Journal johndiii's Journal: Interesting thoughts on health care reform 19
From Tuesday Morning Quarterback. "My impression is that so much lobbying attention has focused on the handouts, giveaways and interest-group demands for a gigantic new civil-service bureaucracy that not enough attention has gone to a simple change that would remove much of the injustice from health insurance -- standard rates with no denials for existing conditions."
It's interesting to note that Health Savings Account-type plans, which have been pushed by my employer's health insurer for two or three years now, very closely resemble the sort of plan that he suggests a little further down the column. Very low rates, and high deductible/coinsurance requirements, with some limited coverage for preventive care. Monthly payments are divided between the cost of the insurance (about $10), and a contribution to my health savings account. I reduced my per-paycheck cost by $5, and in two years I will have enough money in the account to pay the entire deductible. Since I don't go to the doctor much, I think that this model will work well for me. It might be somewhat less so for families with children, but they would also be able to save up the deductible much faster by continuing the same payment level.
It has modified my behavior in regard to health care consumption. I sprained my ankle in August. Rather than go to a doctor "just in case", I educated myself about ankle sprains - in particular the signs that would indicate a more serious injury - and invested in some ace bandages and ice packs. It's pretty much healed up now, though I am still working on rehab issues. The bottom line is that I elected not to spend my money when it did not appear to be necessary. I did have the advantage of having sprained my ankle previously (albeit 30 years ago), so I had some idea of what to expect.
I very much agree with Easterbrook's contention about uniform prices. When I spent the night in the hospital after my car accident in March or 2008, the gross hospital bill was nearly $27,000. My insurance company paid a little under $12,000. Anyone in the same situation without insurance would have stuck for the whole $26,000 - and in this case, not going to the hospital could have been fatal - I had a partially collapsed lung. Not that the paramedics were giving me any option at that point.
Prices from health care vendors need to be uniform, regardless of who is buying, and they need to be be publicly disclosed. This needs to happen regardless of whatever else we do in the way of health care reform.
(The article by Ron Haskins that Easterbrook links is also well worth reading.)
Intuitively, this would lead to longer-term costs (Score:1)
It's precisely the avoidance of seeking care behavior that would let many people avoid treatment early, when it's cheaper, and thus result in people with serious and expensive care ending up in urgent care facilities or with long hospital stays (which increases cross infections and risk factors).
There's a reason why most health insurance plans make it fairly inexpensive to treat certain things at low or zero cost - to save money in the long run.
That's funny (Score:2)
For DECADES insurance worked more or less like this (albeit with temporary exclusions for existing conditions). There was no such thing as a policy being denied because you had zits as a kid and went to a dermatologist or because you were raped and had an STD test. Worst case, you got told you were on your own if you came down with HIV, but anything else would be a-OK. All the current idiots moaning about people waiting until they got sick to buy in
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And then it stopped. What happened?
Richard Nixon approved HMOs, which despite everything he said in public about how they will benefit the public, his own office tapes point out that he was only interested in allowing people to seek profit on the system.
So, what happened? We let the profit hounds loose...
It's like Montana Power... the most stable stock in the world, and everyone trusted it... they sought deregulation saying that it would lower consumer prices, and then they went out, sold most of their assets, and bought up a ton of fiber-op
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Good point about providing fundamental human needs for profit. That's a moral issue, as far as I'm concerned. I don't have a problem with investors in a power company making a reasonable return on their investment, but this is a public trust, not a private venture. The example that you gave is just wrong.
The financial market meltdown was a similar scenario, and a similar abuse of public trust.
The problem is, I don't believe that government is a better provider of such services. The typical regulation sc
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Not the bigger the organization... the more powerful and efficient the organization the more corruption will happen.
That's the principle of a divided government, and it's why our government is inefficient with lots of red tape...
Frankly, I'm fine with regulators keeping a status quo... that's kind of WHY I want regulators in the first place...
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Portable health savings accounts would be a very good initial step. The "use it or lose it" plans are indeed evil incarnate.
