Greg Laden is a blogger, writer and independent scholar who occassionally teaches. He has a PhD from Harvard in Archaeology and Biological Anthropology, as well as a Masters Degree in the same subjects. He is a biological anthropologist, but for many years before going to graduate school to study human evolution, he did archaeology in North America. He thinks of himself as a biologist who focuses on humans (past and present) and who uses archaeology as one of the tools of the trade. Greg blogs regularly on ScienceBlogs at http://www.scienceblogs.com/gregladen/.
Dr. Joseph J. Salvo attended Phillips Andover Academy, received his A.B. degree from Harvard University and his Master and Ph.D. degrees in Molecular Biophysics and Biochemistry from Yale University. Dr. Salvo joined the GE Global Research Center in 1988. His early work focused on the development of genetically modified bacteria and fungus, for the production of novel high performance polymers. In the mid 1990's he turned his group's efforts towards developing large-scale internet-based sensing arrays to manage and oversee
business systems. Most recently, he and his team have developed a number of complex decision engines that deliver customer value through system transparency and knowledge-based computational algorithms. Commercial business implementations of his work are currently active in Europe, and Asia as well as North and South America.
Dr. Peter Tu received his undergraduate degree in Systems Design Engineering from the University of Waterloo, Canada, and his doctorate from Oxford University England.
In 1997, he joined the Visualization and Computer Vision Group at the GE Global Research Center in Niskayuna, NY. He has developed algorithms for the FBI Automatic Fingerprint Identification System. He is the principle investigator for the ReFace program, which has the goal of automatically computing the appearance of a person’s face from skeletal remains. Dr. Tu has also developed a number of algorithms for the precise measurement of specular and high curvature objects. His current focus is the development of intelligent video algorithms for surveillance applications.
This is the fifth daily question on the Collective Imagination blog.
Every day, respond to the question (or another commenter's answer) and you will be eligible to win a custom ScienceBlogs USB drive. We'll announce the previous day's winner in each daily question post.
Yesterday, we asked how digitized medical records have changed your experience with managed health care. The answers varies—some said they've seen no change, others said they made for faster, less error-prone communication of medical records, and one commenter said that the change actually made it for difficult to get a full annual report of lab reports.
Rodney is our randomly selected winner of the day. Rodney, please email [email protected] sometime within the next couple of days to claim your prize.
We'll be giving out USB drives daily through the end of March. To get your own, answer our next question, which many of you touched upon a couple of days ago in the comments:
How do you define adequate health coverage?
Tell us below!
For more information about health care and technology, check out GE's healthymagination.
Medicine & Health
Comments
I define adequate health care coverage as that which covers all major illnesses and hospital stays without excluding pre-existing conditions. It should also cover wellness and preventive care and cover medications with deductions for medicines not to exceed $25/month per brand name (patented) medications or $10/month per generic. Office visits should have a co-pay no higher than $25 per visit and hospital stays not to exceed co-pay of $250 per stay. Emergency room visits should be covered only for emergent care. Cost of the policy should not exceed $600/month for one person, $1200/month for 2 people or $1800/month per family.
Posted by: NewEnglandBob | March 5, 2010 5:31 PM | Reply
You must be a very wealthy person to think that's affordable. But then it's not far off what a Medicare HMO offers, so maybe I'm the unreasonable one.
Donna B. replied to comment from NewEnglandBob | March 6, 2010 9:55 AM | Reply
I don't mean to say that the premiums are comparable to Medicare premiums, unless you happen to be one of the unfortunate who have to pay a part A premium.
Donna B. replied to comment from Donna B. | March 6, 2010 10:01 AM | Reply
I like NewEnglandBob's answer, though I find his maximum policy cost to be untenable. I make approximately double the poverty limit a year right now, and $600 is almost half of my take-home pay for a month. I cannot imagine someone who makes even less than I do would ever be able to afford such high costs. I would prefer a cap of 1/5 monthly net income OR the cost scheme of $600/1200/1800 suggested, whichever is lower. I think that with a dedicated, regular GP and no fear of the costs of preventive medicine, this wouldn't necessarily limit care at all.
