3 ms·

There issue is two folds here. 1. Medical liability. Doctors must cover their basics or will get sue. 2. There is no cost relationship between doctors and pat

by wdn 9y ago

There issue is two folds here. 1. Medical liability. Doctors must cover their basics or will get sue. 2. There is no cost relationship between doctors and patients. Doctors and patients work with 3rd party call health insurers. Worst, a lot of people (medicaid recipients) have no skin in the game. Obama could have fixed item #2 with a universal health care that require (1) doctors to list the price of their services and (2) cover major catastrophic health expenses, such heart issue, cancer, long term care, etc. Prevention care should physical, cold should be out of pocket for the first 5 or 10 visits of the year, then it is covered. I know some may called foul because poor cannot pay. Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse.

liqu0rice 9y ago
Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse. Germany had something like you propose from 2004 until 2012 (1). It was not particularly successful and therefore consequently abolished. (1) https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1 https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1
arkades 9y ago
>Paying 20$ per visit... Such experiments have been made with Medicaid demo projects in the US. They've failed every time. People can't distinguish needed care from unneeded care; they end up foregoing needed care, deteriorate, and end up costing the system much more in the form of hospitalizations, disability, etc.
- michaelmrose 9y ago
  Its because poor people overusing free medical care is the problem with the health care system like people buying doritos with food stamps is the problem with SNAP.
conanbatt 9y ago
Healthcare is expensive for multiple reasons, the fee structure being a part of it. If insurance were decoupled from the employer, the individuals would be able to pick the best insurance as opposed to a negotiated insurace by the employeer. That would move people to what is generally considered the best insurance options and that alone makes the competition a lot better. As a patient you dont know which one is better medical care, but you will make some sort of judgement per-insurance. THere are other issues, like restrictions on the importation of drugs, restrictions on the immigration of doctors, high law suit liabilities that end up costing a lot in insurance and processes that not necessarily are better healthcare, etc.
- cletus 9y ago
  This is such a US-centric view that the free market will just magically fix things. I used to hold the same view. Now? I think truly individual insurance would be an unmitigated disaster. The problem? Pre-existing conditions. Let's say you have lifelong degenerative condition that will require constant medical care. What incentive does an insurance company have to take you on? You can try to make discriminating against pre-existing conditions illegal but insurance companies know who their most expensive clients are and will try and find a reason to invalidate them. Why employer-based insurance works is that it groups people. It's really a form of collective bargaining. If you insure one person you look at how much that person costs you vs their premiums. If you insure 50,000 employees of a company then you're looking at revenue vs cost of 50,000 vs 0. This is something insurance companies are exceedingly good at. Large numbers even out individual variance (and thus risk). This idea can go too far. In Australia we have (had? I haven't lived there for 7 years and we have a conservative government so who knows what they'e done to the health system while I've been gone) what's called a "community rating" for private health insurance. Emergency care is largely the government's responsibility (through Medicare). Community rating means insurance companies basically treat everyone the same other than allowed factors (eg # of children). The downside to this is that elderly people cost more but get charged the same as young people. This makes no sense for young people so they leave the private system and health premiums go up. This has been a decades-long problem. The solution here is for there to be an alternative for employer health insurance. So someone else needs to come in and negotiate for a group rate. It needs to be small enough so there's no Walmart like situation of all but one company getting squeezed out. It needs to be large enough so the number of plan participants averages out individual variance. The question then becomes who should that be? In smaller states it should probably be the state. Maybe there should even be more than one supplier? In larger states, maybe it might be split further? Cover this with state taxes. Decide what this covers. It should at a minimum include basic preventative care, affordable access to a GP (PCP), ER visits, emergency medical care, big-ticket medical items like transplant surgery and cancer treatment and so on. Then maybe employer health insurance is just for extras like better elective cover. Americans in particular have a real false dichotomy view of health insurance as in the choice is between a free market and a 100% state-run system where all hospitals and medical professionals are government employees. This is patently false. The current US system has providers deal with any number of insurance companies with the differences between their various billing systems (eg there are jobs where people simply have to convert between billing codes used by different companies). It's insanity. State-run insurance would grealty simplify this.
michaelmrose 9y ago
Health care costs in America aren't dominated by poor people getting medical care for no reason. This is somewhat like believing that wages being flat is because of illegal immigrants.

