A fresh solution to our health care problems--the free market? YES!

http://www.theatlantic.com/doc/200909/health-care

That's the surprising conclusion the author of this article arrives at. He concludes that a typical family receives 1.77 MILLION DOLLARS in health care insurance (employer plus employee premium costs) over a lifetime.

Imagine the coverage we could afford if we had direct access to that wealth and could spend it on our own behalf.

He proposes

1. mandatory tax-free savings accounts of 10,000 (saved over several years) that can only be spent on health care.

2. mandatory catastrophic health insurance for costs over 10K.

3. routine medical costs should be paid out of pocket.

4. hospitals, doctors, dentists have to post their fees and charge the same price for the same service.

5. hospitals must be rated so that patients can make informed decisions.

******

I've so far been a proponent of a single-payer system like Canada's, but this guy makes a lot of sense.

We don't have insurance to buy groceries. Why do we need insurance to pay for a physical check-up, dental filling or colonoscopy?

for privatizing Social Security.

Who gets to be the custodian for all those $10,000 accounts?

For one thing, the account is only 10 grand. You can't retire on 10 grand.

Secondly, the account won't be invested. It'll just be banked in a super-safe savings account.

The same banks that needed a few trillion to bail them out of the bad loans they were making?

Right.

find a safer investment.

duh.

For future need. Maybe we should have used the bank bailout to help everyone in the country start these accounts and then we'd know how the banks are going to pay back US citizens.

Without that kind of assistance how does someone earning minimum wage or unemployed save $10,000? When you're earning $15,000 a year, it would be impossible, even over several years.

If medical costs are not contained, that $10,000 will soon be inadequate and the mandatory savings amounts would have to be increased.

No, this sounds like a investment banker's wet dream.

Over several years of diverting high-cost insurance premiums, one could easily sock away 10 grand, especially if you could take it tax free.

For instance, I figure that between my employer and I, my insurance cost is somewhere around 800 a month, and I'm perfectly healthy and never really use it except for routine stuff.

Now calculate the cost if I had a medical insurance savings account and only paid for catastrophic insurance. The total premium would drop to below 200 a month.

People who have, say, a family income of 45K and routinely spend 10K or more on healthcare, year after year? Families with a sick child, for example, who would be covered under an all-in shared risk system, are now pushed to the limit by your liberloon nonsense. Oh the heck with them, their problem, not yours, right?

sarcasm

Look, I'm just exploring some interesting ideas here.

I don't know why that has to be so threatening.

under some naive idea that these are fresh ideas that haven't been discussed and debunked for YEARS and wondering why you get met with insults, that after demanding that everyone pointing out the massive flaws in your tired retread liberloon nonsense just hasn't read this marvel of originality you are reposting. Sheesh.

It isn't threatening it is tiresome and stupid and it is annoying to have posters here promoting rightwing bullshit.

I was part of a campaign that circulated petitions for a public option with DFA.

I can't imagine that millions of other people are more informed than I am.

Using actual evidence instead of "Liberal Loon" would be more helpful.

And the smug, superior attitude also isn't winning any arguments.

Would have to be $20-40,000, not $10,000. So that takes nearly as big a bite out of their income as $10,000 for a single person at minimum wage.

And while the other poster in this sub-thread insulted you, they have a point - how about when someone is chronically ill or if they are older and need a series of treatments? For instance, since 2001 I have had five surgical procedures. Only two of those were for the same problem. There would be no way I could have raised the $40-50,000 "deductible" for each of those procedures.

I was lucky that three of the surgeries were covered by an earlier insurance coverage with no deductible and almost no co-pay. The last two were different - we had to switch to a high deductible with 20% co-pay since we could not afford the monthly payments for a lower deductible.

With health care costs going up so much, my out of pocket expenses have been outrageous. This last one was three times our monthly income - so far and the bills keep coming. And this plan you are discussing would have me raise much more than that for each surgery as well as pay out of pocket for all office visits.

That is not practical or doable for MOST people in this country.

Sorry, but if you post rightwing bullshit here on DU you will get called out for posting rightwing bullshit. The insult is posting the rightwing bullshit, not having that fact noted.

The lifetime cap would kick in.

They're called food stamps. No person in this country should go without food, and no person in this country should go without health care. A large number of Americans couldn't save up $10K for a health insurance savings account, and making people pay out of pocket for routine health matters will stifle preventative medicine--the smartest kind to get. Forcing people to save money and forcing people to buy insurance are draconian measures fit for a fascist state. No thank you.

The proposal described in the OP is very badly-conceived.

:dem:

-Laelth

As another posted pointed out, $10k could be gone through very quickly for a chronic condition or if someone is involved in a car crash, for instance. It really won't pay for very much.

Geezus, that's Randtard level insanity right there :eyes:

If groceries were insured, then we would present an insurance card every time we bought food and the grocer would be reimbursed by an insurance company. Third party payment does seem to me like an invitation to over-charge. Nobody should go without health care, but what kind of health care? There could easily be questions about how much of my hospital bill was necessary or if my knee operation and 2nd EGD were necessary. I don't think we can afford to cover everybody for everything, or really that we want to. Of all the DUers who insist that 'everybody should have healthcare' there are probably very few who are willing to pay more taxes (say at European rates) to make sure that everybody is covered. We want it partly because it is a free lunch for us and we are gonna take the bill out of somebody else's hide.

