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November 25, 2007

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Lotin

What is the elevator runner guy's salary?

Do we need a elevator runner guy? Those elevator repairmen are expensive and the elevators can run themselves.

MayBee

Whenever I read a DailyKos diary about universal government-paid healthcare, I realize that what many people want is the right not to work and still get coverage.
I noticed it with the argument over the Frosts. Shouldn't he have the right to reject corporatism and follow his dreams, they asked?
But someone has to work to pay for the health care. If it is too expensive for an individual to pay for her COBRA while she is out of work, how can the taxpayers absorb *that* cost plus the cost of their own healthcare?

Jane

I have an idea. Why don't a few of the millionaires in the House and Senate get together and kick in and pay the elevator guy' mother's bill.

We had a democrat state senator in MA who was completely opposed to entitlements so he never opted into the state's very lucrative pension fund. After he was in the senate about 15 years he got a second opportunity, to be grandfathered in at no cost with full benefits dating back to the beginning of his service. Again he declined. He retired after 25 years and got very ill and died.

The senate decided that the taxpayers should award full pension benefits to his wife, despite the fact that he had never contributed, signed up for, or believed in them.

Romney proposed a bill that mandated that the senate and house each kick in something like $200 bucks a year and he and Kerry Healy would kick in $800 bucks to fund the pension benefit, so as to not place this giveaway on the taxpayers.

I'm sad to say I've never heard if it passed, so I suspect it didn't.

It's my favorite Romney as governor story, regardless.

dick

A brief note on the COBRA problem. I was offered COBRA when I left my last job (retired with golden parachute) at the age of 62. I was told that as part of the package my medical insurance would be covered for 3 months and then I would have COBRA. I went to my doctor and was told I had no insurance. I called the company and was told that the plan was passed off to an outside company to manage. I called them and was told that because I was no longer an employee my plan was cancelled and I had to reapply. I did so and they sent me the wrong forms. I got the right forms and submitted them and heard nada. I called back to the outside company and they told me I had to contact the insurance company. I tried and every time the phone would disconnect before I got to the head of the line. At the same time I was told to pay the COBRA so it would take over the insurance. There was no insurance in effect because I had nothing from the insurance company. I called to ask what the COBRA would pay for and they told me that if I did not pay it I would have to repay all medical bills for the 3 month period. I told them when the insurance company told me I had coverage I would pick up the COBRA as then I would be paying for something. The opportunity to pick up the COBRA passed and I never did hear from the insurance company nor could I ever get in touch with them. The second company told me that I had to call them on the phone and I was never able to get in touch with them on the phone at all.

I would call and be told I was 75th in line, then 60th in line, then 45th in line, then it would disconnect. I would call back and the same thing. Wash and repeat for 2 weeks with no resolution at all. I called back to my company and was told I had to work through the second company. The second company was no help at all. End result was no medical insurance for 3 years until I turned 65. I was just lucky that my emphysema did not get worse during that time.

The other thing is that COBRA would have been $299/month. For a retiree with no pension yet and no SSA, that is a chunk of change to kick in with nothing to show for it due to the insurance company phone problems. If I had paid it, what would I have been paying for?

dick

A brief note on the COBRA problem. I was offered COBRA when I left my last job (retired with golden parachute) at the age of 62. I was told that as part of the package my medical insurance would be covered for 3 months and then I would have COBRA. I went to my doctor and was told I had no insurance. I called the company and was told that the plan was passed off to an outside company to manage. I called them and was told that because I was no longer an employee my plan was cancelled and I had to reapply. I did so and they sent me the wrong forms. I got the right forms and submitted them and heard nada. I called back to the outside company and they told me I had to contact the insurance company. I tried and every time the phone would disconnect before I got to the head of the line. At the same time I was told to pay the COBRA so it would take over the insurance. There was no insurance in effect because I had nothing from the insurance company. I called to ask what the COBRA would pay for and they told me that if I did not pay it I would have to repay all medical bills for the 3 month period. I told them when the insurance company told me I had coverage I would pick up the COBRA as then I would be paying for something. The opportunity to pick up the COBRA passed and I never did hear from the insurance company nor could I ever get in touch with them. The second company told me that I had to call them on the phone and I was never able to get in touch with them on the phone at all.

