Seems worthwhile to me. This prescription thing with doctors is cumbersome and expensive for everyone involved. This plan might be worth trying. I predict we get it.

Obviously there are many, many drugs that should still have a doctors prescription, but there are many that intelligent people could figure out themselves what they should take.

http://www.omaha.com/index.php?u_page=1219&u_sid=10150627

With our society growing older, exploring ideas like this is smart. If the trip to the pharmacy is already two buses, why make Grandma go all the way to the doctor's office on MAX too?

The system should be airtight to prevent abuse by patients, physicians, pharmacies and the drug manufacturers, but this could work out nicely for folks who need simple medicines for common problems.

Interesting.

I'm not opposed to it.

I do think it will create a new class of professionals: Medical Consultants. Not doctors, work under waivers, but can process the information and the paitent history to assess risk.

I know good pharmacists do this, but others will step in to fill the gap for a number of reasons.

You could have an automatic machine at the pharmacy that takes blood pressure, heart rate etc. pee in a bottle at the pharmacy have that wsent to the lab, etc.

I've been saying that for years, why do I have to see my doctor every 6 months, so she can prescribe the same blood pressure medicine I have been taking for over 15 years.

At least a third of the tests doctors have you take, are CYA for the doctor.

You can get Cholesterol checks all kinds of places. Pharmacists are pretty skilled in what medicines someone should be taking. It would be easy to have guidelines wherein severe cases have to be referred to a doctor. Blood pressure is one of them. Cholesterol another. Nasal allergies yet another.

Believe me, the medical profession will fight this. It's a business. This takes away a lot of easy office call charges.

Agreed on the office call.

Of course, if we hammer insurance companies, then overhead goes down, and office call charges are not so necessary to support the organization.

And, self diagnostic aids will become available / viable and there is profit in those.

there is very littel overhead, from a doctors perspective in insurance costs, they all have automatic billing to the various providers.

And if you totally eliminated the insurance overhead, most of it would have to be replaced with some kind of administration.

I've been interacting with a lot of doctors lately and can tell you this is somewhat true in larger organizations where admin is distributed. No disagreement there, other than it's still a cost that does not add value to either the doctor or the paitent, and that's my primary beef.

Specialty doctors, or just small practice is far more unbalanced. Office visits keep that all running. The automatic billing is not the focus. That actually works, and seems to work fairly well. It is not however, the primary drain.

It's the communication required to deal with insurance companies and all of their issues. That takes plenty of people and time, and that's where the overhead is.

Will it get paid, how much, does this carrier require a pre-authorization, does that authorization make sense, do we support that carrier, if not, why, how can we bill them, is there an alternative, where, when is it available, can the paitent pay, if so, how, when, how much, are some testing units covered or all, which ones, is the dollar amount different if a preferred provider / means / method is used, if so, which one, can we see the records, is this pre-existing, why / why not, etc.... !?!

Billing the result of that mess is quick and easy. Getting to the point of the billing is very high overhead.

If we were to limit insurance companies to optional status, the majority of people would not have these issues and the overhead in terms of just human interaction necessary for something to happen, would drop significantly.

With that goes a *lot* of costs that would either be out of the system completely, or go toward actual care instead of the meta-activity surrounding said care.

One example is the colon specialty group we are working with right now. Had to spend some time in that office and did a head count, and asked a few questions. (why not right?)

There are 4 doctors, only one of whom is in the office at any one time, barring some need for a group consult. There are 6 administrative people, with two of them doubling as the prep staff, queuing people for the doctor, who moves from patient to patient.

I asked what the other 4 did. They spend their entire time scheduling resources (which just isn't going to change) and dealing with insurance companies. (which totally could)

Of that time, the insurance is the majority, with one person in particular dealing with schedules and communication of prep / pre-op stuff.

To go in, say "hello" and leave is about $250. Most of that $250 is overhead.

At least two of those people are not required to be there, but for the hassle of the insurance companies. In that office, there are two who deal with insurance full time. That is all they do.

On their desks is a computer, used for billing. During the time I watched them, about 10, maybe 20 percent of the time was spent interacting with that machine. The rest of their time was spent on the phone, or via fax dealing with authorizations, justifications for such, and tracking down payment, or fulfillment required for said payment to occur.

There is one person managing finances, that person would remain as well.

If those two people, were removed, maybe we get lucky and get rid of three, the impact on the office visit would likely be a third or so.

$250 then becomes $175.

Multiplied by this happening everywhere, it's a *lot* of money, which is why I am a strong advocate of single pay systems, baseline care standards, and prevention.

Here is another interesting perspective. My father in law sees a doctor, who specializes in older paitents. That means mostly medicare / medicaid paitents.

Prior to the new law, where supplemental care was an add on, medicare / caid handling was simple. Everybody either had both plans, or didn't.

