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Health care proposals: Let's start over

post #1 of 20
Thread Starter 
OK, let’s start over. Forget plan A. Let’s just start without a plan but just asking for your ideas. Here’s a list of what I want to do. How would you go about making that happen?

1. Everybody is covered by health insurance. Strike “uninsurableâ€, “benefit deniedâ€, and “pre-existing condition†from the health-care lexicon.

2. Everybody has affordable access to health care. And everybody is required to access health care through annual screening. Those who are unable to pay are subsidized.

3. Health care decisions are made between the patient and the doctor, without interference by any third-party entity.

4. Get the patient involved in spending decisions as a health-care consumer in order to foster competition in health care. The patient must share some portion of the cost, either as copayments, insurance, taxes, or some combination so that wise spending decisions are made.

5. Excess costs are removed; e.g. costs due to:
\t- multiple layers of middlemen between provider and payor
\t- cost shifting due to health care for uninsured (see #1 and #2)
\t- legal protection: malpractice, product liability
\t- patent protection
\t- duplication of services
\t- lack of competition
\t- defensive medicine
\t- patient demand for uneeded health care
\t- patient neglect of health care
\t- patient ignorance of the cost of health care

6. The Medicare/Medicaid/VA systems are dissolved and their functions absorbed.

7. Discourage or do away with the employer-provided health insurance model.
post #2 of 20
Just so you know, this has been fun. I'm sorry no-one here seems very interested in the subject.

I hadn't replied so far because I disagree with some of your goals. If I disagree with your goals, why would I bother to come up with a system to fulfill your goals? The same may be true of other posters.

I actually agree with most of your goals, but the bits I disagree with are big.

I agree with #1 in that I agree that everyone should be covered by some type of health care, but I don't agree that insurance is necessarily important.

I disagree with #3 entirely. Decisions should be made by the patient, the doctor, and the group responsible for providing the resources. I think that this may be such a basic disagreement that we can't get past it to create a plan. Sure, in an ideal world with unlimited resources, I can see how #3 could be a good goal. But we don't live in a universe with unlimited resources, so I think that this goal is misguided.

I agree with #4, that there should be competition both on best care and least resources used to get that care. I'm not convinced that patient cost-sharing is the best way to do this. To me, this should be discussed in the "how do we fulfill these goals" not the "what are the goals" part.

Everything else I agree with, but it's not enough agreement to work towards building a system.
post #3 of 20
I'm interested, but it takes me a day and a half to come up with a response!
post #4 of 20
You've given this a lot of thought and I think you are off to a great start. Sorry I'm not more helpful though. I'm just thrilled that this might actually happen!
post #5 of 20
It is something that looks interesting... Personally I would love help with my choice of dr which is mostly acupuncture and chiropractic but my limited insurgence wont pay
post #6 of 20
Thread Starter 
Enuja - good observation about #4.

About #3 -- what would be your solution to the problems of the payor denying benefits or telling the doctor that this and that has to be tried before that can be done? I've run into that multiple times where my Doctor and I both know that options #1 and #2 aren't going to work, but the insurance company won't pay for option #3 until I waste my time and THEIR money on #1 and #2.

Are there other reasons why #3 isn't feasible other than the pragmatic reasons you noted?

2dogmom gave me a whole bunch more stuff in a post on another forum, thanks for that input!!

sharky - should all alternative therapies be included do you think? I can see accupuncture and chiropractic because of the training and credentialing and licensing required. What about other therapies that people claim help them? Reflexology? Cranial-sacral? Massage? Chinese herbs? Where should a line be drawn, or is a line necessary?
post #7 of 20
Thread Starter 
Enuja -