by wdn 9y ago

liqu0rice 9y ago

Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse. Germany had something like you propose from 2004 until 2012 (1). It was not particularly successful and therefore consequently abolished. (1) https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1 https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1

arkades 9y ago

>Paying 20$ per visit... Such experiments have been made with Medicaid demo projects in the US. They've failed every time. People can't distinguish needed care from unneeded care; they end up foregoing needed care, deteriorate, and end up costing the system much more in the form of hospitalizations, disability, etc.

michaelmrose 9y ago
Its because poor people overusing free medical care is the problem with the health care system like people buying doritos with food stamps is the problem with SNAP.

conanbatt 9y ago

Healthcare is expensive for multiple reasons, the fee structure being a part of it. If insurance were decoupled from the employer, the individuals would be able to pick the best insurance as opposed to a negotiated insurace by the employeer. That would move people to what is generally considered the best insurance options and that alone makes the competition a lot better. As a patient you dont know which one is better medical care, but you will make some sort of judgement per-insurance. THere are other issues, like restrictions on the importation of drugs, restrictions on the immigration of doctors, high law suit liabilities that end up costing a lot in insurance and processes that not necessarily are better healthcare, etc.

cletus 9y ago
This is such a US-centric view that the free market will just magically fix things. I used to hold the same view. Now? I think truly individual insurance would be an unmitigated disaster. The problem? Pre-existing conditions. Let's say you have lifelong degenerative condition that will require constant medical care. What incentive does an insurance company have to take you on? You can try to make discriminating against pre-existing conditions illegal but insurance companies know who their most expensive clients are and will try and find a reason to invalidate them. Why employer-based insurance works is that it groups people. It's really a form of collective bargaining. If you insure one person you look at how much that person costs you vs their premiums. If you insure 50,000 employees of a company then you're looking at revenue vs cost of 50,000 vs 0. This is something insurance companies are exceedingly good at. Large numbers even out individual variance (and thus risk). This idea can go too far. In Australia we have (had? I haven't lived there for 7 years and we have a conservative government so who knows what they'e done to the health system while I've been gone) what's called a "community rating" for private health insurance. Emergency care is largely the government's responsibility (through Medicare). Community rating means insurance companies basically treat everyone the same other than allowed factors (eg # of children). The downside to this is that elderly people cost more but get charged the same as young people. This makes no sense for young people so they leave the private system and health premiums go up. This has been a decades-long problem. The solution here is for there to be an alternative for employer health insurance. So someone else needs to come in and negotiate for a group rate. It needs to be small enough so there's no Walmart like situation of all but one company getting squeezed out. It needs to be large enough so the number of plan participants averages out individual variance. The question then becomes who should that be? In smaller states it should probably be the state. Maybe there should even be more than one supplier? In larger states, maybe it might be split further? Cover this with state taxes. Decide what this covers. It should at a minimum include basic preventative care, affordable access to a GP (PCP), ER visits, emergency medical care, big-ticket medical items like transplant surgery and cancer treatment and so on. Then maybe employer health insurance is just for extras like better elective cover. Americans in particular have a real false dichotomy view of health insurance as in the choice is between a free market and a 100% state-run system where all hospitals and medical professionals are government employees. This is patently false. The current US system has providers deal with any number of insurance companies with the differences between their various billing systems (eg there are jobs where people simply have to convert between billing codes used by different companies). It's insanity. State-run insurance would grealty simplify this.

michaelmrose 9y ago

Health care costs in America aren't dominated by poor people getting medical care for no reason. This is somewhat like believing that wages being flat is because of illegal immigrants.