Here are my ideas for healthcare "improvements"

[battlemaiden]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. Why can't this be done? We absolutely have to have proof of insurance to drive. Same goes for health insurance. But only if it is done by individuals and family.

 

Set up a rating system for insurance companies- like Amazon third parties.:D You can leave comments if you had a great experience, or if they screwed you out of coverage. Transparency, Transparency, Transparency.

 

Do the same rating system for doctors. I would even be willing to have the government run the website for these ratings. It's cheap.

 

I have more, but those are my main pillars of the plan. Individual responsibility and transparency. It is simplistic, I know, but those main pillars would solve soooo many of the problems.

 

What do you think?

[OHGrandma]

Between 5% & 15% of the drivers on the road are NOT insured at any one time. The bureaucracy created by the gov't to try to verify liability insurance is very costly, for the gov't and the insurance companies.

So, requiring insurance doesn't work.

[TXMomof4]

In Dallas they just started towing your car if you're stopped for any reason and don't have insurance. I'm not sure what sort of penalty you could offer for not having health insurance though. Hmmm....my firstborn child? I might take you up on that today! (JUST KIDDING, mostly)

[Carol in Cal.]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. Why can't this be done? We absolutely have to have proof of insurance to drive. Same goes for health insurance. But only if it is done by individuals and family.

 

Set up a rating system for insurance companies- like Amazon third parties.:D You can leave comments if you had a great experience, or if they screwed you out of coverage. Transparency, Transparency, Transparency.

 

Do the same rating system for doctors. I would even be willing to have the government run the website for these ratings. It's cheap.

 

I have more, but those are my main pillars of the plan. Individual responsibility and transparency. It is simplistic, I know, but those main pillars would solve soooo many of the problems.

 

What do you think?

 

And that is that individual policies are underwritten. Not everyone can get them. If you get sick, the price can become unaffordable the next year. Your plan needs another pillar--guarenteed issue/guarenteed pricing.

[Anne]

I'd like to see some serious tort reform/malpractice reform. I think the fear of being sued drives a great deal of unnecessary tests/procedures done by doctors. I also think the huge malpractice insurance premiums charged to doctors affect the fees doctors charge their patients.

 

Anne

[Cedarmom]

I like it!

[battlemaiden]

Between 5% & 15% of the drivers on the road are NOT insured at any one time. The bureaucracy created by the gov't to try to verify liability insurance is very costly, for the gov't and the insurance companies.

So, requiring insurance doesn't work.

 

 

 

More costly than what is being proposed in congress?

 

There will ALWAYS be uninsured- for everything. Can you give a source for the 5-15% stat? I am not suggesting there won't some who choose not to get insurance. But I don't think it is the Government's job to provide it either. There must be a balance.

[battlemaiden]

And that is that individual policies are underwritten. Not everyone can get them. If you get sick, the price can become unaffordable the next year. Your plan needs another pillar--guarenteed issue/guarenteed pricing.

 

Yes. I agree. But the exposure to competition, via very public and transparent scrutiny of insurance companies should keep down the abuse of price gouging or refusal of treatment. It works. And if people were responsible for their own insurance, gaps between job changes would expose less people to insurance denial based on preexisting illness.

[OHGrandma]

More costly than what is being proposed in congress?

 

There will ALWAYS be uninsured- for everything. Can you give a source for the 5-15% stat? I am not suggesting there won't some who choose not to get insurance. But I don't think it is the Government's job to provide it either. There must be a balance.

 

Insurance Research Council: http://www.ircweb.org/news/20060628.pdf

 

I don't know if it could be more costly than what is being proposed by congress(need tongue in cheek smiley!). But if the purpose of health care reform is to insure everyone, I just wanted to point out how gov't requiring insurance does not result in 100% insureds.

[battlemaiden]

I'd like to see some serious tort reform/malpractice reform. I think the fear of being sued drives a great deal of unnecessary tests/procedures done by doctors. I also think the huge malpractice insurance premiums charged to doctors affect the fees doctors charge their patients.

 

Anne

 

Yes. I didn't want to include this in the pillars.I believe this should be done too, but it is less of a root cause to insurance problems than most people think.