You present a card, and the state reimburses the grocer for the amount of food purchased.

I am certainly willing to pay more taxes for universal coverage. In fact, I think most Americans would be willing to do so, but a vocal minority is very opposed to the idea here.

:dem:

-Laelth

Where are they supposed to come up with this money? And once again, it's like tax cuts for the wealthy. Why do people believe employers will pass this money on to their employees? They never have before.

These are HSA's, nothing new.

And why is regulation fine when they propose it, but government interference when we do.

I'll keep my comments about greed to myself.

is a drop in the bucket.

My husband's knee surgery (a 30-minute outpatient procedure) was over $3,000.

We have to kneejerk post that it's a dumb idea WITHOUT even reading it!

as a liberloon 'solution' for years.

Keeping Dad company in the hospital for five weeks had left me befuddled. (His father DIED from an easily controlled hospital infection, along with perhaps 100,000 others nation-wide.) How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?

******

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

*******

From 2000 to 2008, the U.S. economy grew by $4.4 trillion; of that growth, roughly one out of every four dollars was spent on health care. Household expenditures on health care already exceed those on housing. And health care’s share is growing.

By what mechanism does society determine that an extra, say, $100 billion for health care will make us healthier than even $10 billion for cleaner air or water, or $25 billion for better nutrition, or $5 billion for parks, or $10 billion for recreation, or $50 billion in additional vacation time—or all of those alternatives combined?

The answer is, no mechanism at all. Health care simply keeps gobbling up national resources, seemingly without regard to other societal needs

are not in a position to make intelligent choices about value/cost tradeoffs.

Do we really want to have a person deciding to forgo a colonoscopy this year so that we can treat the stage 3 colon cancer in three years?

HSAs are not the answer because medical care is not like buying a car or buying a house. You actually want a plan that encourages a lot of small outlays for primary care visits and early intervention or preventative tactics. What HSAs do is discourage relatively cheap primary care practice and encourage highly expensive (for the consumer and/or payor) and lucrative (for the provider) care.

What is needed is a single payer system that emphasizes primary care, and says to front line PCPs (primary care physicians) we will pay you so much to treat this population -- we will pay you bonuses if you achieve certain improvements in measures like blood pressure, cholesterol, etc. In fact, the healthier your patients become, the more you will make.

But the food industry would scream bloody murder about that. Because the food industry knows what is causing our health care costs to skyrocket.

catastrophic insurance, and have money to pay routine costs?

To answer your question. Because health care costs have been allowed to unlimitedly increase for the past 40 years without any government controls, very few people can afford to 'routine stuff'. I used to have a family doctor that charged $15 for an office visit. He drew blood, took X-rays, set broken bones, stitched up cuts, delivered babies, etc. for his costs and a few bucks. I challenge you to find a doctor who will do that today. Most primary care doctors will send you to a lab for blood tests, somewhere else for X-rays, etc. When I grew up, people only carried what was termed 'major medical' insurance for hospital costs.

P.S. What will $10,000 in a health savings account pay for? I've had over $126,000 in medical bills so far this year.

Health savings accounts? We as a country are trillions of dollars in debt, and the average american is tens of thousands of dollars in debt, and people actually think that the everyone in the country is going to have "health savings accounts?"

Do people even THINK beyond their innane impulses when they come up with these kind of nonsense.

Also, the most fundamental talking point from the right is that government should not be telling people what to do ... This retardness has the guvment forcing people to set up health savings accounts, forcing people to get "catsstropic insurance, forcing hospitals to be rated ...

BTW - "catastrophic insurance for costs over $10,000 ... Catastrophic? Again, is THIS a joke? Anything beyond a bad migrane is going to push $10,000 in medical costs ...

Health Saving Accounts are a small step behind "tax breaks" as an answer to the issue at hand ... The people who are not insured DO NOT HAVE THE MONEY TO SET UP HEALTH SAVING ACCOUNTS and DON'T FREAKIN ITEMIZE THEIR TAXES.

This is more of the painfully contrived idiodicy that comes from those who reflexively go batshiite crazy in the opposite direction of what actually makes sense, and is completely oblivious that it ends up being even worse in the crape it is throwing around as opposition (see, projecting) ...

who obviously need a safety net.

He's talking about everybody else and making the health care providers more responsive to consumers by empowering consumers instead of insurance companies.

I think we need to think flexibly about what can improve health care, not simply buy into the latest "group think."

That said, I still remain a proponent of a medicare for all option.

"Imagine the coverage we could afford if we had direct access to that wealth and could spend it on our own behalf."

That is where the delusion starts.

"We don't have insurance to buy groceries."

Are you series?

In designing Medicare and Medicaid in 1965, the government essentially adopted this comprehensive-insurance model for its own spending, and by the next year had enrolled nearly 12 percent of the population. And it is no coinci­dence that the great inflation in health-care costs began soon after. We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense.

"libertarian bullshit", agreed.

