Jazzfanz: how would YOU rebuild America's health-care system?
Wait. If I am south of you.. and you are moving south (here).. then to whom would you possibly be saying brb to?
framer
Well-Known Member
Bah, in order to expand coverage and keep costs down there are a number of things that need to happen.
1. Medical Savings Accounts: Everyone needs the ability to contribute tax free into a medical savings account where you can hold money for medical expenses only. This is absolutely YOUR money that doesn't shift back to the government if you die. You can pass it on to your children, or whoever the hell you want.
2. The ability to buy high deductible insurance policies. Once you have money socked away in your medical savings account, the high deductible no longer becomes an issue. If you want a physical, the money comes out of your account, not an added "insurance" expense. This goes a long way to making routine health care things an expense and insurance actually insurance.
3. For those who need subsidized, a scaled amount will be added to their HSA each year by the government. The people will then be free to spend this money on health care where and with whom they see fit and aren't stuck in a medicaid system. Once they reach a threshold like double the amount of their deductible, the money can then be used to pay their monthly insurance costs. Whatever is left over they can keep.
4. Because of this, medical care will start to shift to a cost conscious based system. If the money is MY money and the procedure isn't in an emergency room, I will price shop.
5. For complete disasters like full blown cancer or organ transplants, the government could step into help in life and death situations, but there will be consequences like drug testing and the need to quit smoking as part of the bargain.
6. A certain portion of the money can be spent on alternative health. If I want to see a chiropractor who the hell are you to tell me "that's not medicine!"
7. If I continually waste my savings account by getting aspirin from the emergency room or calling the ambulance when I have gas, there may not be money left over when I am 65 to replace my hip. That is the choice that I made and I need to live with it.
8. Medical malpractice suits need to be reined in a bit. A freer cost based marketplace will help weed out bad doctors. Malpractice insurance costs help drive up the cost of medical care.
9. Favor legal immigration of health care workers from other countries. There is something wrong about stealing other country's medical personal, but I can get over it.
10. There needs to be limits on the multibillion dollar drug lawsuits. If a company gets FDA approval in good faith, there should be some type of protection provided in that certification. If a company lies to get that certification, then not so much. Generally however my bias is that if people are spending their own money, and alternative medicing (which is substantially cheaper) is an option, overall prescription drug use would probably decline.
There are a lot more details, but that is a start.
1. Medical Savings Accounts: Everyone needs the ability to contribute tax free into a medical savings account where you can hold money for medical expenses only. This is absolutely YOUR money that doesn't shift back to the government if you die. You can pass it on to your children, or whoever the hell you want.
2. The ability to buy high deductible insurance policies. Once you have money socked away in your medical savings account, the high deductible no longer becomes an issue. If you want a physical, the money comes out of your account, not an added "insurance" expense. This goes a long way to making routine health care things an expense and insurance actually insurance.
3. For those who need subsidized, a scaled amount will be added to their HSA each year by the government. The people will then be free to spend this money on health care where and with whom they see fit and aren't stuck in a medicaid system. Once they reach a threshold like double the amount of their deductible, the money can then be used to pay their monthly insurance costs. Whatever is left over they can keep.
4. Because of this, medical care will start to shift to a cost conscious based system. If the money is MY money and the procedure isn't in an emergency room, I will price shop.
5. For complete disasters like full blown cancer or organ transplants, the government could step into help in life and death situations, but there will be consequences like drug testing and the need to quit smoking as part of the bargain.
6. A certain portion of the money can be spent on alternative health. If I want to see a chiropractor who the hell are you to tell me "that's not medicine!"
7. If I continually waste my savings account by getting aspirin from the emergency room or calling the ambulance when I have gas, there may not be money left over when I am 65 to replace my hip. That is the choice that I made and I need to live with it.
8. Medical malpractice suits need to be reined in a bit. A freer cost based marketplace will help weed out bad doctors. Malpractice insurance costs help drive up the cost of medical care.
9. Favor legal immigration of health care workers from other countries. There is something wrong about stealing other country's medical personal, but I can get over it.
