What are the Health Care options?

[kyounge1956]

Since the recent court ruling striking down part of the Health Care act, I've been wanting to make a poll, on the question "how should Americans' health care be paid for?" The options that occur to me so far are

• the status quo
• the Health Care act or something similar (which may be unconstitutional)
• a tax-funded, government-operated single-payer system
• individual responsibility (no-one is required either to be insured for health care expenses or to help pay for anyone else's health insurance or health care)

I'm sure there are other possibilities, but what are they?

 

[ERD50]

I don't understand the question: "how should Americans' health care be paid for?".

In all your cases, we are paying for health care.

I'm sure there are other possibilities, but what are they?

We get Canada to pay for it? I think we could get the votes to support that, even if we let Canadians vote.


Seriously, if you are asking "how should the health care system be reformed?", we have had dozens of threads on that, including a recent one on the one court declaring one part of it unconstitutional. Are you asking something separate from all those?

-ERD50

 

[kyounge1956]

I don't understand the question: "how should Americans' health care be paid for?".

In all your cases, we are paying for health care.

We get Canada to pay for it? I think we could get the votes to support that, even if we let Canadians vote.

Yes, we are paying for it. The question is how. Should "we" (the citizenry) pay for "our" health care, or should I pay for my own and you pay for your own? If the latter, what about those who don't have enough money to pay for their own? If everybody pays for everyone's health care, should it be done via taxation and a government health system, or some other way? Should (can?) everyone be required to pay, and if not, what about those who chose not to pay and then get sick or hurt?

The four possibilities I included in my original post are those I can think of, based on discussions here and elsewhere, but are they the only ones?

Seriously, if you are asking "how should the health care system be reformed?", we have had dozens of threads on that, including a recent one on the one court declaring one part of it unconstitutional. Are you asking something separate from all those?

-ERD50

Yes, we have had many threads, but not a poll that I recall. I think a poll would be interesting, but before creating it I want to find out what possibilities I should include in addition to the ones I've already mentioned. I want to minimize the number of "your poll doesn't include the choice I want to vote for" replies.

 

[Independent]

There are some people who would say "The status quo without tax deductions", or some other significant change. So "Status quo except (see comments)" could be an option.

I'd vote for a combination of 3 and 4. Tax-funded single payor for catastrophic losses, you're on own (buy private insurance with your own after tax dollars if you like) for non-catastrophic.
The problems with health insurance are that 1) people tend to get health problems that make them unattractive to private insurers and 2) people choose to not buy and then end up getting care at someone else's expense because we won't "let them die". I think the combination of 3 and 4 deals with those two problems about as well as Americans can expect.

 

[FIREd]

Another option would be a public/private hybrid system (like Medicare and some European systems).

 

[kyounge1956]

Another option would be a public/private hybrid system (like Medicare and some European systems).

My knowledge about the Health Care act, Medicare and European systems is very scanty. To help me make the poll options clearer, how does a European style hybrid system differ from the Health Care act (which if I understand it is status quo plus mandated coverage and subsidies for some) and from Independent's "combination of 3 & 4"?

I think there are now 7 choices for the poll, which I will put up later this evening:

• Status Quo
• Health Care Act or similar
• Tax-funded Government Health System
• Individual Responsibility
• Government Catastrophic Coverage + optional supplemental policy
• Medicare/European-style Hybrid
• "Other" (anything that requires an explanatory comment)

 

[FIREd]

My knowledge about the Health Care act, Medicare and European systems is very scanty. To help me make the poll options clearer, how does a European style hybrid system differ from the Health Care act (which if I understand it is status quo plus mandated coverage and subsidies for some) and from Independent's "combination of 3 & 4"?

The hybrid systems come in various flavors.

For example, in France, which contrary to popular belief does not have a single-payer system, the public insurance system only pays for part of the cost of health care. If you go to the doctor, only 70% of the consultation cost will be covered by the public insurance system. For drugs, the public insurance system covers 15-100% of the cost depending on the type of drug prescribed. The remainder has to be covered by the patient or by a supplemental insurance, if the patient elected to purchase such coverage from a private insurer. On average, the public insurance system in France only covers 75% of the cost of health care. The other 25% is covered privately. It is not unlike the Medicare/supplemental insurance system here in the US.

In 2010, for example, the government decided that a visit to a family physician would cost 22 euros. That's the "official" price of a doctor visit. A doctor can choose to charge 22 euros per visit or more. The public system will only pay 70% of 22 euros or 14.40 euros per visit no matter how much the doctor charges. The rest has to be covered privately.

So if you can afford to buy a good supplemental insurance, you can afford to go to a private clinic and visit the best specialists for your care. If you don't, you can still get decent care at a public hospital which will charge you the "official" low rate.

Germany has a different hybrid system but, similarly, the public system only covers about 77% of health care costs.

 

[dgoldenz]

Fully underwritten policies, every policy is catastrophic coverage only, compatible with HSA's, no benefits except preventative care until deductible is paid.

Companies cannot exclude pre-existing conditions for those with at least 12 months of continuous prior coverage (63-day break still allowed), but can apply a rate adjustment.

Anyone who can't qualify through underwriting can join a national risk pool (note that I said national, not state). Subsidies could be applied on a sliding scale for the risk pool based on income.

Employers allowed to contribute to HSA accounts and subsidize employee premiums in the individual market with an HRA setup, but coverage would not be offered directly by the employer.

Change taxation of HSA distributions after age 65 to be tax-free instead of taxable like they are now. This account could be a "Super Roth" because it could be used for healthcare costs instead of just retirement. Allow for contributions indexed for inflation.

Require providers to give written documentation of costs before services are administered except in cases of emergency when time does not allow. No more "I don't know how much it costs, you'll find out when you get the bill" garbage.

Tort reform.

There's a start.

 

[kyounge1956]

OK, the poll is up