# A proposal for lower health care costs **URL:** \ **Category:** Great Debates\ **Created:** [January 31, 2015, 4:27pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436 "2015-01-31T16:27:06Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![The\_Joker\_and\_the\_Thief](https://avatars.discourse-cdn.com/v4/letter/t/e79b87/32.png) [@The\_Joker\_and\_the\_Thief](https://boards.straightdope.com/u/The_Joker_and_the_Thief)\ **Post date:** [February 3, 2015, 10:07pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/21 "2015-02-03T22:07:44Z")
> [@Martin\_Hyde](#): > > [Link](http://amzn.com/081299695X), “America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System”, it’s available in Kindle format. It’s by the same guy who read a really good long-form article for Time awhile back on all the issues with our healthcare system, my appreciation of that article is why I read this when I heard about it. Thanks. > [@Really\_Not\_All\_That\_Bright](#): > > That’s not quite true: there is one type of malpractice reform that works very well. Namely, pulling licenses from physicians. Something like 60% of malpractice claims are made against a very small group of physicians (5-10%, depending on the jurisdiction and practice area.) > > The AMA is strongly in favor of tort reform, because it will (at least in theory) reduce the cost of doing business for its members. Oddly, it is not in favor of more stringent licensing requirements. Wonder why that is? Interesting, I didn’t know that. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [February 3, 2015, 10:30pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/22 "2015-02-03T22:30:41Z")
> [@Wesley\_Clark](#): > > Some of us do not trust the AMA, so if the AMA is against something that is not automatically a bad thing. The AMA was against medicare, opposes single payer and has worked to keep the supply of physicians low to increase physician wages (which drives up health care costs). If anything, if the AMA is against something I look at it like the health insurance or pharma industry being against something. It is more than likely good for consumers and patients in that case. I trust the AMA when it says to vaccinate, etc. . . . but otherwise, you’ve got a point. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [February 3, 2015, 10:43pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/23 "2015-02-03T22:43:54Z")
As I understand it, costs are only part of the whole health care debate. A significant portion of the discussion centers on how to get care to people who are ill equipped to pay for it. So this plan of yours eliminates a possible cost increase. That’s nice but how does that help people who get sick or injured and can’t afford to pay now? ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [February 3, 2015, 10:57pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/24 "2015-02-03T22:57:15Z")
> [@DrCube](#): > > > [@Dewey\_Finn](#): > > > > Remember that ICD-9, the system we’re currently using, was designed in the late 1970s and only now is being replaced in the US. So we might still be using ICD-10 forty years from now. Obviously, today, a spaceship collision is unlikely. But who knows whether it will be more likely twenty or thirty years from now? The idea is to have codes to allow for even unlikely events. > > Why? Why do we need a code for unlikely events? > > Especially since we’ve had an infinitely flexible code for a thousand years, called “English”. The code in that system for spaceship injury would be “spaceship injury”. It also covers simple ailments like “the flu” and “a broken arm” or health problems we haven’t even thought of yet like “tentacle-ization” and “gustatory plague”. And it costs $0 to implement and no one needs special training. In addition to what **Eonwe** said about the value of standardized codes in research, they also facilitate the billing and payment process. Let’s say we follow your idea of just dropping standardized codes in favor of English descriptions. The net result would be the healthcare and insurance industries grind to a halt as every claim requires ten times more manual effort to process. “$0 to implement” is not at all correct. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [February 4, 2015, 12:43am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/25 "2015-02-04T00:43:07Z")
> [@Twoflower](#): > > All I can tell from the OP is that it must be bad, since it has codes for humorous-sounding conditions. Is there a code for møøse bites? For recto-cranial inversion? I…I can’t find one! :eek: Might I interest you in being Struck by a Sea Lion instead? That’s my favorite. Don’t forget to indicate whether it’s the Initial Encounter W5612XA or Subsequent Encounter\* W56.12XD \*I’m not sure if said subsequent encounter is with the doctor or the sea lion. Frankly, I think anyone careless enough to get struck by a sea lion twice doesn’t deserve medical care. Look, ICD10 is going to suck. We know that. But it’s the least of the suckiest things driving up medical costs today. On a practical, day to day patient care level, I’d be delighted if we could simply all use the same goddamn medical records system. I spend a huge amount of my days just trying to get information from hospitals so I know whether my patient is coming home with two legs or not. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [February 4, 2015, 2:33am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/26 "2015-02-04T02:33:16Z")
Møøse bites would fall under [W55.81](http://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W55-/W55.81), “bitten by other mammal”. And you know what? This was my first exposure ever to this system, and I was still able to find that easily. I started by following the link to the closest thing I’d heard of, the duck one. Then I followed that to its parent classification, “animate mechanical forces”. From there, it was a fairly short path to “encounter with other mammal” and “bitten by other mammal”. If even I, a complete newbie to this entire topic, can find it so easily, then it can’t be that arcane or incomprehensible a system. ---