10. There needs to be limits on the multibillion dollar drug lawsuits. If a company gets FDA approval in good faith, there should be some type of protection provided in that certification. If a company lies to get that certification, then not so much. Generally however my bias is that if people are spending their own money, and alternative medicing (which is substantially cheaper) is an option, overall prescription drug use would probably decline.
There are a lot more details, but that is a start.
I read #1 and loved it.. and feel ashamed I was unable to read on. Dumb I know. I bet there's good stuff in there.
anyway, ELECT ME for Pres 2016!
Not really sure but one thing I would like to see added is the ability for someone to cover anyone.
Examples:
Good friend gets laid off and looses his insurance. If I am willing to pay insurance coverage for him than why not?
As I get older and my kids are off on their own why can't I carry their coverage into their 30s and 40s?
Examples:
Good friend gets laid off and looses his insurance. If I am willing to pay insurance coverage for him than why not?
As I get older and my kids are off on their own why can't I carry their coverage into their 30s and 40s?
Didn't know you couldn't do that. If true, kind if creepy to think you can have a life ins policy on someone else but not health?? Yikes.
D
Deleted member 848
Guest
- so you want everyone to use their income to leave some money in a medical savings account? Is there a mandated percentage of your income that automatically funnels inside-- or are you leaving this up to the discretion of each individual?
- you mention the government potentially subsidizing these savings accounts for those who are poor-- are we talking just those under the poverty line?
- your malpractice suit point is an extremely good one-- but keep in mind that their impact has been overblown. It's estimated that only 2% of America's health-care costs are from direct & indirect impacts of these malpractice suits.
- making lax immigration on health workers would have to be selective, and they still would need to take the respective medical-aptitude exams upon arriving here. I think it would be easier if we simply found ways to educate more home-grown physicians.
All in all, your ideas are interesting. There is definitely a common theme of individualism throughout, which I find incredibly problematic. You simply cannot count on the general public self-assessing their symptoms, and have them be able to call the shots regarding whether their stomach is just being annoying, or whether they have appendicitis. 100% people will err on the side of "I'll just take an aspirin" and the entire health of the population will degrade. To me, I find that very problematic.
This also doesn't do a great job of trying to combat the unpredictability of medicine. When someone is working between ages 18-40, obviously they aren't going to throw in a lot of money into savings accounts-- why? Because it's human nature. Consequently, this leaves a population incredibly vulnerable to surprise illnesses, like cancer. Now, you have a 40 year old talking to to the government tryin to justify his need for state-intervention, which the state deals on a case-by-case basis? How long would this take? What would the administrative costs of this be?
This all strikes me a plan that, sure, will cut costs-- but it will guaranteed drop the health of the American population even more. Not sure that's what we want with health care reform.
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framer
Well-Known Member
1. I think the natural goal would be to have maybe twice your yearly deductible in the account. Once you arrived there, there wouldn't be much upside into put more away, unless it was to pay for a physical, for instance. You could even make an employee matching scheme to it like a 401 K. Keep in mind that now that you are taking the third party payer out of the mix, general health care costs are going to fall.
2. It would be a sliding scale and depend upon employment. Depending upon your situation some or all of the money would be subsidized, but not immediately. A certain amount would be contributed monthly, for instance. Some of the rest would be your responsibility.
3. I know MANY doctors. They tell me that the 2% total is bogus because the lawsuits force them to practice defensive medicine (like ordering a raft of tests that really aren't necessary.)
4. In the long term educating more is great. In the short term we are bordering upon crisis levels for health care professionals. They are certainly a bigger need than H1B visas for instance.
You are going to HAVE to introduce some individualism into the mix. Limited resources are NEVER going to overcome unlimited wants. So either you let individuals ration or the government will impose rationing. My plan also cuts most of the middle men out of the deal which should make costs drop WITHOUT sacrificing quality of care. Additionally it lets you see the doctor you want, NOT the doctor you are assigned. There comes a point where you need to stop fearing freedom. People are smarter than you give them credit for. They just need to be in a position where they are rewarded for good choices.
And as far as the younger people go, most wouldn't start at dollar zero, because a portion of their parent's account would transfer with them. Because it would cost a lot less to insure young people against catastrophe, the cost would be FAR less than it is currently under Obamacare, because they aren't paying for the basic care of old people as well.
