4 ms·

I agree, that in a form current insurance companies exists - i.e. perpaid medical discounts plan, they should be removed. People should be getting insurance fr

I agree, that in a form current insurance companies exists - i.e. perpaid medical discounts plan, they should be removed. People should be getting insurance from insurable events - i.e. accident, heart attack, etc. Not from routine vaccination, annual checkup, seasonal cold. High-deductible plans are a hack to get people to pay for more of routine stuff and I think it moves into the right direction.

ams6110 8y ago
Except even on a high-deductible plan, the provider bills the insurer, they play their games with the price, and eventually you get a bill. There is no up-front price. There is no market pressure. You still don't know what you will need to pay until weeks or months later.
- hippich 8y ago
  That's why I called it a hack and not proper implementation. While what you described is true - patients are hit with "real costs" instead of $10 co-pays and rising premiums. ideally - yes, most minor stuff would be paid out of pocket - market forces would immediately put things in a right place. And for emergencies - leave that to insurances.
  - snovv_crash 8y ago
    Switzerland does this right: there is an annual excess (which patients can choose, typically between $500 and $2500, and which is reflected in reduced premiums if you choose a higher excess) which is paid entirely by the patient, and after that the insurance kicks in for 90% of costs up to another threshold, after which the insurer covers everything. In this way the insurance is actually an insurance like a car insurance, and not some bastardized medical payment plan where incentives of different parties aren't aligned.
    - hippich 8y ago
      This sounds pretty much what high deductible plans are in the USA. Are there some other differences? Perhaps patients file insurance claims themselves?
Faark 8y ago
> Not from routine vaccination, annual checkup, seasonal cold. I feel like you lump in a lot of preventative care in that statement. If your routine checkups / vaccination prevent necessary emergency care and thus save money down the line, not incentivization people to do so seems stupid to me. The insurance company would have to pay for it regardless, unless they manage to cut those cases from the body of their insured. That would feel a lot like preexisting conditions to me... Having individuals pay for vaccinations also ignores the value of lost herd immunity, due to a prisoners dilemma like situation. But this mean vaccinations have to be provided by insurance. Directly funding it though tax money might be a better option.
- hippich 8y ago
  Lack of vaccination/etc should be a "pre-existing condition". Otherwise, people who know they will be saved will choose to do stupid things, like https://www.nytimes.com/2019/03/09/well/oregon-child-tetanus-vaccine.html https://www.nytimes.com/2019/03/09/well/oregon-child-tetanus... "When the time came for his second round of DTaP, doctors talked with the family about the need for vaccinations. Surviving tetanus, unlike some other diseases, does not offer immunity in the future. But despite an “extensive review” of the risks, and the benefits of vaccination, the article said, the family declined the second vaccination — or any other recommended immunization."

ams6110 8y ago

Except even on a high-deductible plan, the provider bills the insurer, they play their games with the price, and eventually you get a bill. There is no up-front price. There is no market pressure. You still don't know what you will need to pay until weeks or months later.

hippich 8y ago
That's why I called it a hack and not proper implementation. While what you described is true - patients are hit with "real costs" instead of $10 co-pays and rising premiums. ideally - yes, most minor stuff would be paid out of pocket - market forces would immediately put things in a right place. And for emergencies - leave that to insurances.
- snovv_crash 8y ago
  Switzerland does this right: there is an annual excess (which patients can choose, typically between $500 and $2500, and which is reflected in reduced premiums if you choose a higher excess) which is paid entirely by the patient, and after that the insurance kicks in for 90% of costs up to another threshold, after which the insurer covers everything. In this way the insurance is actually an insurance like a car insurance, and not some bastardized medical payment plan where incentives of different parties aren't aligned.
  - hippich 8y ago
    This sounds pretty much what high deductible plans are in the USA. Are there some other differences? Perhaps patients file insurance claims themselves?

Faark 8y ago

> Not from routine vaccination, annual checkup, seasonal cold. I feel like you lump in a lot of preventative care in that statement. If your routine checkups / vaccination prevent necessary emergency care and thus save money down the line, not incentivization people to do so seems stupid to me. The insurance company would have to pay for it regardless, unless they manage to cut those cases from the body of their insured. That would feel a lot like preexisting conditions to me... Having individuals pay for vaccinations also ignores the value of lost herd immunity, due to a prisoners dilemma like situation. But this mean vaccinations have to be provided by insurance. Directly funding it though tax money might be a better option.

hippich 8y ago
Lack of vaccination/etc should be a "pre-existing condition". Otherwise, people who know they will be saved will choose to do stupid things, like https://www.nytimes.com/2019/03/09/well/oregon-child-tetanus-vaccine.html https://www.nytimes.com/2019/03/09/well/oregon-child-tetanus... "When the time came for his second round of DTaP, doctors talked with the family about the need for vaccinations. Surviving tetanus, unlike some other diseases, does not offer immunity in the future. But despite an “extensive review” of the risks, and the benefits of vaccination, the article said, the family declined the second vaccination — or any other recommended immunization."