4 ms·

Here is more nuance for you: A) Americans need to be more health centric. Half the problem is that a minority of chronic patients account for 50% of the costs.

• majormajor 9y ago
  These are very good and fair points that I was ignoring so far. Personally, to avoid being someone just criticizing but not offering my own ideas, here's my initial recipe at the moment based on what I've learned so far is (subject to change from new information, of course :) ). It actually includes all three: * Government-mandated health insurance coverage at a certain useful minimum level. Insurance companies allowed to offer bettter plans as well, at higher prices. Keeping insurance coverage private reduces transitional shock to the system. * Government subsidies based on income to make the minimum mandated coverage level attainable. * Employer-sponsered plans are banned. Get rid of some corporate power imbalance vs small companies/individuals, and get hidden private subsidies out of the system. * I'd try to take your (A) a bit further: the minimum-coverage plans could have some coverage gaps around self-inflicted conditions, and very little coverage for optional/purely cosmetic/not-necessary treatments. This may not be politically feasible - it could be seen as too cruel, or it could catch on with America's latent "personal responsibility" instincts; either way, I think it's the fairest place to treat as a first-line cost-control location for coverage. I need a second part, here, though, about making healthier options easier to come by for some, though. * Completely agreed on banning drug B2C marketing. Let the drug's effectiveness sell itself to doctors, let that sell it to consumers. * Beyond that, aggressively pro-research pricing and tax incentive policies, both for domestic drug companies and foreign ones - some of this might require policy discussions with other countries, but ultimately it's in everyone's interest if we get a bunch of research funded as in the long run, we'll make way more things treatable and have way more cheap drug options available. I think as long as we have a healthy market that we make sure rewards performance, not marketing we can keep the incentives in the right place. * I think an annual physical is a good thing to include in the individual healthcare mandate as part of the insurance re-up process. Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner, and would run into a lot of resistance if pitched as a "fixable by individual action" thing. And penalties for not meeting certain targets might be impossible - does anyone really want to put someone in jail for not paying a health fine for not getting healthier compared to the previous year? I don't, but if there's no teeth to it, how would it ever work?
  • kazen44 9y ago
    >Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner. The reason people are obese also has to do with many other factors. Fat food is very, very cheap in the US, especially compared to normal food and greens. one solution to this is to tax fat food and use this tax to lower the tax on healthier foods, thus subsidizing healthy behaviour. This makes healhy food available for the poor strata.
  • curun1r 9y ago
    > Employer-sponsered plans are banned No need to ban them, which would likely be challenged successfully in court. But removing the tax deduction would come pretty close to ending the practice. If you look at why employers started offering sponsored health insurance, it all came down to tax incentives that, if they were forced to offer equivalent pay, would be subject to payroll taxes.