[LG Gone Wild]

My memory is a bit foggy but if (and that is a big if) I can remember correctly, part of the high cost is government interference. It started back when congress fiddled with health insurance stuff. ..

 

A solution would have to (1) address how much government meddling has affected cost, (2) illegal immigration, (3) frivolous lawsuits (4) waste, fraud, and abuse in medicare and medicaid that have also contributed to high health care cost.

 

It seems to me that problems with insurance coverage is a result of these things and not the root of the troubles with healthcare costs.

 

It surprises me that people want government to fix things, particulary the US government. I can't think of anything that it has done well, kwim? I certainly don't want my health to be overseen by it, egads. Here is my list of government mess ups:

 

US Postal service

Amtrak

Fannie Mae

Freddie Mac

Medicare

Social Security

Medical (this is California)

DMV

DHS

TARP

 

I am sure there is more.

[battlemaiden]

Insurance Research Council: http://www.ircweb.org/news/20060628.pdf

 

I don't know if it could be more costly than what is being proposed by congress(need tongue in cheek smiley!). But if the purpose of health care reform is to insure everyone, I just wanted to point out how gov't requiring insurance does not result in 100% insureds.

 

I see. No, my purposes are not to insure everyone. I see it a bit differently. I also think hospitals should be given the authority to triage and send away non-emergency patients. But that is further away from my point.

 

I'm trained as a RN. I have seen what comes through the ER- it is unnecessary to treat much of what comes through the door there. But people have gotten in the habit of using it as their primary care clinic. There is very little individual responsibility taken when the care is "free." I think hospitals should have auxillary clinics and should have incentive to subsidize that care.

 

But my main pillars stand. As long as people are not paying for their insurance, In other words, if the government is paying...I mean we, the taxpayers, are paying, the abuses of healthcare will continue, and people will make few changes to their lifestyle to promote their own optimal health. And the cost will rise unsustainably, as in Massachusetts.

[OHGrandma]

I see. No, my purposes are not to insure everyone. I see it a bit differently. I also think hospitals should be given the authority to triage and send away non-emergency patients. But that is further away from my point.

 

I'm trained as a RN. I have seen what comes through the ER- it is unnecessary to treat much of what comes through the door there. But people have gotten in the habit of using it as their primary care clinic. There is very little individual responsibility taken when the care is "free." I think hospitals should have auxillary clinics and should have incentive to subsidize that care.

 

But my main pillars stand. As long as people are not paying for their insurance, In other words, if the government is paying...I mean we, the taxpayers, are paying, the abuses of healthcare will continue, and people will make few changes to their lifestyle to promote their own optimal health. And the cost will rise unsustainably, as in Massachusetts.

 

But I thought the whole purpose of health care reform was to have everyone insured?

I agree with everything else you said.

[TraceyS/FL]

Yes. I didn't want to include this in the pillars.I believe this should be done too, but it is less of a root cause to insurance problems than most people think.

 

Not according to the doctors that i've talked to on the subject.

 

The premiums are OUT. OF. SIGHT. They just can't afford to stay in private practice these days between those and the crappy payments they get from the insurance they do accept.

 

IT's not pretty....

[sthompson]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. Why can't this be done? We absolutely have to have proof of insurance to drive. Same goes for health insurance. But only if it is done by individuals and family.

 

Set up a rating system for insurance companies- like Amazon third parties.:D You can leave comments if you had a great experience, or if they screwed you out of coverage. Transparency, Transparency, Transparency.

 

Do the same rating system for doctors. I would even be willing to have the government run the website for these ratings. It's cheap.

 

I have more, but those are my main pillars of the plan. Individual responsibility and transparency. It is simplistic, I know, but those main pillars would solve soooo many of the problems.

 

What do you think?

 

I agree that we should eliminate the employer benefits programs. If not for the governments interjection many, many moons ago we wouldn't have it in the first place.

 

Requiring someone to have anything is part of the problem. We should not be required to have health insurance anymore than we should be required to have car insurance. I personally would rather put that same $700/month in the bank for emergencies as opposed to paying an insurance company and have them tell me that they won't cover something.

