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US healthcare cost solutions
Here is an elegant idea from the past..

Quote:The problem with American health care is not the care. It’s the insurance. Both parties have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model. The insurance company model drives up prices and fragments care. Rather than rejecting this jerry-built structure, the Democrats’ Obamacare legislation simply added a cracked support beam or two. The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.

An alternative structure can be found in the early decades of the 20th century, when the medical marketplace offered a variety of models. Unions, businesses, consumer cooperatives and ethnic and African-American mutual aid societies had diverse ways of organizing and paying for medical care.

Physicians established a particularly elegant model: the prepaid doctor group. Unlike today’s physician practices, these groups usually staffed a variety of specialists, including general practitioners, surgeons and obstetricians. Patients received integrated care in one location, with group physicians from across specialties meeting regularly to review treatment options for their chronically ill or hard-to-treat patients. Individuals and families paid a monthly fee, not to an insurance company but directly to the physician group. This system held down costs. Physicians typically earned a base salary plus a percentage of the group’s quarterly profits, so they lacked incentive to either ration care, which would lose them paying patients, or provide unnecessary care.
How Did Health Care Get to Be Such a Mess? - The New York Times
Quote:What if we could save millions of lives, eradicate a contagious disease, and repair a structural defect in the U.S. economy, all by asking the question: What is reasonable? This question—put another way, What is just?—is at the center of a health-care initiative brewing in, of all places, Louisiana. If successful, it could eradicate hepatitis C and put a fatal crack in a drug-pricing system that systematically balloons costs and kills the sick.

The word “reasonable” comes from a piece of federal law known as 28 U.S. Legal Code 1498. It establishes the government’s right to infringe on privately held patents, should doing so serve the national interest. The government, in return, is obligated to give the patent holder what the code calls “reasonable compensation.” As with eminent domain, the government determines “reasonable” by the specifics of the case. In the case of the gestating Louisiana initiative, the patent in question covers a grotesquely overpriced new cure for hepatitis C, a highly contagious blood disease that kills more Americans than every other infectious disease combined.

In the interests of commerce, public health, and national defense, the U.S. government has been disrespecting patents since it stole proprietary designs for cannonballs during the Revolutionary War. The government has routinely excercised the right ever since. In 2009, the U.S. Treasury invoked its soverign immunity under 1498 to assume liability for banks using patented check-fraud software.

Tragically, and curiously, 1498 has only fallen out of use with regard to pharmaceuticalsUp until the early 1970s, it was often used to spur the production and import of cheap generic drugs. During the Vietnam War, for example, the Pentagon’s Medical Supply Agency used the law to procure dozens of generics and name-brand drugs at pennies to dollars. In the case of the antibiotic nitrofurantoin, the Defense Department decided that a “reasonable” reimbursement for the patent holder was 2 percent of the sticker price.
How the Government Can Bring Down Drug Prices
Quote:Dr. Jamie Koufman has her own idea about how to curb healthcare spending. And while Republicans are looking to reduce spending through cuts to health plans, Koufman's solution hinges a lot more on the people who actually care for patients.

The answer: Cut down on the number of specialists patients see for conditions that only need a primary care doctor to look at. The way the current healthcare system is set up, people pay for each visit to the doctor. Visiting specialists for cases that might not warrant them is one way costs to the healthcare system are being driven up.

"Most Americans mistakenly believe that they must see specialists for almost every medical problem. What people don’t know is that specialists essentially determine the services that are covered by insurance, and the prices that may be charged for them," Koufman wrote in an op-ed for The New York Times.
Healthcare reform Dr. Jaime Koufman and cost of reflux - Business Insider
Start here, busting cosy deals that protect insiders profits, before kicking millions off of insurance..

