Request critique on universal health insurance plan

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coaster
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Post by coaster »

Aiken, I think that those problems which you described (and thanks for doing so) are addressed by my plan, which retains the private sector provider model. From the standpoint of the patient, the patient is dealing with the private sector, from the standpoint of the provider, the provider is dealing with the private sector, and when it comes down to it, the only direct contact with any government entity is the claims processor, and the insurance company, both of whom are dealing only with transfer of funds already agreed upon. Do you see any weaknesses in there that I need to address?
~ Tim ~
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Aiken
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Post by Aiken »

The doctors will know where the money comes from, whether they see it directly or not. It's not like there will be a big black curtain hiding the innards of the payment scheme. They'll know the money is coming through the government, and that the patient had no choice in giving that money to the government to pay out.

Anyway, the main thing I see wrong with your plan is the assumption that all claims are paid. That only works in a sociopath-free, fraud-free, thief-free society, and we don't live in one of those. Some claims MUST be denied or costs will run rampant.

And then it gets just as messy as the current system, except now the government is involved, and the government doesn't run ANYTHING well or inexpensively. They waste money, they shortchange you (if you think insurance companies are bad...), they skim off of the top, they redirect to pet projects, they appropriate for other uses in "emergencies," etc. Oh, and don't assume that because you start them out just running part of the deal, they'll stay that way. Give a government a foot in the door and they'll push it open wide so they can step their big fat butts through and take over.

Governments should govern, and nothing else. They shouldn't run industries. They suck at business. Ultimately, though more indirectly, any and every socialized health care plan costs the people more than it would have without the government's interference.

I read a saying recently: If you think health care costs a lot now, just wait until it's "free."
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Neco
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Post by Neco »

Sorry but I have to disagree.. Many insurance companies will pull crap and tell you something isn't covered under your plan, or try not to pay as much as they should..

As far as unqualified doctors. THAT is a failure of the school who trained them, for giving them a degree in the first place. I think my original statement is very valid.

SquirmingSusan
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Post by SquirmingSusan »

Much as I would love to have universal health care, I agree with Aiken that government doesn't do anything well. Although I did live in Germany for a while, and really liked having government-run health care. It seemed to work well there, as it does in many of the Northern European countries.

I have to say that we have a pretty good system in MN. We have what's called "Minnesota Comprehensive" health coverage. People with chronic illnesses or preexisting conditions that would get them excluded from private coverage can sign up for the plan, which, by law, can cost no more than 10% more than a private plan. But it's administered by a private company. My family has used it and the coverage was good, and they were better than most insurance plans about actually paying the claims. Perhaps if there was something similar on a nationwide basis it could work. But there are still those people who can't afford the premiums, so there would have to be some way of taking care of those people...
Susan

coaster
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Post by coaster »

Aiken wrote:Anyway, the main thing I see wrong with your plan is the assumption that all claims are paid. That only works in a sociopath-free, fraud-free, thief-free society, and we don't live in one of those. Some claims MUST be denied or costs will run rampant.

:lol: Ya, you got a point there. How about the point where doctors who file fraudulent claims get their license to practice pulled nationwide (ie they're permanently out of medicine)? Now they can just move a couple states away and start a new practice. Do you think that addresses that sufficiently to make it a minor issue?

The main reason I'm hitting that "all claims are paid" so hard is to get through the point that there's no claim denial based on pre-existing conditions, and there's no interference from the insurer on telling the doctor what he can or can't prescribe.
~ Tim ~
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coaster
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Post by coaster »

SquirmingSusan wrote:Although I did live in Germany for a while, and really liked having government-run health care. It seemed to work well there, as it does in many of the Northern European countries.

I've talked to other people from Germany and from Scandanavia who had much the same comments. That's why I think here in the U.S. we're in a great position to research what works and what doesn't work in other countries, and be able to pick and choose the best and discard the worst from the rest of the world. In fact, one reason I retained a role for insurance companies was for that very reason; like in Germany, for example.

PS, Susan, I know it's awfully long, and I know it's hard to sit and look at a computer monitor to read that long of a post (I really DO) but I think it already addresses your objections: not gov't run, private admin, can't afford subsidized, no claim denial, no "uninsurable" ;)
~ Tim ~
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coaster
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Post by coaster »

Aiken wrote:.... Give a government a foot in the door and they'll push it open wide so they can step their big fat butts through and take over...."

I missed this first read. You're absolutely right, of course, BUT, they're already inside the door big fat butts and all, and not just with Medicare. And Obama's plan is going to get them right into the center of the room. My primary care doctor and I talked about this once. He said that we're kidding ourselves if we think that government doesn't already run healthcare. I think by scrapping Medicare/Medicaid we start fresh with them at least outside that door. As far as government interference goes, the current system is bad and going to get worse, and we're not getting everyone covered either. What could possibly be worse than doing nothing?
~ Tim ~
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ViewsAskew
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Post by ViewsAskew »

Coaster, I still plead ignorance of your plan, but you said something important I think.

Let's take a HUGE step away from what we have. Let's forget anything you have heard of or know about. Let's assume there are no constraints, no drivers, and that anything is possible. Nothing has to be like it is, nothing has to be the way it is or was someplace else, etc.

If you could wave a magic wand, what would healthcare be? How would it happen?