 

Having a rating system would be awesome if you chose to use the insurance companies. It would make for better competition. Something I believe the gov't will be taking away with their plan.

[JennC]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. Why can't this be done? We absolutely have to have proof of insurance to drive. Same goes for health insurance. But only if it is done by individuals and family.

 

What do you think?

 

 

Another important thing, IMO, is to make all first dollars up to a certain amount be out of pocket. This does two things - puts the consumer in charge & makes it the consumer's responsibility.

 

Also, I don't believe that anyone should be forced to purchase any type of insurance plan or be penalized by a tax if they don't.

The government is not our guardian. Choose not to be insured? Fine, pay it yourself. Don't have the money? Fine. Sell some of the stuff you CHOSE to use your money on instead. Don't have enough still? Wow, are you in a quandry - my taxes should not be required to bail you out. Maybe you better set up a payment plan.

It is not illegal to be stupid or make stupid decisions. It is not always stupid to be uninsured.

[battlemaiden]

But I thought the whole purpose of health care reform was to have everyone insured?

I agree with everything else you said.

 

 

I just don't think it is possible. There will always be the homeless- I worked in a Salvation Army medical clinic in college. They did a great job, and they were able to deal some of the root causes of problems.

 

There will always be illegal aliens. We have public health departments all over the country already. We've been underfunding those existing programs. We don't need to create new beauracracies. I'm radical enough to believe these public health offices should charge a minimal fee for certain services- $5, $10 etc. Nothing for absolutely free unless you are completely destitute. We must move away from dependence on the government. It is NOT a kindness to make people dependent on a dispassionate distant government. This didn't work out well with Katrina, and it wouldn't with healthcare. We must help people break away from that mindset and empower them to be involved in their own healthcare.

 

Everyone should be *expected* to get their own insurance. If there is true competition, the costs will come down.

[KrissiK]

Tort reform - definitely. Doctors should "have" to perform 2-3 tests if they can get the info from one test, but they don't want to get sued.

[OHGrandma]

I just don't think it is possible. There will always be the homeless- I worked in a Salvation Army medical clinic in college. They did a great job, and they were able to deal some of the root causes of problems.

 

There will always be illegal aliens. We have public health departments all over the country already. We've been underfunding those existing programs. We don't need to create new beauracracies. I'm radical enough to believe these public health offices should charge a minimal fee for certain services- $5, $10 etc. Nothing for absolutely free unless you are completely destitute. We must move away from dependence on the government. It is NOT a kindness to make people dependent on a dispassionate distant government. This didn't work out well with Katrina, and it wouldn't with healthcare. We must help people break away from that mindset and empower them to be involved in their own healthcare.

 

Everyone should be *expected* to get their own insurance. If there is true competition, the costs will come down.

 

Aahh, we still agree then. But I think the people who want UHC think it's possible for everyone to have coverage.

[Sara R]

I like your ideas.

 

I would add:

 

(1) More transparency ideas: posted prices so consumers can decide whether or not they need a service before they use it. Have available a set number of standardized insurance policies for consumers to choose from.

 

(2) Get-the-government-out-of-the-market idea #1: Repeal any laws that define what insurance companies must cover. It's ridiculous that insurance companies that cover breast cancer must also cover a $100,000 reconstruction/revisions/etc. Also ridiculous that meds like Viagra must be covered.

 

(2a) Get the government out of the market idea #2: Charity care at ERs should not be mandated by law. It's horrible to contemplate turning away true emergencies, but the consequence of not turning them away is looking at routine medical complaints in ER, long wait times (reducing care available for true emergencies), and horribly high bills for the people who actually pay. Charity care should be separated from regular care, at least to the point where regular care doesn't cost twice as much or more to offset those who don't pay their bills. That just encourages more people to not pay their medical bills. It's getting to the point now that people who do pay their medical bills are feeling like chumps.

