This is the crux of the issue. (And many other issues.)
Who do you fear more: Government or private corporations? The answer to this question basically predicts your position on this issue and so many others.
Yes, it is terrible. The only thing I can think of that would be worse is giving that power currently held over us by our employers to the government. At least I can change employers if I don’t like mine. The only choice I have to remove myself from a government run system would be to move to France.
Here’s the hierarchy:
Good: People could choose their own coverage using their own money. No linking health care to employer or to the government.
Bad: Current system. Health care generally linked to employer. If you want to take certain birth control and work for a Christian company you might be out of luck. If you get laid off you might be out of luck.
Worse: Government run system. For examples, see VA hospitals, the IRS, or basically anything else that the government attempts to run.
BTW, for the “good” system to work, you would need to have only healthcare for catastrophic issues. You get cancer and the care is provided by your insurance.
Day to day expenses like going to the doctor or an ER visit for stitches would just be paid out of pocket or through a health care savings account like GWBush was always suggesting.
It would work like how dentist or eye doctor bills work now. Note how much the price has dropped for laser eye surgery. Health care should work the same way. Hospitals bill tens of thousands for things a lot simpler than eye surgery that can be done for $1500 an eye.
Care to explain how getting laid off in the Bad system is worse than getting laid off in the Good system? Seems to me everyone who’s unemployed gets to take advantage of “Good” employer free health care.
I’m not saying that anectodes = data, but of all my acquaintances who have had health care finance troubles, not one of them would have been helped by your “Good” system, and every single one would have been helped by your “Worse” system. Frankly, the very fact that I know multiple people with serious health care based financial problems speaks volumes about our system vs. Gov’t supported UHC.
Laser eye surgery is an elective. I have glasses, and maybe could use this, but don’t want to and my health is the same. Not quite the same for my wife’s detached retina.
You are also assuming a bimodal distribution of costs - either very high, like cancer, or affordable, like checkups. That is simplistic. Not to mention that the affordability of any such treatment depends on your income. I had a bad tooth year this year and hit my maximum. I could afford to pay the excess but it would be a major hardship for lots of people.
You don’t mention whether your “good” system would require insurers to cover pre-existing conditions. I have AFib which right now costs just some drugs and a cardiologist visit every year. But I could easily suffer an expensive heart attack. Would I be covered?
By any metric except your personal dislike of the idea government systems run better than ours.
ETA: As for savings accounts, they might work fine so long as your body waits until you’ve accumulated money to get sick. And that your ability to save matches your needs. How is the retirement equivalent of that going? The mean amount in 401Ks for persons over 60 is $65k. Thank Og for Social Security, one of many government programs that work just great, thank you.
So what? Not to be flip, but why does this matter?
Plenty of health care now is elective. People who don’t have to pay for it are much more likely to go to a specialist for something they barely need then if they have to pay for it.
I can attest to this personally. I’ve had good plans at some companies and bad ones at others. I definitely give it a second thought whether to get treatment based on if there’s a copay or deductible that will hit me hard.
This is a good thing in two ways: People paying themselves for care will self select and only pay for the care they need vs just getting every test if it’s all free. Also, the care itself will get cheaper (elective and otherwise) because people will shop around for price.
The fact that laser eye surgery is cheap isn’t due as much to the fact that it’s elective as that it’s competitive. People wouldn’t pay 10K when there’s a good doctor willing to do it for 8K and so on. The resulting competition lowers the price.
My post of a couple paragraphs might have been simplistic, but it’s true that health care tends to come in two varieties: Healthy and sick. Lot’s of people are generally healthy and don’t need care outside of a checkup. Some people have terrible injuries or illnesses that some sort of insurance needs to cover.
If you think there’s some problem accounting for that let the market figure it out. People can pick a deductible that works for them, just like with car insurance.
You’re goal is to fully insulate people from this? Not realistic.
You could say the same thing about food or shelter. Lots of things are a hardship for people who don’t have money to pay for them. Healthcare shouldn’t be any different.
Sure. This had nothing to do with my point, so I don’t know why you mention it like it’s some sort of problem.
I guess this is why the rich who need care come from all over the world to American hospitals and not the other way around, right?
