Starting over: your suggestions for universal health

Anything on your mind that isn't about RLS? It's nice to realize that there is life beyond this disease and have an opportunity to get to know our online family in a different context.
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coaster
Posts: 58
Joined: Fri Jul 14, 2006 12:56 am
Location: Wisconsin

Starting over: your suggestions for universal health

Post by coaster »

OK, let’s start over. Forget plan A. It was just getting too contentious on some forums. Let’s just start again without a plan but just asking for your ideas. Here’s a list of what I want to do. How would you go about making that happen?

1. Everybody is covered by health insurance. Strike “uninsurable”, “benefit denied”, and “pre-existing condition” from the health-care lexicon.

2. Everybody has affordable access to health care. And everybody is required to access health care through annual screening. Those who are unable to pay are subsidized.

3. Health care decisions are made between the patient and the doctor, without interference by any third-party entity.

4. Get the patient involved in spending decisions as a health-care consumer in order to foster competition in health care. The patient must share some portion of the cost, either as copayments, insurance, taxes, or some combination so that wise spending decisions are made.

5. Excess costs are removed; e.g. costs due to:
- multiple layers of middlemen between provider and payor
- cost shifting due to health care for uninsured (see #1 and #2)
- legal protection: malpractice, product liability
- patent protection
- duplication of services
- lack of competition
- defensive medicine
- patient demand for uneeded health care
- patient neglect of health care
- patient ignorance of the cost of health care

6. The Medicare/Medicaid/VA systems are dissolved and their functions absorbed.

7. Discourage or do away with the employer-provided health insurance model.

Thanks for your input. :)
~ Tim ~
hot topics & current events: The Bill Sebastian Forum

Aiken
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Joined: Thu Jul 14, 2005 6:53 am

Post by Aiken »

One of the things you'd probably have the hardest time with is #5. The idea of a patient being involved in making the cost/benefit analysis with doctors and treatments is an issue, because most patients are frankly nitwits when it comes to medicine.

It's not like buying food, for instance. Like health care, we all need food from time to time to stay alive. However, our bodies are kind enough to let us know the requirements for food, in loud and certain ways. Beyond discomfort, though, there's no good barometer for a layman to know exactly how much of the offered care is necessary, or how well-rendered it was, since medicine is an extremely (and increasingly) complex science. Thus, someone might decline a complicated and difficult-to-understand treatment that they deem a ripoff, which is in fact the cheapest possible way to keep them alive.

A possible solution is third-party advisors, or at least second opinions, but then you get into the neighborhood where collusion or bribery, or perhaps some other form of corruption, are possible. Unfortunately, these factors show themselves over and over to be real and common.

Personally, other than needing to improve what is currently implemented as medicaid, I'm not entirely sure the US system is as broken as people assume it is. I think there are a lot of comparisons made to socialized medicine, which are unfortunately superficial to the point of "omg free health care rocks," and don't consider the bigger picture. To elaborate...

If you look at another country and see operation X appearing to be "free," then it's inevitable that the same operation at $20,000 will seem ridiculously expensive. However, if it happens that you can work out that the cost was really about $24,000 in taxes, or, heck, let's be generous and say it was an unlikely $15,000 in taxes, then it's harder to claim that there's a huge disparity, or that there's a glut of corporate greed driving prices insanely high. It then seems more like a believable variation with a probably-rational explanation.

It's difficult, though, to see all aspects of more than one nation's system, because you pretty much have to live with it for a long time. I've spent about 60% of my life in Canada and 40% in the USA, so the nuances of each system are a lot clearer to me than to most. It doesn't appear to be that way for a large number of americans, who see the system as fraught with corruption and overpricing due to the seemingly-huge differences in cost vs. socialized countries.

I know I'm kind of reiterating things I said in your other thread, but some of these factors are important to keep in mind, because if you don't incorporate them into your set of givens, then you end up building your structure on a sketchy foundation. For instance, in this case, starting from the position of thinking our health care is overpriced would be unwise.
Last edited by Aiken on Mon Apr 06, 2009 7:00 am, edited 1 time in total.
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.

Aiken
Posts: 880
Joined: Thu Jul 14, 2005 6:53 am

Post by Aiken »

As an aside, I'd like to mention something I learned recently that frustrates me very, very much.

Since developing drugs (including the far larger number of failed drugs) and getting them tested and to market costs a great deal in the first place, drug manufacturers generally recoup the costs through the selling price. However, it's common for socialized systems to set price caps that drug manufacturers cannot exceed, so that's a problem.