 

(3) Make insurance actual insurance, not prepaid medical expenses. The purpose of insurance is to insure against catastrophe. Normal medical care should be budgeted for and paid for out of pocket. Encourage HSAs so people can set aside money for their own medical care expenses. I know in our household this has drastically cut our doctor's visits; I'm sure the same will be true in just about every household. The cost savings from this one thing could be huge. This has other benefits besides cost savings: (a) if the money is sitting in the HSA, people will pay their medical bills more quickly, making hospitals more efficient; (b) if insurance is used for only catastrophic emergencies, it doesn't have to be involved in most medical transactions, which should cut down on money wasted by insurance bureaucracy.

 

(4) Coming to terms that many modern medical advances are becoming unaffordable. I don't know the solution for this one, but it's something that people need to think about. Always remember that the money to pay medical bills comes from someone actually working somewhere else in the economy (or from yourself working in the past, or others in your family working, and saving the surplus then for your needs today). There is a lot less money floating around than there was a few years ago. I think eventually that's going to mean that expensive medical care is going to be out of reach of all except the very wealthy. People aren't going to come to terms with this very well, but getting the money by borrowing from foreign governments or printing money isn't a long-term solution.

Edited July 23, 2009 by Sara R

[LG Gone Wild]

 

(3) Make insurance actual insurance, not prepaid medical expenses.

 

 

Succint.

[mommaduck]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. Why can't this be done? We absolutely have to have proof of insurance to drive. Same goes for health insurance. But only if it is done by individuals and family.

 

Set up a rating system for insurance companies- like Amazon third parties.:D You can leave comments if you had a great experience, or if they screwed you out of coverage. Transparency, Transparency, Transparency.

 

Do the same rating system for doctors. I would even be willing to have the government run the website for these ratings. It's cheap.

 

I have more, but those are my main pillars of the plan. Individual responsibility and transparency. It is simplistic, I know, but those main pillars would solve soooo many of the problems.

 

What do you think?

 

A sure way to guarantee that MORE families will be left without insurance.

 

And if you want to fine families for not having insurance, you are not only taking money they don't have for insurance, but now cutting into their limited grocery, rent, utility budget.

 

 

Oh, and you would have a person die of an untreated non-emergency infection simply because they can't afford to see a primary care doctor. There are families out there working up to 60hrs a week at one or two jobs and still barely making ends meet...because of inflated cost of living and companies lowering wages or laying off those that make a living and hiring twice as many others that will work for half the price and not make an adequate living.

Edited July 23, 2009 by mommaduck

[farmmom4him]

Ok, if we do away with employer base ins, we need to get ins companies to accept all, no matter what the conditions. Our dd who is a whopping 6 mos can not get individual ins because of RSV. If you take every child who has had rsv, that is a lot. Supposedly, she must go 10 yrs without a respiratory, ear, sinus infection or any other possibly related issue that needs prescription meds, or other treatment beyond over the counter medication. We would kill her trying to do that, so we have a group policy through our farm.

 

I think locking in reasonable charges would help a lot. Many charges are regulated. Healthcare is a monopolized necessity that has gotten out of control.

[TXMomof4]

I see. No, my purposes are not to insure everyone. I see it a bit differently. I also think hospitals should be given the authority to triage and send away non-emergency patients. But that is further away from my point.

 

I'm trained as a RN. I have seen what comes through the ER- it is unnecessary to treat much of what comes through the door there. But people have gotten in the habit of using it as their primary care clinic. There is very little individual responsibility taken when the care is "free." I think hospitals should have auxillary clinics and should have incentive to subsidize that care.

 

But my main pillars stand. As long as people are not paying for their insurance, In other words, if the government is paying...I mean we, the taxpayers, are paying, the abuses of healthcare will continue, and people will make few changes to their lifestyle to promote their own optimal health. And the cost will rise unsustainably, as in Massachusetts.

 

Two weeks ago, ds smacked himself in the head with a latch out at the horse barn. It wasn't a huge cut, but it really needed stitches because it was DEEP. I was trying to get a referral to an urgent care place because it was ridiculous to go to the er for a little cut on the head. However, there was no one available to give referrals after 5:00pm. The urgent care place said after x number of hours they can't do stitches because of the risk of infection. So, that left us with the ER as our only choice. I went and sat down - looked around and left. Ds will have a pretty good scar on his forehead, but there were real emergencies coming in right and left, plus all of the "I don't have insurance so I'm here because my child has a cough" people. It absolutely was not worth it to sit there for hours exposing all of my children to heaven knows what to prevent a scar.

