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It's the Cato Institute, it's supported by the Koch Foundation, and the Koch Brothers are supporters of economic and individual liberty. Whoever is supported by

It's the Cato Institute, it's supported by the Koch Foundation, and the Koch Brothers are supporters of economic and individual liberty. Whoever is supported by someone's money is not going to argue against their dearly held viewpoints. An interesting question that a scientist would ask: how does that book argue against price caps and monopsony buyers, considering that that approach works extremely well in the civilized world. Health expenditures in all other OECD countries are about 1/4 of what they are in the US.

seibelj 8y ago
One model suggested is we let people take the money they put into health insurance and instead put it into a health savings account. Given that family plus employer pays about $20k per year for a family of 4, the value adds up quite quickly. Then you let the family take as income any amount they don’t spend. This encourages frugality and price shopping for routine procedures. Additionally, the government should backstop everything with catastrophic insurance as is done in Switzerland, so if cancer hits you don’t go destitute. Also, we should drastically expand retail medical care, with advertised prices, as it has routinely been shown to reduce costs through competition and price shopping (LASIK, Botox, vasectomies, etc. all prove this out). They go in great detail about pharmaceuticals and the suggestion that a prize based system would be better than the current system of the government paying for all the research and then letting a private company gouge the consumers who paid for it with tax dollars. The book is very detailed, if you are interested in this subject I highly recommend it. Keep an open mind, clearly neither the American left or right has solved this issue and this book is very refreshing.
- HarryHirsch 8y ago
  When it comes to health insurance you want to spread the risk over a group of people. Health savings accounts are very nice, except when you have a chronic illness and need continuous medication and frequent physician visits. Price shopping doesn't work - when you need medical care you need it, and it's the big-ticket items that drive the cost. When you take the kids to the doctor because they have a fever, that kind of visit is a few hundred dollars at most.
  - seibelj 8y ago
    I think you should just read the book. It has a solution for chronic illnesses. Essentially, you have a relatively small group of people with huge one-off bills or longterm chronic illnesses, and the government can help those people. But the problem with American healthcare isn’t those situations - it’s when a hospital charges $500 for a couple Tylenol, because they can. There is no need to moral grandstand. The situation is so beyond messed up and corrupted that we really need to change the entire system from top to bottom.
  - adventured 8y ago
    > Health savings accounts are very nice, except when you have a chronic illness and need continuous medication and frequent physician visits That's covered by the parent's catastrophic scenario, which would be backstopped by the Federal Government. If you have a diagnosed chronic illness, you are no longer operating under any semblance of normal health terms, it's catastrophic. The US could easily segment itself into these two systems (Federal catastrophic program, eliminating most bankruptcies; and a market system, for routine and trivial healthcare items), and it would be a drastic improvement over how the healthcare system works today. Medicaid is 22% of all health coverage today, expand that to 25-30%. Medicare is 15% of the population, expand that to 20%. Use that 50% leverage to aggressively deflate pricing in healthcare (which is a stick the government largely refuses to use). Create a Federal catastrophic program for the other 50% of people. Now to implement this obvious, dramatic improvement, all you have to do is change everything about US politics and remove nearly every politician.
- mgkimsal 8y ago
  > Then you let the family take as income any amount they don’t spend. This encourages frugality and price shopping for routine procedures. We had this, sort of, with HSA legislation in the mid 2000s. But... you still need some sort of guarantee or insurance to deal with catastrophic issues. This is essentially what a high-deducticle insurance instrument provided. I had a $5k deductible and... $240/month premium for 2. Now.. 9 years later, it's a $10k deductible and $1300/month. > Additionally, the government should backstop everything with catastrophic insurance Agreed, whatever it looks like, yes, something like this. It doesn't matter how 'frual' I am or how much 'comparison shopping' I do, when I'm still on the hook for $25k out of pocket before the insurance company steps in. It is only useful for the direst of emergencies at this point, but is costing $15k/year just to have that catastrophe safety net. And, no one does price shopping or engages in frugality when they're in any type of accident.
  - seibelj 8y ago
    Yes, thank you for restating exactly what I said. Catastrophic health insurance is actually the only insurance we should want. The concept of health “insurance” is a misnomer when it’s used to pay for routine, expected care. That’s just pre-paying for services that you must use or you are wasting money. We don’t sell home insurance that pays out for painting your house or mowing your lawn. Home insurance covers you if a fire destroys your house, pools risk, and is pretty cheap. Health insurance should cover disaster. Routine care should have a robust free market, where I can shop around for my allergy shot and MRI. This already happens for some big ticket procedures such as knee and hip replacements, where foreign hospitals compete directly with US hospitals, and even domestic competition between states.

