Author Topic: A better way to do health insurance  (Read 915 times)

hoping2retire35

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A better way to do health insurance
« on: March 31, 2017, 02:28:42 PM »
Just curious about other ideas of ways to do this.

Please refrain from saying it was "XXX" fault, just curious what would make it better. I do not believe single payer, at this point, is politically viable, but if you want to discuss it at some level knock yourself out.


Just to get the ball rolling, I think a lot of the problems began 'in the beginning' when it was a tax deduction and health coverage/costs began to inflate in the early fifties, leading up to our current position. I would like to see the health insurance industry not being subsidies no more than I would like to car insurance industry subsidized.

ok your turn.

caracarn

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Re: A better way to do health insurance
« Reply #1 on: March 31, 2017, 02:45:52 PM »
OK, I'll bite. 

I think a lot of the problems began in the 1970s when insurance became anything other than catastrophic.  Before then you went to your doctor and paid the bill.  There was not the overhead of knowing billing codes and sending it off to some other agency to "negotiate" a discount for you per some contracted rate.  Doctors would charge you like any other business.  You spent a half hour with him and his hourly rate was $100 so your visit was $50.  You paid it and went home and he cashed your check or took your cash to the bank at the end of the day and went home and had dinner.  It all worked well.  You only needed insurance when something you could not afford happened.

I always like to use the automobile insurance industry as an analogy.  When I take my car to the mechanic I do not run it through my auto insurance after the shop charges me $200 for an oil change (annual physical) and it is then discounted down to the agreed upon rate of $24.95, which I either pay with a co-pay or against my deductible or they pay directly.  When I need my transmission replaced (gall bladder removed) I am not handed a "bill" as I walk out the door for $15,000 and then two months later the shop gets the payment of $900 that Autocaid considers reasonable for that billing code.  Instead I pay the $24.95 and the $900 because I know that is what it will cost me before I go and I go to that shop and get the work done and pay my fee.  Because the shop does not need a whole department of coders, negotiators and other personnel to deal with the insurance company my services cost less.  If my car gets totaled (heart attack) then I need insurance.  For everything else the market works just fine.

To get back to that we'd need to rip out the entire insurance industry from the process and they pay lobbyists lots of money to say why we can't possibly oprerate that way because then there would be no one to control costs.  Guess what?  There would be, because the doctor who charged $1,000 for an office visit would very quickly have no one in his office if the rate being charged by everyone else in town was the market supported $115 and he would eventually lower his price or go out of business. 

scottish

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Re: A better way to do health insurance
« Reply #2 on: March 31, 2017, 03:43:32 PM »
Canada did not always have single payer health insurance.

It took many many decades of incremental improvements to get to something good.

You guys could do it too.    One step at a time instead of all at once.

I read an article that suggested that in order to repeal Obamacare (the private insurance part), the government would be force to expand medicaid.  (I can't find it right now...)  A step in the right direction, if you ask me.

Drifterrider

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Re: A better way to do health insurance
« Reply #3 on: April 10, 2017, 07:57:55 AM »
We keep saying "health care" when we should be saying "medical insurance".

Once upon a time, if you couldn't afford to see a doctor or get test or get prescriptions, you did without.  Also, think how far medicine has advanced over the last 50 years.  All of that new technology comes at a price.  In 1970 childhood leukemia was a virtual death sentence.  Now, not so much.


In December I had a blocked artery.  I had chest pains and had enough sense to see a cardiologist and have a stress test.  That test was very expensive.  As a result of the test my blockage was found before I had a heart attack that probably would have killed me.  Four years ago I underwent a routine stress test (part of turning 50) and the results showed no blockage. 

The total cost of "fixing" my blockage was over $80,000. 

The cost of insurance is high because the cost of life saving medicine is high.  The Cath center is manned 24/7 because you can't schedule a heart attack.  All those people and those million dollar machines have to be paid for.

I would have preferred to see the states handle the lack of insurance problem but for the most part they didn't. 

The ACA is a great idea, long overdue, poorly written and badly implemented.  If the two parties (which means the eligible voters in the US) were more interested in fixing the problem than in casting blame, it could be done.

I think expanding Medicare to allow (not mandate) people to "buy in" would have been a smart idea.  I have good insurance at a relatively good price through work as do a lot of people so I wouldn't have switched but some people didn't have any because of 1.  prohibitive cost or 2.  inability to obtain at any cost.

My brother had a heart attack at 46.  Before ACA he would have been unable to obtain medical insurance from any company at any cost that would have covered any cardiac condition because of "preexisting conditions".  And then, his premium would still have been $1,200 per month with huge deductibles.  Fortunately for him he was covered by his work insurance at the time.