Because there is no incentive to keep them down as long as "insurance" pays for everything.

Medical procedures like Lasik eye surgery, tummy tucks, teeth whitening etc that are NOT covered by insurance continue to FALL in price, just like flat-screen TVs and computers.

tummy tucks are.

Surgery is surgery.

well no it isn't.But keep on thinking that.

Explain to me again how one goes about shopping for a heart surgeon. Is that done before or after the heart attack?

A lot of people don't have heart surgery directly as a result of heart attack.

Also, hip and knee replacement surgery is going up too.

Why?

It's paid for by "insurance."

Screw the rest of us!

Why do we have to re-invent the wheel? There are plenty of systems out there that get much better results than ours for far less in expenditures. The least we could do is to just copy them wholesale, if we really felt that we had to meddle with them, we could take the best ideas from all of them. Why do we feel this compulsive need to create an untested solution from whole cloth?

Germany/Switzerland's GDP for health care is around 12 percent and going up about as fast as ours.

This isn't sustainable either.

Rising costs in a system which covers everyone and bankrupts no one is very different from a system like ours in which 47,000,000 of our fellow citizens are uncovered and millions more are bankrupt due to medical bills.

Handling rising costs while all citizens have the security of knowing they can get medical care when they need it and it won't bankrupt them, is very different from our cruel Pay-to-Play system of letting millions suffer while we discuss how to be fair to the private insurance corporations that have led us into this national health emergency. We've tried many times to give them room to prove their case and they have failed miserably.

Single Payer like Canada has is still far more successful. They can handle cost control as a group, confident that whatever is done will affect everyone fairly equally.

We have single payer for our seniors, so we've got the existing infrastructure to adjust and expand upon. Medicare for All who choose it is the most efficient way to go.

Never happen here.

Period.

single payer that it is not passing now.

Taiwan reinvented their health care system in the 90s. Theirs is essentially Medicare-for-everyone, but with even more benefits. Consolidation has made them incredibly efficient. Their administrative costs are under two percent. No one goes bankrupt due to medical bills. There are no gatekeepers controlling access to specialists--people are free to choose who they want to see. Waiting times are short. Taiwanese people are overwhelmingly happy with their new system. While Taiwan's system is under strain, as of 2008 they only spent around 6.25% of GDP on health care. The U.S. spends around 16% of GDP on health care.

No, I don’t think we need this health care savings nonsense. The author of that piece rambles on and on, and I feel horrible for what happened to his father, but his solutions aren’t the most sensible. Maybe for Milton Friedman or Ron Paul or bankers, but not for the American people.

if they lose a couple of days' pay with a hard cold. How the hell are they supposed to save ten thousand bucks? They're living in substandard, unsafe housing, eating substandard food, and going without routine medical care just to survive now. They have much better uses for the little money they get than putting it into a savings account like the one suggested.

Marginal workers account for an increasing percentage of the US population as we've moved from a manufacturing economy to a service economy. Service jobs are low paid, dead end affairs that don't allow any savings at all.

Marginal workers don't get colonoscopies, dental care, or physical checkups. They often can't afford even over the counter remedies when they get the flu.

Your suggestion is ignorant and cruel and misses a huge part of the US working population, the working poor. This is the population that most needs universal health insurance.

Most of the people in this country simply can't afford it.

First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.

. . . .

Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.

Anyone with whom I discuss this approach has the same question: How am I supposed to be able to afford health care in this system? Well, what if I gave you $1.77 million? Recall, that’s how much an insured 22-year-old at my company could expect to pay—and to have paid on his and his family’s behalf—over his lifetime, assuming health-care costs are tamed. Sure, most of that money doesn’t pass through your hands now. It’s hidden in company payments for premiums, or in Medicare taxes and premiums. But think about it: If you had access to those funds over your lifetime, wouldn’t you be able to afford your own care? And wouldn’t you consume health care differently if you and your family didn’t have to spend that money only on care?

and preventive and timely care are both far out of reach.

What part of that didn't you get?

Once again, this is a rich man's plan. It won't work for the majority of people in this country.

You are going to MAKE me PAY for catastrophic insurance (AGE FUCKING-BASED PREMIUMS) See how you like that at the age of 55 or 60 or fucking 80.

Greaat idea if your'e healthy and 25 years old

FUCK FUCK FUCK FUCK FUCK

WELFARE for insurance companies. Because they will get their MANDATED BY LAW premiums and I will get S.C.R.E.W.E.D.

And so will you, but you asked for it.

And I never use it.

Does that sound like a good system?

That's 800 bucks a month I don't get. And if I don't take their health insurance, I have to pay everything myself.

I'm already S. C. R. E. W. E. D. by what we've got now.

And I share your frustration that even when you don't use health care, the insurance company takes your money. Do you know why they can? Because they are assuming your risk. That is the contract. With catastrophic insurance, their risk is minimized (I would like to know by what multiplier, but I'm no actuary) and they still get paid. And they make a profit. And they pay themselves gy-normous salaries. It's catastrophic insurance and you're going to pay for your own checkup out of your own pocket. And you're healthy. How much preventative care can you afford? Do you really think you need it? You're pretty healthy, right? So health care continues to be a reactive rather than a proactive measure.