I would call and be told I was 75th in line, then 60th in line, then 45th in line, then it would disconnect. I would call back and the same thing. Wash and repeat for 2 weeks with no resolution at all. I called back to my company and was told I had to work through the second company. The second company was no help at all. End result was no medical insurance for 3 years until I turned 65. I was just lucky that my emphysema did not get worse during that time.

The other thing is that COBRA would have been $299/month. For a retiree with no pension yet and no SSA, that is a chunk of change to kick in with nothing to show for it due to the insurance company phone problems. If I had paid it, what would I have been paying for?

Rick Ballard

"If I had paid it, what would I have been paying for?"

Under ClintonCoerciveCare the primary benefit is that you don't wind up in a reeducation camp in Barrow, AK. Aside from that, you as an individual will receive absolutely nothing with regard to medical care that is not available without charge today (upon proof of indigence).

Now, if you currently have medical insurance the benefits of ClintonCoerciveCare are much different. First off, your rates will not go down because that little note mentioned above

state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.
is going to apply to all the new coercees as well. Second, your quality of care will drop slightly (vide sopra) and third, you're going to spend more time waiting for that slightly lower quality of care.

Before you mention any slight problems that you may discern regarding ClintonCoerciveCare, be sure to read that sentence about the reeducation camp in Barrow, AK. It's pretty chilly up there.

MayBee

So dick, for $897 you decided to go uninsured for 3 years? Perhaps you, too, were among the young and invincible.

I did COBRA for a pregnancy. I like to think that if I could figure out how to get coverage, anyone could.

Paul Zrimsek

The Times doesn't mention a remarkably foolish "reform" that Massachusetts enacted along with the individual mandate: to outlaw the high-deductible plans that make the most sense for most of the voluntarily uninsured.

Rachel Soloveichik

This article glosses over a very fundamental point: Children aren't responsible for their parent's debts. Mr. Olaya does't owe a penny of himself. He's complaining about the fact that some of his mother's money was spent on medical bills - and so he won't get a big inheritance. Even after paying medical bills I'll bet he still gets a nice chunk of money. Most people get no inheritance at all.
I don't know whether we should spend tax dollars providing free medical care to poor people. But I'm pretty sure we shouldn't be providing free medical care to middle-class people just so that their kids can inherit a million dollar house.

cathyf

There is another suspicious piece of the story... You have 60 days to decide whether or not to take COBRA, and the coverage is retroactive. So if she had been unemployed "since December" then she had until February that she could have signed up and gotten coverage. And also, there is this whole portability issue. When you take COBRA, you not only are buying insurance for the period between jobs, but you are also ensuring that there will be no exclusions for pre-existing conditions when the new job starts. Imagine that Mrs. Olaya's stroke had been more minor and treated successfully and she completely recovered from that and was able to start the new job -- she would have still been screwed because she had decided to decline COBRA, and because of the lapse in coverage, they would have excluded the brain cancer.

Also, as far as "worst case" scenarios, this isn't it. Because, first of all, Mrs Olaya may not have had health insurance but she certainly had health care -- health care to the tune of $255,000 in about a month. And, to be brutally frank about it, she's dead, and doesn't actually need the house anymore. The son is not liable for the mother's bills, her estate is. So what this really means is that he gets a smaller inheritance than if his mother had acted more prudently and not gambled and lost with her health insurance premiums. Given the prices of real estate in the DC area, even a pretty modest house will leave the son with thousands of dollars even after settling his mother's debts. As opposed to, say, a random orphan aging out of foster care with nothing more than his belongings which fit in a plastic garbage bag...

Sounds to me like a fairly classic story repeated a bazillion times... Parents are prudent with money, leave large estate to children; parents are imprudent, children inherit little or nothing. Why should I feel more sorry for Sergio than for someone whose parents went on credit-card-financed spending sprees and die with a zero or negative net worth?

MayBee

cathyf and Rachel-
excellent points. When I had to do COBRA, it was because my husband's new company wouldn't cover my pre-existing condition (pregnancy). The new company also had a 3-month waiting period for insurance coverage. Most of our friends joining the company - the ones that weren't pregnant- just waited the 3 months to see if anything happened. If it had, they would have retroactively signed up for COBRA through their previous employers. If they made it 3 months with no medical problems, they had that money in their pockets.

