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View Poll Results: How Should Americans' Health Care be Paid For?
Keep the status quo 4 2.72%
The Health Care Act, or something similar 4 2.72%
Individual responsibility with minimal, if any, government involvement 19 12.93%
A tax-funded, comprehensive government health plan 54 36.73%
A government plan for catastrophic illness/injury, plus optional supplemental coverage 22 14.97%
Hybrid—a government plan pays a set amount; the remainder is paid by supplemental coverage or out of pocket 14 9.52%
Underwritten policies for catastrophic coverage + national risk pool + HSA + tort reform 22 14.97%
Other (please explain) 8 5.44%
Voters: 147. You may not vote on this poll

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Old 12-21-2010, 12:38 PM   #81
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We already spend ~2x the amount as the UK (among other countries) per capita on healthcare.
The comparison of costs for the USA with Europe has been discussed before and the inconsistencies of the comparisons have been pointed out - there are a whole host of them if you take the time to think about it.

For example:
- UK has rationing - lowers costs
- Automobile ownership an automobile mileage per driver - increased accidents and increased costs
- Growth of the USA into suburbia increasing capital outlays - Europe little growth
- Liability costs
- USA higher illegal immigration relies on emergency care services
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Old 12-21-2010, 12:41 PM   #82
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There is no simple answer and we'll not solve the matter here but I generally think less federal government involvement is better. The framework I imagine allows individuals to "shop around" to purchase the type and level of insurance coverage they want. ...
The first problem is that many people develop health issues that prevent them from "shopping around". I was wondering how you planned to deal with that. Saying "let the states deal with it" doesn't do anything for me, I'm a voter in a state and I don't see what my state would do.

I'm fine with removing the tax preferences for both group health insurance and for medical expenses. But I don't think that "solves" the problems with health care or health insurance.
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Old 12-21-2010, 01:04 PM   #83
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I chose individual responsibility. If I choose to go it alone, so be it. At no time are you responsible for my bills or bad choices, but I am not responsible for yours.
This reminds me of the motorcyclists who elect to exercise individual responsibility and ride without helmets. We call them 'free range organ donors.'
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Old 12-21-2010, 01:08 PM   #84
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I think you don't have a very strong grip on how insurance pricing works and are ignoring what people are willing to pay for what they get. If only people who could qualify for health insurance through underwriting could get life insurance or LTC, there'd be a lot less people with life insurance and LTC. You can't make it guaranteed issue because then you'd also be making life and LTC guaranteed issue, which would be a disaster.

People struggle to pay $300-400/month for health insurance for their families now, most don't buy enough life insurance, and very, very few buy LTC. A group health policy for a family averages over $1000/month by itself today, where will that be in 15 years? You really think people will drop $3-5k/month for the combination of all 3 guaranteed for 10, 20, 30 years? The pricing for different types of insurance is very different, hence the reason they are sold as separate products.

What happens when the insurance companies misprice one of those products and the company goes down the tubes because they can't pay claims? If such a product worked, it would already exist. The demand for such a product would be somewhere between slim and none, even if it were offered.
The products don't exist because they are not sold by same people or underwritten by same people.

I agree pre existing conditions price some people's policies higher. The problem with insurance is people might not pay for it until after they need it. The goal of programs like I suggested would be to get more young people to pay into system, which is part of reasoning Obama used for passage of his plan (I don't agree with it entirely, but if that logic is going to be used, why not offer more).

If people are struggling with paying $400/mo for insurance, that is a different problem than what the policy covers. If we want to view health insurance as a "right", then the solution is not the system we have now, and I see more economies of scale with my idea than I do with most other ideas.