After allowing insurance companies to participate in that scheme, people were added to handle guess what?

Insurance company communication and overhead. The number of staff in that office has increased, yet the number of doctors and patients really hasn't. (I've been going there for a long time, watching.)

Now, all of those patients are different! It's the same mess! What carrier do they have, how are they billed, etc....

It's not as bad as the general insurance for most adults is, but it's clearly costing more now than it did before.

We really don't need a bazillion different sets of rules for baseline / preventative care. Eliminating insurance for these things alone would take a ton of costs out of the system, still permit robust competition among service providers and permit large buying pools to form, giving cost breaks in return for regular, sustaining business.

For a great comparison, on how things should run, take a look at lean manufacturing.

Our baseline health care needs to be lean in every regard. From there, people can easily add on options that make sense depending on who they are, and what resources they may or may not have.

Right now, none of this is lean. It's fat ass and we need to change all of that. The justification is simple actually: it's just pure dollars that don't add value to anybody but large insurance companies.

If one were running a private corporation, would this kind of non-value add be tolerated? It sure wouldn't in mine. If it does not add value, it is not needed and would get quickly eliminated / routed around.

The small firm I work for does exactly that. We look all the time for the value add. If we don't, we go out of business. Lean and mean keeps us paid, and paid well.

There is no reason for medical care to be any different --at least for baseline / preventative care.

At the very least, a focus on lean, would make buying healthcare more affordable. Medicaid runs about 7 percent administrative costs. If it were not hobbled with the poor perscription drug plan (no large buying pools), it would see significant savings above that as well.

Most insurance covered health care runs at 20-30 percent administrative costs.

Subtract, for maybe 15 percent difference, then multiply times a lot of people and suddenly there are a lot of dollars there. Too many dollars, not adding value.

Don't care how it happens, but those dollars need to go away. There is no value add.

BTW: This plan, the topic of this thread, is Lean, in a big way.

I think is has some merit and is totally worth consideration. These are the kinds of ideas we need to be talking about on a large scale.

Many think the doctor is the ultimate protection and that having someone less give out medications is leaving the patient in trouble.

I was recently in the hospital to figure out why I was having dizzy spells. Turned out to be nothing, but in the meantime, my regular doctor and a cardiologist were both seeing me. Several others also.

At checkout time, the nurse gives me my prescriptions. One doctor had prescribed one blood pressure medication, the other two others. Nurse said I should take all three. Guess what. I shouldn't have. Blood pressure dropped to 95 over 55. I could hardly get up without blacking out. I cut back to one on my own, they later agreed that was the correct medication and I'm doing just fine on one minimal dose. A pharmacists could have done at least as well as this, probably better. I wasn't exactly protected by the doctors.

Doctors and nurses make mistakes all the time, their usually overworked, and their human. Plus when your seeing several doctors, you have to make sure their communicating with each other.

That is the biggest problem, we don't have enough doctors, if you add millions of patients, cost is going to go up, its simple supply and demand. There is a fixed number of doctors and nurses, you require more work, its going to cost a lot more, plus you will have a lot more mistakes!

So then not making the change keeps the status quo? Those of us who have, really need to resist change, or we risk being a have not? Like there is not enough to go around?

There is no reason to fix the number of doctors. That's a very short term problem.

If there is demand, it will be filled, it's really that simple. There is no reason to let greed or fear get in the way of fixing things. If we are needing more doctors, people will see that need and fill it, wanting to be gainfully employed, just like most of us do.

Non issue.

I want to try it. There is NO reason not to try it.

Agreed!

If you want universal health care,you have to first increase the supply of health care. Increase the size of medical classes by 1/3. Give scholarships to future doctors, in return they work for the public health service for 8-10 years. Like the military does. Heck, lets establish a medical service academy, along the lines of the military academies.

Same for nurses and other health professionals.

Allow more medical assistants to do more, like military physicians assistants.

Let people renew most prescriptions without seeing a doctor.

Give everyone 2 free doctor visits a year, for preventive care.

Tell doctors, if they set one day a week aside, to see patients without insurence, at no cost, they get a 10% tax break.

I would be for ALL of that. And it's realisitic. I especially like the Medical Service Academy idea. You could really expand a system like that. And it would have the added benefit of giving us something tangible to really be proud of. The world would envy us for a program like that. It's right in line with what makes America special.

You cant jsut address demand, you have to increase supply.


Art works are more expensive, because there are more billionaires to buy them.

If you give more people health care, you have to increase the amount of health care, or costs go up.

You cant just address one side of an equation.

Same principle, if you provide sub

"Art works are more expensive, because there are more billionaires to buy them."

What else is going on in your parallel world?

Yeah, and I'm bidding on that Faberge Egg...