Walter

Paul,

Insurance only works if the healthy subsidize the sick. Those enrolling in high-deductible plans wherein the healthy pay roughly their expected benefits do not contribute enough to others' care.

clarice

BTW, those elevator jobs in the Capitol are, as you may have guessed, plum patronage jobs.

cathyf

Maybee -- was this before June 30, 1997? Because after HIPAA companies weren't able to get away with excluding pre-existing conditions as long as you had been covered at the previous job, through COBRA, or some other way.

Paul Zrimsek

Walter is conflating risk pooling with community rating. High-deductible plans for the healthy achieve the former but not the latter; thus, they work just fine as insurance, but not at all as welfare.

bgates

Given the role of diet, exercise, and genetics in determining health, I wish some brave Democrat would take it upon herself to announce mandates on what we may eat, how much we must exercise, and who is allowed to reproduce.

bgates

Given the importance of diet, exercise, and genetics in determining health, I wish some brave Democrat would take it upon herself to provide mandates for what we may eat, how much activity we must have, and who is allowed to reproduce.

debate whether Americans should be forced to - it makes me livid to see this in print. Whatever comes before this phrase and whatever comes after it, the answer is 'no'.

Hey, getting so upset must be bad for my blood pressure. Maybe the government ought to regulate what I read. It wouldn't violate the First Amendment if they did it for my own good, right?

Walter

Paul,

Walter may have mistakenly assumed we were still discussing MA's mandatory insurance scheme. Allowing the healthy to opt-out of a larger risk pool increases the cost for those remaining and leads to the problem of adverse selection. Note that

In particular, state-subsidized insurance packages offered to low-income residents have been so popular that the program’s spending may exceed its budget by nearly $150 million.

I once worked for a banking subsidiary of a (then) Fortune 50 insurance company whose original product was a $500 burial benefit for a $5 monthly premium. The policies were sold and the premiums collected by door-to-door salesmen.

Somehow, the policies tended to lapse before redemption. [Perhaps the policyholders ran into financial difficulties, perhaps the salesmen couldn't make it out there for a few months, qui sait?] Those types of policies were immensely profitable and still a material part of the company's business when I last checked some 15 years ago.

My point? The way a market is structured and works in practice sometimes determines the result. My understanding is that the MA plan is similar to most universal insurance plans: Expand the risk pool and eliminate the problem of adverse selection. I could be wrong, but if I'm right, it is less than surprising that MA would like to broaden the risk pool[s] to provide acceptable underwriting performance at reasonable rates, thus reducing the need for public subsidies.

MayBee

cathyf- yes, pre 1997.

Topsecretk9

My friends not so smart ex informed her he was leaving his union grocer job for a union construction job and would it be alright with her if he didn't do the cobra for a few months until his new job probationary period and then benefits kicked in? Since they have 3 children she said NO - to no benefits - and since she worked as a bookkeeper and finance manager she knew that their health care provider actually would continue their benefits at a rate not much more than they were already paying -- if he just looked into it! (she did on her own and found it to be true, so she was going to stand her ground and say no benefits for 3 children was not only not apart of the divorce but morally not OK)

Well, he's so union minded he thought nothing of informing his employer he was planning on giving his notice in a few weeks ---- not telling them his plane was to get wrist surgery he was needing -- so he was dropped but at anytime he could initiate Cobra. Employers shouldn't have to pay benefits of employees not planning to work for them.

Telegraphing to your employer your plan to quit on such and such date is dumb, but had he done his homework (like suggested) he'd have found that their would have been very little disruption in his and his children's healthcare...since he needed his wrist surgery he had no choice than to pay the Cobra.


--they guy has a union job and only has to pay $200 per child = 600, in California! (p-nuts). He has nice things, a nice car, does nice things and lives with his parents and complains about all his obligations.

I am not about soaking a divorced father, and making his life a struggle...but come on? His health care provider was willing to continue he and his children's benefits at a slightly - slightly!- increased rate far below Cobra. AND his plan was to soak his employer for a PERSONAL injury BEFORE he left his job and THEN not do Cobra because it's too expensive.

Healthcare is a canard or a tool for the left. Nothing more, nothing less.