Quote:Faced with competition, some pharmaceutical companies are cutting deals with insurance companies to favor their brand-name products over cheaper generics. Insurers pay less, but sometimes consumers pay more. Adderall XR, a drug to treat attention-deficit hyperactivity disorder, is a case in point.
Take the Generic Drug, Patients Are Told — Unless Insurers Say No - ProPublica
And here is another problem that needs fixing which none of the Republican plans addressed:

Quote:Around 1 am on August 20, Ismael Saifan woke up with a terrible pain in his lower back, likely the result of moving furniture earlier that day. “It was a very sharp muscle pain,” Saifan, a 39-year-old engineer, remembers. “I couldn’t move or sleep in any position. I was trying laying down, sitting down, nothing worked.” Saifan went online to figure out where he could see a doctor. The only place open at that hour was Overland Park Regional Medical Center in his hometown of Overland Park, Kansas. The doctor checked his blood pressure, asked about the pain, and gave him a muscle relaxant. The visit was quick and easy, lasting about 20 minutes. But Saifan was shocked when he received bills totaling $2,429.84. The bill included a $3.50 charge for the muscle relaxant. The rest — $2,426.34 — were “facility fees” charged by the hospital and doctor for walking into the emergency room and seeking care.
Emergency rooms are monopolies. Patients pay the price.  - Vox
Quote:In 1960, the average U.S. health care cost per person was $146. As a nation, we expended $27.2 billion, which represented 5 percent of GDP. Fast forward to 2016 when average per capita spending on health care was $10,348, an increase of more than 7000 percent in fifty-six years. In 2016, the U.S. expended $3.4 trillion on health care, note the “tr” instead of “b,” or 18 percent of GDP..
Price transparency is sound health-care policy | TheHill
Reasons for the American exceptionalism (that is exceptionally high health care cost):

Quote:Why did American health care costs start skyrocketing compared with those of other advanced nations starting in the early 1980s? At the same time this was happening, American longevity gains were failing to keep up with peer countries. In addressing these twin mysteries in a recent article, experts suggested two main reasons: The United States didn’t impose the same types of government cost controls on health care that other nations did, and we invested less in social programs that also promote health.
Reagan, Deregulation and America’s Exceptional Rise in Health Care Costs - The New York Times
Quote:On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son Park Jeong-whan fell off the bed in the family’s hotel room and hit his head. There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital. The doctors at the hospital quickly determined that baby Jeong-whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula, and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten. Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” which sometimes is known as “a trauma response fee.” “It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, okay. That would be okay. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”
ER bills: A baby was treated with a nap. His parents got an $18,000 bill. - Vox

Quote:After Alexa Sulvetta, a 30-year-old nurse, broke her ankle rock climbing at a San Francisco gym this past January, she faced an out-of-pocket cost of $31,250. An ambulance brought Sulvetta to San Francisco General Hospital, where, she recalled, “my foot was twisted sideways. I had been given morphine in the ambulance.” Sulvetta was evaluated by an emergency medicine doctor and sent for emergency surgery. She was discharged the next dayThe hospital charged Sulvetta a $15,666 trauma response fee, a hefty chunk of her $113,336 bill. Her insurance decided that the hospital fees for the one-day stay were too high, and — after negotiations — agreed to pay only a charge it deemed reasonable. The hospital then went after Sulvetta for $31,250.
ER bills: A baby was treated with a nap. His parents got an $18,000 bill. - Vox

Quote:Sam Hausen, 28, was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, California, last January. An ambulance brought him to the Level 3 trauma center after a minor motorcycle accident, when he took a turn too quickly and fell from his bike. Records show that he was alert with normal vital signs during the four-mile ambulance ride, and that the ambulance staff alerted the hospital that the incoming patient had traumatic injuries. He was at the hospital for only about half an hour for a minor cut on his head, and he didn’t even need X-rays, CAT scans, or a blood test. “The only things I got were ibuprofen, two staples, and a saline injection. Those were the only services rendered. I was conscious and lucid for the whole thing,” said Hausen. Sam Hausen was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, Calif., in January after a motorcycle accident. Heidi de Marco/KHN But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee.
ER bills: A baby was treated with a nap. His parents got an $18,000 bill. - Vox

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