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Needed: critique of universal health insurance plan  

post #1 of 63
Thread Starter 
There’s plenty of discussion elsewhere in this forum about the problems of health care in the U.S. This is my plan for a solution. I’d like constructive criticism. What are the weak points and how should I fix them? What are my omissions? What do you object to? Where is my rationale weak? It's rather lengthy, but please take the time and read all the points and let me know what you think. Thanks for your input!!


The Problem

The rapidly escalating cost of healthcare and health insurance; the growing lack of coverage and reduction of benefits; the growing numbers of uninsured; the detrimental effects on the nation’s overall health.


The Solution: Universal Health Insurance

A public-private partnership to provide health care to everyone regardless of income or employment. The principal features of the plan:

1. Every person in the country covered by health insurance consisting of two programs: Basic coverage and Catastrophic coverage.

2. The private sector providing health care much the same as currently.

3. The government as sole payer for catastrophic health care expenses, and for basic health screening and pre-natal screening.

4. Insurance companies providing Basic health insurance to cover the risk up to the catastrophic limit.

5. Subsidized Basic coverage for those unable to pay.

6. Everyone is required to be insured.

7. Everyone is required to have annual health screening.

8. Regional claims processing subcontractors to coordinate claims and payments.

9. Federal government as the malpractice insurer.

10. Reduce duration of patent protection on new pharmaceuticals.


About this Plan for Universal Insurance

Catastrophic Coverage

The Federal government will be sole payer for catastrophic health care expenses. For example, expenses over a per person per year cap will be paid in full by the government.

Basic Coverage

Private insurance will be the payer for health care expenses less than the catastrophic cap. Insurance companies will bid for a contract to be single payer for a given region. They’ll compete on the basis of best service and best payments to providers, and least expense to the insured. They’ll contract for a schedule of fees paid to providers and for premiums, copays, and deductibles to the insured. They may or may not offer dental and/or vision insurance as part of the Basic program, or as add-ons. Contracts will run on a yearly basis. Since the insurance companies won’t do their own claims processing, substituting one company for another will be fairly easy. The need to compete annually will keep this a competitive market.

Health Screening

The Federal government will pay for one basic health screening exam per person per year, and one pre-natal health screening for a pregnant woman. Perhaps basic vision and dental exams could be included, since they can escalate into significant health problems.

Fees for Services

A Regional Medical Board will set a fee range for every medical service. The actual payment to the provider will be somewhere in that range depending on their contract with private insurance. Those same fees as contracted for will apply to claims over the catastrophic limit. The fee schedules will be posted on the internet for public access.

Mandated Coverage

Every person is required to participate. A person who isn’t participating will be denied medical service. Any provider providing service to a non-participant will do so either at their own expense or on the basis of a cash arrangement with the patient.

Subsidies

Those who are unable to pay for the Basic health insurance may be subsidized by the public sector through a means-test program and direct payments of insurance premiums to the insurance company, and copays and deductibles to the providers.

Federal Malpractice Insurance

Providers will be insured against malpractice by Federal malpractice for a modest no-profit premium. Perhaps there could be a provision to assess physicians a penalty for multiple malpractice judgments. Tracking malpractice claims centrally should also deter doctors with high numbers of claims from picking up and beginning a new practice in another state. Since the risk is shared over a wider base and since it’s expected judgments will be limited in size and reduced in number, the premiums will be much less.

Patent Protection

Reducing the time a drug company can patent their new products will lower the cost of prescriptions and new medical devices. They will also not be allowed to renew patents on minor or superficial improvements.

Adverse Selection & Pre-existing Conditions

Adverse selection is an insurance term which refers to people who are sick buy insurance but those who are healthy don’t. Insurers contend with this by refusing insurance to those with “pre-existing conditions.†Since the risk will be borne by the entire population, as well as the cost, these two terms may be stricken from the health insurance lexicon.