Posted by: Ali | March 5, 2010 11:17 PM | Reply
I can certainly see such a reasonable wish-list for an idealized policy. Though as we are tossing numbers around at the base is one big question of how much should health care providers be reimbursed? Should it be the median income of their patients, fixed but proportional to the time spent training in comparison to other professions, variable depending on patient outcomes, or open to market forces?
A few things about the proposed policy. Only covering emergency room visits for emergent care is a bit optimistic. Many individuals simply cannot find a primary care source in their area, have recently moved or can't even afford the 25 dollars, and need some kind of health care in the next 24-48 hours. These are not often emergent cases though what would you suggest for such instances? Should primary care providers leave slots open every day so that they may handle a given number of urgent visits? Who will pay if those slots go unused and what happens to those patients if the slots end up full? i.e. flu season.
Another very much related topic is how long should a primary care visit take? Right now medicare/medicaid reimburse for 12 minute long visits. Last week, I tried shopping for car insurance and just one customer service rep had more than 12 minutes of questions about my car, driving behavior, where I live, etc. Yet, somehow I am supposed to do health care in less time and ask fewer questions about health concerns and behaviors? Specifically, in your system a provider would be diagnosing and treating acute conditions, chronic conditions and doing wellness and prevention. Guess which parts get cut off over and over again? The wellness and prevention if not chronic condition management. That is what is quite literally killing us right now. We have to make office visits a lot longer and/or add other ways to reimburse for patient follow up. It is beyond silly that in this age the only thing that is "valuable" in medicine is care delivered in person. I will give another hint. The people who need the most wellness care or preventative medicine are not making regular office visits and are the most likely to end up with poor health on medicare or medicaid.
I also notice that your policy doesn't mention psych, optical, or dental insurance. Would these be extra or included? Furthermore, where do nursing home stays factor into your list. Considering that no pre-existing condition could be excluded, how would long-term living situations be covered?
In short, I don't think that defining economic boxes that insurance companies have to fill will ever work. The whole point of the problem is that these profit driven entities find ways to skim if not steal from the system. Whether it is through high co-pays, high policy costs, flat out denial of treatment, short-changing provider reimbursement or rationing the time spent with patients. They have short term, bottom line thinking which makes it impossible to practice long-term medically and economically sound health interventions.
I guess I have been too critical and not nearly constructive enough, so I will propose a policy around the same theme. I define adequate health care as a system whereby providers are paid a flat, reliable salary and are responsible for a given number of patients. A system where reimbursement isn't defined by number of office visits, but instead by responsibility to a number of patients. One that will fairly reward the time spent by highly trained individuals (MDs, DOs, RNs, PAs, PTs etc..) whether they are doing procedures, diagnostic medicine, educating patients, coordinating care through several sub-specialists, tracking down the individuals who don't show up, and in general building long-lasting relationships.
On top of that for anyone under the age of 18 add free blanket coverage (expensive surgeries, optical, dental and psych). Plus free prescriptions for a few key medicines such as bupropion, a smoking cessation aid and mild anti-depressant. Insulin, metformin, and testing supplies for diabetes. Plus warfarin, statins, beta blockers, and diuretics for vascular disease. Make everything else out of pocket or covered by health savings accounts.
In such a system will people still get sick and die? Absolutely, that is the end for all of us. But it would be a lot cheaper than what we are paying for now and would be an amazing improvement in quality. Not great, but currently plausible and adequate.
Posted by: MS3 | March 6, 2010 7:04 PM | Reply
Adequate health coverage would apply resources and the best science (from marketing and neurosciences) towards health promotion and the production of well-being.
Currently we apply 97% of our resources to illness and 3% to public health or prevention (yes, this number is an estimate- ref Turnock and IOM)
Thus, opportunities to inform, educate, or "nudge" people toward health and well-being are not taken nor even considered- left to Mom and marketing.
If we improve health coverage we won't improve health because health isn't produced by the health system.
