About

This blog is about American health care.  The emphasis here is on SOLUTIONS.

The author is Ralph Beckett, MD and sometimes other people who also have a passion for improving health care.  Dr. Beckett has extensive experience with patient care, health care quality, formulary management and the electronic medical record.

All Americans know we have health care problems.  Every day we see TV reports of problems, polls showing dissatisfaction, newspapers with stories of health care disasters, advertisements for hospitals, Wall Street betting on new drugs but very few serious discussions about solutions to health care problems.   Just going to a different doctor, a different hospital, or a different clinic does not solve the problem for anyone else and perhaps not even for you.

This blog is NOT about your health problem.  It is not about your cough, your foot pains or your hemorrhoids.  It is about why you can’t get an appointment, why doctors don’t spend enough time with you, why healthcare costs so much and what are the solutions.

You may think a change to current health care law will fix all that is wrong but that’s not how quality improvement works.  Health care is complicated, and changes to the system uncover new problems.  Health care is a moving target.   When we see a problem we must ask why, why, why, why, and why again to get at the root of the problem and do our best to implement a solution.  Then repeat the process over and over and over.

Sometimes problems can be solved by the patients and health care providers by just realizing something is wrong.   Sometimes problems can be solved by legislation, but this is slow.   Sometimes problems can be solved by the market place; but, the market runs by supply and demand — in health care it is not always clear what is supplied and what is demanded.  You did not ask for a heart attack and you may not know to ask for an aspirin and you don’t really care what it costs.  We all just want Quality Health Care, Please!

Your comments are welcomed.   If you have discovered a problem with American health care this is the place to point it out and hopefully we can come to a solution.  If you see solutions here that look good then tell others and give them the link to this blog.  Thanks.

  1. #1 by Orlando on March 10, 2016 - 12:08 PM

    Everyone out there complaining about “HealthCare” in the US and the cost is missing the point. Healthcare here is the best in the world. People from Canada, Belgium, Japan, England come here to seek some of the best doctors not to mention that their doctors/students come here to learn and train in some of our top facilities. They pay cash and seek reimbursement from their health insurance when they are saved/fixed and fly back. Yes their insurance company!. People in “socialize medicine” get private insurance to pay for these things and to pay what is not covered through their government covered healthcare. They tell me they have to wait months many times for certain surgeries. “wait in line like the rest of the cattle”. Mind you, it is not free. People pay for this through their taxes. Will the people in the US want to pay more taxes? of course not.

    As for cost of course it is 2-4 times higher. everything cost more here. people get paid more here (thank you unions) the dollar is worth less and professional want their mercedes and million dollar homes. They deserve it right. One of the best liver surgeons in California makes about 5 millions a year. Is that not enough for the guy who saves hundreds of lives and works basically 24 x 365 days. These doctors have high right of divorce and alcohol or drug abuse.

    There is a comment on this about blog: You did not ask for a heart attack and you may not know to ask for an aspirin and you don’t really care what it costs. We all just want Quality Health Care, Please!

    Of course people in the US are asking for a heart attack, Diabetes, Obesity, etc..!!. These are all preventable. But people here have a different life style then in Belgium for example as this blogs has referenced. They walk, they use public transportation, they sleep, they stress less, they eat better, vacation yearly and are allowed to by employers, they may even enjoy a McDonald once a month as I do an In and out , but many people here in the US are on the go, eat fast food almost daily, don’t exercise, don’t sleep well. sit in traffic, argue with everyone, stress, work way too much and don’t vacation like they should.

    The real issue here is the health INSURANCE companies and pharmaceutical companies that charge ridiculous premiums, have high deductibles, a bunch of non-covered items (ACA did help with that I will agree) and use every excuse or loophole not to pay. They create a 25% of expenses to hospitals and billing services to resubmit, appeal, argue and file legal action against insurance companies. Lets not mention the boat load of money given to government officials, politicians and interest groups to not pass laws against this. The ACA made a good attempt but really what it did was make insurance companies along with their CEOs richer. Why do you think their was not uproar from insurance companies.

    If the insurance paid at 100%, lets say, then hospitals can reduce their charges to cover expenses, overhead and salaries. For example a surgery costing $8,000.00 is paid at $8,000.00 that surgery will then not suddenly be billed at $24,000 because they need insurance to pay the $8,000. If the surgery stays at $8,000 then insurance come back trying to negotiate $2,500. then they say the patient has a $2,000 deductible and pay $400.00 because patient has a 20% co insurance. The patient now cannot pay the $2,000. what does this equal = hospitals go out of business as many have through the years. Insurance companies will say they are saying their members money by negotiating costs …. BULL C…..P ! they are saving themselves money. Insurance companies are not out for you.