Topsecretk9

--and since she worked as a bookkeeper and finance manager she knew that their health care provider actually would continue their benefits at a rate not much more than they were already paying -- if he just looked into it!--

IIRC it was for a 3 month (but my memory says 6 month) period for transition ---(which make perfect market sense - they'd like to accommodate for when the choice comes up at new employer with new choices, you'd choose comfort and ease and remain the same)

Paul Zrimsek

Who said anything about "allowing the healthy to opt-out"? Letting them buy high-deductible plans would not have that effect; indeed, it would make them less likely to opt out. In any case, their presence in the risk pool lowers the cost to others only if they are overcharged for the benefit of the higher-risk population. Where adverse selection exists, it is created by just this sort of cross-subsidy.

Walter

Paul,

We seem to be in rabid agreement.

I see no difference from an economic perspective between a healthy person

  • purchasing a policy with a cost equal to the expected benefit, or,

  • given sufficient assets, electing to self-insure.

In either case, I'd describe the choice that person made as "opting out" of the broader insurance pool.

And yes, my initial point was that mandatory insurance schema are, in general, more costly to the sponsering government when the relatively healthy do not subsidize the relatively sick.

With my anecdote, I was attempting to convey that consumers often lack the ability and information to accurately judge expected benefits. Insurance providers (and governments!) exploit this lack to pursue their goals, which may (and often do) differ from those of any given consumer.

I do understand that I was not sufficiently precise--for that I apologize.

I differ not a whit from your conclusions; I merely wanted to point out that barring individual self-insurance and high-deductible, low-premium plans is a logical characteristic of a mandatory health insurance plan.

After all, one way to reduce* the problem of adverse selection is to make it illegal.

*Unfortunately, the Privileges and Immunities Clause precludes full elimination of this problem. Hawaii has been protected by an ocean. It'll be interesting to see whether MA's population becomes relatively sicker than surrounding states as this policy takes full effect.

MayBee

The Times doesn't mention a remarkably foolish "reform" that Massachusetts enacted along with the individual mandate: to outlaw the high-deductible plans that make the most sense for most of the voluntarily uninsured.

That's frightening, because if purchasing insurance is mandatory, insurance companies end up with no incentive to keep insurance affordable (or at least at a desirable rate) for those with some means.

Walter

The personal anecdote Tom cites to begin this discussion and those submitted by commentators demonstrate that consumers can underestimate as easily as overestimate their expected benefit.

To that extent, what appears on the surface to be a subsidy may be less so in practice.

But, as bgates pointed out, diet, exercise, and genetics are rarely fully considered in pricing policies. The current structure of the health insurance market precludes accurate individualized pricing. HIPAA prohibits group plans from considering health status, medical history, genetic information, or disability* (in addition to the pre-existing condition restrictions already noted above).

Of course, that is why individual plans are often far more expensive than individual coverage under group plans: individual plans are priced with individual characteristics in mind. With no cross-subsidy, premiums equal expected benefits plus profit and administrative overhead less expected investment return. As those who (reasonably or not) expect to be healthy opt to self-insure, the average cost of issued individual policies greatly exceeds the cost of individual coverage under group policies.

In other words, our current system already embodies (by federal fiat) a mandated cross-subsidy in the vast majority of the insured populatation.

*29 USC 1182 (a)(1)(G) forces the overall group to pay for abusive spouses' tendency to, well, abuse their spouses. I'm all for helping the victim, but shouldn't the abuser pay the added costs? Or at least be forced to stop abusing until he does so?

Walter

Premiums equal ...

... plus agent commissions. I am not familiar with health insurance practices, but it's not unusual for an agent to keep better than 50% of the first year premiums paid towards whole life policies.

Walter

For the record, I do know how to correctly spell 'sponsor' and 'population'. I simply chose not to

...

proofread carefully enough. Sorry.

SunnyDay

The commissions on health insurance are much lower than life insurance, and are paid as earned, where life insurance commissions are often annualized and advanced to the agent.

From the agent's side of it - it's not worth the work involved, and it can make an agent's policy holders get mad and cancel their other policies.

I've seen individual policies issued with exclusions you wouldn't believe. It's an E&O claim right off the bat. Consumers don't understand it.


cathyf

Well, Walter brought up adverse selection, so I'll jump in with the other two biggies: moral hazard and substitution.