I can buy exactly the type of plan you're talking about today. Cost v benefit, it just isn't worth it. I've decided to bop till I drop, put my money into general savings -- okay it's not tax-free money, but I can spend it on whatever I choose (even health care) and I'll keep the insurance money for myself.

Unless a plan like the one described in the OP is imposed, 'cause then even that option is gone.

Sounds like a stealth approach to eliminating successful, popular government programs like Medicare.

Leave those alone. Expanding Medicare for All would be the most cost effective way to cover everyone.

Turn your libertarian concepts to controlling our military expenditures. That is a much greater invasion into our private pocketbooks. My tax dollars went to funding a war built on false premises and to sustain it for years. My tax dollars are going for sustaining thousands of military bases around the globe-- those could be rationalized to save millions.

I'd rather have national health security as part of our national security. Government insures that we can get help when we need it. Medical services privately delivered, doctors to patients, and publicly administered. Single Payer in Canada is doing well; they will work together as a people to control the costs. Medicare is doing well and could do better if we had a more progressive income tax, since we have seen what a failure "trickle down" economics has been.

I have experienced the profound sense of security that having national health insurance (even as a resident alien) can provide. I did not resent paying taxes to cover that.

Mandatory this and mandatory that which then need to be monitored and fined instead of one monthly deduction or payment to get all the medical care I need? No thank you.

single payer.

We'll you could get single payer, but then you'd have to move to Canada.

Let's not toss out the best option and jump in to discuss this or that expensive bureaucracy laden alternative plan as though we didn't have Medicare up and running successfully and popularly for decades now.

Let's get the fancy alternatives to tell us-- just how would your plan beat Medicare for All ?

of our federal budget, up from 1 percent in 1966.

This is not sustainable.

to pay for a single payer system into Medicare for all, you know, the Medicare that now covers the sickest, most expensive part of the population. All the healthy young taxpayers, who rarely get sick, enter the Medicare system and costs go down for everyone.

With a universzal, single-payer, not-for-profit system, we wouldn't be investing that much in insurance over a lifetime.

Nobody would ever have to defer, or reject, needed health care because they didn't have the money to pay for it out of pocket.

Fees would be regulated:

<snip>

Q16: How are doctor and hospital fees determined?
{Section 202(b) (2)}
A16: Provider fees will be set through negotiations between physicians and
other clinicians, and in consultation with the National Board of Universal
Quality and Access and regional and State directors. Initially, prevailing
fees would be the basis for fee negotiation.

Q17: How soon will doctors and hospitals be paid?
{Section 202(b) (2) (E)}
A17: Within 30 days of submitting bills.

Q18: Can doctors or hospitals charge more than the USNHC Program
pays?
{Section 202(b) (2) (F)}
A18: No—no balance billing is allowed.

http://singlepayernow.net/sb810/HR676-35Questions.pdf

Nobody would have to worry about those out-of-pocket expenses, which naturally go up as we age, overwhelming a smaller, post-retirement income.

We don't need "insurance;" we need CARE. The government being the "single-payer" that ensures that care is appropriate. Health care is a right; it ensures the "pursuit of life."

"For those of us who are healthy, HSAs with catastrophic coverage would serve our purposes well. But those of us who later develop significant disorders will discover why we should all have comprehensive coverage using a common risk pool. Many of us would decide in advance that we want that degree of security and would want to purchase traditional coverage. But we’ll find that traditional coverage will have left the market because of the death spiral of unaffordable premiums.

This fundamental flaw in dividing the risk pool into segregated accounts, favoring the wealthy while penalizing the sick, alone is enough to disqualify HSAs as a rational model of reform. But there are a great many other problems, only a few of which are listed here."

Much more about this assault on meaningful progressive reform here: http://www.pnhp.org/news/2003/december/stop_the_hsa_tsunami.php

If I have a family with health issues, likely I will have to dig up the $10,000 well before the account is fully funded. And it's likely I'll have to dig up another $10,000 next year and the year after. Some folks have chronic health conditions, and those are the same folks who are struggling most under our current system.

So, worst case scenario, I'm paying out up to $10,000 every year, plus I'm paying for catastrphic insurance which likely has provided no benefit at all, plus I'm trying to fund an HSA on top of paying for my medical costs out of posket. Explain to me, where is the advantage?

This kind of bullshit makes my blood boil.

If it's a bad idea, I want to know how to stop its proponents from offering it as an alternative.

There is a reason why the insurance industry pushes these types of crap policies. They keep 100% of the premiums of the vast majority of customers. People with serious illnesses or chronic conditions pay the maximum out-of-pocket year after year. Most people driven to medical bankruptcy ARE insured. They have crappy policies like the one being proposed in the OP for everyone.

year after year? Sounds familiar.

Good grief, reminds me of bushdaddy's last state of the union speech wherein he proposed that poor people be allowed to withdraw downpayment money from their IRA without penalty. Hey, maybe we can start those savings account the same way.

What the hell?!

I prefer the choice of Medicare for All. Choosing to make a monthly payment into a system that is a mixture of public and private elements.