    When this government and politicians grow some they will hopefully fix that system. They first must stop with accept contributions from these companies. I suppose you cant blame them now since running for a job that pays under 1/2 millions cost 20 million to get.

    Good luck America.

    • #2 by qualityhealthcareplease on March 10, 2016 - 4:27 PM

      Orlando —

      Thanks for reading the blog. US Health Care is complicated — in this election season political candidates make statements that are simply not true. You repeated one of the things I have also heard from several candidates that US healthcare is the best in the world. It sounds good to Americans but it is simply not true. The World Health Organization ranks healthcare based on RESULTS, like infant mortality or the ability to get a doctor appointment (just look at the WHO website). The US ranks about 26th in the world — just below Costa Rica. We rank first in the amount of money spent but we don’t get the benefit other countries get by paying a lot less. It’s like paying $500 for a pair of shoes and finding they are all scuffed and have holes in them, yet the salesman tells you they are the greatest shoes in the world.

      Think of health care insurance premiums like a tax. There is a difference between paying that money to an insurance company and paying that money as income tax. The insurance company takes about 30% of the money as profit. If you invest in insurance companies and are really rich then that scheme may seem really good to you. But, the average American would get a better deal if everybody just got Medicare and cut out all the insurance middlemen.

      People do cause some of their own health problems, but that’s not going to change based on some insurance plan or based on some government plan. It seems self-inflicted health problems are mostly related to poor health education and poor choices. There is no law against making bad decisions.

      Pharmaceutical and device manufacturers are global companies. Any country that does not negotiate with them is just asking for price gouging. Sadly, almost all the insurance companies in the US are not big enough to cut reasonable deals. No US State has enough clout, the Federal Government is needed to do some of this negotiation — I realize they are not doing what is needed probably due to extensive lobbying.

      Can we fix the system? Well, not so far. I send letters to my congressmen and so should you. If they can’t make the system work better then vote them out of office! We need SOLUTIONS, not statements like we have the greatest healthcare system.

  2. #3 by Jane Akre on January 17, 2014 - 7:10 PM

    There seems to be a great deal wrong with the policy of implanting transvaginal mesh in women when there are so many unanswered questions. At least 50,000 lawsuits and very little coverage of the issue has many coming to Mesh Medical Device News Desk dot com for community and answers. Not only are removal surgeries common after complications arise, but very few doctors can remove the permanent implant and many patients turn to numerous attempts to remove it after infection, erosion, nerve damage etc.. 10 surgeries is not uncommon with most failing to remove the polypropylene material. What is that costing us all?

    • #4 by qualityhealthcareplease on January 19, 2014 - 5:09 PM

      You might find it helpful to do a force field analysis as suggested in my article on the Morcelator. Also, I understand there are new types of mesh — are they better or safer or more expensive? Is there a patient choice? And, the popularity of mesh is because of what? Possibly shorter and less invasive surgery which women really want, just not with complications. What is the complication rate? Knowing the complication rate and the known difficulties removing the “permanant” mesh would a reasonable person go ahead with the surgery — if the patients were adequately informed and later sought legal recourse is that a problem? Of the 50,000 suits how many did the plaintiffs win?

  3. #5 by kara on August 8, 2013 - 8:19 AM

    Are community benefit expenditures of hospitals based on chargemaster prices?

    • #6 by qualityhealthcareplease on August 8, 2013 - 10:51 PM

      Yes, to some degree. Each hospital develops a “formula” to write off bad debts often calculated with the chargemaster fees. Some hospitals limit this write off. Non-profit hospital tax forms are posted on the Internet so it is possible to get a little information from those forms if you can find them.

      • #7 by Kara on August 9, 2013 - 4:53 AM

        Thank you. But what about the other categories such as subsidized services or charity care…do they just write off what it costs the hospital to provide the service, and if so how do they calculate those costs? Thank you very much for any insights.

      • #8 by qualityhealthcareplease on August 10, 2013 - 7:18 PM

        That is a good non-profit accounting question, I personally don’t know the categories. Here is a simple example: some hospitals have a program to grant patients funding for care. The patient applies and based on financial need the grant is approved. The grant is considered charity care. The funds actually go from one pocket to another — from the grant fund to pay down the hospital charges. Whether the hospital charges reflect the “chargemaster” or reflect some approved benchmark rate like Blue Cross Blue Shield is up to the hospital.

  4. #9 by Ha-Vinh on October 21, 2012 - 9:37 PM

    Thank you for following my blog, I will follow your blog too because we share exactly the same concerns about how the mechanisms of health care delivery and health condition alteration work.

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