Sliding Catastrophic Cap

Obviously people require more health care as they grow older. The flip side is young people who are healthy don’t use much health care. But to go along with this, young people starting out in life usually can’t afford to spend a lot on health care, either, and a major medical issue could burden them for a very long time. This situation would typically be addressed by graduated insurance premiums; greater for the higher risk. But since the risk is set by the cap, perhaps another way to address this would be a sliding catastrophic cap: lower for young people, higher for older people. The thinking here is that the sliding cap would compensate for the age-related cost of care; the Basic plan premiums for older people will be higher because of the higher cap, but the catastrophic costs will still be shared equally by the entire risk pool.

Health-Care Consumer

By paying for their own insurance, by publishing the costs of their care, by being offered Health Savings Accounts, it’s expected the patients will behave more like consumers: seeking the best service at the lowest cost, and not using more service than they need.

Shared Risk

Universal insurance will accomplish what insurance is supposed to accomplish: reducing the risk for any one particular party by spreading that risk over all parties. Pre-existing conditions, adverse selection, denied benefits, exhorbitant premiums, and cost-shifting will all disappear.


The Players

Federal Government

Primary and only payor for Catastrophic Plan claims. Subsidize insurance premiums, deductibles and copays for those unable to pay.

State & Local Governments

Relieved of current obligations to Medicare and Medicaid states and localities will be able to reduce state income taxes and local property taxes to the extent they’re now required to pay the states’ shares of these programs.

Insurance Companies

Primary payor for the Basic Plan. Contract with providers for service fee schedule and with insured for premiums.

Claims Processors

Regional claims process services receive claims from providers and are responsible for verifying the claim and services rendered, forwarding claim to insurance company, receiving payment from insurance company, and remitting payment to providers. The insurance company with the regional contract may NOT also be the claims processor for the same region (but may for a different region with a different insurer).

Providers

No change. Except: back-office and malpractice expenses will be greatly reduced. And physicians will actually be able to practice medicine instead of jumping through hoops to satisfy insurance company requirements or government Medicare requirements. They’ll be paid rapidly and a rate they agreed to be paid.

Employers

Employers will no longer offer insurance as a standard employee benefit, but may offer Health Savings Accounts with which employees can accrue funds to pay for their basic health insurance and copayments and deductibles, also other medical services not offered or paid for under the local Basic plan contract.

Patients

Responsible for purchasing Basic Plan insurance, getting annual screening, and paying copayments and deductibles (if able to pay).


Advantages of this Plan

1. Providing health care for everyone will improve the overall health of the nation.

2. The private sector continues to provide health care service, as that’s something they’re already doing well.

3. Competition for the Basic plan should foster good service and low cost.

4. Limited risk will dramatically reduce insurance company costs and thus premiums.

5. No uninsured will dramatically reduce provider costs and they won’t have to pass on these costs.

6. Federal malpractice insurance will dramatically reduce provider costs. Doctors who get too many judgments will lose their license to practice in all states.

7. Required health screening should catch health issues before they become expensive.

8. The Medicare, Medicaid, and Veterans Administration health care systems will be terminated since they have no purpose under universal coverage. The payroll withholding tax current assessed for these purposes may be eliminated.

9. Reduced patent protection retains a profit motive for new drug development but without excessively long periods of being able to price the product at non-competitive levels. Perhaps patent protection can be on a sliding term such that the protection is in place until the company has recovered the cost of development plus a modest margin.

10. A single regional claims processor will dramatically reduce paperwork for all system participants and thus the cost of filing claims and speeding payment, and taking out all the middle-men takes out each entity’s profit margin. Also divorcing processing from insuring removes conflict of interest.

11. The Regional Medical Board, consisting of a mix of providers, will be familiar with health care costs in their area and be able to set fee schedules realistically.

12. Requiring patient participation through insurance premiums, copays and deductibles, and publishing fees will get the patient involved as a medical consumer, fostering an awareness of the cost and competing for the best service at the lowest cost.