Just one example, of a health promotion activity--
http://gaybumgarnerimages.blogspot.com/2010/02/health-promotion-activities-to-promote-health
Thanks for the questions
Posted by: Sharon McDonnell MD MPH | March 6, 2010 7:13 PM | Reply
I define it as follows:
1) Preventative care - no charge. This includes physicals as necessary.
2) Hospitalization covered by single payer government system like Medicare.
Simple, easy and ready to roll.
Posted by: Tony P | March 6, 2010 10:34 PM | Reply
Adequate coverage would be the cheapest medical treatment/prevention methodology that provided any improvement in health statistically different from a placebo.
Posted by: Mike | March 7, 2010 1:04 PM | Reply
"How do you define adequate health coverage?"
having the healthcare insurance that I need at a reasonable rate. At the same time, not having the hospital rob me and my insurance company blind.
I do not call Obama's single payer plan adequate coverage at all. Government takeover of healthcare, or anything else for that matter is a grave mistake. It can only spell certain doom to freedom.
The left says Obama is not planning a single payer socialist system. If that is true then why did he make the proclamation himself before he ever ran for president? He himself said he would like to see a single payer HELLthcare system. This senate bill would indeed lead to insurance companies going broke in order to install a governmemnt system. That is its design and purpose. The marxists have wanted socialism in this country for so long until they are willing to commit treason of the constitution to get it done. We should throw the bums out of the country.
Posted by: Rumpleforeskin | March 7, 2010 8:48 PM | Reply
I live in Canada. I consider our health care system to be about the minimum acceptable. If it also covered drugs, optical, and dental that would be a lot better.
Basically, if a doctor says you need it, it's covered. That's my minimum standard.
I simply can't comprehend anyone seriously arguing that the government shouldn't run healthcare. Would you want your police, fire department, and educational systems to be privatised? Health is arguably more critical than any of those, and I want the people who make my health decisions worrying about what's right, not how to make the most money off me.
Having for-profit companies make health decisions for people is completely insane. I don't want some faceless corporate bureaucrat able to deny me coverage because it doesn't make financial sense. I want that decision made by people that answer to people that answer to me at the polls.
Posted by: Penn | March 7, 2010 10:11 PM | Reply
I define adequate health care as follows: Patients should have access to whatever medical services they need (preventive and downstream), and have access to a GP at any time to help them figure out what services they need with no out of pocket expense. This includes disability insurance that covers even a few days home from work for hourly workers, and employers should not be allowed to fire people who miss work due to documented illness.
Basically, being sick should not cost money, and neither should getting well. Costs should be covered in a single-payer, tax-funded manner so as to be distributed in a progressive manner.
But what do I know, I'm just Canadian.
Posted by: Jake | March 8, 2010 9:05 AM | Reply
Oh and Penn, I agree that our system is barely adequate. Other things that aren't covered can include ambulance rides, medical devices, and psychotherapy. Plus it doesn't include much of my missed-work provisions that I think are essential to making sure poor people can care for their health.
Posted by: Jake | March 8, 2010 9:10 AM | Reply
One last comment:
Rumpleforeskin (gross name, btw), I know you're probably just trolling but I would like to have an actual conversation with you, if you're interested. I've spent my whole life in a country with government-run health care. I've also had many friends in the USA, who live under your health care system. I will tell you some differences I have seen between our systems and I would like it if you could explain to me how I have less freedom as a result.
1)a. When I get sick, I can go to any GP in my country and have it covered. If that GP and I decide together that I need specialised care, they write me a referral, which I can take to any relevant specialist in the country and *that* will be covered.
1)b. When my American friends get sick, they have often been limited to going to a doctor in their insurance network or HMO. If the doctor they like best is not in that network then those visits will not be paid for.
2)a. When I get strep throat or similar, I don't have to decide between care and groceries because my doctor's visit costs me nothing at all out of pocket.
2)b. When a friend of mine in the US got strep throat, he didn't go to the doctor and risked getting scarlet fever or some other complication because he couldn't afford the $25 co-pay he would have had to pay to go to the doctor.