**Author:** ![Grumman](https://avatars.discourse-cdn.com/v4/letter/g/43a26b/32.png) [@Grumman](https://boards.straightdope.com/u/Grumman)\ **Post date:** [February 4, 2015, 2:52am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/27 "2015-02-04T02:52:02Z")
> [@Martin\_Hyde](#): > > There’s a great book I just got done reading about Obamacare and the two forces in the Obama Administration that were fighting for different visions for the plan. The policy wonks were fighting for the concept of universal coverage, the economists were fighting for reigning in out of control costs. Both are important goals, but my argument is the latter is the most important–because universal but unaffordable coverage does no one much good. Worse than that - universal but unaffordable coverage is actively harmful to your quality of life. Health _insurance_ is not health _care_, and forcing people to buy the former for more than it’s worth does not automatically mean they’ll have better access to the latter, and it _will_ mean they have a diminished capacity to meet their other wants and needs. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 4, 2015, 2:24pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/28 "2015-02-04T14:24:15Z")
> [@Chronos](#): > > If even I, a complete newbie to this entire topic, can find it so easily, then it can’t be that arcane or incomprehensible a system. As someone who has to work with ICD-9 _a lot_, but without any formal training in that coding system, I can tell you it’s the opposite of what you describe. So roll on ICD-10! ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [February 4, 2015, 4:12pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/29 "2015-02-04T16:12:52Z")
So could the OP be summarized as follows: “Haw Haw! This new system has a coding for duck bites! Therefore, not implementing it would undoubtedly save money.” ? ---
**Author:** ![boffking](https://avatars.discourse-cdn.com/v4/letter/b/858c86/32.png) [@boffking](https://boards.straightdope.com/u/boffking)\ **Post date:** [February 4, 2015, 5:09pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/30 "2015-02-04T17:09:12Z")
If we want to cut costs, we need to stop throwing away perfectly good supplies. It must be billions of dollars just thrown in the trash, of supplies that might not have even been used. When my father worked in the sterilization room in a large hospital, he would come home with pockets full of batteries, and if he hadn’t taken them, they would have just gone to the dumpster. If the hospital isn’t going to use all the supplies they buy they should at least sell them, or give them to charity for a tax write-off. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [February 4, 2015, 5:40pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/31 "2015-02-04T17:40:25Z")
> [@BobLibDem](#): > > So could the OP be summarized as follows: “Haw Haw! This new system has a coding for duck bites! Therefore, not implementing it would undoubtedly save money.” ? This is like Obama’s “silly” idea of saving gas by properly inflating your tires. It actually works, but it sounds funny, therefore it must be a trick! ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [February 5, 2015, 10:58am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/32 "2015-02-05T10:58:07Z")
> [@boffking](#): > > If we want to cut costs, we need to stop throwing away perfectly good supplies. It must be billions of dollars just thrown in the trash, of supplies that might not have even been used. When my father worked in the sterilization room in a large hospital, he would come home with pockets full of batteries, and if he hadn’t taken them, they would have just gone to the dumpster. If the hospital isn’t going to use all the supplies they buy they should at least sell them, or give them to charity for a tax write-off. Not going to bring down costs when they’re sued because someone at a shelter gets an infected toenail from donated nonsterile tweezers. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 6, 2015, 4:48am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/33 "2015-02-06T04:48:20Z")
> [@Grumman](#): > > Worse than that - universal but unaffordable coverage is actively harmful to your quality of life. Health _insurance_ is not health _care_, and forcing people to buy the former for more than it’s worth does not automatically mean they’ll have better access to the latter, and it _will_ mean they have a diminished capacity to meet their other wants and needs. If there are a new set of potential customers who can now pay for health care, don’t you think that the market will eventually provide them that health care? ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [February 6, 2015, 9:41am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/34 "2015-02-06T09:41:37Z")
> [@Dewey\_Finn](#): > > In addition to what **Eonwe** said about the value of standardized codes in research, they also facilitate the billing and payment process. Let’s say we follow your idea of just dropping standardized codes in favor of English descriptions. The net result would be the healthcare and insurance industries grind to a halt as every claim requires ten times more manual effort to process. “$0 to implement” is not at all correct. Generally 80% or more of health insurance claims are paid by computer without a human ever seeing it. Plain English instead of codes would reduce that dramatically. ---