We spend over $600 BILLION dollars every year on the defense industry.  That money goes mostly to paying people (jobs).  Some of that money might be better spent paying those same people to do different work.

Kris

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Re: A better way to do health insurance
« Reply #4 on: April 10, 2017, 08:03:37 AM »
We keep saying "health care" when we should be saying "medical insurance".



This.

Where this started to go wrong was when we tied medical insurance to employment. And then bit by bit, "we" started to collectively believe that "health care" (in other words, medical insurance) was something that only "worthy", non-lazy people with decent jobs deserved. The rest of y'all? Well, if you want health care so bad, get a job that gives you medical insurance!

I have no idea how we turn back time and get to the place where a significant percentage of our population, and a major political party, does not think that certain people haven't earned the right to get decent treatment for illness and injury because they don't have a job with health insurance benefits.
"Well I'm sure I'd feel much worse if I weren't under such heavy sedation."   - David St. Hubins, This is Spinal Tap

golden1

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Re: A better way to do health insurance
« Reply #5 on: April 10, 2017, 08:08:01 AM »
Quote
http://www.golddirectcare.com/

Something like this sort of model intrigues me, and I hope this guy can prove it is viable.  It was one of the first of it's type a few years ago, and I love the idea of going outside the insurance system for your basic care.  You just pay him a monthly fee, and it covers all sorts of routine care based on a sliding scale for your age.

 

cheapass

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Re: A better way to do health insurance
« Reply #6 on: April 10, 2017, 08:46:39 AM »
We spend over $600 BILLION dollars every year on the defense industry.  That money goes mostly to paying people (jobs).  Some of that money might be better spent paying those same people to do different work.

I think "defense" is a bit of a misnomer when used in the context of our military, but I digress...

Why not just refrain from confiscating that $600B from taxpayers in the first place? Then we can choose to spend it on healthcare, or education, or big screen TV's, or VTSAX or...

cheapass

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Re: A better way to do health insurance
« Reply #7 on: April 10, 2017, 08:48:12 AM »
I have no idea how we turn back time and get to the place where a significant percentage of our population, and a major political party, does not think that certain people haven't earned the right to get decent treatment for illness and injury because they don't have a job with health insurance benefits.

Anyone can walk into any hospital in the country with a medical condition and get it taken care of. Payment is another story.

Drifterrider

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Re: A better way to do health insurance
« Reply #8 on: April 10, 2017, 09:51:46 AM »
We spend over $600 BILLION dollars every year on the defense industry.  That money goes mostly to paying people (jobs).  Some of that money might be better spent paying those same people to do different work.

I think "defense" is a bit of a misnomer when used in the context of our military, but I digress...

Why not just refrain from confiscating that $600B from taxpayers in the first place? Then we can choose to spend it on healthcare, or education, or big screen TV's, or VTSAX or...

1.  No government body has ever found a tax it didn't like.
2.  Add about 25 Million to the unemployment rolls (virtually overnight).  Remember that money goes to primary, secondary, tertiary employees before they spend it at your place of business. 
3.  Let's abolish all taxes and we can all fend for ourselves.  I have both silver AND lead:  how about you???

Tasty Pinecones

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Re: A better way to do health insurance
« Reply #9 on: April 11, 2017, 02:34:50 PM »
We spend over $600 BILLION dollars every year on the defense industry.  That money goes mostly to paying people (jobs).  Some of that money might be better spent paying those same people to do different work.

You said it. You are right.

Wilson Hall

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Re: A better way to do health insurance
« Reply #10 on: April 13, 2017, 02:00:22 PM »
We keep saying "health care" when we should be saying "medical insurance".



This.

Where this started to go wrong was when we tied medical insurance to employment. And then bit by bit, "we" started to collectively believe that "health care" (in other words, medical insurance) was something that only "worthy", non-lazy people with decent jobs deserved. The rest of y'all? Well, if you want health care so bad, get a job that gives you medical insurance!

I have no idea how we turn back time and get to the place where a significant percentage of our population, and a major political party, does not think that certain people haven't earned the right to get decent treatment for illness and injury because they don't have a job with health insurance benefits.

YES!

Those entrepreneurs and small business owners...they're so LAZY! Why don't they work in a cubicle like everyone else? Who do they think they are?

In all seriousness, health insurance is our biggest impediment to FIRE, same as many people here. By the time we can take the plunge, we'll both be over 50 and there's no telling what the insurance market will look like then.