Any solution which has the government controlling supply or demand is bad or worse than mine (IMO). I am looking to make sure supply of affordable policies is available on private market- combining them (LTC and health insurance) for example is not required, but should be an option for the consumer to decide yes or no.
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Old 12-21-2010, 01:11 PM   #85
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The first problem is that many people develop health issues that prevent them from "shopping around". I was wondering how you planned to deal with that. Saying "let the states deal with it" doesn't do anything for me, I'm a voter in a state and I don't see what my state would do.
The competition lowers the costs before the people need them - think gas prices. Yes, a very few people might run out of gas and have to pay the price posted at the closest gas station. But, the majority of people who get gas before running out keeps the price down - even at that close gas station.
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Old 12-21-2010, 01:31 PM   #86
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But, the majority of people who get gas before running out keeps the price down - even at that close gas station.
I don't know what that means. How do I keep the price of gas down?
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Old 12-21-2010, 01:38 PM   #87
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The competition lowers the costs before the people need them - think gas prices. Yes, a very few people might run out of gas and have to pay the price posted at the closest gas station. But, the majority of people who get gas before running out keeps the price down - even at that close gas station.
You've completely lost me on the attempted analogy.

To try to make the analogy work you'd have to imagine a world where the seller's costs of gasoline is much higher for some people than for others - where "much" could mean a year's supply is $100,000. That's not even perfect, but I don't see how "competition" solves that.
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Old 12-21-2010, 01:42 PM   #88
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You've completely lost me on the attempted analogy.

To try to make the analogy work you'd have to imagine a world where the seller's costs of gasoline is much higher for some people than for others - where "much" could mean a year's supply is $100,000. That's not even perfect, but I don't see how "competition" solves that.
if 90% of people can shop for an MRI, the cost of an MRI will go down.

The 10% of people which get into a car accident and get an MRI at hospital benefit from the 90% of people which can shop for the same service.


If only 1 gas station exists, it might have slightly higher prices. If too many people drive further away to get gas, that 1 gas station either loses money, or has to lower prices.

The hundreds of people which drove to other (further away) gas stations lowered the cost for those people which could only use that one gas station (because of location).
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Old 12-21-2010, 01:53 PM   #89
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I think one very easy thing to do would be to allow consumers to buy their insurance from any company and in any STATE they want. If Wisconsin BC/BS wants $1300 a month, and I can get the same coverage from Aetna in Idaho for $950 a month, I should be allowed to make that choice. There IS regional pricing inherent in health care prices..........
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Old 12-21-2010, 02:07 PM   #90
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I think one very easy thing to do would be to allow consumers to buy their insurance from any company and in any STATE they want. If Wisconsin BC/BS wants $1300 a month, and I can get the same coverage from Aetna in Idaho for $950 a month, I should be allowed to make that choice. There IS regional pricing inherent in health care prices..........
This is a talking point a lot of people use, but it won't work. The only way it works is if every single state's department of insurance has uniform laws and regulations.
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Old 12-21-2010, 02:22 PM   #91
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This is a talking point a lot of people use, but it won't work. The only way it works is if every single state's department of insurance has uniform laws and regulations.
Or all the insurers congregate in a state with the most malleable favorable regulations. Could be very profitable for some state legislature members...

If interstate sales were allowed, I predict a race for the bottom between a few states to become the regulatory 'home state' for insurers.
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Old 12-21-2010, 02:35 PM   #92
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I don't know what that means. How do I keep the price of gas down?
This

Quote:
Originally Posted by jIMOh View Post
if 90% of people can shop for an MRI, the cost of an MRI will go down.

The 10% of people which get into a car accident and get an MRI at hospital benefit from the 90% of people which can shop for the same service.

If only 1 gas station exists, it might have slightly higher prices. If too many people drive further away to get gas, that 1 gas station either loses money, or has to lower prices.

The hundreds of people which drove to other (further away) gas stations lowered the cost for those people which could only use that one gas station (because of location).
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Old 12-21-2010, 02:36 PM   #93
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You've completely lost me on the attempted analogy.

To try to make the analogy work you'd have to imagine a world where the seller's costs of gasoline is much higher for some people than for others - where "much" could mean a year's supply is $100,000. That's not even perfect, but I don't see how "competition" solves that.
This.

Quote:
Originally Posted by jIMOh View Post
if 90% of people can shop for an MRI, the cost of an MRI will go down.

The 10% of people which get into a car accident and get an MRI at hospital benefit from the 90% of people which can shop for the same service.