♪alt13
Well-Known Member
I don't think we can have a very rational conversation about our health insurance system as long as we are referring to it as a healthcare system.
Health insurance- Ideally I tend to favor a single payer system with punitive out of pocket costs. I think that for single payer to work at it's best you need an effective mechanism to keep people from seeking unnecessary/excessive care and to encourage the patient to do some price shopping. I don't know that maintaining punitive out of pocket expenses would ever be politically easy task. It would be too tempting for a politician to buy votes by reducing out of pocket expenses. I think that it can be done though. I think that when the system becomes stressed you may even be able to convince people that an increase in OOP would be necessary.
Healthcare-There are probably a great many ways to make healthcare more affordable. Subsidize medical school, allow RNs to run a family practice, medical malpractice lawsuit reform, etc.
Ultimately I think we need to make relatively small adjustments to our healthcare system and probably need to completely overhaul our health payment system. We should when considering change to both emphasize 'price responsibility' on the part of patients, doctors, and hospitals.
Unless I am just completely wrong, possible, you can only cover your own dependents (family members). The ACA jsut increased a persons ability to cover thier own children tilla ge 26 (or 24?).
But if I am willing to pay that persons premiums then why not? Hell if I want to cover some random guy in Portland, maine that I have never met and I am willing to pay the premiums then why not?
♪alt13
Well-Known Member
I'm pretty sure you can pay his premiums you just can't put him on your plan. The reason is that your employer or the government subsidizes your plan and they would not be able to continue to do so if everyone added a bunch of extra people to their plan.
Ahh, ok. Thanks for the info.
Still think I should be able to cover my children on my plan for as long as I choose.
There are some good answers in this thread, there are some great answers in this thread and there are some answers that are incredibly myopic and view healthcare through the rubric of well to do folk. I think if you have money most anything is possible but for the majority of folks in the US, healthcare is a necessary evil that is incredibly expensive. Remember, compare all the healthcare programs and their respective quality throughout the various countries around the world and one universal truth remains. The US is the only westernized, global power, where it's citizens can go bankrupt as a result of an emergency or non-emergency procedure. That fiscal component alone puts some lesser programs ahead in my opinion.
So, how would I fix healthcare?
These are just off the top of my head in no particular order.
In totality, competition needs to be added back into the system/ market. Currently, there is none.
-Use the Sherman (https://en.wikipedia.org/wiki/Sherman_Antitrust_Act) and Clayton (https://en.wikipedia.org/wiki/Clayton_Antitrust_Act) Acts to stop anti-trust and anti-competition in the health care industry. These two acts state in black letter law how to do this. Currently the US government has failed in this respect. See USC 15 (https://www.law.cornell.edu/uscode/text/15/1) for specifics especially in regards to medicine, which brings me to my next point.
-Get rid of the drug re-importation ban. All other developed and undeveloped countries benefit from the R&D done in this country and force the drug manufacturers to charge a specific amount for medicine or risk losing that territory. I don't need to explain the cost shift that happens. The idea that prescription medication from Mexico or Canada is subpar in comparison to the U.S. is an often used excuse for the drug re-importation ban. Apply the doctrine of first sale to drugs if possible.
-No one rides for free. Repeal EMTALA. This is a huge cost shift that adds billions to the healthcare costs of the insured. There is no free lunch. Prior to 1986, most uninsured were handled by charity hospitals and the like. Here is a brief paper on it: https://www.mffh.org/mm/files/hospitalchairtycareissuebrief.pdf
-Price discovery. Currently, the healthcare industry is the only industry, unless I am mistaken, where there is no price discovery before procedures are done. Meaning, there is no price list. Furthermore, depending on how you pay, meaning whether you have insurance or not, the price changes. Imagine, if you will, going to the local Best Buy to purchase a TV and the price changes depending on what form of payment you're using? The protests would start today. This is routine in the healthcare industry.
These are the top of my head. I think these would lower medical costs so much that even poor folk could afford routine procedures and augment that with catastrophic insurance that would probably be lower than their car insurance.
Hell, look at the prices of the Oklahoma surgery center. They do not take insurance and function on a per cash basis. Compare their prices to what you or I would pay with insurance.
https://www.youtube.com/watch?v=0uPdkhMVdMQ
Price discovery is important in a free market system!!