Medical services privately delivered, between me and my doctors.

Payment and cost controls publicly administered, accountable to all.

Healthcare as a basic human right and not a Pay-to-Play privilege for those who can afford it.

The system you describe seems to have lots of new overhead costs and would call for more government departments to administer the different elements.

Single Payer spends far less on overhead than the "free market" solution you propose.

up so damn much so damn fast AFTER Medicare?

The post hoc ergo propter hoc (after this therefore because of this) fallacy is based upon the mistaken notion that simply because one thing happens after another, the first event was a cause of the second event. Post hoc reasoning is the basis for many superstitions and erroneous beliefs.

I don't know much about why costs have actually spiralled. I've seen people here debate the claim that it had anything to do with Medicare. At the very least healthcare is a huge and complex system, and ferreting out a root cause would be tremendously difficult. I dunno how deeply you've looked into the subject.

Sec. 59B. Tax on individuals without acceptable healthcare coverage.

SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of

(1) the taxpayer’s modified adjusted gross income for the taxable year, overCommentsClose CommentsPermalink

(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.




Why should I be fined 2.5% of my income for choosing not to have health insurance? Who am I hurting by not having it? Car insurance, yeah I can see it being a law. You could go out and kill someone with your car. Health insurance I don't think I am going to go out and get someone sick and my health insurance is going to cover that person.

The only way that everyone can have quality affordable healthcare is if everyone is paying into the system, healthy or not. If the healthy are allowed to opt out then we cannot have quality affordable healthcare for all.

Do you favor a system that provides quality affordable healthcare for all?

I have yet to see how much it is going to cost us.

With deductibles like it has I don't see how it is very affordable. Honestly I would be better off and pay much less to go with a private plan for approximately $3800 a year which includes the $2500 deductible that I was recently quoted.

And also I would favor a system that provides quality affordable healthcare for all, if one was created. HR 3200 is not that plan.

Don't get me wrong. I like some of the stuff in this bill, but there are some bad things that need to be worked out before I would be for it. Like the deductibles should be realistic, chop it in half like most of the private plans. Don't take away my freedom of choice, I didn't do anything wrong.

Do you favor affordable quality healthcare for all?

I would favor a system that provides quality affordable healthcare for all, if one was created. HR 3200 is not that plan.

But I see you could not answer my question to you.

The only way that everyone can have quality affordable healthcare is if everyone is paying into the system,

How much is everyone going to be paying?

And most DUer's lambasted him and are now boycotting Whole Foods.

Personally, I don't have a problem with some of these ideas. However, it doesn't address covering people who don't have the money to buy the mandatory insurance you talk about.

Also, option #4 makes no sense. If it's a marketplace, they can't all charge the same price for the same service. That's called collaberation and it's illegal.

which meanwhile wrecks coverage for those not so healthy by keeping healthy people out of pool coverage.

Plus it pushes the problem off into that bucket labeled 'catastrophic coverage', which through some liberloon handwaving suddenly is problem free and solves everything. It isn't problem free and it doesn't solve anything. It has all the same problems that we are facing with private non-catastrophic insurance. Under this scheme, as each of us would be on our own purchasing catastrophic coverage as individuals we would be cherry picked, rate inflated, rescissioned, deductabled, managed for profit, and co-payed into bankruptcy, in addition to being out of pocket 10K a year. But we would have a fantasy 1.xx million in monopoly money. Sort of. Or not.

Liberloons, plus ca change....


I do like the idea that we can shop around for the cheapest heart surgeon. Do we do that before or right after our heart attack from getting our catastrophic care policy canceled?

charge different rates to different customers.

A lot of the time, you can't even find out what a procedure will cost ahead of time.

it is paying for needed procedures from the government. If the poor and uninsured could afford to put $10,000 away I'm sure they would. Tax breaks for people at this end of the spectrum do almost nothing.

with such information freely provided to the patient.

A single list price for all, whether they're paying out of pocket or with insurance. None of this insurance company nonsense of Company A paying 60% of "normal costs" and Company B paying 40% of "normal costs" so that doctors and hospitals have to set their prices artificially high to break even on what insurance pays.

I read the article last night, and it's an affluent person's "solution." (The same can be said for many of the ideas in The Atlantic.)

doesn't seem like an impossible dream. Affluent enough that absorbing $10,000 a year in medical expenses is easily affordable.

Aetna were going to you instead.

That's how the HSA gets funded.

And it wouldn't matter if they did, which they won't.

Your rightwing libertarian free market solution results in the healthy staying out of the pool and the chronically ill stuck with the full bill. It does not have an everyone in shared cost approach, and consequently it fails. Healthcare is affordable to all only when we all share the costs for everyone. Any approach that does not do this will fail to deliver quality affordable healthcare to all.

Is your goal quality affordable healthcare for all?

I've been self-employed since 1993.

Many middle class families don't pay $10,000 in taxes, so where are they to get the $10,000 for a health savings account?