**Author:** ![SciFiSam](https://avatars.discourse-cdn.com/v4/letter/s/47e85d/32.png) [@SciFiSam](https://boards.straightdope.com/u/SciFiSam)\ **Post date:** [February 6, 2015, 10:51am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/35 "2015-02-06T10:51:04Z")
I’m not American so am not going to comment on ICD-10 or catastrophic healthcare. I do sometimes comment on American-only things but only where it’s similar in my country or a comparison is requested. Anyway, over-the-counter medicines would be a good idea, and the way to combat the fear that people will over-use such medicines is to require the pharmacist to record them getting the medicine, with the recipient’s SS# or somesuch (whatever migrants, tourists and immigrants get? Data from their visa or passport?), and making that record available to their primary physician if possible. If making the data available to their primary physician isn’t possible then at least there’d be a record that could be found. Most people go to one or two pharmacists for all their needs so it would be easy for a pharmacist to tell if their customer had already bought three preventer inhalers for asthma that week. Coupled with that, pharmacists should also have the right to refuse service when it comes to drugs that were formerly prescription-only. They reserve the right to say “go back to your doctor.” This does actually happen in the UK and quite probably the US, in some respects; if I have a regular prescription for something, and need it RIGHT NOW but going to emergency services is inappropriate, then the chemist will give me a one-time prescription and require my details in order to be able to dispense that prescription, though they’ll usually give the medication before asking for details if you’re obviously ill. Like with asthma - your breathing is bad and an inhaler can stop it all, but you’ve run out or your bag’s been stolen or something. The nearest chemist can give you an inhaler because that’s better than you getting worse and going to A&E (the ER). But they’ll record what happened and to whom. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [February 6, 2015, 1:21pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/36 "2015-02-06T13:21:49Z")
> [@Mdcastle](#): > > > [@Dewey\_Finn](#): > > > > In addition to what **Eonwe** said about the value of standardized codes in research, they also facilitate the billing and payment process. Let’s say we follow your idea of just dropping standardized codes in favor of English descriptions. The net result would be the healthcare and insurance industries grind to a halt as every claim requires ten times more manual effort to process. “$0 to implement” is not at all correct. > > Generally 80% or more of health insurance claims are paid by computer without a human ever seeing it. Plain English instead of codes would reduce that dramatically. That’s what I was saying. Dropping codes in favor of plain English descriptions would mean that _all_ claims would need to be processed manually. So **DrCube** ’s claim that using English would cost zero dollars to implement is bullshit. ---
**Author:** ![doctigger77](https://avatars.discourse-cdn.com/v4/letter/d/ce73a5/32.png) [@doctigger77](https://boards.straightdope.com/u/doctigger77)\ **Post date:** [February 9, 2015, 3:22am UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/37 "2015-02-09T03:22:41Z")
Our EMR sends to payers the ICD-9 (currently, ICD-10 in the near future) and the snomed code (an international nomenclature made up to improve translation of problems across the world but really, very difficulty to find useful). Anyway, saving money— You know about ACA (Affordable Care Act) and how it really ain’t so. But do you know about NannyCare? Let me give you an example– Guy comes to you, long history of smoking, c/o of shortness of breath and wheezing. Will he quit smoking–no way. Does he want n-th degree in treatment–why sure. Do I have to beat him over the head on each and every visit to quit smoking–why sure. There are many examples of this that have to be repeated often and really wastes time on the patient visit. The patient complains that their doc only spent 5 min on their problem and exam. Why yes, 'cause he had to update all his EMR data points in order to be paid for his time. Then when the patient does not want to change his ways and comes down with end-stage lung disease or lung cancer, you and all the other taxpayers will be compassionate and give him a chance to live with all sorts of expensive interventions. Does he deserve this compassion (or do we even have the right to say no to these interventions)? Do we improve the quality of remaining life? So, the cost of care can also be driven by the provision of extreme interventions that commonly have a low extension of life or improvement of quality to the problems often caused by the patient’s bad habits. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 9, 2015, 2:34pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/38 "2015-02-09T14:34:12Z")
> [@SciFiSam](#): > > Most people go to one or two pharmacists for all their needs so it would be easy for a pharmacist to tell if their customer had already bought three preventer inhalers for asthma that week. Drug-seekers certainly don’t. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [February 9, 2015, 2:50pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/39 "2015-02-09T14:50:38Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Drug-seekers certainly don’t. Truth. But again, a single universal medical records system that we could all access would help prevent multiple pharmacy abuse. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [February 9, 2015, 2:58pm UTC](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436/40 "2015-02-09T14:58:28Z")
It would. But it’s been in the interest of everyone who matters for 30 years and we don’t have one yet (though we do have state databases now.) [Previous page](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436.md?page=1) [Next page](https://boards.straightdope.com/t/a-proposal-for-lower-health-care-costs/711436.md?page=3)