When you can't get a sufficient selling price in country A to offset the cost of R&D, what do you do? You jack up the price in country B, where there aren't artificial limits.

I say this because one reason why there's a huge disparity in drug costs between Canada and the USA is because the USA retail prices subsidize the restricted Canadian (and other countries') prices. So, the low prices in Canada et al actually inflate the prices in the USA.

I suspect that if all countries were socialized, the drug companies would have a hard time breaking even and might even go out of business, or at least divert their attention to an industry where they could actually make money. That, or the government would have to relent with its price caps.
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.

coaster
Posts: 58
Joined: Fri Jul 14, 2006 12:56 am
Location: Wisconsin

Post by coaster »

I like the idea of third party advisors. I think the reason people are "nitwits" is because everything is done for them. The Medicare Part D was a huge fiasco when it first came out. Now that seniors have educated themselves on it, it seems to be running much smoother.

The drugs issue you mentioned, Aiken, is to me, the thorniest issue. To be fair, all countries should bear the cost of R&D equally. This would require negotiations with literally hundreds of countries. Not likely. What about putting an export embargo on newly patented drugs until R&D is recouped? Ah, but then the U.S. would be accused of even nastier things than normally we're accused of. I don't know. Just let that part slide, or is there another way that I'm missing?
~ Tim ~
hot topics & current events: The Bill Sebastian Forum

ViewsAskew
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Post by ViewsAskew »

Coaster, something in another thread just reminded me of one of the biggest pet peeves I have about insurance: number 1 on your list. The more they learn about RLS, the more companies are starting to deny coverage. What crap!

I've been denied 3 times so far. Good thing I didn't need that insurance, but was just checking to see what my rates would be if I switched. Guess I know I cannot switch, either.

The whole group thing is baloney in terms of the private companies who get to play by different rules. While there are many things I want changed, I'd breath a huge sigh of relief if I knew that I could always fine a carrier and that the rate would be similar to what I'd get in the corporate world.
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
Posts: 58
Joined: Fri Jul 14, 2006 12:56 am
Location: Wisconsin

Post by coaster »

I'm sorry to hear about your insurance. I'm so thankful I had a great benefits package with the company I was with; after 15 years of service they pay 80% of the premium. Still.....I suppose they could drop that at any time. They're self-insured, so minimal regulations.

Our friends in countries with national health systems who complain about waiting for the doctor or hospital have no idea how it feels wondering if you're even going to be able to see a doctor next year if you lose your insurance. Have no idea how it feels to have to keep working at a job you hate because you can't afford to lose the health insurance. You get a job at another company and then what you were covered for now becomes a pre-existing condition.

This is not health care in this country, it's health terror.
~ Tim ~
hot topics & current events: The Bill Sebastian Forum

ViewsAskew
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Joined: Thu Oct 28, 2004 6:37 am
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Post by ViewsAskew »

I am lucky - I do have insurance, but it's from a source that could easily stop providing it at any time. Being self employed, I'd have to give up my business to get insurance. That's just wrong! I still can't comprehend that I'm uninsurable by a private company and that if I lost what I have, I'd be without.
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
Posts: 58
Joined: Fri Jul 14, 2006 12:56 am
Location: Wisconsin

Post by coaster »

I had a lengthy and interesting conversation with a knowledgeable person inside the insurance industry yesterday, giving me some insight on how the insurance industry would view a two-tier hybrid risk-sharing system as I proposed. Mainly I wanted to get a sense of whether it would be easier to underwrite the bottom tier or the top tier. I didn't get any firm answer because that depends on the actual numbers. What I did get is that insurance companies don't want to underwrite risk when the maximum possible loss is unknown. So that gives me the sense that insurance companies would do a better job insuring the bottom tier, with the government insuring the top. Unless a three-tier system is used, with private insurance companies insuring the middle, and the government the top and the bottom. This adds another level of complexity, though. This would make the government the payor for the high claims frequency of routine care and minor ailments and also for the super-catastrophic but low-frequency claims of major illnesses. It's worth considering, I think, despite the extra level of complexity.

Actually this idea of insuring up to a cap is already used extensively in the insurance industry through re-insurance. Essentially an insurance company buys insurance from another insurance company (the re-insurer) to cover claims over a certain amount. So if we think of the government as the re-insurer, then this tiered system of risk is something they're already quite used to working with. And with the already extensive claims history, they should be able to competitively price insurance policies.

Any more thoughts would be welcome. ;)
~ Tim ~
hot topics & current events: The Bill Sebastian Forum

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