<p>I am desperate or else I won’t be here begging for help.</p>
<p>I have been reading articles after articles and legislations after legislations. I am trying to understand HMOs, managed care, managed competition, etc. I am in way over my head… The amount of issues is overwhelming: access, spiraling costs, quality, funding, responsiveness, etc. I think x_x is the perfect expression for me at this moment.</p>
<p>How can you fix U.S. healthcare with 25 million dollar grant? Or at least how can you alleviate the social problem?</p>
<p>I can’t think of anything that I can do with $25 million dollars that can really help with the situation. Yet I am supposed to write a grant proposal.</p>
<p>I would love to hear some comments on your personal views on U.S. healthcare problem. Your views on universal healthcare? Giving Medicare and Medicaid to private sector? First hand experiences?</p>
<p>Please, give me some insights. Opinions? Thoughts?</p>
<p>You’ve got $25M? Insure every child you can find. </p>
<p>Why children? Because childhood health care really lowers medical costs later. Most medical costs for adults come from chronic diseases: diabetes, asthma, etc. These have their roots in childhood.</p>
<p>Me, I’m a cynic. I’d like to see this country insure every child to age 18–for free–and means-test Medicare to pay for it. I’m at a loss to explain why my father-in-law (very wealthy) gets low-cost medical insurance and children don’t. Actually, I know why he gets it–he votes and thus he scares politicians.</p>
<p>I was thinking along the same line. However, I realized that California implemented a similar program in 1997 and it costed 20 million dollars for two years.</p>
<p>25 millions for the whole nation?! I cannot fathom how much money that would take to insure every child between the gap of incomes too high to receive Medicaid yet too poor for private sectors.</p>
<p>I also think Medicare should only insure those who are actually unable to paid not everyone over the age of 65… But that is more of a bill/legislation than a grant proposal.</p>
<p>I would love more responses. It doesn’t even have to pertain to the grant proposal. I genuinely want to know what other people think of this situation that will affect your children, your grandchildren, your great-grandchildren, etc.</p>
<p>The health care system is cracking and is going to break. Fewer and fewer employees are covered by employee-sponsored health plans and health costs are rising.</p>
<p>We took a deep breath and, effective Jan. 1, we’ve switched from an HMO (Health Net) to a PPO (Blue Cross) because while the HMO was fine for both emergencies and routine preventative work like physicals, it was lousy to the point of becoming akin to a Third World practice for intermediate things requiring specialists, everything from radiology to orthopedics. And God forbid things like heart specialists or oncology specialists are needed.</p>
<p>Just a thought re your $25m grant proposal. Since that amount is, we all seem to be agreed, a drop in the ocean, I recommend that your proposal be for what we used to call a “demonstration project.” Whatever you think the solution, propose it for a small enough area (state, city, metro area) that the $25m can do the job. If it works there, the idea would then be to expand it nationally.</p>
<p>I’m still stuck on the costs of chronic diseases. If you can’t offer health insurance to every child, how about a program where you make a difference in one city. Asthma is epidemic in the inner city, so how about a program to lower the emergency room admission rate of asthmatic children? Train LPNs or even interested parents to make house calls to work with families to help them manage the condition. You even have a measurable product: were ER admissions rate lower after the program?</p>
<p>You need to think outside the box with which health care has been defined in this country. Health insurance does not equal access to medical care. And access to medical care does not equal good health. The health of a primitive population has much more to do with things like adequate food supply, sanitation, and safe water than it does with anything we would call health care. As you go up to more developed societies, another level of factors comes into play, like immunizations, smoking, alcohol, seat belts, healthy diet, exercise, general education (particularly of girls) and access to effective means of family planning. All of these types of things have more impact on the health of a country’s citizens than presciption drugs or medical procedures requiring doctors or hospitals, which is where we tend to focus our attention. And some of these things could actually be impacted with a $25 million program.</p>
<p>DMD77, I’m thinking on the same line as you are. Do you know how many people call 911 or the paramedics for a fever or flu because they don’t have transportation to the ER? (I live in a big city). There need to be 24 hr. medical clinics (they have 24 hr pharmacies now), open and ready for minor emergencies, and save the big hospital ERs for the heart attacks, car accidents, and appendicitis and gall bladder attacks. I’ve seen parents in ERs with kids with colds or a virus and because the Dr’s office is closed at night, insurance companies tell you to go to the ER. Most ER visits are $600-1000. In a large city, you can wait all night to be seen because of all the minor emergencies.</p>
<p>Another service which might help alleviate the high cost of $1000 a pop ambulance trips, would be to have a low-cost van service for people who do not drive or who do not have transportation. Maybe it already exists, I don’t know.</p>
<p>As far as who has the best insurance, it seems like Medicaid patients (although finding a doctor who takes Medicaid is hard), and government employees have it made in the shade. My daughter had Medicaid with her first child and they pay EVERYTHING until the child is a year old. I just don’t know how the Government can afford it.</p>