When it comes to buying most things, the laws of space-time mean that if you pay for it you get it, while if you don't pay for it you don't get it. Those things which don't follow that rule are called "externalities". So, for example, pretty landscaping is an externality -- you pay for it you get to enjoy it, but passersby who don't pay for it also get to enjoy it. Two companies next to each other that both pollute the air -- one pays for pollution abatement while the other continues to pollute -- the non-polluting company suffers the same same (remaining) air pollution that the polluting company does, while the polluting company gets the same benefit from the pollution abatement that the other company paid for. The obvious result is that we get less pretty landscaping and more pollution than if we could figure out some practical way to exclude the free riders from receiving the benefits of the externalities without paying for them.

Ok, how does that relate to health insurance? Take Mrs. Olaya. She decided to gamble and not take COBRA. If she had truly been self-insuring rather than acting as a parasite on the goodwill of her neighbors (us), then there is no way that the doctors and hospitals and drug companies would have let her run up $255,000 in health care charges before arranging for payment. And there is no way that even the NYT could make any reasonable argument that there is something wrong with taking Mrs. Olaya's house to pay her self-insurance bills. If Mrs. Olaya had really been self-insured here's what would have happened: as soon as she got sick, all of her assets would have been liquidated and placed into escrow. Then whenever the money ran out, the treatment would have stopped. If she was cured, and survived, but all of her money was gone, then she would have lost it all, and would have started her post-illness life penniless and homeless.

So whenever anyone says, "oh, those people are self-insuring," that is a crock. None of those "young invincibles" have anything like the assets needed to self-insure for the absolute worst most expensive thing that could happen to them. No, those people are relying on the law that says if you don't pay insurance premiums and get sick, then you get treatment and wholly or partially stick the providers. The providers who, of course, have no choice but to pass along those costs to the people who do have insurance. And not just the costs of their care, but also the costs of hiring the bill collectors to hound them, and the costs of hiring lawyers to file for partial payment in their bankrupcy hearings, etc. (Bankruptcy, of course, being the ultimate reinsurance plan for the "self insured" and they get bankruptcy coverage without any premiums.)

So the basic groundrules of our society, whether codified in laws against patient dumping and denial of care, or just our cultural values of reacting with cost shifting and charitable contributions when "uninsured" people get sick, are quite simple: there is no such thing as an uninsured person. There are only insured people who pay for their insurance, and insured people who free ride on the good will of others. So, especially for people who don't expect to get sick, there is a strong temptation to go the "free" route. It's called moral hazard because being a free rider is immoral, and the temptation inherent in the system is a hazard to one's moral health.

Ok, the other interesting topic is "substitution" which is the problem when there are covered and uncovered items which are substitutes for each other. Naturally, the cost difference will give people an incentive to substitute the covered for the uncovered item. Drugs are the canonical example here. Substitution is the naked financial reason for things like the medicaid drug benefit. We don't pay for a medicaid beneficiary's $2000/year heart medication because we are nice and lovely people; we pay for the meds because we are on the hook for that person's $150,000 heart attack if he decides that he can't afford the drugs. The insurance company doesn't cover well-baby care because babies are cute and sweet, but because the difference between catching something early and catching it late is many thousands of dollars and more than makes up for the well-baby appointments. This is actually the problem with high-deductible health plans. They create an incentive rather than to pay the year-in-and-year-out costs of preventative care (which are all out-of-pocket because they are below the deductible) and instead just wait for the massive $10K, $50K, $250K catastrophe which means paying the deductible in only one year and sticking the rest to the insurance company.

You can't talk about health insurance without talking about adverse selection, moral hazard, and substitution.

MayBee

They create an incentive rather than to pay the year-in-and-year-out costs of preventative care (which are all out-of-pocket because they are below the deductible)

Which is why it is wise to pair the high deducible insurance with an HSA. For the same cost as our old insurance plan, we put the difference in premiums into the HSA and can pay for out of pocket expenses through that. My high deductible plan also does have low co-pays for annual doctors visits and important tests.

Walter

CathyF,

That was a great summary of the issues arising from our current approach to health care.

Some 30% of insurance premiums are spent attempting to allocate the payment, copayment, and non-payment of medical expenses to the proper parties under this system. Universal care systems cut that to 5 - 10%. The government pays for 15 - 35% of all private insurance through the tax subsidy.*

Add it up and you find that a universal care program could cost the same amount, achieve the same results, and have room for 20% more fraud and waste than we currently experience.**

I am in principle quite opposed to large government programs. But I'm more opposed to wasteful allocation of resources. If we currently have, in practice, a universal health system, why not recognize that fact and eliminate some of the overhead? Or let people everywhere die in hospital waiting rooms like they (used to) do in LA?