If you think social security is a program that works, I’m not surprised you are in favor of government health care. It would be equally disastrous.
Getting laid off is going to be a bad thing regardless of system, as it should be.
In the bad system, you lose your insurance when laid off. (Yes, we’ve got things to deal with this such as COBRA, but it’s not optimal to say the least.)
In the good system, you continue on as before.
If you need a checkup you go get one and pay for it. (Which might be harder without a job, admittedly.)
If you have a more serious thing like a broken bone from skiing (during your newly freed up days of being laid off) then you dip into your health care savings account. Since that’s not tied to an employer you still have it. The thousand bucks or so per month that usually go to your employer provided health care are now sitting for you with interest waiting to be spent.
If something really bad happens like you get hit by a bus or get cancer then you still have your catastrophic coverage that again isn’t tied to your employer. This is relatively cheap since it’s got a huge deductible that you would never dip into for less than an emergency costing tens of thousands of dollars.
Unfortunately “need” is not binary in health care. What you’re describing is exactly why there’s such a push for preventative care: it saves money later. When people have to worry that much about paying for something they might need, they end up gambling.
Apparently you think that switching to your system is going to buy me ongoing catastrophic insurance, ongoing health care AND build up a huge HSA nest egg at the same time, from the same money that my employer spent to just get me catastrophic insurance and ongoing care.
Most people may manage to be slightly better off, IF they can negotiate a rate with their providers that is as good as the insurance company does. Good luck doing that. However, slightly better off isn’t going to pay a $5,000 bill for a major incident, you’re just fucked.
Or, we can take a hint from other countries that spend a fraction of what we spend, and cover everybody with high quality care.
Would the “good” system have some kind of 100% coverage on catastrophic events, or would they get to cherry pick what they want to pay for, and what they don’t, like they do now?
Case in point- I tore my patellar tendon in my right knee in January. This is potentially a crippling injury, since it essentially detaches my kneecap from the lower leg. I had an ambulance ride to the hospital and repair surgery in less than 24 hours. When all was said and done, there were a zillion little charges that insurance wouldn’t pay for, or that insurance only paid part of and I was on the hook for the rest (and that didn’t apply toward the deductible either) I ended up paying about $3000 total, which was roughly 10-15% of the bill IIRC.
Another thing that needs changing- balance billing and this absurd game of nickel and diming every thing- does insurance pay it at all? Does insurance pay all of it? Is it in network?
If you’re in the hospital, you should get one bill, not one from the hospital, one from the ER doctor, one from the pathologist, one from the anesthesiologist, one from the X-ray guy, and so on and so-forth. It’s doubly important because you don’t have any choice either- the anesthesiologist on duty that day doesn’t take Aetna? Bend over and spread 'em buddy.
You do know that when measured by health outcomes and cost, VA and Medicare perform much better than the current health insurance marketplace? And, by coincidence, they are the most like socialized medicine programs worldwide. The current VA scandal (as screwed-up as it is) does not change the system’s overall performance.
Let me make it clear that I fully endorse having the market control truly elective procedures - plastic surgery except as a results of other problems, laser surgery, etc. By definition no one has to have these, so let them do it if they can afford it.
My group has GPs and specialists, and access to the specialists is through the GPs. I can’t just decide I need a CAT scan because I feel like it. I’m for using evidence based medicine to control costs. However, the other side of going to specialists too much and wasting money is not going enough, and wasting money by not catching something quickly enough or dying or both.
Ever get in trouble because of this? I got rejected when I tried to donate blood because of a racy pulse. I had just drank a gallon of Mountain Dew, and was sure it was caffeine. But, because I had a reasonable co-pay I went to the doctor to see if I could get a letter saying it was okay to donate. If I had a high deductible, or was cash strapped, I probably wouldn’t have. And I might be dead today or at best had an expensive heart attack. I saved the economy a lot of money by going to the doctor.
We should let medicine control access, not money.
People buy bad food because it is cheaper, people buy shoddy merchandise because it is cheaper. Are you sure that selecting care based only on price is going to lead to a good result?
Elective care is a single procedure which is a non-emergency, so you can shop on price. Emergency care does not allow for shopping, and this is the expensive stuff. Even when you establish a relationship with a doctor you are doing it based on a small subset of his prices. I can see medical centers offering cheap check ups and expensive surgery.