Insurance is not really insurance, as such, anymore. Employers buy a kind of health care subscription plan. It's not a bad idea, but the companies that provide the plans increase their profits by excluding patients that cost them more.
not necessarily (Score:1)
the gross hospital bill was nearly $27,000. My insurance company paid a little under $12,000. Anyone in the same situation without insurance would have stuck for the whole $26,000
I don't know about hospital visits, but more things are negotiable than one might think. I had a chronic condition around age 20 or so and had to get some minor foot surgery. Paid thru insurance, but the following year I needed the other foot done, but dad's company switched insurance plans, that somehow would not pay anything for
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Ah... you're right on the nose there. I've heard a great number of stories about people receiving care that insurance won't pay for, and the prices are quite often at least half of what they would be if insurance did cover it.
Probably a good example would be to look at plastic surgery. The price of a boob job is about $7k (in my area), while one trip to the emergency room with an x-ray and CT scan turned out to be $4k... let's see, full anesthesia, surgical sterilization, a sterile operating room... all t
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That's a very good example - elective surgery, where market forces pretty much determine the cost, contrasted with an ER visit where the cost is effectively set by a cartel. The hospital does have a lot more overhead (maintaining an ER with on-call staff is not inexpensive), but the real cost is not an accessible aspect of the situation.
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That's a very good example - elective surgery, where market forces pretty much determine the cost, contrasted with an ER visit where the cost is effectively set by a cartel. The hospital does have a lot more overhead (maintaining an ER with on-call staff is not inexpensive), but the real cost is not an accessible aspect of the situation.
Actually, this is why a lot of private care providers don't like working with medicare and medicaid people... the government strong-arms prices and MAKES the private institutions accept a specific amount of money for their service...
It's why those who do do medicare and medicaid tend to OVER run tests, and treatments. If they can run a test and already know that the results don't matter, then their generating profit... same with providing treatments that won't necessarily kill someone... like chelation the
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Exactly so. The question is how to align the incentives to make the system work the way that it should. More control means more artificial disruption of incentives. Less control might bring incentives around to where they should be. But, politically speaking, Medicare and Medicaid aren't going away. I work for a company t
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Less control might bring incentives around to where they should be.
Less control almost always means that incentives are turned inwards towards profit... it's the fact of how corporations are REQUIRED by law to work. They MUST increase profits to the maximum.
HSAs work great for people with jobs (Score:2)
But if you haven't noticed, the U6 rate has been hanging between 12%-26%, depending on your state. U6 includes the "underemployed"- those who work, but don't earn enough to pay for a living, let alone for health care, and "discouraged workers"- those who have been out more than 18 months at this point and have given up looking for work.
The majority of those who aren't insured, are in the U6 group- for whom that $5 you gave up from your paycheck is a meal.
FORCE the Free Market to have standard prices? (Score:2)
You're tying the invisible hand of self-interest.
If you're going to have the government intrude and tell insurance companies what they must charge, then why not just take over the whole insurance system in the first place?
Recall, done right, this new system shouldn't increase anyone's net income... just instead of the money going to some greedy money-hungry CEO who wants to profit off your healthy status, the money goes to a public system that guarantees everything that you're talking about.
You know... it r
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Didn't RTFA, I see. :-) The point is not to set price levels, but to stop providers from artificially inflating prices for uninsured patients. When I had my car accident last year, my insurance company and I paid a little under $12000 for the overnight hospital stay (this did not include payments directly to doctors or the ambulance service). If I had not had insurance, the bill would have been a bit over $26000. Easterbrook would prohibit that practice, advocating a "standard price" only in the sense t
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You're still suggesting tying the hands of the Free Market. A Free Market system should be able to incentivize people to get insurance by artificially inflating prices for the uninsured.
But guess what? Typically, they don't. The uninsured get these weird discounts, because the hospital doesn't have to deal with insurance.
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I think that it would be an improvement on what we have now. Also, I'd be surprised if that particular suggestion worked in the absence of effective monopolies. The economics of it work against the insurance companies; the only way that it works for the individual is through cost averaging. Someone like me, who is a much
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But you have to realize that the USA spends a great deal more than any 1st world country. Just by switching to a government run system that controls and constrains costs, we would see an increase in being able cover people.
And guess what? Besides longer wait times for elective surgery... we wouldn't see any change. *SHOCK!!!*
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Oh, and...
I'm with you at this point.
But I don't believe that this is in the realm of reasonable possibility.