How this Plan Will Be Paid For

Because payroll withholding for Medicare will be eliminated for both employees and employers, there should be more take-home pay for employees . Those who are able will pay for the full cost of the Basic insurance plus their copays and deductibles. Employers may provide Health Savings Accounts as an employee benefit. The subsidies plus the catastophic expenses plus malpractice awards plus claims processing will be paid through additional tax levies to be determined.

Basic Plan – insurance premiums assessed against the insured. Those who can pay will be required to pay the full amount, plus their deductibles and copays (except for the free annual screening). Those who aren’t able to pay, or are only able to pay a portion, will be subsidized by the Federal government.

Catastrophic Plan – will need to be paid for by taxes. Since there won’t be any more payroll withholding for Medicare there will be almost three percent more take-home pay in an employee’s paycheck, assuming the employer passes on their half of the tax. Since the government is only picking up the health-care expenses over the cap, plus subsidies, and is no longer in the business of providing Medicare funding, hopefully the net tax increase (as there probably will be) will be small.

Note: About Non-participants

There will always be some who refuse to participate. Do we deny them access to the medical system? If we say no, then we destroy the whole concept of universal shared risk. My response is we do deny them because they have no insurance. If they want to work out some cash or barter arrangement, let’s look the other way when providers are willing to provide service under these arrangements. There will always be some willing to do that, so non-participants won’t be going without health care.

Final Note: Illegal Aliens

I know this question is going to come up: will illegal aliens be covered? My answer is yes, and my reasoning is this: they’re already here in the country and they’re already getting public assistance and health care. Under this plan they’ll at least be paying into the system through premiums for the Basic plan and their taxes, and they won’t be taking services out of the system as uninsured patients. Perhaps we’ll need a provision that they don’t get any services until they’ve been working and paying their taxes for a certain number of months. The secondary option is the same as outlined under non-participants.
post #2 of 63
Tim how would this:

Quote:
A Regional Medical Board will set a fee range for every medical service. The actual payment to the provider will be somewhere in that range depending on their contract with private insurance. Those same fees as contracted for will apply to claims over the catastrophic limit. The fee schedules will be posted on the internet for public access.
be different from the existing CPT codes?
http://patients.about.com/od/costsco...a/cptcodes.htm
http://www.reimbursementcodes.com/
post #3 of 63
Tim, I think your plan is awesome!
Quote:
5. Subsidized Basic coverage for those unable to pay.
Have you tried to figure what constitutes not being able to pay?
post #4 of 63
Thread Starter 
Quote:
Originally Posted by Rockcat View Post
Have you tried to figure what constitutes not being able to pay?
No, what is your suggestion?

Quote:
Originally Posted by 2dogmom View Post
Tim how would this:
be different from the existing CPT codes?
I'm sorry, in bit of a rush right now, didn't read the links. Are the current fee schedules adjusted for regional variations in cost? One couldn't expect a cardiologist in Ames, Iowa to get the same fee as one in New York City. That's my thinking behind the boards. They'd be made up of providers from that area, not government bureaucrats in Washington.
post #5 of 63
Quote:
Originally Posted by coaster View Post
No, what is your suggestion?
I don't have any, just more questions.
For instance:
Couple #1 can barely pay their bills. They have 3 maxed out credit cards, mostly because of previous medical expenses. They have one compact car and are making payments on it. If it wasn't for their high credit card payments, they would have enough money for health coverage, but currently they don't have the money.

Couple #2 can barely pay their bills. They have a large home with a huge mortgage. They have two car payments, one for an SUV and one for a high-end car. They currently don't have the money for health coverage.

Both couples have approximately the same annual income. Neither has health care coverage in their budget.