Drifterrider

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Re: A better way to do health insurance
« Reply #11 on: April 14, 2017, 06:23:54 AM »
I think a lot of previously "red" voters, when faced with the possibility of losing the medical insurance they now have but didn't used to have, are starting to see more "Purple".

I would prefer a national system (with opt ins/out for people who have a better plan elsewhere) vice a state by state (for the ACA).  With a state by state, you have to go to your state of residence (benefits don't cross state lines).  Kinda limits those who might want to take up the nomadic life.

I think expanding medicare for all (at an additional cost for those still working) would be a smart move.


Gin1984

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Re: A better way to do health insurance
« Reply #12 on: April 14, 2017, 11:33:33 AM »
I have no idea how we turn back time and get to the place where a significant percentage of our population, and a major political party, does not think that certain people haven't earned the right to get decent treatment for illness and injury because they don't have a job with health insurance benefits.

Anyone can walk into any hospital in the country with a medical condition and get it taken care of. Payment is another story.
That is really not true.

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MayDay

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Re: A better way to do health insurance
« Reply #13 on: April 14, 2017, 11:44:03 AM »
I have no idea how we turn back time and get to the place where a significant percentage of our population, and a major political party, does not think that certain people haven't earned the right to get decent treatment for illness and injury because they don't have a job with health insurance benefits.

Anyone can walk into any hospital in the country with a medical condition and get it taken care of. Payment is another story.
That is really not true.

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So true.

Our daycare lady and breast cancer. No insurance at the time (the center she worked at when we knew her did provide insurance). Sure she could get stabilized in the ER but not chemo. The oncologist made people pay up front, although he made an exception for her and she was able to get treatment.

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MayDay

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Re: A better way to do health insurance
« Reply #14 on: April 14, 2017, 11:51:56 AM »
To answer the original question, I see it as a situation where you HAVE to control costs. By whoch I basically mean rationing care. You can save some administrative costs by going single payer and eliminating the billing/coding back and forth, and perhaps we can negotiate lower drug prices*. But ultimately we have to stop wasting money giving your 90 year old grandma chemo that will extend her life by 3 days, or doing mamograms and paps every year just because we always have even though decades of statistical analysis says it doesn't save lives, etc.

Basically, I am.pro death panel.

The other angle is that a lot of the preventative health stuff makes people live longer, but it costs more. It's cheaper to let a smoker smoke, and die young, than it is to have them quit and live longer, in terms of medical costs. Do we as a society want to let people kill themselves but off to save money, or do we want to encourage them to be healthy?

Another component I'd enact is ending all federal subsidies on grains and their sugar byproducts. Which has wider reaching economic effects than our waistlines, I'm sure. But at a high level, I'd like to see ag policy make healthier food cheaper rather than HFCS cheaper.

*Although I have doubts- if the newly launched NHS told the drug companies no, and the drug companies said fine! No insulin for you! It would take about five minutes before the NHS caved.
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Sibley

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Re: A better way to do health insurance
« Reply #15 on: April 14, 2017, 01:22:57 PM »
To answer the original question, I see it as a situation where you HAVE to control costs. By whoch I basically mean rationing care. You can save some administrative costs by going single payer and eliminating the billing/coding back and forth, and perhaps we can negotiate lower drug prices*. But ultimately we have to stop wasting money giving your 90 year old grandma chemo that will extend her life by 3 days, or doing mamograms and paps every year just because we always have even though decades of statistical analysis says it doesn't save lives, etc.

Basically, I am.pro death panel.

The other angle is that a lot of the preventative health stuff makes people live longer, but it costs more. It's cheaper to let a smoker smoke, and die young, than it is to have them quit and live longer, in terms of medical costs. Do we as a society want to let people kill themselves but off to save money, or do we want to encourage them to be healthy?

Another component I'd enact is ending all federal subsidies on grains and their sugar byproducts. Which has wider reaching economic effects than our waistlines, I'm sure. But at a high level, I'd like to see ag policy make healthier food cheaper rather than HFCS cheaper.

*Although I have doubts- if the newly launched NHS told the drug companies no, and the drug companies said fine! No insulin for you! It would take about five minutes before the NHS caved.

The US has forgotten, culturally, how to die. We all die, eventually, from something. Nothing is going to change that. Trying to prevent it when it is inevitable is responsible for a massive proportion of medical costs in the US. Palliative care has a place, and we should be doing way more of it for people with conditions that are fundamentally incompatible with life (including old age).

Giving CMS authority to negotiate drug prices would also help. But the US currently bears a lot of the costs of developing new drugs for the world.