Health care for all: Comments on Conservative comments

[septimus]

In a current GD thread, Conservatives are asked “What should we do about people who can’t pay for medical care?” I think it will be interesting to see what they come up with. To avoid “poisoning their well” I propose that centrists discuss conservative solutions in this thread.

Let me say at the outset that I am not expert on health care or health care financing, but instead rely on philosophy, intuition and common sense.
I will be happy to have my own ignorance fought here.

@Sage_Rat

Make health care free to anyone who wants it. But, the dollar amount of care which is covered on a free plan is only required to be X% of the national average of health care spending for someone in that age group, such that X is low enough to encourage sufficient numbers of people to buy paid insurance plans that the free plans are affordable for the insurance companies.

Although details vary, this seems very logical to me, and may even resemble socialized systems. It does seem to pose practical problems: suppose your heart is failing, needs a bypass, but your insurance affords only a stent. What now? You can’t afford to pay for bypass yourself; is the hospital supposed to give you a stent that they know will probably not solve your problem?

I’m curious how such problems are dealt with in socialized systems. I’m somewhat familiar with Thailand where, if you appear well-to-do, government hospital workers will advise you, if you don’t want to join the long government queue, that the doctors in the government hospital also moonlight across the street in a private clinic .

I agree that health care needs to be rationed and that, like anything else, it is logical for the rich to get more, if they pay for it. Even utilitarians should agree that paying large sums for a heart bypass on an aging indigent American makes little sense: You could save far more lives by spending the same money on, e.g., mosquito nets for Africans.

@smiling_bandit

(2) Change the tax code to push most predictable, ongoing costs are not covered by insurance. I can see a good argument for the odd checkup, but nowadays insurance covers many optional or easily-anticipated procedures along with drugs, which tends to make them all way more expensive.
(2.5) Insurance should cover, y’know, unexpected and catastrophic damages, just like every other damn insurance in existence.

This also seems extremely logical, and it may be hard to articulate exactly why it’s wrong. But for one thing, many lower-income people cannot afford even simple preventative care. You are asking for perverse incentives (which already exist, as reported in other SDMB threads) such as “Don’t get that tooth fixed yet: if the gum gets infected, care will be free.”
One reason to require payment for simple doctor visits is to discourage wasteful hypochondria but this is to solve a non-problem. I think medical professionals would agree that not visiting a doctor, even when free, is more of a real problem than excessive visits.

@Drum_God

From what I can tell, the conservative solution is very much like Obamacare.

This is the irony! What’s not to like, for conservatives? Increased profits for insurance and pharmaceutical companies; premiums extracted from lower-income people to the extent they can afford it.

Romney was for an Obama-like plan before he was against it. Nixon proposed it (or rather something even more socialistic) 40+ years ago, which was rejected by the Democrats. Blame the Democrats for the Obamacare controversy if you wish: If they had opposed it, the GOP could have embraced it. :smack:

[snowthx]

@septimus

In [URL=http://boards.straightdope.com/sdmb/showthread.php?t=646860]Although details vary, this seems very logical to me, and may even resemble socialized systems. It does seem to pose practical problems: suppose your heart is failing, needs a bypass, but your insurance affords only a stent. What now? You can’t afford to pay for bypass yourself; is the hospital supposed to give you a stent that they know will probably not solve your problem?

I’m curious how such problems are dealt with in socialized systems. I’m somewhat familiar with Thailand where, if you appear well-to-do, government hospital workers will advise you, if you don’t want to join the long government queue, that the doctors in the government hospital also moonlight across the street in a private clinic .

You need not look oversees to see how this could be handled. Look to Medicare - they have a payment schedule for basic services and care based on the latest studies and medical literature. If someone wants more, they can purchase a supplemental policy from a private insurer. If you cannot afford something extra, well, then you are stuck with the basic care. Is that fair? - I say yes. As long as everyone is covered with basic care, then you reduce costs and have better outcomes. I think everyone would agree that is what is being sought.

There is a “Medicare for All” bill that has failed repeatedly to get traction. I think with some tweaking something like that could work. Perhaps let younger people buy-in to the Medicare network. The infrastructure is already there. Critics bemoan how Medicare is too expensive. That is because the people in Medicare are at an age where the most expensive and chronic treatments are common (Health insurers are shielded from these costs when Medicare takes over). Also, make costs of paying for Medicare health insurance a tax deduction (as opposed to calling it a “tax”). Getting more young and healthy people into the risk pool lowers costs for everyone. It may also help in detatching health insurance from your place of work.

I think there needs to be a definition of what “basic health care” means. IMHO it should include basic preventative care like annual check-ups, ER visits when warranted, well-woman/well-baby, 2x/yr dental check-ups and cleaning, generic drugs and yes, contraceptives. If someone wants more than that, or a private hospital room, or a trip to the front of a line, then private policies from a insurer are available.

Conservatives and Liberals and Progressives have taken their eye off the ball - managing costs and improving outcomes. There are solid ideas on all sides, however politics are clouding any reasonable discussion on real solutions.