 

The insurance company made the ER my only choice in that situation when there are plenty of good places to get stitches outside of an ER. At a significantly lower cost. Ridiculous!

[Mommyof4ks]

I'd like to see some serious tort reform/malpractice reform. I think the fear of being sued drives a great deal of unnecessary tests/procedures done by doctors. I also think the huge malpractice insurance premiums charged to doctors affect the fees doctors charge their patients.

 

Anne

 

:iagree: We are so thankful that at least my son's clinic does not do 'random' tests 'just in case' (mainly because radiation and such is very bad for him, well everyone, but especially him), but I have had docs want to send me for a CT scan on the off chance that I had x,y or z in order to cover their rear ends. All of those tests are great if they are necessary, but there are risks to patients and no one mentions that.

 

My family would not be able to get the individual policy that OP mentioned, because my 4 yr old is a 'drain on the system'. We only pay $100 a month through dh's employer, but we would not even get an individual policy if we paid $1000 a month.

[mommaduck]

If the employed got the $$$ instead of the "hidden benefit" they could decide for themselves how to use the money for insurance. Employers who pay $100,000 for an employee's salary assume the liability of $150,000, which includes the costs for insurance--which is often much more insurance than any individual needs. The upshot is that the individual takes home much less money than s/he would if s/he had the *choice* as to what to do with it. (I am using the $100,000 number because it is easy for math--but the ratio is usually 50% uplift.)

 

Our family purchased catastrophic insurance --which is by definition what health insurance was originally *about*-- and we pay cash for all non-catastrophic care.

 

We pay less than what insurers pay for their clients at every turn. So yeah, at the doctor's visit, the insured pay less, because they have paid big money into insurance already. I pay less for insurance, AND I pay less at the doctor's THAN THE INSURER pays. The reason? It is cheaper for the doctor to deliver services to me because of the paperwork involved, and because of the decreased likelihood of lawsuit. So the insurer pays $54 to my chiropractor, I pay $36. The insured can't get a phone-call check-in with a doctor--it is not allowed--so the insurer pays $150 for a doctor check-in because he must go in to the doctor, where I pay $75 cash *and* save a 70 mile round-trip drive (time and money).

 

The point is that part of the *cost* of health CARE is due to the fact that it is encumbered by health INSURANCE. The two are conflated.

 

There are risks in living. Insurance is not about the day-to-day requirements of living. It is for the extraordinary events. The problem with our healthcare system is that we have attempted to offload the normal events of of our life into the realm of the extraordinary, and the model simply doesn't work.

 

What's next?

Grocery insurance so we can all have what we want to eat, when we want it?

Clothing insurance, so we can all be fashionable?

Education insurance so we can all attend Harvard?

 

Do not think I am stupid about the costs of healthcare. I have been in need of (and blessed by) more healthcare than any three people together on this board. For the past 8 years, I'll bet I have spent more on healthcare in any given year than a student would spend on college tuition. I'm not ignorant as to the costs. I am also very thankful for the benefits I have derived because the healthcare was available to me. I am aware that the doctors (and alternative practitioners) I visit do a LOT of pro-bono work with is effectively funded by the fees paid by the insurers and self-payers. I don't resent this at all. I'm glad they have the ability and heart to do this.

 

But I guaron-dang-double-tee that what I have been able to self-pay would not have been approved for payment under a single-pay system. I am very glad I have been able to self-pay for a medical treatment the FDA does not and never will approve. I know that without it, at this point, I would not have the energy to resist or even to write this post.

 

I am very grateful to live in a country where I have had access to great medicine and the ability to choose the path that no government would approve, one that has taken me back to health.