Good article on SCO:
https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi
SCO's website:
https://www.surgerycenterok.com/
So, how would I fix healthcare?
These are just off the top of my head in no particular order.
In totality, competition needs to be added back into the system/ market. Currently, there is none.
-Use the Sherman (https://en.wikipedia.org/wiki/Sherman_Antitrust_Act) and Clayton (https://en.wikipedia.org/wiki/Clayton_Antitrust_Act) Acts to stop anti-trust and anti-competition in the health care industry. These two acts state in black letter law how to do this. Currently the US government has failed in this respect. See USC 15 (https://www.law.cornell.edu/uscode/text/15/1) for specifics especially in regards to medicine, which brings me to my next point.
-Get rid of the drug re-importation ban. All other developed and undeveloped countries benefit from the R&D done in this country and force the drug manufacturers to charge a specific amount for medicine or risk losing that territory. I don't need to explain the cost shift that happens. The idea that prescription medication from Mexico or Canada is subpar in comparison to the U.S. is an often used excuse for the drug re-importation ban. Apply the doctrine of first sale to drugs if possible.
-No one rides for free. Repeal EMTALA. This is a huge cost shift that adds billions to the healthcare costs of the insured. There is no free lunch. Prior to 1986, most uninsured were handled by charity hospitals and the like. Here is a brief paper on it: https://www.mffh.org/mm/files/hospitalchairtycareissuebrief.pdf
-Price discovery. Currently, the healthcare industry is the only industry, unless I am mistaken, where there is no price discovery before procedures are done. Meaning, there is no price list. Furthermore, depending on how you pay, meaning whether you have insurance or not, the price changes. Imagine, if you will, going to the local Best Buy to purchase a TV and the price changes depending on what form of payment you're using? The protests would start today. This is routine in the healthcare industry.
These are the top of my head. I think these would lower medical costs so much that even poor folk could afford routine procedures and augment that with catastrophic insurance that would probably be lower than their car insurance.
Hell, look at the prices of the Oklahoma surgery center. They do not take insurance and function on a per cash basis. Compare their prices to what you or I would pay with insurance.
https://www.youtube.com/watch?v=0uPdkhMVdMQ
Price discovery is important in a free market system!!
Good article on SCO:
https://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi
SCO's website:
https://www.surgerycenterok.com/
Last edited:
framer
Well-Known Member
We just got price discovery passed in Arizona, I actually helped lobby for this. It is only a start.
EMTALA is never going to be repealed. That is not a reality. But yeah, it is part of the healthcare issue that makes everything difficult.
Eventually the real cost of healthcare needs to be driven downward. That can't happen with excessive third party involvement.
Removing the free riders to only certain hospitals does not change their free-riding, it just reduces the amount of care they can receive.
Prices change in all kinds of ways. How much a pizza joint charges will depend on whether and which coupons you have. The price you pay at an auto dealership depends on your industry knowledge, research ability, and haggling ability. You can both find out how much a medical procedure costs, and negotiate the price, if you are so inclined. However, most people are not in a frame of mind to negotiate when it comes to serious medical procedures.
No entity is more effective at lowering costs than a health insurance company that can offer the potential for thousands of local customers.
You misspelled illuminati.
♪alt13
Well-Known Member
Did you just make an argument supporting the health insurance industry?
Has the ACA moved the left that far to the right on healthcare?
Okay, so I'm experiencing the frustrations of all this right now. Here are some of the problems I'm seeing:
1. Cost of insurance ins't proportional to expenses. I work for my dad. It's just the two of us as full time employees. My dad covers himself and my mom. My mom has had some health issues, so naturally her insurance is expensive. But because I'm their employee, my insurance is linked to theirs, meaning the price is outrageous. It's over $400 a month JUST FOR ME. and that's for a high deductible, low coverage policy without vision or dental. And that cost goes up every year. I'm an overall healthy guy who hasn't been to the doctor (other than one physical and one x-ray) in well over a decade. Seriously, no health issues at all. The insurance company is making a fortune off me. Why the hell does my insurance cost so much? I look at this situation and I think to myself "why does the cost continue to go up for something that isn't being used?"