3)a. When someone in my country needs urgent medical care for which the best provider can only be found in another country, my government will pay for that person to go get the care they need.
3)b. I don't actually have any info on this, but I suspect that doesn't generally happen in the US.
4)a. Now that I've aged out of my parents' plan, but don't have a job that provides insurance, the vast majority of my health care is still free to me. I never have to worry about changing jobs or starting my own company because I'm afraid to lose coverage on my chronic condition.
4)b. I don't know anyone personally with this problem, but my understanding is that because insurance companies can refuse to cover pre-existing conditions, many people are locked into one health insurance company, and one job, if they are diagnosed with a chronic condition for which they need care.
5)a. The supplemental insurance I buy to cover things the government doesn't pay for (drugs, dental, etc.) only costs me $125/mo on the private market. If I got it through work it would be less. And they would never be allowed to refuse to cover something because it was pre-existing.
5)b. NewEnglandBob at the top of the thread there seems to think $600/mo is reasonable for a single person's health insurance. I deduce that this is on the low end of current market rates in the US. Ouch! Plus they can deny care for pre-existing conditions.
In sum, I have the freedom to decide which doctor to see and when, anywhere in the country. If the care I need isn't available in my country I have the freedom to get it elsewhere. I rarely have to choose between getting care I need and keeping money I need. I have the freedom to change jobs or schools at will without worrying about losing coverage for most things, and the insurance I do have to pay for costs less than a quarter of yours and I get more out of it.
So please do explain how I have less freedom than most Americans with respect to healthcare.
Posted by: Jake | March 8, 2010 9:29 AM | Reply
Jake
Good for you, but this is America. Our founders meant for us to NOT to be dependent on the government, but to be self reliant and free. The more power and authority government has, the less individual freedom you have. Obama keeps talking about "the collective good". Sounds like a Soviet premiere to me. Canada is a beautiful country, but has its authoritarian aspects. People are not as free there as in America. Here we have the right to own virtually any firearm that exists outside of military weapons. We have the legal right to shoot any bastard that breaks into our house and do us harm. That's in our constitution. What's more, our constitution grants the people the right to own firearms to defend them selves aginast a government gone mad (second Amendment).
More than that, Benjamin Franklin often wrote about England enslaving its people through entitlements. That is true. A government who gives out free handouts, or entitilements gets its citizens addicted to that entitlement therefore enslaving them to the government.
I do not want a singke payer socisliast system here. America is meant to be a free country, not dictatorship. Besides what Obama wants is a complete takeover of the system. People living in that kind of a system often die waiting in a long line or refused care altogether. In England the horror stories about being refused treatment becuase of age abounds. Doesn't an 80 year old woman with breast cancer deserve the same medical care as a 30 year old woman with breast cancer? What Obama proposes and what all other single payer health care systems have in common is :
1) population control
2) power
3) control over society and individual soverieignty.
This is evil and I refuse to live in that hell.
Many people come to America from socialist countries to recieve medical care that they are refused in their home country.
Besides if we could pass a regular sales tax on all items and abolish the income tax and the IRS, we would have more than enough money to pay for the emergency room visits of illegal aliens and to fund a border wall to cut down on illegal aliens getting in here to abuse the system. 12 million people getting a free education, free medical, and free housing costs alot of money that could be spent elsewhere.
When I get strep throat, I got to the doctor, pay $25 copay, the insurance pays the rest. I take my medications which is mostly payed for by the insurance (I usuaully pay less than $10)and get well. Isn't it simple?
Living under your system i would pay significantly more money in taxes which is just wrong since I already pay 30 % of my income to a lousy government who wants to control everything in my life. I am a sovereign citizens and free and should not have to answer to government, at least not according to our constitution.
This is America, not England, canada, Europe, etc. We do our won thing, not copy everyone else. We have tried the Europe model in California and it failed miserably.
Posted by: Rumpleforeskin | March 8, 2010 8:20 PM | Reply