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Originally posted by Replaced_Texan
Depends on the hospital. I went back and checked again, because it was bothering me, and the stark exception is more likely to be in 42 C.F.R. section 411.357 (m) (medical staff incentives). There are a lot of hospitals in the Texas Medical Center that only provide meals to residents and medical staff members with Medical Director appointments.
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TMC is a group of teaching hospitals? If so and if they do a significant amount of indigent care, that wouldn't surprise me that they don't have money to spend on free food. But I don't think they are deterred by the laws. I think they are deterred by their budgets. If the TMC includes any for-profit hospitals that don't have a significant indigent care burden to absorb, I bet they give free food in the doctor's lounge.
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Originally posted by Replaced_Texan
Your comments regarding education and lifestyle as not being part of health care. Public health, in part, is about developing programs to assist people in changing lifestyle. From simple things like washing hands and brushing teeth, to more complex nutrition education.
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Defining what activities qualify as the healthcare system doesn't mean someone doesn't know about public health. If you define healthcare to include programs educating people about washing your hands to prevent viral spread, then school teachers are part of the healthcare system. If we have a disagreement on this, it is definitional in nature.
My point in my prior post was in regards to HMOs because I was responding to what you were talking about in your post regarding HMOs. I read your post as saying that the theory behind the HMOs was a good theory and that it was only in practice that they failed (because of some unspecified reasons). My point was that it was not just that they failed in practice, they failed in theory, too, because ultimately these lifestyle choices are not within a doctor's control. The HMO model is based on providing financial incentives to healthcare providers to prevent illness. This theory was proposed to counter supposed financial incentives to treat disease but not to prevent disease. I say supposed because this sort of thinking fails to take into account the effects of the tort system.
If you believe that you can institute public health programs to influence lifestyle choices, I don't dispute that public health programs can help some. However, it is still up to the patient ultimately and many of the factors that influence people to abuse their bodies are not within the control of healthcare providers. I dispute that the HMO theory is a good one because it is based on this assumption that the healthcare provider is capable of influencing the patient to the degree necessary to save money by preventing disease. Human nature being what human nature is, the doctor's ability to do that is very limited.
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Originally posted by Replaced_Texan
I agree, and I think that MSAs could be promising. I think, though, that there need to be some minimum, perhaps rationed, safety nets put in place outside of the MSA that would help in the event that there is not enough in the MSA to cover an otherwise treatable disease or condition.
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You could have a system in which people who didn't have the money to fund the MSA got vouchers from the government. A non-employer based MSA program, properly structured in terms of discretionary/non-discretionary care/ patient contribution, with vouchers to help low-income people would help to corrrect some of the market failures in our current system. I would also structure Medicare as an MSA with means testing. That would stop your grandma from overutilizing healthcare resources.