 

One thing I think people should think about: the plastic surgery medical practice has more reasonable rates than most of the rest of the surgical practices. They are also the least insured, least regulated practices--meaning they are mostly cash-pay. I think it is worth thinking about, that there might be a relationship between the freedom of the market and lower costs.

 

Most companies, if they didn't pay for insurance, would not pass that savings onto their employees...they would simply keep their profits and continue paying their workers low wages. This has been proven by the various tax breaks companies get...they get the breaks, but they certainly don't raise the worker's wages. Hubby's company is earning MORE right now and has a lot of business. None of it is going to the employees. In fact, they have laid off 10 employees and hired temps. And they canceled the company picnic "because of cost" (uhm what cost? BBQing up at the park or pot luck).

[Vida Winter]

Just a few late-nite thoughts-

 

We currently have a system that is broken down as follows:

Low income = free insurance

Middle income = very expensive insurance that families can't easily afford unless subsidized by an employer

high income = very expensive insurance but doesn't matter much since they can afford it.

 

!. Tort reform, to bring down malpractice insurance. What doctors have to pay for this is obscene. Bring malpractice insurance down, and medical care costs will go down. Let the lawyers take a pay cut.

 

2. Changes to Medicaid and Medicare. These programs are being subsidized by the taxpayer because they pay the facility so little. This is important -- please realize that the government is causing many of the problems it seeks to "cure" now.

How could they be changed?

a) Require a co-pay from Medicaid patients. I know they cannot afford much but paying zero encourages abuse of the system. Using the ER as your primary care doc is an abuse that is encouraged by the way Medicaid is set up.

b) Make citizenship a requirement for use of government programs. Illegals have been the cause of many ER closures. Sorry if that sounds heartless but if someone is in this country illegally, they should not automatically receive free health care.

c) There should be some way to legally be able to turn away individuals who come to the ER with the sole intent of obtaining narcotic drugs. It is tricky because these individuals have studied and rehearsed what to say. This is a big problem with repeat offenders, costs a lot and uses up time that would be better spent on patients with legitimate problems.

 

3. I agree with the poster who says to use insurance for what it was intended for - catastrophic coverage. If we were to pay out of pocket for some things, market forces could work to improve quality of care and decrease cost.

 

4. Wherever possible, keep government out of the health care system. Government intervention = inefficiency & waste.

[creekland]

I think everyone should be in non-profit co-ops or health sharing programs. This, of course, means that many more of them would need to be set up...

 

These groups would be set up to have everyone in a similar grouping of people who wouldn't mind sharing each others health needs. Christians have a couple of options already. Groups could be based on anything... an occupation, place of residence, love of cigarettes, even an "I love blue" group. Each group would decide what is covered and what isn't and you could have an internet site where individuals could put in what they wanted covered and see what groups would be open to them - and what the monthly share rate is for each.

 

Then, each month, needs are submitted, checked for fraud, and paid out by fellow members. A membership fee for all who belonged would pay the staff, electric, and other assorted bills, but otherwise, the only monthly fee would be actual medical payments (normalized to keep the payments the same each month - extra going into a gov't fund). If needs outweighed payments in unexpectedly, then the gov't fund could cover it. If this happened three months in a row, then the normalized payment would go up to reflect reality for that group.

 

Pre-existing conditions would be covered - as long as there was no ethical reason for not covering them in that particular group (ours don't cover abortions). Group change could happen anytime one wanted (lower rates in 'x' group or suddenly deciding one likes red, not blue).

 

Those not wanting any coverage could sign to that effect and stay out of the system - then couldn't sue and shouldn't complain when/if they don't have the cash to pony up in their times of need.

 

Otherwise, everyone else would be sharing each others needs within their group - presumably other similar minded people just like themselves (more or less). This isn't much different than insurance, but without the profit of insurance companies - bringing the costs down to everyone. People that have jobs with insurance companies could easily switch to being staff with their favorite group... or with the overall internet site listing the options.

 

The gov't would still need a minor role - having the fund that would accept overpayments and redole it out when there is an extraordinary need - or covering when needs go up, but before the 3 month time period to readjust that group's payments, but it would cost a LOT less than anything else I've seen proposed.