2. The rules regarding signing up are ridiculous. Based on my income and how many kids we have, my wife qualified for Medicaid while she was pregnant with our last kid. That only lasted through the pregnancy and for two months after the birth. I'm great with that. Now she qualifies for government help with our premiums, but she has to be uninsured for three months before that can go into effect. And she has to go with literally the worst plan offered. So she isn't insured until December 1. Now my uninsured wife is dealing with what we are 99% sure is pneumonia. Do we go to the doctor (Insta-Care or ER) and have to pay thousands and thousands of dollars? Or do we try to treat it as best we can at home and hope she gets over it? Not exactly the type of decisions humans should be forced to make.
3. The income levels between qualifying for government help (Medicaid, CHIP) don't translate into real life. I never understood how people let themselves stay on government assistance without doing anything about it. Now, dealing with it, I totally get it. In order to make a change and get off assistance, people almost need to get a second full time job to make up for the money they'll have to start paying for insurance and food. It's way easier for most people to just stay where they are and take the assistance.
How to fix this? I haven't the foggiest. I fear that without the government stepping in and mandating a maximum cost or mandating certain "benefits" for people who don't have big yearly medical expenses, nothing will change. If car insurance companies can give discounts to those who don't make claims or who practice good driving, why can't health insurance companies do the same? It's pretty simple: $$$$.
1. Cost of insurance ins't proportional to expenses. I work for my dad. It's just the two of us as full time employees. My dad covers himself and my mom. My mom has had some health issues, so naturally her insurance is expensive. But because I'm their employee, my insurance is linked to theirs, meaning the price is outrageous. It's over $400 a month JUST FOR ME. and that's for a high deductible, low coverage policy without vision or dental. And that cost goes up every year. I'm an overall healthy guy who hasn't been to the doctor (other than one physical and one x-ray) in well over a decade. Seriously, no health issues at all. The insurance company is making a fortune off me. Why the hell does my insurance cost so much? I look at this situation and I think to myself "why does the cost continue to go up for something that isn't being used?"
2. The rules regarding signing up are ridiculous. Based on my income and how many kids we have, my wife qualified for Medicaid while she was pregnant with our last kid. That only lasted through the pregnancy and for two months after the birth. I'm great with that. Now she qualifies for government help with our premiums, but she has to be uninsured for three months before that can go into effect. And she has to go with literally the worst plan offered. So she isn't insured until December 1. Now my uninsured wife is dealing with what we are 99% sure is pneumonia. Do we go to the doctor (Insta-Care or ER) and have to pay thousands and thousands of dollars? Or do we try to treat it as best we can at home and hope she gets over it? Not exactly the type of decisions humans should be forced to make.
3. The income levels between qualifying for government help (Medicaid, CHIP) don't translate into real life. I never understood how people let themselves stay on government assistance without doing anything about it. Now, dealing with it, I totally get it. In order to make a change and get off assistance, people almost need to get a second full time job to make up for the money they'll have to start paying for insurance and food. It's way easier for most people to just stay where they are and take the assistance.
How to fix this? I haven't the foggiest. I fear that without the government stepping in and mandating a maximum cost or mandating certain "benefits" for people who don't have big yearly medical expenses, nothing will change. If car insurance companies can give discounts to those who don't make claims or who practice good driving, why can't health insurance companies do the same? It's pretty simple: $$$$.
framer
Well-Known Member
The root of all of this is that treating Pneumonia costs thousands of dollars. It shouldn't. Historically it didn't. Insurance should cover pricey medical catastrophes, everything else should be affordable without it. Every medical procedure NOT "covered" by insurance comes down in price as the technology and competition advances. Remove the incentive for competition the price goes up and the quality declines. Every time government mandates insurance cover something additional, your price goes up because math. With my expanded Medical savings account idea, somebody that had enough health care dollars tucked away while on assistance would have those dollars carried over when their financial situation improves. You wouldn't be starting at zero the beginning of every month. In your case, since you don't go to the doctor very often, you could probably have stopped contributing to your account some time ago and would be paying a pittance for your insurance premium. As a company you could probably contribute a bit more and refill your mother's account more frequently.