seibelj 8y ago

One model suggested is we let people take the money they put into health insurance and instead put it into a health savings account. Given that family plus employer pays about $20k per year for a family of 4, the value adds up quite quickly. Then you let the family take as income any amount they don’t spend. This encourages frugality and price shopping for routine procedures. Additionally, the government should backstop everything with catastrophic insurance as is done in Switzerland, so if cancer hits you don’t go destitute. Also, we should drastically expand retail medical care, with advertised prices, as it has routinely been shown to reduce costs through competition and price shopping (LASIK, Botox, vasectomies, etc. all prove this out). They go in great detail about pharmaceuticals and the suggestion that a prize based system would be better than the current system of the government paying for all the research and then letting a private company gouge the consumers who paid for it with tax dollars. The book is very detailed, if you are interested in this subject I highly recommend it. Keep an open mind, clearly neither the American left or right has solved this issue and this book is very refreshing.

HarryHirsch 8y ago
When it comes to health insurance you want to spread the risk over a group of people. Health savings accounts are very nice, except when you have a chronic illness and need continuous medication and frequent physician visits. Price shopping doesn't work - when you need medical care you need it, and it's the big-ticket items that drive the cost. When you take the kids to the doctor because they have a fever, that kind of visit is a few hundred dollars at most.
- seibelj 8y ago
  I think you should just read the book. It has a solution for chronic illnesses. Essentially, you have a relatively small group of people with huge one-off bills or longterm chronic illnesses, and the government can help those people. But the problem with American healthcare isn’t those situations - it’s when a hospital charges $500 for a couple Tylenol, because they can. There is no need to moral grandstand. The situation is so beyond messed up and corrupted that we really need to change the entire system from top to bottom.
- adventured 8y ago
  > Health savings accounts are very nice, except when you have a chronic illness and need continuous medication and frequent physician visits That's covered by the parent's catastrophic scenario, which would be backstopped by the Federal Government. If you have a diagnosed chronic illness, you are no longer operating under any semblance of normal health terms, it's catastrophic. The US could easily segment itself into these two systems (Federal catastrophic program, eliminating most bankruptcies; and a market system, for routine and trivial healthcare items), and it would be a drastic improvement over how the healthcare system works today. Medicaid is 22% of all health coverage today, expand that to 25-30%. Medicare is 15% of the population, expand that to 20%. Use that 50% leverage to aggressively deflate pricing in healthcare (which is a stick the government largely refuses to use). Create a Federal catastrophic program for the other 50% of people. Now to implement this obvious, dramatic improvement, all you have to do is change everything about US politics and remove nearly every politician.
mgkimsal 8y ago
> Then you let the family take as income any amount they don’t spend. This encourages frugality and price shopping for routine procedures. We had this, sort of, with HSA legislation in the mid 2000s. But... you still need some sort of guarantee or insurance to deal with catastrophic issues. This is essentially what a high-deducticle insurance instrument provided. I had a $5k deductible and... $240/month premium for 2. Now.. 9 years later, it's a $10k deductible and $1300/month. > Additionally, the government should backstop everything with catastrophic insurance Agreed, whatever it looks like, yes, something like this. It doesn't matter how 'frual' I am or how much 'comparison shopping' I do, when I'm still on the hook for $25k out of pocket before the insurance company steps in. It is only useful for the direst of emergencies at this point, but is costing $15k/year just to have that catastrophe safety net. And, no one does price shopping or engages in frugality when they're in any type of accident.
- seibelj 8y ago
  Yes, thank you for restating exactly what I said. Catastrophic health insurance is actually the only insurance we should want. The concept of health “insurance” is a misnomer when it’s used to pay for routine, expected care. That’s just pre-paying for services that you must use or you are wasting money. We don’t sell home insurance that pays out for painting your house or mowing your lawn. Home insurance covers you if a fire destroys your house, pools risk, and is pretty cheap. Health insurance should cover disaster. Routine care should have a robust free market, where I can shop around for my allergy shot and MRI. This already happens for some big ticket procedures such as knee and hip replacements, where foreign hospitals compete directly with US hospitals, and even domestic competition between states.