 

I don't like either the current system of insurance or socialized care, but I VERY willingly send payments monthly to my peers to help in their times of need and have accepted payments in our times of need.

[TraceyS/FL]

We pay less than what insurers pay for their clients at every turn. So yeah, at the doctor's visit, the insured pay less, because they have paid big money into insurance already. I pay less for insurance, AND I pay less at the doctor's THAN THE INSURER pays. The reason? It is cheaper for the doctor to deliver services to me because of the paperwork involved, and because of the decreased likelihood of lawsuit. So the insurer pays $54 to my chiropractor, I pay $36. The insured can't get a phone-call check-in with a doctor--it is not allowed--so the insurer pays $150 for a doctor check-in because he must go in to the doctor, where I pay $75 cash *and* save a 70 mile round-trip drive (time and money).

 

 

This actually hasn't been my experience around here. Cash payers are paying more to make up for the crappy payments from the insurance companies. I keep thinking they'd prefer me paying cash - but not really.

[TraceyS/FL]

Just a few late-nite thoughts-

 

We currently have a system that is broken down as follows:

Low income = free insurance

Middle income = very expensive insurance that families can't easily afford unless subsidized by an employer

high income = very expensive insurance but doesn't matter much since they can afford it.

 

!. Tort reform, to bring down malpractice insurance. What doctors have to pay for this is obscene. Bring malpractice insurance down, and medical care costs will go down. Let the lawyers take a pay cut.

 

2. Changes to Medicaid and Medicare. These programs are being subsidized by the taxpayer because they pay the facility so little. This is important -- please realize that the government is causing many of the problems it seeks to "cure" now.

How could they be changed?

a) Require a co-pay from Medicaid patients. I know they cannot afford much but paying zero encourages abuse of the system. Using the ER as your primary care doc is an abuse that is encouraged by the way Medicaid is set up.

b) Make citizenship a requirement for use of government programs. Illegals have been the cause of many ER closures. Sorry if that sounds heartless but if someone is in this country illegally, they should not automatically receive free health care.

c) There should be some way to legally be able to turn away individuals who come to the ER with the sole intent of obtaining narcotic drugs. It is tricky because these individuals have studied and rehearsed what to say. This is a big problem with repeat offenders, costs a lot and uses up time that would be better spent on patients with legitimate problems.

 

3. I agree with the poster who says to use insurance for what it was intended for - catastrophic coverage. If we were to pay out of pocket for some things, market forces could work to improve quality of care and decrease cost.

 

4. Wherever possible, keep government out of the health care system. Government intervention = inefficiency & waste.

Overall i agree.... in fact, i'm pretty sure i voted to exclude illegal aliens from receiving stuff in CA before i left - but well, that didn't work did it? Let them PAY for it, but stop giving them free medical, food and schooling. Save that for the citizens.

 

ANYWAY..... our kids are on the states program here, we do have a small monthly premium, and i'm sure that is to get parents to take "ownership" in it. Don't pay, they are kicked out for 60 days.

[creekland]

This actually hasn't been my experience around here. Cash payers are paying more to make up for the crappy payments from the insurance companies. I keep thinking they'd prefer me paying cash - but not really.

 

I can't speak for all, but I know our local medical clinic/dr. gives an automatic 10% discount for paying cash.

[Jugglin'5]

This actually hasn't been my experience around here. Cash payers are paying more to make up for the crappy payments from the insurance companies. I keep thinking they'd prefer me paying cash - but not really.

 

 

Yeah, around here you could get a cash discount 10 years ago, but now the policy seems to be, "Let me get the money from the cash payers to make up for what I can't get out of insureers or Medicare/Medicaid". :glare:

[mommaduck]

Hey, Mommaduck,

I'm not meaning to be argumentative, but I have to say that my experience is different. Worker's wages are much more closely tied to what it takes to hire good employees than to tax breaks--market forces. Companies are required to offer either insurance or no insurance. The company I worked for had most of the employees requesting the difference in the salary for salary, not benefits, but the law prevented that option. Legal interference was the deciding factor.

 

Tax benefits are still an interference from the government.