.

*Depends on whether you think the untaxed amounts would be taxable to the individual (roughly 15% FICA + Medicare for 1/2 of all wage earners) or companies (~ 35% Federal + State income tax).

** Actually spend 5% on auditing expenses & I'd wager that waste would go down rather than up.

boris

I'm more opposed to wasteful allocation of resources.

In life n death situations wasteful allocation rates pretty low. Despite the apparent acceptence of the argument that medical care for profit is somehow immoral and unfair, the people who can afford the higher quality it delivers don't want to downgrade.

It's pretty easy to get people to talk the talk on profit imorality but when it comes to the walk they balk.

Walter

I'm young enough, and my parents are young enough, that I do not have (and hope that it's a long time before I must have) an informed opinion on end-of-life care.

I like profit.

I was talking about admin expenses.

boris

I was talking about admin expenses

I know. Didn't mean to conflate that with profit motive, it's just that gov takeover warps or removes profit which downgrades quality.

High admin (if true) expense is largely (IMO) because the current situation is neither fish nor fowl. Settling on one or the other would reduce admin overhead.

When combined with other cost reductions (profit removal) the admin argument seems to be used to support one of the alternatives and not both. As a result I do not support the use of the admin expense argument.

Walter

Any suggestions on how to settle on one or the other? I don't like my proposition, but I dislike the current system more.

Again, I like profit. You can't beat it for inspiring innovation (well, that and NIH-funded academic egotism, but we'll leave them out of it).

Why not utilize the existing tax collection infrastructure to provide funding and use private industry to do the rest?

Say we leave every current profit center (pharm cos., hospitals, clinics, medical practices, drugstores, equipment suppliers, etc.) and simply remove the underwriting and investment functions from insurance providers (many themselves non-profit already) leaving them the payment distribution function.

Isn't that roughly what an ever-increasing portion of the population experiences with the Medicare system?

In other words, stop spending so much money on the billing infrastructure. Most doctors I know hate that they have to hire 2-3 people just to process claims. They really resent spending any time, let alone hours a week, justifying their decisions to clerks with, at best, a BA.

I understand that lots of people would lose their jobs. My neighbor (retired MD who recently sold a large practice) earns a couple grand per seminar flying around the country teaching practices how to code procedures to maximize reimbursement. But I think society at large would be better served if he went back to treating patients.

clarice

A few years ago we shifted to a doc who isn't on any insurance plan. We pay her whatever her cost is,she gives us an invoice,we file our own claims and pay whatever the insurance company doesn't. We get far better care and she keep her costs down,and she is not constrained in the services she provides by some pencil pusher.

Walter

Whoops. Forgot something.

Unlike Medicare, allow doctors/practices/drugstores/pharm cos./equipment suppliers to charge more than scheduled reimbursements. That way, a base level of care is available to everyone, but more popular/effective doctors can allow the market to allocate their time. With auditing and quality control to reduce shoddy care on the low side and a profit incentive for innovation and/or better care on the high-end, the system isn't significantly different than our current approach (in practice, if not theory).

When my wife had surgery a few years back, we paid 25% over and above the insurance company's idea of 'ordinary and reasonable' fees for care from an expert practitioner with innovative treatments. Compared to the outcomes experienced by others we know, the money was well worth it. I'd hate to see that option go by the wayside.

Walter

Note to self: Clarice is always on top of it.

Regardless of what "it" is.

Upon further review, I note that the Medicare restriction I noted above does not apply if the patient prepays for services and receives direct (and likely partial) reimbursement from Medicare.

boris

I'd hate to see that option go by the wayside.

Which is EXACTLY why that will be the first to go.

I dislike the current system more ...

Most look at UK and Canada and disagree.

I know hate that they have to hire 2-3 people just to process claims.

That's gonna be a feature of any gov program.

A fair system based on HSA with catastrophic coverage (mandatory choices: private or gov with premiums* collected by IRS) would eliminate most of that paperwork.

Walter

Works for me!

Doesn't seem to affect doctors much, nor big pharm.

HMO's would likely be the major opponents, as other healthcare groups could continue as is. Oh, and state insurance boards, as they currently regulate the heck out of (read as receive donations/lobbying from and against) any plans not exempt under ERISA.