How about this: an independent medical advisor/counselor/advocate would represent the interests of the payor in doctor/patient health-care decision-making. I want to preserve the separation between payor and provider such that we can still strike "benefits denied" but I can see your points about #3. Keeping the payor out of the doctor's office is an essential point with me, but there's got to be some way your concerns can be accounted for as well. The idea above was suggested on another forum. It adds another layer of complexity and expense, but there's merit in it if it can address the issues with #3.
post #8 of 20
Quote:
Originally Posted by coaster View Post
I've run into that multiple times where my Doctor and I both know that options #1 and #2 aren't going to work, but the insurance company won't pay for option #3 until I waste my time and THEIR money on #1 and #2.
That is quite counter-productive on the part of the insurance company. I advocate controlled experiments (clinical studies) to figure out which approaches have what chance to work with given symptoms, and detailed cost analysis to figure out which is the cheapest and most effective way to go is. I don't think that any special methodology is necessary to get rid of this type of behavior. One possible explanation for that type of behavior is worries about malpractice, but that usually causes the doctor to order extra tests, not the insurance company.

I doubt that a separate payer advocate makes sense, but it really depends on the rest of the system. In basic care, giving the best care is either cheaper in the long term or simply required to give good care. I think restricting resources only becomes important for the patients that create high costs, so a payer advocate would be just counterproductive for most patients most of the time.
post #9 of 20
Quote:
Originally Posted by coaster View Post
Enuja - good observation about #4.


sharky - should all alternative therapies be included do you think? I can see accupuncture and chiropractic because of the training and credentialing and licensing required. What about other therapies that people claim help them? Reflexology? Cranial-sacral? Massage? Chinese herbs? Where should a line be drawn, or is a line necessary?
reflexology is something that a certificate is obtainable and thus yes a cetified person could be the line

cranial sacral same as above

message - also licensed like acupuncture

herbs - I would cover but realize Kandie and Gigi and I all have or had extra time do to them ... perhaps the dr would have to write a RX for it to be covered not someone saying I want to take this
post #10 of 20
Thread Starter 
I agree that covering something requiring a prescription is a good way to define what's covered and what's not. However, the dietary and health supplements industry has been fighting FDA efforts to regulate them tooth and nail for years. I'm sure they'd really pop over requiring prescriptions (and that includes me, since I use dietary supplements.)
post #11 of 20
Just a question because I'm curious. Why are you getting this information from everyone? Are you planning on getting this plan enacted yourself?
post #12 of 20
Quote:
Originally Posted by coaster View Post
I agree that covering something requiring a prescription is a good way to define what's covered and what's not. However, the dietary and health supplements industry has been fighting FDA efforts to regulate them tooth and nail for years. I'm sure they'd really pop over requiring prescriptions (and that includes me, since I use dietary supplements.)
Many herbs( Chinese) that truly are medicinal already are only found in oriental practitioners offices so it is not like your daily multiple( I dont want a rx for those either )
post #13 of 20
Thread Starter 
Quote:
Originally Posted by Yosemite View Post
Just a question because I'm curious. Why are you getting this information from everyone? Are you planning on getting this plan enacted yourself?
Your question sounds cynical, especially in light of your previous comments on the topic, but instead of dismissing it with the snide remark that first came to mind I'll treat it as a genuine question; someone else reading this might have a genuine curiosity: I hope to get something worthy of sending to my legislators; perhaps put up a website. If you've been tracking my postings here, you know this is one of my hot button issues. Right up near the top of the list. In this country we have the attitude that anybody can accomplish anything if they set their mind to it, and that it's up to the people to solve the problems of the country. We have a system whereby not just the power flows from the people but the ideas as well. Good ideas do get listened to, especially when enough people are saying the same thing.
post #14 of 20
Quote:
Originally Posted by coaster View Post
Your question sounds cynical, especially in light of your previous comments on the topic, but instead of dismissing it with the snide remark that first came to mind I'll treat it as a genuine question; someone else reading this might have a genuine curiosity: I hope to get something worthy of sending to my legislators; perhaps put up a website. If you've been tracking my postings here, you know this is one of my hot button issues. Right up near the top of the list. In this country we have the attitude that anybody can accomplish anything if they set their mind to it, and that it's up to the people to solve the problems of the country. We have a system whereby not just the power flows from the people but the ideas as well. Good ideas do get listened to, especially when enough people are saying the same thing.
Well, believe it or not, it was a serious question and not meant to be in the least cynical. I agree that change needs to start somewhere and applaud you for making the effort, taking the time and enlisting people from this site as well as the others sites you are involved with. Good for you and I mean that very sincerely. I may not agree with your proposed health insurance plan but I applaud your efforts.
post #15 of 20
Thread Starter 
All right, Linda, thank you for the kind words and I apologize for the presumption of guilt until proven guilty. And the answer is no, I don't plan on doing it myself. If you lived here, I'd ask for your help.
post #16 of 20
Quote:
Originally Posted by coaster View Post
All right, Linda, thank you for the kind words and I apologize for the presumption of guilt until proven guilty. And the answer is no, I don't plan on doing it myself. If you lived here, I'd ask for your help.
If I lived there I would try to help you myself because, as you know, I strongly believe the US needs some kind of medical plan/insurance.
post #17 of 20
Thread Starter 
And this process is being productive. I'm finding where my original ideas are weak and I'm getting some really good input, too.
post #18 of 20
Not sure anything has been mentioned about MA so far. There is enough material on the web to read for days, so just a few quick links and quotes that summarize the problems with RomneyCare. God help us all if one day anything even remotely similar becomes law that applies to every state.