I guess my point is that it's going to be difficult to decide who is eligible for a subsidy. Lots of people would have enough money to pay for health coverage if they weren't overextended. Sure, it's their fault, but what do we do about it? Others are in debt and can't afford another bill, even those who (on the surface) look like they make enough money.
post #6 of 63
I'm a little more up on how things work for durable medical goods (for example wheelchairs) which are governed by HCPCS Level II codes than I am for services which are governed by HCPCS Level I codes.
http://www.cms.hhs.gov/HCPCSCodesforStateMed/

I'll give this my best shot at clarifying. It's extremely messy but here is about the most concise explanation I've seen online.
http://findarticles.com/p/articles/m...7/ai_n8991828/

The Level II codes are regional, but they divide the US into four parts, as opposed to differentiating between areas on the basis of cost of living.
http://www.prorehab.us/en-us/pg_9.html
Also if you look on pg 2 of the findarticles link, they refer to "appropriate geographic areas" when adjusting payments for outpatient facilities, but I do not know if these are the same geographic areas as for the Durable Medical Equipment codes. There is a little more on that here.
http://www.hcet.org/pdf/resource/pos...stman/term.pdf

My understanding of how this all works is that there are many health insurance companies, but most orient themselves on the reimbursement rates from CMS (Center for Medicare and Medicaid Services.) So if a medical provider, ie a doctor or physical therapist performs diagnosis or treatment on a patient, they can in theory charge the patient whatever they please, but the reimbursement rate is effectively set by CMS and that determines what the insurance company will pay. The CPT codes are determined by the AMA
http://acro.org/washington/CPT_Approval_Process.pdf
but I cannot figure out who sets the reimbursement rates.

If you ask me the reimbursement system itself deserves to be revamped.

Edited to add: You wanna see bureaucracy, take a look at this, this is what you have to do for example to get reimbursed for proving medical services.
http://codes.ohio.gov/oac/3901-1-59
post #7 of 63
Oddly enough, I have put out virtually exactly that plan online. Maybe somebody took me seriously.

I gave just a brief overview.

1. Catastrophic coverage, maybe a $2500 deductible, everyone required to get it, every insurance company required to carry it, no exceptions. You can pay for it, or your employer can, and those who are UNABLE to work can get it from the government. I would guess it would cost in the area of $100 per person per month, but that's just a guess.

2. Insurance companies could offer basic coverage, fill-in coverage, etc., and could adjust the cost of that according to demographics, health history, etc. HOWEVER, in order to offer any health insurance, they would be required to participate in the catastrophic coverage. In other words, you're either in it for the cat coverage, or you're not in the market at all.
post #8 of 63
Thread Starter 
mrblanche, really??? You know what they say about great minds. Can you give me the link? I'd like to read it. Maybe we ought to join forces!! Where we differ is the cap; I'd see it much higher; $2500 is hardly catastrophic. I'd probably scale from $5K for the low end to $100K on the high end. Maybe I'll have to add an income factor to the scale. Also, I'd keep the insurance companies out of the catastrophic plan altogether except for claims processing. They're going to want a profit on their risk; we need to get that out of the system as the biggest single factor.

Rockcat - I know what you're saying, but I think that we can't be making exceptions for people being in tough times because of their own stupidity. The hard-edged answer to your scenario is payroll withholding, so the premium for the basic insurance is deducted before they get their hands on it. I wouldn't want to do it that way; I'd rather keep employers out of the premium loop, obviously that's an extra expense.

2dog - the CMS reimbursement rates are ridiculous. That's part of the cost-shifting going on. They all need to be on the same page. Four regions isn't enough. And who sets the rates now? Are they setting rates on actual cost of doing business or are they setting rates based on x% increase over last year's rates (which were an x% increase over the previous year's, etc) and you're spot on about the reimbursement system. A clinic director described what they have to do to get paid, and they get paid six months or more after the DOS. In two of my own claims, they providers were paid a full YEAR after DOS.
post #9 of 63
Quote:
Originally Posted by coaster View Post
2dog - the CMS reimbursement rates are ridiculous. That's part of the cost-shifting going on. They all need to be on the same page. Four regions isn't enough. And who sets the rates now? Are they setting rates on actual cost of doing business or are they setting rates based on x% increase over last year's rates (which were an x% increase over the previous year's, etc) and you're spot on about the reimbursement system. A clinic director described what they have to do to get paid, and they get paid six months or more after the DOS. In two of my own claims, they providers were paid a full YEAR after DOS.
The four regions only apply to durable medical equipment. As far as how CPT reimbursement rates are set, it's on p 4 of this link:
http://www.hcet.org/pdf/resource/pos...stman/term.pdf
and there is a bit more here on how the procedure for setting them.
http://www.auanet.org/content/practi...imbprocess.pdf

Basically CMS appears to have the final say. And I can tell you from personal experience they really work hard to keep all reimbursement rates low and/or classify durable medical equipment into codes that will have a lower one as opposed to a higher one.