You could probably get Wall Street behind it to the extent they'd manage the HSA's.

Would you partially or fully fund the HSA's for low-income people, and make them somewhat refundable to encourage wise use of healthcare services?

The only downside I see is that it doesn't eliminate wrangling over which company gets stuck with the bill. OTOH, it could well reduce personal injury lawsuits--a surprisingly large majority of which are filed by those who lack other means of paying medical bills.

boris

partially or fully fund the HSA's for low-income people

Like an HSA voucher? Might work.

Walter
I dislike the current system more ...
Most look at UK and Canada and disagree.

Yes, but I'm proposing no net reduction in healthcare spending overall. I suggest we redirect current overhead towards medical care. As I read the stats, that'd leave us spending nearly double per capita than what is spent in the UK or Canada. If we dedicate even a small portion of that to waste and fraud prevention, we can't help but have a better result.

Walter

Reading further on my 'stats' link, I'd like to disavow the socialist commentary provided by the good folks at the University of California, Santa Cruz (Mascot: The Banana Slug). It was the first relevant result from Google.

I think the numbers are good, though.

clarice

Thnx, Walter, but ours is not a retainer system. It's a doctor providing services and charging what she deems necessary for the services she alone deems warranted. Her patients understand that they may pay more than the insurance company will reimburse her for those services, and we don't care because we consider her services worth it. (Actually, it comes to very little more for infinitely better service and care.)

If the HMO pays a participating doctor $X per head, how much incentive does the doctor have to really take a detailed history? To actually listen to you and be proactive? Not much.

All the doctors in this office operate the same way. All are top quality, Johns Hopkins trained.
And here's the best part--no damned mags in the waiting room. The doctors bring in those coffee table travel and picture books. %^)

boris

proposing no net reduction ...

Gov doesn't always waste money, but they're very good at it. It may be better for 20% overhead and 80% well spent than 100% poorly spent with no overhead.

cathyf
I am in principle quite opposed to large government programs.
I am, too. But I have also noticed that health care has intriguing violations of the usual laws of free markets. Take health care portability. Before the law was passed, someone with a chronic condition, or someone with a family member with a chronic condition, couldn't change jobs without losing coverage to pre-existing condition exclusions. If one insurance company didn't have the exclusion, then people would transfer in, but nobody with a chronic condition would transfer out. If all of the companies eliminated to exclusion, then, on average, people transferring in would be balanced by people transferring out. So the insurance companies lobbied congress, and congress passed a law which took away the insurance companies' right to exclude pre-existing conditions when a person was transferring from another insurance company. Which allowed the insurance companies to provide a more valuable product at the same cost, and everyone was better off.

And as for a government bureaucracy's ability to screw things up -- yeah, that's absolutely true in principle, but we've all noticed that there are plenty of non-government bureaucracies in health care that can give the feds stiff competition in the screw-up department. And I could see that the government could actually help by taking over some more of the bureaucracy. I mean forget taking over the whole universal health care for now -- hows about we start with the government hiring a contractor to write a single billing system software and then require everyone to use it. Speaking as a software professional, even if it's crappy software, it will still be infinitely better than the multiplicity of software that's all different and that every doctor needs 2-3 full-time people to keep them all sorted out.

boris

I mean forget taking over the whole universal health care for now -- hows about we start ...

Yikes !!! Hows about we forget taking over the whole universal health care for ever.

I live just a few blocks from Epic Systems. Admin paperwork software is more likely to sort itself out long before any gov project could.

If the gov had standardized PC operating systems what do you think we'd all be using now ??? Windows XP, Macintosh, or Linux ?

Try DOS.

kim

Procrustes or nusties.

Hmmm. Needs work. Doesn't have the ring of 'Fifty-four forty or fight'.
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Individual Health Insurance

I read your article. It provides good information about health insurance."universal" health care coverage in Massachusetts.But I have also noticed that
Health insurance planshas intriguing violations of the usual laws of free markets.

Assurant Health

Wow! a nice article. I agree that each state should be provided with medical coverage from government side.
Health care
is a necessary thing for a common man

Health insurance plans

It is really not good sign that people are taking Health insurance plans due to penalty or tax saving.I think health insurance is a mandatory thing of our life.

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