Some of those "routine" medical costs save not only lives, but much bigger bills down the road. The bill for some of those "routine" things can be quite high. For example, my colonoscopy was more than $4200. If people are paying such "routine" expenses out-of-pocket, many people are going to skip the many screenings that they should have to avoid those expenses. The result is much greater expenses because treatable diseases are not caught in the early stages.

http://www.huffingtonpost.com/michele-swenson/for-profit-health-insuran_b_201405.html

There is research that shows that even a small copay deters woman from having regular mammograms.

http://www.breastcancer.org/symptoms/testing/new_research/20080123.jsp


For people who are generally healthy, this scheme may be workable, but for the very people who need health care the most, it could be disastrous. People with chronic conditions will be forced to incur the maximum out-of-pocket expenses year after year. How does this protect those people from medical bankruptcy?

The author said something about "vouchers" for routine care, but then isn't that the same thing that single-payer would do?

including age, sex, family history, chronic conditions, injury, etc. The system you describe is far too complex and would deter people from getting the screenings and routine care that they as individuals need. Why have a for-profit insurance company bureaucracy decide what should be routine and take the chance that people skip screenings and preventative care that they need?

We don't have the highest health care costs due to over-utilization of services across the board. People are putting off preventative care and screenings and then end up using the emergency room when their medical problems reach a crisis point. It's not just ineffective from an overall cost point of view, it's inhumane.

Other countries with universal health care with low or no copays have much lower costs per capita and as a percentage of their GDP. Why don't we look at what is working elsewhere rather than allow the insurance companies sell us a defective product repackaged in a shiny new box?

Not only that some of those points are illegal in the private market, like price fixing. Only the government can fix prices on health care like they do for Medicare and Medicaid. It often doesn't work so well as doctors will refuse to take patients if the fee reimbursement is too low. In Canada doctors and government meet at regular intervals to hammer out fee schedules that are satisfactory to both sides. This is what real compromise and bipartisanship is about.

Medical savings accounts are of no use to people who are too sick to work and earn money. Also, inflation often eats up savings as many of us seniors have found out. Our IRAs and 401Ks aren't worth what they were when we retired, no matter how carefully we planned. The Bush administration's criminal manipulation of the markets and banks took care of that.

How are people who are too sick to work supposed to pay for routine medical costs out of pocket? Everyone thinks they are responsible and will hold down a job, but cancer, accidents and other unforeseen disasters will often make someone unemployable.

We actually still have safety nets like welfare and food stamps to help us buy groceries when we can't provide for ourselves anymore. They aren't much but at least with those, food banks and charities most Americans will only be half-starved if they can't provide for themselves and their children.

This is old stuff being posited by conservative interests since I took an interest in this issue back in the middle nineties after Hillarycare went down in flames.

sugar-coated corporate-love RW memes and selectively omitted facts...


I almost stopped reading midway through the first page:

"All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well."

The motives of insurers and big pharm are profit-driven, and profit-driven ONLY...


And of course in this passage he leaves out what is by far the biggest eater of the budget:

"Yet spending on health care, by families and by the government, is crowding out spending on almost everything else. As a nation, we now spend almost 18 percent of our GDP on health care. In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising. Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation. Education, public safety, environment, infrastructure—all other public priorities are being slowly devoured by the health-care beast."


Here; he admits the single-payer is better but still sneaks in that "ration" meme:

"Many reformers believe if we could only adopt a single-payer system, we could deliver health care more cheaply than we do today. The experience of other developed countries suggests that’s true: the government as single payer would have lower administrative costs than private insurers, as well as enormous market clout and the ability to bring down prices, although at the cost of explicitly rationing care."


Pretty good at spitting out statistics with no context (i.e., population growth, demographics, etc) and a shaky conclusion

"From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits. "


This guy really doesn't live on our planet:

"In competitive markets, high profits serve an important social purpose: encouraging capital to flow to the production of a service not adequately supplied." O RLY?



This is at least the third time he's spewed the 'over-regulation hinders the effectiveness of insurers' line:

"Health care is an exceptionally heavily regulated industry. Health-insurance companies are regulated by states, which limits interstate competition. And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them."


More selective omission:

"Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room?"

I know this isn't always the case everywhere, but I imagine the costs of saving someone who got shotgunned or tried to get cute on his motorcycle and arrived to the ER 60 seconds from death can be quite high...Not to mention to cost of a chopper (sometimes) to get them in...



And here, he gets to the jist of it...Funny how a pro-business, free market lover guy liberally quoting the WSJ never realized how much single-payer would pay for itself in the long run:

"Regardless, the administration has suggested a cost to taxpayers of $1 trillion to $1.5 trillion over 10 years. That, of course, will mean another $1 trillion or more not spent on other things—environment, education, nutrition, recreation. And if the history of previous attempts to expand the health safety net are any guide, that estimate will prove low."

and two paragraphs later, NOW he wants to get into the "but this will pay for itself!! it makes too much sense NOT to do it!!!"

"The Rand Corporation has estimated that the widespread use of electronic medical records would eventually yield annual savings of $81 billion, while also improving care and reducing preventable deaths, and the White House estimates that creating and spreading the technology would cost just $50 billion. But in what other industry would an investment with such a massive annual return not be funded by the industry itself?"


and on the last page, the author just goes right over the edge...to sum up he wants:

1. One universal manditory insurer (abolish everything we have now, government and private)

2. mandatory healthcare accounts (with provisions to spend it elsewhere if desired) for routine things...