If you want an example for how a given CPT code gets reimbursed according to location, here you go:
http://www.bostonscientific.com/temp...System_QRG.pdf
This lets you see the actual geographic areas for the CPT codes.
Have fun.

I'm delighted that we have more than one great mind working on this because I have smoke coming out of my ears sometimes trying to make sense of it.
post #10 of 63
Thread Starter 
Quote:
Originally Posted by 2dogmom View Post
....I have smoke coming out of my ears sometimes trying to make sense of it.
I've seen that smoke -- I've talked to clinic directors and clinic business office personnel. I think that's a common hazard to health in those professions.

Thanks for all the info; I'll have to defer reading until later. I've got this posted on six forums.
post #11 of 63
Thread Starter 
How the Basic Plan Works

I decided to add this because I can see from the responses on the various forums I posted this that there’s a lot of confusion here. I think it’s confusion stemming from our concepts of how health insurance works having been influenced by the way it’s done now. There’s no good reason why it can’t be done a totally different way. And I think it makes more sense when we just cast aside our knowledge of how health care is paid for now and entertain a whole new way of doing things. Surprisingly, I think it’ll be easier for the insurance companies themselves to understand, because they know underwriting risk, and this is just a matter of underwriting risk. Yes, it’ll take a few years for their actuarial tables to get enough data to be able to underwrite the plan properly, and during that time some premiums may be too high, some may be too low. But before I get too far ahead, let’s look at the new way of buying and selling and providing health insurance under the Basic plan:

1. The insurance company has nothing to do with insurability, because everybody gets insured.

2. The insurance company has nothing to do with deciding whether or not to pay a claim, because all claims get paid.

3. The insurance company has nothing to do with deciding how much to pay the doctor because they pay according to the schedule they’ve contracted to pay.

4. The insurance company has nothing to do with deciding how much of a copay the patient pays because the copay is the difference between what the doctor charges and what the insurance company pays the doctor.

5. The insurance company receives the premiums from the insured and pays out the claims as they’re told to by the claims processor. Nothing else. There’s no getting turned down for insurance, there’s no getting a claim denied, there’s no having to do this or do that before paying for this. That’s all between the patient and the doctor.

6. The insured pays the insurance company the premium agreed to in the regional contract for that year, and that’s basically all the contact he/she has with that company.

Let’s take an example:

Insurance companies bid on a contract to provide Basic plan insurance to a region. Company AAA says they’ll insure everyone for a premium schedule of from $500 a year to cover a 25-year-old with a cap of $5,000 to $2,500 a year to cover a 50-year-old with a cap of $50,000 a year. And they’re the low bidder, so they get the contract. For those premiums, they’ll pay 100% of the low end of the fee schedule that the Medical Board for that region has published, the copay will be the difference, and each patient will have a $250 deductible before they pay anything.

The Medical Board’s fee schedule for a standard office visit to a Rheumatologist allows a fee of from $95 to $125. The patient’s doctor has set his fee at $115. The patient pays the doctor $20 on the date of service, the doctor remits the claim to the processor, the processor verifies it’s a valid claim, coded correctly, fee charged correctly, patient has satisfied deductible and is under his cap, and all that, and remits the claim to the insurance company. The insurance company remits $95 to the processor, and the processor sends $95 to the doctor.

Let’s take the above example, but it’s the first office visit of the new year. Everything works the same except that in addition to sending $95 to the doctor, the processor also sends a bill to the patient for $95, since he hasn’t yet met his deductible.