To me, that's making it different. We often try to take the blown bicycle tube and patch it. But, that doesn't always work. Even if the air stays in, maybe the rim is bent and it won't roll. Maybe there are so many patches in some spots, it hits the fender and it won't turn. Sure, you could take the fender off, but you'd still have other problems.

To me, the only solution, truly, is reinvention.

For example, how can we deal with the issue that "for profit" and "health care" are antithetical? It's an oxymoron. You cannot ensure that the patient gets what they need when the boardroom and the shareholders come first. And, in any company that is for profit, that is indeed what happens.

How do we find a way to ensure that the company stays solvent, but that the patient truly does come first?

Or the layers? If you've listened to the Dick Gordon interview, those layers were amazing to me. That doctor said he needed five administrative staff to handle the insurance and billing issues per doctor. FIVE! When he cut out all insurance, he could 1) charge less 2) give more time to each patient 3) treat them as he felt they needed 4) actually be a doctor, not an administrator, and 5) make as much or MORE than the doctor who was beholden to the system.

And the other majors problems that we must address, such as Aiken's point about lawsuits, insurance and malpractice.

The system doesn't work. Again, I haven't read your idea and it may be a great one if we stick with what we've got. But, my guess is that it's still working within the system. And, maybe that's what has to happen.

But, I'd sure love someone to not just think outside the proverbial box, but to pretend that there never was a box.
Ann - Take what you need, leave the rest

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coaster
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Post by coaster »

Ann, you sure have the best insight into this problem of anyone who's responded anywhere I've posted this. And what you say about health care and profit. wow. Have you been reading my posts on a certain other forum? :shock:

You are 100% correct in saying we need to think outside the box. Unfortunately, this is a boxed-in world. Not many people dare think like that. Too many people are tied into continuing to do business the way it's done. So, I think at this point, the main goal is just to get everybody covered. Think of that as the first step, if you will. To do that, a certain level of pragmatism is required. That pragmatism means throwing the insurance companies a bone. Because with their opposition, nothing, and I mean nothing worthwhile will get done. Look at Pres. Obama's plan. It reads like it was written by the insurance industry. :roll:

But to do nothing is the worst course, a course that leads us down a path into a pit that gets deeper by the year.
~ Tim ~
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ViewsAskew
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Post by ViewsAskew »

Maybe you're right. I work in a world where I try to convince people to throw away the box. I still hold hope, lol.

But maybe it takes people like the Dr in the interview to literally step OUT of the box and not participate to start the real revolution. I'll leave you to find patches that do the best they can (and I'm sure it will help and it may be the interim necessary step); I'll do my best to foster a revolution.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

coaster
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Post by coaster »

Before George Washington put on his general's uniform and had himself rowed across the river to Trenton, the Minutemen in their farm clothes and muskets took the first shots at the Redcoats. Every revolution has to start with the first shot. Maybe the first shot is just getting everyone used to the idea of everybody is covered; every gets health care. I'm finding that one of the biggest blocks in people's minds. So, hey, let's work together. I'll be the Minuteman; you can be Washington. :)
~ Tim ~
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ViewsAskew
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Post by ViewsAskew »

Sounds good.
Ann - Take what you need, leave the rest

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coaster
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Post by coaster »

I'm amazed at the negativity I'm encountering in the various forums I've posted this proposal. I can't respond to people who only nitpick from an attitude of negativism and don't want to give me or don't have any ideas for alternatives, so for everyone else, I'm posting this:

How about approaching it from a whole different angle? How about this idea:

National Health Savings Accounts

This would work like employer-funded Health Savings Accounts but everybody in the country would have an HSA and they’d be funded by the government. Let’s say everyone in the country is credited with $1000 a year that could be used toward their share of their share of their health expenses. With a fixed amount to spend, health care consumers would want to seek the best service for the lowest price, so they could get the most health care for the money in their HSA. Whatever they don’t spend in a year gets carried over to the next year, so everybody who lives a healthy lifestyle and doesn’t use up their HSA dollars accumulates money they can spend on the health problems they’re more likely to have later in life.

Problems to resolve:

1. What is the role of health insurance companies? If we just give the people HSA’s then we don’t resolve the problem of insurance companies denying claims and dictating what doctors can and can’t do for their patients. And doesn’t address the unnecessary expenses in the system.

2. What happens when a person’s HSA funds run out? If we just have the government pay for it, then what’s the difference between the government crediting funds for an HSA and the government simply paying for everything?

Let's think outside the box, people, and come up with something that works, that's acceptable, and that's enough change to fix what's wrong. At least I'm trying. I want to hear constructive ideas; I don't want to hear negativity. Help me with some positive brainstorming!! :)

PS - these comments aren't necessarily directed at any comments here; I have this posted on a number of forums.
~ Tim ~
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coaster
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Post by coaster »

OK, I can see I'm taking the wrong tack here. My apologies for my grumpiness. I've started a new thread to just ask for your ideas:

http://bb.rls.org/viewtopic.php?t=6705
~ Tim ~
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ViewsAskew
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Post by ViewsAskew »

Tim, you've chosen an unbelievably controversial topic...there is a reason that no one's made changes to this for many years.

Hang in there. I'm sure it's frustrating....but most things of value (related to change) are.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

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