3. universal catastrophic insurance for anything over $50,000 (there's the real rub...hospital administrators are either going to start filing a bunch of $50,001 broken arms, or a bunch of $49,999 broken arms...) and then there is this epic line:

"But the real key would be to restrict the coverage to true catastrophes—if this approach is to work, only a minority of us should ever be beneficiaries."

does the word 'ration' mean anything to him??

4. Big Gummitt covers the poor and low-income on a sliding scale, including vouchers for free checkups every 2 years...

And to finish it off he gives some love to Wal-Mart for cornering the market that used to buy cheap drugs from Canada, boutique doctors and a few other things, never bothering to say how much more efficient or cost-effective it could ever be over a single-payer program...or how it would really control costs...

in percentage terms was one of his strongest arguments.

How can one explain health care costs going up 33 percent in Canada when the gov't sets the prices?

or bring costs down...

after all, if this would theoretically bring costs down, why does the 'catastrophic' cutoff have to be so high?

And to answer your Canada question, without crunching the numbers i can bet that their cost increase can be linked somehow to major population/immigration/demographic shifts...

Now I have some more questions of my own about the proposal:

1. What kind of single insurance company would it be? Government or private run? (or the public-private; the worst of both worlds?) If it is government run, then you may as well go all the way and have the gov't cover everybody, since it is already covering the no-income, low-income and kids...If it is private-run, then the ultimate motive is greed and graft and it is doomed to fail from the start, even with heavy, 'regulated monopoly' utility-style controls... Also, how long before somebody decided he could start his own company to do it better and cheaper (or just wanted to rob the people), and started lobbying for open competition?

2. How are stay-at-home parents covered? Is Mrs. Multi-Million-Dollar stay at home trophy wife going to get it for free since she technically has 'no income?'

3. Say I'm a rich man and over the years I put away $5 million...On a whim I decide to pull it out to blow it on a bad investment and now I'm bankrupt...How am I covered? And how to deal with other careless uses of the account knowing big gummitt will help me out anyway?

4. What about diminishing returns? It says if I'm short I can borrow against future deposits to my account, but what if I never make enough to make up the difference? and who sets the terms and rates for me paying it back?

5. Even with this plan; won't the "never go to the doctor until being trucked to the ER" problem still be with us?

6. Would doctors and hospitals still not play favorites with those who have meatier health accounts?

7. In this free-market paradise plan, why does Big Gummitt still have to play such a huge role for it to have a chance to work?

8. How long would it really take in this new plan (especially if the income disparity keeps growing) for the teabag mindset to start grumbling once again about their taxes supporting the low and no income? The rich will wonder what kind of healthcare service they are getting for their money when the poor get it for free -- this would inevitably lead to country-club hospitals and private doctors...

9. The percentage I'm supposed to contribute to the account rises as I age...What if my income doesn't rise at the same rate?

there's more (including a lot more holes i could punch in the story), but this should do for now...

and how fitting -- our author is a CEO of a cable network (the game show network, believe it or not!) http://corp.gsn.com/corporate-info

and he gives an even more simplified interview to NPR...(if my dad got such shitty care from a local hospital, i'd at least have the stones to name it publicly): http://www.npr.org/templates/story/story.php?storyId=111831757

The biggest one is that consumers are not good judges of which medical care they need or don't need. Even doctors sometimes get confused and that is why the stimulus bill called for $1.1 billion to research comparative effectiveness of medical treatment so doctors would have an idea which treatment works best in which situation.

The average American has a high school diploma, no medical training whatsoever and reads at an 8th grade level. How can people be expected to negotiate which cardiology interventions are the most cost effective with no medical training and the literacy skills of a 14 year old? Add into that the emotional pressure patients are under (medical decisions can be made in haste, unlike buying a DVD player which is passionless) and you have troubles. I do think competition and transparency should play a bigger role in medicine, but that should be after the fact and after a person has an idea what intervention they need. A person with no medical training should not be forced to choose between various medical interventions based solely on cost as they don't understand the benefits or drawbacks of them.

His argument about LASIK was good. However that was competition where a consumer knew what intervention they needed. I can support that and I'd support transparent prices for domestic and foreign medical care, but only when the consumer has a good idea what is wrong and what needs to be done about it.

If anything, low cost primary care would help cut medical costs, as problems could be caught early. Making people pay $100 for every doctor visit will just make people stop seeing the doctor. However a flat copay of $5 or $10 to see a doctor will allow people to get primary care and still offer a barrier that will stop waste.

Market forces may help lower costs when the consumer is dispassionate, knows what he/she needs and the product is reasonably priced. However many people are going to turn down a $20,000 surgery no matter how good of an idea it is because they don't want to spend that kind of money. A surgery that costs a year's wages is not the same as a DVD player that costs a day's wages. Add in expecting someone with no medical training to understand benefits and drawbacks of complex medical treatments, and you have a problem.