Third example: patient is over his cap. The insurance company drops out of the loop. The processor sends the claim to the government (yes, there’ll have to be some kind of a new bureacracy to handle these over-the-cap claims, but we’re getting rid of Medicare.) Government pays $115 and the processor sends $115 to the doctor. Patient pays nothing.

There’s one thing I haven’t figured out yet and that’s how the processor gets paid. Any ideas? A per-claim fee from the government? A cut of the claim?

One other question: should the doctor be allowed to charge more if the patient is willing to pay the difference? What if the doctor wants to charge more but the patient isn’t willing?
post #12 of 63
I'm sorry, but I haven't read through this thread in its entirety.

However, I will say that on the topic of "Universal Healthcare" that the best healthcare system is actually 2-tiered. Yes, a Universal system is great, but when paired up with private insurance for those who want extra coverage or are willing to pay for procedures rather than waiting, the results are much better. The combining of both means that everyone has access to healthcare, and those who can afford to pay at private clinics, help take the burden off of the lineups that those who can't afford to pay extra, find themselves waiting in.

It's a win-win situation.
post #13 of 63
Quote:
Originally Posted by Natalie_ca View Post
I'm sorry, but I haven't read through this thread in its entirety.

However, I will say that on the topic of "Universal Healthcare" that the best healthcare system is actually 2-tiered. Yes, a Universal system is great, but when paired up with private insurance for those who want extra coverage or are willing to pay for procedures rather than waiting, the results are much better. The combining of both means that everyone has access to healthcare, and those who can afford to pay at private clinics, help take the burden off of the lineups that those who can't afford to pay extra, find themselves waiting in.

It's a win-win situation.

Linda, it is suicide for a Canadian to get involved with this thread.

This thread isn't about Universal Healthcare, it's about Universal Insurance - big difference!

I believe you'll find the majority of Americans do not want universal healthcare because they don't trust their governments enough to run it. We often don't trust our governments either but they don't do too bad a job on the healthcare.
post #14 of 63
Quote:
Originally Posted by coaster View Post

Rockcat - I know what you're saying, but I think that we can't be making exceptions for people being in tough times because of their own stupidity. The hard-edged answer to your scenario is payroll withholding, so the premium for the basic insurance is deducted before they get their hands on it. I wouldn't want to do it that way; I'd rather keep employers out of the premium loop, obviously that's an extra expense.
I agree that we can't be making exceptions for people being in tough times because of their own stupidity. What about those who are deep in debt because of a tragic event? Should the guidelines be strictly income or should other factors be involved?

I think that whether is is real or percieved, not being to be able to "afford" it could result in people opting out. If enough people do, it will affect the risk pool which is essential to the plan. Like I said though, I don't have the answer.

I think payroll deductions are the way to go - just like medicare. It may be a little more work for the employer, but will help guarantee that the premiums are paid.
post #15 of 63
Thread Starter 
There is no opt-out. That's the only way it'll work.
post #16 of 63
Quote:
Originally Posted by Yosemite View Post
Linda, it is suicide for a Canadian to get involved with this thread.

This thread isn't about Universal Healthcare, it's about Universal Insurance - big difference!

I believe you'll find the majority of Americans do not want universal healthcare because they don't trust their governments enough to run it. We often don't trust our governments either but they don't do too bad a job on the healthcare.
Linda, I think that was true at one time, and perhaps still is on TCS (especially in IMO). Almost everyone I know IRL is FOR it.
post #17 of 63
Quote:
Originally Posted by Rockcat View Post
Linda, I think that was true at one time, and perhaps still is on TCS (especially in IMO). Almost everyone I know IRL is FOR it.
I hope that is so because as bad as some people think it is, it certainly is a better alternative to what is happening in the US right now (or should I say not happening in the US). I feel so bad for the folks that cannot afford proper medical care or have to go into huge debt for that care. With so many jobs being lost now in this recession, it is only going to get worse.

