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Thinking really outside the box on healthcare
Old 08-17-2009, 03:22 PM   #1
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Thinking really outside the box on healthcare

This article really made me question a lot of my assumptions on how healthcare should be delivered.

I always like it when an 'outsider' does the analysis and weighs in on difficult issues.

How American Health Care Killed My Father - The Atlantic (September 2009)

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Old 08-17-2009, 03:46 PM   #2
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One of the best summaries of the current health care mess I've seen anywhere. Wow.

hospitals bill according to their price lists, but provide large discounts to major insurers. Individual consumers, of course, don’t benefit from these discounts, so they receive their bills at full list price (typically about 2.5 times the bill to an insured patient).
This is remarkably similar to the mess with health insurance paying for medical equipment such as wheelchairs. Artificially high prices are quoted, then insurance companies negotiate discounts, then consumers pay deductables. As a result a $129 machine can not be purchased by the insurance plan, but must be rented for $99 a month for 13 months. Maybe an insurnace company pays $29 a month (or rather the consumer does until their deductable is satisfied), but really in a rational market they could have just bought the thing far less expensively. And if there's any change in insurance coverage or employment (through which insurance is indirectly provided) the patient might have to start the timers all over again.

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Old 08-17-2009, 05:23 PM   #3
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Originally Posted by walkinwood View Post
This article really made me question a lot of my assumptions on how healthcare should be delivered.

I always like it when an 'outsider' does the analysis and weighs in on difficult issues.

How American Health Care Killed My Father - The Atlantic (September 2009)
Excellent article. Thanks for pointing it out.
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Old 08-17-2009, 05:53 PM   #4
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Thank you for posting this. VERY interesting
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Old 08-17-2009, 06:21 PM   #5
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What a well-thought, insightful article! This is the type of person that Obama needs at his side.
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Old 08-17-2009, 06:33 PM   #6
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Really excellent. Speaks to most of my views and more. Thanks for bringing it to our attention.
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Old 08-18-2009, 07:40 AM   #7
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Excellent article! Long, but worth the read.

My biggest fears have long been dealing with catastrophic costs for an adult child who looses his or her coverage. How many of us would refuse to help if our kids got cancer during a lapse in coverage or got whacked by some perverse exclusion based on pre-existing coverage. I saw it first hand when my nephew turned up with a virulent cancer a month after college coverage ended and just before employment based insurance would have kicked in. My second greatest pet peeve is the authority of hospitals and physicians to charge usurious rates to the uninsured. There is simply no free market for consumers in the health industry.

This guy's approach of limited, universal insurance covering truly catastrophic illness/accident coupled with HSAs (also mandatory at a minimal level) for routine care sounds like a sensible long term solution. Or at least a concept that should be explored for the future after we institute some sort of costly band aide in the current legislative go round.
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Old 08-18-2009, 08:45 AM   #8
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Interesting article with a number of excellent points. I am still not sure about what I think about having insurance cover the catastrophic (as in over $50,000) and you pay the rest. His idea is that cost would do down. After all, an MRI costs too much and bears no relationship to the cost of the machine and the operator. He compares it to Lasik, where the cost has dropped dramatically because it is not covered by most insurance. But the problem with that comparison is that the MRI might be necessary and the Lasik is not. It is easier to walk away from the Lasik than the MRI. So, you need one. The idea then is that you will shop for the cheapest MRI or skip it. To shop for an MRI in my area I would have to drive 150 miles. And once you are in the hospital or have an emergency you can't shop. You can always shop for Lasik. This doesn't mean that I reject the ideas, but I have concerns.

He does briefly address the issue of people foregoing needed medical care because of cost. He suggests a voucher for a doctor appointment once a year. Well, ok, but what about the prescribed treatment? Physical therapy. Drugs. I did read one study once where people who had higher deductibles on their insurance were more likely to skip treatments. You can say that is a choice and maybe the choice is a even a good one. After all, maybe you don't need the MRI. I think I mentioned once an xray I had of my hands after a compression injury. In retrospect, it wasn't really necessary and I bet I would not have had it done if I had to pay out of pocket. But what if the choice is not a good choice? The problem is that the cost is higher in the end. For example, if you are depressed and don't take your antidepressant and go to counseling, you may be more likely to be hospitalized.

Insulin is a necessary drug. You die without it. But there isn't generic insulin, it is all branded. It costs a lot. Does it really need to cost so much? I doubt it. How many brands of insulin are there? Three companies sell insulin but the products are not all the same. Tough to see how the price will drop.

But worth thinking about and if nothing else the article illustrates the problem of the screwed up marketplace.

Can't think about this more right now--off to the annual library book sale!


No more lawyer stuff, no more political stuff, so no more CYA

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