 

I don't think we have a perfect system for health care. I do think it is preferable to any other that has been implemented. Sort of like democracy: who was it who said that "Democracy is the worst form of government except for all the rest." Something like that. And I do think there are things that could be improved.

 

One of the main improvements is the taking on by the individual the care for our neighbor, as Christ commanded. But doing this by government extortion/enforcement is the least efficient way of benefiting the needy, and the obviation of the benefit to the individual soul.

 

Kind regards,

Patty Joanna

 

Patty, what kind of work did you do and what kind of company. I'm talking bottom of the pile factory work. The companies mess these people over the most. There's more workers than positions, thus they can mess them over all they want.

 

In our current situation, sure, we have "health insurance". The deductible is $5000 per person, per year. We are having to go on state medical care because with insurance like that we might as well not have insurance as everything is still coming out of OUR pocket. I WOULD rather the company just give us the money. But the fact is, if the company could get rid of the insurance, they would but we wouldn't see a dime in raises either.

[mommaduck]

Cash paying varies place to place. In IL I had doctors that refused, simply refused to take on patients that didn't have insurance, even if they were cash paying. Here, they offer a discount to those that pay upfront cash.

[Lawana]

Remove employer based healthcare insurance.

 

Require people find their own like auto insurance. .

 

I have more, but those are my main pillars of the plan. Individual responsibility and transparency. It is simplistic, I know, but those main pillars would solve soooo many of the problems.

 

What do you think?

 

In your proposed system, what would happen with those that have chronic conditions?

 

Dd has Type 1 diabetes. She has an insulin pump that cost $6000 with a useful life expectancy of 4 years. She changes her infusion set every three days at a cost of $25. Insulin runs $180 per month. Test strips add another $6 a day. 4 doctor visits per year at $220 plus tests. So the yearly minimum cost, just for maintenance, assuming nothing goes wrong, is $8572. And that is actually unrealistically low, because it never happens that she can use just the minimums, and I've left out a few things.

(These costs are the amounts without insurance.)

 

In the present system she cannot get an individual insurance policy. Would your proposed system require insurers to issue policies to those with chronic conditions? Would you expect individuals to cover maintenance costs out of pocket such as those listed above?

 

I'm really interested to know what you think.

 

Lawana

[TraceyS/FL]

Yeah' date=' around here you could get a cash discount 10 years ago, but now the policy seems to be, "Let me get the money from the cash payers to make up for what I can't get out of insureers or Medicare/Medicaid". :glare:[/quote']

 

Yup, the place i go is $95 for a basic visit. Blue Cross reduced that to $65 and i had a $15 co-pay. Our insurance changed and we now had a $75 co-pay, and about the same reduction.

 

But if i walk in with cash today - because i have no insurance now, it's $95.

 

Same for my kids doctor and the dentist... no discounts for cash.

 

 

I'm pondering a $40/mo policy from Blue Cross. They would pay $50 towards any visits, and I get their negotiated discounts on those visits. I can use any doctor i want - i get the $50 from them regardless. There are prescription benefits too, and it applies to dental also. There is no underwriting - they take everyone. I'm not sure what the court will order the STBXH to provide for me, we had insurance until recently. Individual policy for me is $250/mo and that isn't affordable for me right now (the $40 isn't at the moment either). At least i'd feel like i could afford to get sick. OH, it also has a no charge for labwork if you use Quest.

 

What it won't help me with is the knee, elbow and bladder surgery i need. individually i had no major medical policies offered to me.....

Edited July 24, 2009 by TraceyS/FL

[Eruditio_Academy]

That quote by C.S. Lewis is one of my favorites (I use it on my Facebook page) and Jonah Goldberg used it in his book "Liberal Fascism." It is because of the topics covered in that book that I say I would not even want the government to be in charge of the rating system you discussed. ...Trying to not be too political here (so I don't get kicked out...), but I firmly believe in LAISSEZ-FAIRE! You've got good ideas and I know there are millions more people with great ideas too, so let US fix our own problems and the politicians can take a vacation!

Edited July 24, 2009 by Eruditio_Academy