Insurance companies are not the answer IMO as they are in the business of making money and not really helping people. Just see how quickly they are willing to pay out when someone really needs the money - just like everything else they will deny the claims and find ways to avoid paying but will gladly reel in the high insurance premiums. At least with a government run health plan rather than an insurance plan, the medical community deals directly with the government for their payment and the patient just needs to show up for the appointment.

But then again I'm Canadian and although we may complain at times about our health plan, we all use it and know we don't need to hesitate to seek medical advice because we can't afford it.
post #18 of 63
Quote:
Originally Posted by coaster View Post
There is no opt-out. That's the only way it'll work.
Good. You mentioned non-participants in your OP.
post #19 of 63
Quote:
Originally Posted by Yosemite View Post

Insurance companies are not the answer IMO as they are in the business of making money and not really helping people. Just see how quickly they are willing to pay out when someone really needs the money - just like everything else they will deny the claims and find ways to avoid paying but will gladly reel in the high insurance premiums.
No argument here. Insurance companies want to insure those with little or no risk. Thats why health insurers won't cover those with pre-existing conditions and property insurers are pulling out of states heavily affected by hurricanes. No plan is going to be perfect, but IMO it's got to be better than what we have now.

Thanks for your views on Canadian Health Care. So many Americans assume the worst. You may have opened some eyes.
post #20 of 63
Quote:
Originally Posted by Rockcat View Post
Thanks for your views on Canadian Health Care. So many Americans assume the worst. You may have opened some eyes.
Unfortunately if you go back and read some other threads on this subject you will see that those of us in countries with a health care system get pretty much bashed and mobbed when we even suggest the US get a similar plan. Therefore I doubt if any eyes have been opened - at least not wide enough to see.
post #21 of 63
Quote:
Originally Posted by Yosemite View Post
Unfortunately if you go back and read some other threads on this subject you will see that those of us in countries with a health care system get pretty much bashed and mobbed when we even suggest the US get a similar plan. Therefore I doubt if any eyes have been opened - at least not wide enough to see.
I know it seemed you (collectively) were banging your heads against a wall for awhile trying to explain. Perhaps there weren't really that many "bashers." It may be that they had the loudest voices though. Or maybe I'm just being overly optimistic today.
post #22 of 63
No offense to any Canadians (or anyone else for that mmatter) btu I'd like to give the system in Singapore a shot.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=7923
http://www.watsonwyatt.com/europe/pu...2.asp?ID=13850
post #23 of 63
Quote:
Originally Posted by 2dogmom View Post
No offense to any Canadians (or anyone else for that mmatter) btu I'd like to give the system in Singapore a shot.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=7923
http://www.watsonwyatt.com/europe/pu...2.asp?ID=13850
It sounds perfect but it seems the government is somewhat involved so that would veto it for the US if what I've read here in IMO is any indication of the feeling of the citizens of the US.
post #24 of 63
Thread Starter 
Quote:
Originally Posted by Rockcat View Post
Good. You mentioned non-participants in your OP.
Although there's no option to not participate, there'll always be non-participants. Such as illegal aliens, resident legal aliens, tourists and students, people who've never had had contact with the healthcare system, people who've never been employed, have no Social Security number, been living in the wilderness, etc etc. Though they be few, their situations need to be addressed. The basic way to address those is upon first contact with health care, they automatically get signed up. Then whether they pay a premium for insurance, or get subsidized, depends on the situation. We're not going to turn people out into the street to die. We ARE going to make them pay their fair share if they're able to pay.
post #25 of 63
Thread Starter 
Quote:
Originally Posted by 2dogmom View Post
No offense to any Canadians (or anyone else for that mmatter) btu I'd like to give the system in Singapore a shot.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=7923
http://www.watsonwyatt.com/europe/pu...2.asp?ID=13850
I wouldn't by any chance know you by another name on another forum, would I?
post #26 of 63
Some people get around.
post #27 of 63
Thread Starter 
Quote:
Originally Posted by 2dogmom View Post
Some people get around.
I gotcha. Thanks for your contributions to the "project."
post #28 of 63
Quote:
Originally Posted by coaster View Post
mrblanche, really??? You know what they say about great minds. Can you give me the link? I'd like to read it. Maybe we ought to join forces!! Where we differ is the cap; I'd see it much higher; $2500 is hardly catastrophic.
I think the places I suggest it (some years ago, mind you) have all died.