Another major problem is that health care is not spread among the population evenly. When you work it out, it is about $7000 per capita. However per year:

The sickest 1% of the country uses about 22% of all medical spending

The sickest 5% of the country uses about 49% of all medical spending

The sickest 20% of the country uses about 80% of all medical spending

On the other hand:


The healthiest 80% of the country uses about 20% of all medical spending

The healthiest 50% of the country uses about 3% of all medical spending



So you have a situation where 3 million citizens use 700% more medical spending than the healthiest 150 million citizens. Health care is not like rent, where you pay a flat rate each month. Most people need very little, and a small number need a whole lot. So market competition may not help when you consider that 80% of us use a fraction of all health care costs.

I believe this is the concept of spreading the risk across the population. Also, look upon it as the most medical you will use, if you are the average person, will be in the last years of your life. Unless you go quickly from an unexpected situation like a fatal heart attack, you will not be exempt from this possibility. The fact that you probably will have paid into more than you've used during your lifetime, levels out the situation in the end, don't you think?

1. mandatory tax-free savings accounts of 10,000 (saved over several years) that can only be spent on health care.

Most middle class families save for many years to have that kind of money - very few have anything like that in the bank - most have less than a month's paycheck available - this is NOT a viable basis for a health care system. The average middle class family of 4 makes $48,000 a year, they will NOT have $10,000 in a savings account even if they wanted to do so.

2. mandatory catastrophic health insurance for costs over 10K.

A giveaway to the health insurance companies forcing people to buy expensive policies that many cannot afford, especially if self employed or unemployed or if their employer does not provide benefits. These mandatory policies will be "junk" policies that won't cover pre-existing conditions or won't cover anything of importance when the time comes.

3. routine medical costs should be paid out of pocket.

There's nothing "routine" about medical expenses - even minor doctors visits can cost several hundred dollars "out of pocket" and if any kind of tests are involved they can quickly become thousands of dollars - money that poor people do not have.

4. hospitals, doctors, dentists have to post their fees and charge the same price for the same service.

They already have to tell you what they charge when they bill you but charging the same price for the same fee is the OPPOSITE of competition. Each hospital should be forced to try to undercut another.

That said, the competition motive is of little value in emergency care - people with gunshot wounds or broken bones don't go comparison shopping and hold off for deals. As one of FDR's cabinet secretaries once said: People don't eat in the long run. They don't seek emergency care that way either. The capitalist system only works when the buyer is not coerced by undue stress ... you know like dying.

5. hospitals must be rated so that patients can make informed decisions.

This is probably the only good idea the guy had but often times being "informed" is of no value in a life threatening emergency, it's the closest hospital period and choice be damned.

and a $2,500 colonoscopy. If you happen to have money, I suppose it's chump change, but to many families that's the difference between heat and no heat.

"Just imagine what the WEALTHY could do if they got their hands on MORE wealth!" :sarcasm:

Man, does anyone GET that the reason the middle/working/poor classes are in this decades-long rut of wage stagnation and treadmill survival is because Big Wealth socialized the risks and loss onto US while privatizing the fruits?

This just reeks of more "personal responsibility" blather without understanding WHY this can never be done. When wages aren't able to keep up with the cost of living, how exactly are you expecting overburdened, underemployed and completely strapped people to comply with this?

with at least 90% full employment. A healthy, robust middle class can handle the funding for any form of health care or health regulation or insurance plan that gets passed, and is critical to help provide the safety net function of society - as frankly, most of the top 1% are able to hide a good amount their personal "wealth" assets from the government, and the poor - well, even if poverty is temporary (single parent, starting out, paying off education, an unforeseen emergency), the people who don't have the means to stretch their budgeting past immediate concerns aren't going to be able to do much to help.

Good jobs, good education, and good health care go hand in hand. Drop one of these, and you end up causing undo stress to those who make "the system" to benefit all of us work.

And "the system" is the price people pay to live in a comfortable, robust society. If there were ever any frontier where "a man can carve out his kingdom and be completely free" - as the Libritoonians and Randriods like to think they can do, it's long since gone the way of the Dodo bird.
The problem with the romance of rugged individualism and freedom comes down to this -
Even in the 1890's, the American frontier was pretty much gone and settled - all available land had been parceled out one way or another, and had some sort of tax assessment assigned to it. If you wanted to live outside a community and provide strictly for yourself, unless you owned the land outright and were able to produce something that could be sold to pay taxes of some sort to keep your title, you were squatting and "the real owner" had every right drive you off the property if desired.
In the 40's, everyone in the US came to depend on common community infrastructure and services to provide the basics of life, whether they lived on a ranch or in the middle of a city. You could still carve out your own living, but you had to have some compact with whatever local community was around - if nothing else, for access and emergency services.
By the 70's, the family farm or ranch was pretty much gone. Very few people "lived free" from the constraints of civilization. And those people had nothing. If you "owned" anything of value or had a family depending on you, you had to be part of a community - and your fortunes rise and fall with that of the community.

This is the dilemma of the Libertarian or Free-marketer - the idea of the "free man" in any society. The only "free men" are ones who either has enough money they don't have to worry about anything (the top .1% of the US) or ones who have nothing - living in the canyons on what they can scavenge.

Haele