http://www.timothybirdnow.com/?p=724

Quote:
In this respect paradoxically, we can be thankful that Massachusetts ignored the cost problems that doomed other recent liberal health insurance overhauls in California, Pennsylvania, Wisconsin and Illinois. The Bay State is showing everyone how not to reform health care.
http://www.cato.org/pubs/policy_repo...cpr30n1-1.html

Quote:
But, as Massachusetts has shown us, mandating insurance, restricting individual choice, expanding subsidies, and increasing government control isn’t going to solve those problems. A mandate imposes a substantial cost in terms of individual choice but is almost certainly unenforceable and will not achieve its goal of universal coverage. Subsidies may increase coverage, but will almost always cost more than projected and will impose substantial costs on taxpayers. Increased regulations will drive up costs and limit consumer choice.

The answer to controlling health care costs and increasing access to care lies with giving consumers more control over their health care spending while increasing competition in the health care marketplace- not in mandates, subsidies, and regulation. That is the lesson we should be drawing from the failure of RomneyCare.
http://kansasprogress.com/wordpress/...eycare-failed/

Quote:
Unfortunately, the program in practice has been a colossal failure, expanding state bureaucracy and government control over the health care market and provider-patient dealings, while simultaneously driving up health insurance premia, increasing health care costs, and creating a chronic shortage of providers - all at an annual price tag of over twice the originally-estimated $600 million.
post #19 of 20
Thread Starter 
Thanks for the links. Learning from others' mistakes is key. Learning from their successes is also.
post #20 of 20
Thread Starter 
I had a lengthy and interesting conversation with a knowledgeable person inside the insurance industry yesterday, giving me some insight on how the insurance industry would view a two-tier hybrid risk-sharing system as I proposed. Mainly I wanted to get a sense of whether it would be easier to underwrite the bottom tier or the top tier. I didn't get any firm answer because that depends on the actual numbers. What I did get is that insurance companies don't want to underwrite risk when the maximum possible loss is unknown. So that gives me the sense that insurance companies would do a better job insuring the bottom tier, with the government insuring the top. Unless a three-tier system is used, with private insurance companies insuring the middle, and the government the top and the bottom. This adds another level of complexity, though. This would make the government the payor for the high claims frequency of routine care and minor ailments and also for the super-catastrophic but low-frequency claims of major illnesses. It's worth considering, I think, despite the extra level of complexity.

Actually this idea of insuring up to a cap is already used extensively in the insurance industry through re-insurance. Essentially an insurance company buys insurance from another insurance company (the re-insurer) to cover claims over a certain amount. So if we think of the government as the re-insurer, then this tiered system of risk is something they're already quite used to working with. And with the already extensive claims history, they should be able to competitively price insurance policies.
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