took her to an
E.R. and got an antibiotic prescription. On Sunday the girl was feeling
better with no fever, but the mother took her to a walk in clinic "Just to
make sure everything was all right". The doctor said "Yes". On Monday the
mother took her daughter, who was now feeling fine, to my friend's practice
"Just to make sure the other doctors knew what they were doing". The ear
infection was cured.
That was two totally unnecessarily visits the Canadian tax payers paid for,
and the first visit should have been to the walk-in clinic, which is much
cheaper than the E.R.
Co-pays have to be meaningful - not too much to dissuade patients from
necessary care, but enough to make them think. That should apply to all
aspects of healthcare.
Let me give you another example - right now, where I live, a basic ambulance
ride (no drugs or treatments) is about $500. I have had a patient come in
by ambulance for a TOOTHACHE. The paramedics should be able to say "No" and
not worry about being sued.
3. Like Britain, every person will choose a primary care provider, who will
provide their primary care. Referral to a specialist will require a request
for consultation from the primary care doctor. In the U.S., there are no
restrictions on seeing specialists who charge twice as much or more than a
primary care doctor. I saw a guy who went to an ear nose and throat doctor
to have his ear wax cleaned - a procedure any nurse can do!
4. Immediate tort reform. Not quite sure of the details, but I estimate that
probably 50% of the tests done in the U.S. are to C.Y.A. against
malpractice suits, and are medically unnecessary. What would probably be
best would be a no-fault system. You are injured by the health care system,
you are compensated a REASONABLE amount for your injuries, regardless of who
was or wasn't at fault. You aren't really injured, you get nothing. This
could be handled by arbitration panels which would take the lawyers out of
the system.
Right now, it takes on average $50,000 to defend a doctor against a
frivolous lawsuit - the doctor wins, but still $50,000 is down the drain. On
the other hand I was involved in a suit where a patient died due to real
negligence on the part of two doctors and the family lost the lawsuit and
got nothing. This would cut malpractice premiums by at least 1/2 and
drastically reduce the amount of testing.
5. We spend WAY TOO MUCH money on end of life care. We have to get together
as a society and decide what we will and will not provide for end of life
patients, and that doesn't just mean cancer patients, it also applies to end
of life heart failure patients, emphysema patients, etc.
For example, a reputable study in The New England Journal of Medicine showed
0% survival from treatment of cardiac arrest on kidney failure patients on
dialysis. Zero. I have had to do numerous "codes" on kidney failure patients
on dialysis - they all died. A code costs thousands of dollars. The first
code I ever ran was on a 38 year-old accountant having an acute heart attack
. In the old days (1960's) I would have simply pronounced him dead. He lived
, and was FINE, no brain damage from loss of oxygen, walked out of the
hospital a week later and went back to work. That was money well spent. We
don't have infinite money. We need to get the most bang for the buck.
The $90,000 chemo drug that extended terminal prostate cancer patients'
lives by 6 months should NOT have been paid for by taxpayers' money.
Patients who want it should have to pay for it themselves.
6. We have GOT to get the gold-bricks off disability and workmen's comp. If
we did, we could put the truly disabled and injured-on-the-job folks in
suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind
boggling to see how many gold-bricks there are.
I really liked the system in Ontario, Canada. Any primary care doctor could
certify a patient as disabled or off work for up to two months. After that,
the patients had to be seen by a panel of specialists paid by the government
. They had NO INCENTIVE to either certify the patients as disabled/unable to
work or not. To make these specialists truly independent they should be
salaried - and the government CANNOT fire them except for the reasons that
would cause them to lose their license (sex with a patient, drug addiction,
etc.).
7. All advertising immediately banned. We go back to the 70's. No doctor,
hospital, clinic, drug company, can advertise to patients. Period.
8. All new drugs have to be compared to existing drugs (if there is a
similar existing drug). ONLY if they prove superior to existing drugs should
the FDA approve them. Every time a new drug is invented, all the other
pharma companies copy it, change a molecule or two, and then study it
compared to PLACEBO. We end up with 20 drugs that do the same thing. It's
ridiculous.
9. Get rid of fraud and abuse - for real. This means doctors AND patients.
You get caught committing health care fraud you pay in fines THREE TIMES
what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is
crucial - fraudsters MUST be made to do time.
Everybody's charges get audited by an independent panel. You charge for
patients you didn't see, or wheelchairs you never provided to patients - you
go to jail. It must be recognized that nobody is perfect, mistakes happen.
A doctor accidentally charges for a patient they didn't see once in five
years is not fraud - it's a mistake.
In the same way, patients caught "doctor shopping" for narcotics and selling
them pay three times what they made and go to jail for a year. Same for
patients selling blood pressure pills (this is a big racket for Medicaid
patients) - doctors are usually suspicious of healthy looking patients
seeking narcotics, but see a Medicaid patient who is on expensive blood
pressure pills, says they ran out and can't contact their doctor - they will
usually get a prescription. You can make a nice income on welfare doing
this.
10. Eliminate health insurance companies, except for people who want to buy
extraordinary coverage like for the $90,000 prostate cancer drugs. Do like
we did in Ontario - fee for service with the fees paid by taxpayers via a
Department of Health, the fees negotiated annually by either state or
national medical associations.
11. Electronic medical records THAT WORK. Right now we are in the "pre-
internet" era of EMR. There are a thousand different ones, they are very
expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH
OTHER. I worked for a long time in an ER in Florida in an area where elderly
people from the north came to winter. They would get sick all the time and
come in not knowing their allergies, meds, or medical history. It was a
nightmare. If I hear "I'm on a little white pill for blood pressure" one
more time I may scream!
With a national standard EMR I could find everything I needed to know with a
few mouse clicks. It will be a disaster if this info is stolen or hacked,
so the punishment must be severe - TEN YEARS in prison WITHOUT PAROLE, and a
hefty fine. No excuses. Set up something with Interpol and the UN so this
applies to all countries. And, since EMRs would benefit patients, doctors,
and the entire country, doctors and hospitals pay half, the government pays
the other half.
12. Get rid of the bad docs/nurses/hospitals/ etc. I'll just speak for the
docs here - there are two kinds of bad docs - ones who are bad usually due
to lack of knowledge or drugs/alcohol but WANT to be good, and those who are
bad and don't care. The second ones are immediately banned from healthcare
for life. The first group gets extensive education/rehab, whatever they need
. Then close monitoring. In my experience, most of them will turn out to be
good docs. A few won't, and get banned from healthcare for life.
13. Finally, immediately outlaw high fructose corn syrup and foods made with
trans fats. We know they are poisonous. Again, minimum one year prison for
the CEO and board of directors of any company that violates this law,
whether it's a mom and pop shop or Kellogs or McDonalds.
That's it, except for a few tweaks. Fifty percent cheaper, everyone gets
what they need. |
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