However, you know this program has already been passed once, here in the U.S? It was called the "Medicare Catastrophic Extension Act of 1988." It was repealed in 1989, due to protests from AARP.

And that brings up a real problem. People with what they consider "good" insurance now will fight what might actually be better insurance.

I went with the $2500 deductible because that is an amount that is high enough to get around most routine care, but low enough to not be a crippling loss.

In addition, I would say that everyone would have a co-pay for every office visit, say $25, just to discourage the attitude that medical care was "free."
post #29 of 63
Thread Starter 
Education is the hardest part. People fear the unknown. You know what they say about the evil you know.

I have to disagree on the last point. The reason I went with an approved range and payment of 100% on the low end (but that can always be changed, say maybe with a minimum copay) is to promote competition among the providers. I want people to be health care consumers. I want them to know how much the doctor charges before they go to the office. I want them to be able to make the choice of going to the low cost provider, but even better, I want to encourage them to do so by making it worth their while. Once people start choosing the low cost provider, and doctors have to publish their fees, competition should kick in to put a damper on spiralling cost increases.
post #30 of 63
What's the advantage of your system over a non-insurance single-payer system? It appears quite complicated, and I don't understand the role of Insurance companies for basic care (except to enrich the Insurance companies). As far as I can tell, only your advantage points 2 & 3 would be absent in a single payer system. However, I completely disagree that the private sector is paying for health care very well already (and your plan is so much of a change that this advantage seems completely irrelevant). Why do you want competition for health plans? Don't you want competition for health care instead, so it's the health care, not the plan, that improves? Any system, single payer or insurance style, has competition as long as the patients have a choice. I also don't understand how your system, with insurance for basic care, could encourage individuals to be intelligent health care consumers. It's the insurance that pays that, right? And the insurance is regional, so the individuals don't even get to chose who pays for their basic care?

Most importantly, I have the impression (not based on research) that, in addition to having the pay the middle man (insurance), the huge cost of American health care is our assumption that everyone should have as much catastrophic care as possible. You put this into a mandated federal program, which means that what counts as "experimental" treatment and what counts as a "standard of care" that should be paid for everyone will continue to be a huge political issue. This is one of the inevitable drawbacks of a single payer system, and you've manged to include it in a system that still has a middle man (insurance). In order to have affordable care, we must admit that sometimes it's not simply not worth the resources to keep trying to save a certain person's live. Putting a left ventricular assist device while waiting for a heart transplant to someone whose kidneys have gone, who is suffering from Alzheimer's, and who has permanent lung damage* is simply not worth the cost of surgery. Period. But many Americans currently have the philosophy that Anything that can be done to safe (or slightly extend) a life should be done. That's simply a disaster for both health care and health insurance. Deciding where the line between reasonable and unreasonable care is, in my opinion, the biggest problem and hardest decision in health care. Right now the decision is made in great part by how much money you have, including whether you have money to have insurance.

An analogy I heard (from a heath care group organized around membership and cash payments) went something like this "having insurance for annual office visits is like having insurance for lunch: paying someone to give money to someone else for something you know you'll need". Ideally, I think that we should have a single payer routine care and emergency system, with optional private health insurance for care above the national standard. That way, the nation makes a conservative choice on what is covered routine care** and individuals can pay for as much extreme end-of-life care as they've got insurance or money to cover.

*Absurd exaggerated case invented by me!
**In my opinion, birth control and insulin and removal of small cancers should all be covered, but treatments for metastasized cancer should not be covered. People will differ on this, and this is by far the hardest part of making this health care plan work.
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