Quote:
Originally Posted by LawnGuyLandSparky
Great...
So, let's hear your ideas!
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There IS a role for private health insurance companies.
There IS a role for a national backstop coverage system.
Mostly though there is a NEED to shift responsibility back to individuals.
Less of Government and Less of Private Insurance.
Two sides of the same nannyism coin.
What does that leave us with?
With the three basic categories of care:
1) The first category is the 80% that constitutes everyone’s day to day use of medical services which should be paid for out of pocket (by most of us) on a fee for service basis to the provider we choose.
And yes, people with a specific condition can expect to pay more for that
basic care than people who don't have that specific condition.
This largish number can be broken down by age and gender and medical specialty but however many subcategories might result what they all have in common is still too similar to warrant detailing those distinctions at this juncture.
There are very few of us who don’t have the same basic recurring sequence of annual professional visits. Some of these are twice a year and others perhaps only once every three years (eg: Dentist vs Optometrist). But whatever our particular pattern, it is indeed a pattern and therefore it can be planned and budgeted for.
This practical reality is the best argument against having insurance company involvement in these common transactions and private relationships with our doctors at all.
For those without that pattern we may need to foster creating facilities and staff that will serve them. And for the rest some protocols for transparent fee structures by these providers will need to be established and some regulation of standards of care along with specific expectations for examinations and clinical tests.
Whether our tastes or resources would send us to the health clinic at the University Medical School or allow us to be pampered by the posh Park Avenue private practice we remain the best arbiters of how much we should spend to get the care we need.
This self-direction and sense of personal responsibility warrants cultivation and should extend to those things we are willing to do (or not) to mitigate what degree of care and services we will have to pay for. Diet, exercise, and smoking are examples of the choices we make. Hopefully when we bear the direct cost of those choices we will do better with them than we have in the past.
2) The second category is the 10% that will occasionally crop up beyond those routine year to year expenses that we can mitigate the budget impact of by having some backstop insurance (or a HSA) which we also pay for on our own. Most of us will use this similarly to how we use high deductible homeowner or auto insurance and for much the same reasons.
No one can anticipate every possible eventuality. Periodic changes in our basic physical condition may present at any time either as diagnostic work related to some previously undetected chronic condition or as a single injury incident.
Everyone knows that such events happen without warning and that we need to be prepared to meet the financial responsibility of that medical challenge. The healthcare savings account (HSA) or backstop medical insurance plan does this until we are able to absorb that expense otherwise and adjust our budget to include this.
These HSA’s tied into an insurance policy also function as a security measure for institutional providers (Hospitals etc) that incurred charges will be paid.
This shift of nearly total financial responsibility to the individual (or family) is balanced by the shift of nearly all tax deductions related to that same individual; as well as ordering all funds previously paid by their employer as benefits being changed to straight wages instead.
Those who had decent coverage before under an employers plan will continue to be able to afford decent coverage into the future and probably for less in direct costs.
The total of these tax-deductible out of pocket expenses for most individuals and families should be less, in many cases considerably less than what is currently paid by or on behalf of them for a comparable quality of service.
Reasons for the savings will vary but the obvious common business practices of lowering the operating overhead of every provider and initiating actual competition between them for your business will be the primary factors. These medical services can be sourced very frugally or very expensively. Kia or Cadillac is your choice.
Your costs should be what YOU choose to spend for the quality that YOU value.
3) The third category is the 10% that NO ONE can reasonably expect to afford
or in most instances to even insure against privately. These catastrophic and
traumatic bankrupting expenses are the perfect category for and reasonable
limit to a government plan with a tax supported 100% actuarial base.
Despite all the rhetoric in the news there are very few working Americans who will be affected by medical treatment that would personally bankrupt them. Some other insurance like workman’s comp or auto liability is far more likely to be responsible.
That said, the collective risk of illness or injury is still quite real and as medical science marches on ever more conditions will have ever more expensive medications and procedures available to treat them and diagnostics used to rule out or define the less serious. This very well documented expense risk is the largest problem with private insurance carriers as they know can’t afford to actually pay for the level of risk their subscribers represent.
When an incident or a diagnosis presents itself it is quite clear to the medical professionals involved and one more document they manage will be to initiate the expansion of coverage to the affected individual.
Expand the existing and generally well functioning Medicare to cover these catastrophic, traumatic and similar bankruptingly expensive disease treatments that worry everyone so deeply. The intention being to take this entire category of medical practice and their costs off the table as a concern to individuals.
Achieve the 100% actuarial base needed to spread this universal risk to universal funding through the same tax supported means we already have in place.
When the employer paid private insurance was shifted to straight wages (as described above) those funds then get assessed with both the employer and the employee paying a modest percentage of that amount in additional FICA withholding. You’ll never even miss it.
The people who never had employer provided insurance and their employers will see the additional deduction. But, as this group are those who represent the largest of unpaid mandates in the current model… it’s hard to feel great sympathy for them now having to pay a modest contribution toward the social compact.
Accommodating the needs of people with known and expensive to treat conditions remain the problem they are today as they directly represent the largest year to year expense and the largest risk of that growing beyond the merely expensive and into the realm of the bankruptingly expensive. Hiding these costs under multiple layers of administrators and deep inside actuarial pools doesn’t help anyone.
As a society we expect these people to do all they can reasonably do for themselves before they ask society for assistance; but once that threshold is crossed that social compact will be there to give that assistance.
In successive years it is entirely reasonable to expect that this category of expense will require greater funding. Balanced against the overhead and operating efficiency savings in described above it may seem modest enough to just accept.
The alternative will be to review and amend standards of care for savings.
4) If we are truly honest we can add a fourth category: Terminal care.
Stop pretending that anyone gets out alive by refusing to flog and abuse
our elderly and other terminal loved ones and still call it medicine.
Most terminal care expenses are covered under Medicare (the elderly) but it still warrants it’s own category because of how it distorts every other cost statistic. It especially distorts when pointless treatments are used because the misguided emotionality and guilt of survivors mistakenly insist on them.
....yes sir I agree 100%!!!!!!
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