Gone4Good
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Sep 9, 2005
- Messages
- 5,381
There would be no price discrimination,
What about subsidies for low income people?
There would be no price discrimination,
Three cheers for dgoldenz! A serious response to Gone4Goods's challenge.
Easy. We can eliminate underwriting by ensuring that ALL folks, including the young and healthy, are in the pool. Even insurers have gone on the record as accepting this, but *everyone* into the pool is needed or else it blows up with adverse selection.
How do we do that? For one thing, the penalties need to be stronger.
Many people have had fairly widespread agreement on the "goals" of health care reform (i.e. eliminate underwriting, get everyone into the pool, put a lid on double-digit cost increases, for example).So the "serious alternative" to "Obamacare" is to adopt 90+% of Obamacare and tweak it around the edges? That's not the debate I was hearing last year. I'm all for it. But call a spade a spade and stop pretending that there is some radically different proposal out there that is far superior to the legislation we have.
But the 800 pound gorilla that Obamacare does not really address is cost control.
Not so fast:
No first-dollar coverage except for preventive care (and perhaps those below the poverty level).So what is the policy that keeps all of the things you like and also controls costs? (be careful because many of them are likely to be in the bill)
Obviously I don't want to subsidize Warren Buffett. But the way the subsidy is phased out means that from about $40-80K, those who buy individual insurance lose more than 15 cents in subsidy for every dollar earned in that income range. It may not be a 15% tax technically, but it has the same financial effect.And how do you avoid phasing out subsidies. There are only two ways I can see. 1) Subsidize everyone. 2) Subsidize no one. Which do you prefer?
It is a lot worse than just politically-incorrect. If health care providers were allowed to refuse emergency service to the uninsured, it would effectively kill-off ambulance service (or drive it into being a purely government service). No EMS provider could risk dispatching a unit to an accident only to find that the injured were poor and uninsured.Thanks. I don't think we'll ever be able to solve the ER problem unless the government goes the non-politically-correct route and tells hospitals to turn people away. People who don't buy insurance will always abuse this law.
OK. I am feeling mischievous today.But call a spade a spade and stop pretending that there is some radically different proposal out there that is far superior to the legislation we have.
You pay, up to your deductible. I think you are confusing co-payments with co-insurance.
Co-payment = fixed cost for service, like a doctor's office visit being $20 or ER visit being $100
Co-insurance = percent you pay after the chosen deductible
Surprise. There will be some unintended consequences and higher costs to employers and employees.
We need some more help from our gvmt. Just like they helped us with credit cards.
- Stay tuned for energy policy and imiigration reform.
I don’t see how costs can be controlled. Insurance companies have become intermediaries and have an unlimited profit motive. This conflicts with providers and patients alike. Providers are spending immense amounts in demand generation. The health care industry promises a degree of diagnostic and treatment certainty that cannot be met by any individual provider but leads to endless testing.
Cost containment demands guaranteed payment as a prerequisite. This is now mostly, but not entirely, covered. Not yet resolved, but at least the main cause of cost shifting has been dealt with. This will limit some of the exploitation and arbitrage going on now and allow for a more systematic approach to cost management.
I do not think co-pays are that big a deal when it comes to utiliztion of services. Almost every time we have gone to the doctor in the last few years the actual costs after the insurance discount is only a few dollars more than my co-pay... (mine are $30 for normal doc and $50 for specialist)..
I agree that copays are an absolute requirement. Research I've seen in other areas show less overall usage and higher levels of satisfaction when people pay something rather than nothing per activity.When cost-cutting backfires | Harvard Gazette Online
Though the copayment increases were counterproductive for elderly patients with a chronic disease like diabetes or hypertension, the study showed that copayments worked as desired for those not chronically ill. Those patients reduced office visits and prescription drug utilization with no negative effects on their health.
"Fast" or "Not so fast." are our only choices for the future.
When cost-cutting backfires | Harvard Gazette Online
Though the copayment increases were counterproductive for elderly patients with a chronic disease like diabetes or hypertension, the study showed that copayments worked as desired for those not chronically ill. Those patients reduced office visits and prescription drug utilization with no negative effects on their health.
I agree that copays are an absolute requirement. Research I've seen in other areas show less overall usage and higher levels of satisfaction when people pay something rather than nothing per activity.
I concur with many of you when it is said that cost controls is one of the most important things in any cost care bill..
Also to the point of the original post:
Small companies have been doing this for years.
As for the rest of the thread, kudos for people offering suggestions on improvements instead of just throwing stones.
I concur with many of you when it is said that cost controls is one of the most important things in any cost care bill. It will help with stop (or at least slow down) both the large and small companies from dropping health care.
AgreeI think if deductibles are copays are high enough, health care consumers can demand transparency in cost structures. One hospital in the area charges $2500, while a new MRI clinic in town boats $699 MRI's. Hard to justify why one is almost 4 times the other..........
Historically "insurance paid it" so we didn't care about the price. With the combination of higher deductibles and transparency in pricing, that would help the cost control issue.I think if deductibles are copays are high enough, health care consumers can demand transparency in cost structures. One hospital in the area charges $2500, while a new MRI clinic in town boats $699 MRI's. Hard to justify why one is almost 4 times the other..........
These are all reasonable.Try this...
A level playing field with a patients bill of rights. This is all patient centric. Add rights as I leave them off...
1) you cannot be denied treatment or coverage with a pre-existing condition
2) any health care provider must be 100% up front with fees (either on web site, in office or something similar)
3) all people using the same healthcare provider pay the same price regardless of insurance or not, and regardless of which insurance carrier they have
2) and 3) are my big ones, and I think these both fix lots of things. First, my employer paid for coverage now costs my employer less, because medicare and medicaid are required to pay equal amounts as my insurance carrier for the same procedure.
Second, If this bankrupts medicaid, then fix that program and that funding. The average family of 4 spends $2500 in premiums and co-pays each year to cover the medicare and medicaid lack of pay to health care providers. I can link to study, but need to go to another site to find it.
Third, level playing field means price competition, and that should drive prices down (eventually).
Fourth- overhead for any health insurance company goes down and any doctor's office goes down- there is less negotiation for the cost of coverage after the treatment is given, so the people which do this for a living need to find new jobs and the companies they work for have now spent less money.
If everyone is not insured the other problems cannot be fixed. So much cost shifting is going on due to mandatory treatment regardless of payment capability that it becomes impossible to identify and deal with abusive pricing and exploitation. Guaranteeing payment doesn’t fix the problems but it enables other measures.I have yet to see a compelling case made for if it is available to everyone, then the other 2 dominos fall easier or are improved.
It would probably help deal with "use control", an important component of cost control.Historically "insurance paid it" so we didn't care about the price. With the combination of higher deductibles and transparency in pricing, that would help the cost control issue.