<p>I would like to put a perspective on 25 million. I am an RN case manager working at a large level 1 trauma center. I deal with all insurances from the best to HMO medicaid, which really aren’t awful. scenario: You get a few premature babies, born at about 24 or 28 weeks gestation, and your 25 million is gone, between the NICU stay, the subsequent problems they will have, medications, nursing care etc etc. gone. A few burn patients, gone. Some nasty head injured traumas, gone. So what to do about this, with 25 million dollars? Nothing nationally. But as others have said, take a small area. How about camden, a town that my mother-baby nursing instructor used to say had the worst statistics on infant survival boardering on third world. go there, and start grass roots clinics and education. go to high schools. pick a topic, like premature infants, and what causes them, and educate. find the pregnant teens and get them prenatal care, bring it right to them at the schools or where ever they are. a mobile prenatal center. help them enroll in medicaid so they and their baby has insurance. go to homeless shelters and anywhere you can. set up a day care center where these children can go after birth, and receive care there from physicians who would volunteer. embarress the drug companies into providing you with medications for these people, prenatal vitamins etc. 25 million dollars in a scenario like that could do a lot. see what infant mortality and morbidity is previous to your intervention, and then see what it is after. have you done any good, and would it convert to a national program. as far as health care costs and trying to do something about that, forget it. Prevent the problems with education, and there you have it. education is always the answer. there will always be illness and disease that you cannot prevent, but much of this stuff can be prevented. do it.</p>
<p>another perspective: health care consumes more than 10% of U.S. GDP, much of which goes to individuals in their last year of life. </p>
<p>Concur with Jmmom – develop a demonstration project grant, perhaps focusing on childhood immunization and/or education, where you can probably get the biggest bang for your buck.</p>
<p>amith, I agree with you-- also emphasizing the prenatal diet (protein is sooooo important when pregnant; vitamins plus Doritos are not enough) AND the promotion of breastfeeding. Breastfeeding has major effect on lifelong health.</p>
<p>I had perfect ritzy medical care for my first kid and never heard one word about nutrition other than the vitamins. Then I did a Bradley class with #2 and my eyes were really opened by all the nutrition info. When women eat adequate protein (80-100g/day) and enough salt, ecclampsia is unheard of. When they study populations who have experienced famines, they can trace adult diseases to which month of gestation those people’s moms did not get enough to eat.</p>
<p>as an academic in the field of health care, i would spend $25 milllion on middle to low income families. they need it the most, imo. about 70% of the 45 million uninsured come from this category. most are full time employees who work for employers who don’t offer health coverage or unaffordable premiums. the u.s. spends $1.8 trillion dollars on health expenditures annually, 17% of GDP. this number is expected to raise drastically with the rising cost of healthcare and the change in government programs (i.e. medicare part d).</p>
<p>It’s actually 16 percent (see the most recent issue of the Economist). The last year of life comment is true, but problematic. How do you know, in advance, when the last year is? </p>
<p>I can just see the pressure. Case manager says dad’s chances are small, so let’s skip all care…</p>
<p>…the preemie, statistically, has one chance in ten of a complication free life. One chance in twenty of dying. Let’s skip care…</p>
<p>The real problem with our health care is a huge market failure. But that’s probably a separate topic.</p>
<p>I agree that education is a huge piece
for instance- education medical doctors about nutrition and impact on health care
In my own family I see children who have had chronic infections- ear tube surgeries but diet is never looked at nor allergies- .
My oldest was a premie- 30 weeker born 23 years ago-
Nothing could have been done to prevent her premature birth- ( she tied her cord into three knots cutting off her food supply)
But I wonder if better knowledge of pregnancy demands would have helped some of the other babies who were in the NICU at the same time. She was born at the local university hospital, alongside babies whose mothers were teens/drug users/low income.
I did a paper noting that there seems to be a connection between women who give birth prematurely and that cycle continuing.
Some of it may be attributed to the fact taht in some communities pregnancy and birth is not considered a condition that you necessarily seek medical care for until delievery- thus problems are not caught early enough to maintain the pregnancy.
By putting more of a focus of spacing of children, available birth control, importance of nutrition, we could help a whole generation.
The circumstances of inutero life can affect an individual throughout their life time.</p>
<p>“We took a deep breath and, effective Jan. 1, we’ve switched from an HMO (Health Net) to a PPO (Blue Cross) because while the HMO was fine for both emergencies and routine preventative work like physicals, it was lousy to the point of becoming akin to a Third World practice for intermediate things requiring specialists, everything from radiology to orthopedics. And God forbid things like heart specialists or oncology specialists are needed.”</p>
<p>We have just done exactly the same, based on actual experience. My younger d., an athlete, had to week 9 weeks! to be seen by an an orthopaedist for a serious injury, which he misdiagnosed, the MRI was broken, and he operated without; when things didn’t get better, four MONTHS later he operated again; followup care was non-existent.</p>
<p>Gosh I wish we’d been on the waiting list in Canada!</p>
<p>$25 million? Want to make a serious dent in health care spending, government spending, and total social spending? Simple - I’ve got the article from the May 5, 2005 issue of “Health Economics” sitting right in front of. Methadone treatment - pay off is 37.73 to 1.</p>