If only 1 gas station exists, it might have slightly higher prices. If too many people drive further away to get gas, that 1 gas station either loses money, or has to lower prices.

The hundreds of people which drove to other (further away) gas stations lowered the cost for those people which could only use that one gas station (because of location).
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Old 12-21-2010, 03:06 PM   #94
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Or all the insurers congregate in a state with the most malleable favorable regulations. Could be very profitable for some state legislature members...

If interstate sales were allowed, I predict a race for the bottom between a few states to become the regulatory 'home state' for insurers.
Not if the states where people reside require specific rules, regulations, and benefits for anyone who lives there regardless of where they buy they policy from...
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Old 12-21-2010, 04:42 PM   #95
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...

Without giving people some skin in the game (a big chunk, not just $10 co-pays) for their own costs, costs will continue to rise. It's always easy to spend somebody else's money. Third party payments for basic health services is the #1 thing driving healthcare costs in my opinion.

I agree with the skin in the game approach. There should be some personal motivation to conserve (i.e., not waste)

I think the co-pay was more about shifting some of the cost burden than affecting behavior.
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Old 12-21-2010, 04:47 PM   #96
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I agree with the skin in the game approach. There should be some personal motivation to conserve (i.e., not waste)

I think the co-pay was more about shifting some of the cost burden than affecting behavior.
Co-pays are a great deal....for the insurance company.
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Old 12-21-2010, 05:21 PM   #97
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if 90% of people can shop for an MRI, the cost of an MRI will go down.

The 10% of people which get into a car accident and get an MRI at hospital benefit from the 90% of people which can shop for the same service.


If only 1 gas station exists, it might have slightly higher prices. If too many people drive further away to get gas, that 1 gas station either loses money, or has to lower prices.

The hundreds of people which drove to other (further away) gas stations lowered the cost for those people which could only use that one gas station (because of location).
This makes sense, but ...

I can see that the original context got lost in the responses. The original post by nvestysly was:
Quote:
The framework I imagine allows individuals to "shop around" to purchase the type and level of insurance coverage they want.
I was saying that people can't "shop around" [for insurance] after they've developed health problems.
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Old 12-21-2010, 05:27 PM   #98
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USA higher illegal immigration relies on emergency care services
As an explanation of why costs are high, that seems to be circular reasoning. In the UK, illegal immigrants - however many there are, I have no way to know if it's a smaller or larger % than the US - get treated free by the national system like anybody else. So they are all, in effect, using the ER.

For me, the biggest reason why health care is so expensive in the US is that the government hasn't woken up to the powerful purchasing position it is in. Prescription meds, for example, are way cheaper in France than the US, because the French national insurance system goes to the manufacturers and tells them how much it's prepared to pay. (Anyone coming to Europe on vacation should bring their prescriptions and stock up.) Yet the US government spends about the same, IIRC, as a proportion of GDP on health care (via Medicare, Medicaid, insurance for military and other federal personnel, etc) as the French government does (with the rest of the US spending being private). To portray Obama's plan as "a government takeover of health care" is wrong in many ways, one of which is that the US government is already up to its neck in health care costs.
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Old 12-21-2010, 05:35 PM   #99
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I was saying that people can't "shop around" [for insurance] after they've developed health problems.
Why do they have to shop around at that point?
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Old 12-21-2010, 06:41 PM   #100
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For me, the biggest reason why health care is so expensive in the US is that the government hasn't woken up to the powerful purchasing position it is in. Prescription meds, for example, are way cheaper in France than the US, because the French national insurance system goes to the manufacturers and tells them how much it's prepared to pay.
I've seen several interesting articles regarding the issue of US citizens paying what the market will bear while citizens of countries where prices are regulated pay less. The last one I came across was about Canada and why they pay less for US patented drugs than US citizens do.

I agree with you. This is an area where the US gov't should step in with export taxes and/or restrictions which force others to pay more and US citizens to pay less. Or, if we're willing to have less funding available for drug research, everyone pay less.

It's a difficult subject for the US since we're plagued with do-gooders who think US patented drugs should be available to outsiders for whatever price they can either afford to pay or, more likely, want to pay.
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