Certainly true. And that is because no one needs it today or else. It is easy to take a few days and shop around for the best price.
But people move from one category to the other with no warning. And anyone who doesn’t die early and inexpensively moves to the expensive category over time.
You get the very thing the mandate was designed to stop - very expensive insurance for the sick and old, and cheap for the young. For the sick and old to afford it you have to charge the young more than the expected value of their benefits.
Then you have the problem that people are bad at estimating the likelihood of low probability events. If too many underestimate you wind up with bankruptcies due to health issues as has been all too common in the US. Is that acceptable to you?
Cars have a strict ceiling on costs. Old cars are cheaper to insure because the point at which you trash them is lower also. If medical insurance were like car insurance my 98 year old father in law would have to pay almost nothing, being fully depreciated. Bad analogy.
Pet insurance is similar, except for those who are willing to pay tens of thousands of dollars for cancer treatment for dogs. That is certainly elective.
The same situation could crop up for more serious things.
As for food and shelter, having enough to not die isn’t all that expensive, and we do have some form of insurance for the minimum in the terms of food stamps and housing assistance - though not so good for the latter. And again there are strict ceilings on how much one needs.
How would your system deal with this problem. Would insurers in the good system be forced to insure everyone? Would they do it at costs not even close to affordable? Or are those with existing conditions SOL like they were if they wanted individual insurance in the old days? It is a critical point.
And the not so rich go to Mexico or Thailand. I could go to Mumbai and live it up and ignore the slums also. We who have money have a lot more freedom. If you are designing a system for the rich, I’ll cheerfully admit your “good” system fits the bill.
If you think Social Security is a failure, you have a reality problem. Worked great for my father. Works great for my father-in-law. I can get it now if I wanted to, and it is there for me. I just wish current conservatives were like Ronald Reagan who did a great job in leading the necessary changes.
That’s just silly. Surely the same people who say “No woman should have health care decisions made by her boss” would feel the same about a man. It’s just the case that women are the ones whose health care choices are being dictated by their employers. Is there some controversial men’s health case where you think the Democrats have been hypocritically silent?
Perhaps Congressional Republicans would not support universal contraception coverage, but why would that matter when we already have pretty close to universal contraception coverage? To reiterate what I’ve said before, there seem to be two different views of contraception in the USA.
First there’s the world inhabited by Hillay Clinton, Sandra Fluke, and most other Democrats. In this world contraception is rarer than vibranium and more expensive than gold. Hence no woman has the slightest chance of ever getting contraception unless her employer pays every single penny of the cost. Thus an employer who doesn’t cover every single penny of the cost is deny women access to contraception.
Then there’s reality, which everyone else inhabits. In reality, contraception is readily available at every Walgreens, Rite Aid, CVS, Walmart, KMart, Target, and countless other stores. It generally costs very little–the pill is less than $10 per month. Condoms cost even less. And for the very few women who can’t pay for the stuff, there are countless places giving it away for free. Hence it’s no surprise that there’s no evidence that any women, much less women with full time employment, are lacking “access” to contraception.
For those of us who live in reality, why worry about “universal” coverage of contraception, when we already have pretty close to that? What’s the big deal here, really?
Of course they should get to pick what they cover. But now employees basically don’t get to pick which coverage they buy. If they did, that would counteract it. So, a bad plan that covers obscure things like sex change operations but doesn’t cover your anesthesia wouldn’t be something that most people would choose.
Giving people more choice is the solution. It’s not perfect, but it would be much better than what we have now.
This sounds perfectly reasonable to me. You had a rare and severe injury. You got most of it paid for. The 3K is something that you can get on a payment plan for. There’s no debtors prison, don’t worry.
Of course, it would be better if you had a health care savings account with some tax free money in it to pay the 3K that you owe. Right?
Yeah, I don’t doubt that the plan which keeps people waiting in line for care forever, until they literally die, and then lies about it to cover it up has better cost then plans who don’t do this. As to health outcomes: Even if true, it’s not a random sample of the population that the VA covers. It’s a group that was healthy enough in the first place to join the military.