As I understand it, the problems with our current health care system include:
[ul]
[li]You can lose your coverage if you lose your job or change jobs.[/li][li]Coverage can be unaffordable if it doesn’t come with your job.[/li][li]You can be denied coverage if you have a preexisting condition.[/li][li]Policyholders can be denied coverage by insurers on narrow grounds.[/li][li]The uninsured seek treatment in emergency rooms, the high cost of which is passed along to everyone else, even as the patients are forced into bankruptcy by the bills (correct me if I’m wrong on this).[/li][/ul]
So instead of being purely naysayers, do conservatives have any ideas for addressing these problems? Or do they feel that the tough luck associated with these problems is preferable to the tough luck that would befall people under any alternative plan?
The most common thing I hear from talking heads is they want to change it to allow you to purchase insurance across state lines. Because then competition will make everything better!
I’d rather have the public option personally.
Well, *this *conservative has long favored two reforms:
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The state-lines thing, which *will *increase competition. Why do you think car insurance is so much cheaper than health insurance?
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Tort reform. A huge portion of the cost of health care is directly (and some indirectly) related to the cost of lawsuits. Not only will the cost of malpractice insurance drop, but so will the huge, unnecessary batteries of tests currently being prescribed by doctors to cover their asses.
Uh, because you’re lucky if a used car is worth 10k? Or that all drivers must be insured, increasing the risk pool. Or the high deductibles? Probably all of the above, including the cross state thing.
Tort reform will save about 1 percent of healthcare costs. That’s not to say we shouldn’t do it, but it won’t be a panacea.
Now who’s being a naysayer? 
I haven’t looked into the state-lines thing very far, but the ferociousness in which the insurance companies yearn for it makes me skeptical.
Wouldn’t, perhaps, all of the insurance companies simply relocate en masse to whatever state has the most advantageous regulations? Then, instead of having to bribe 51 US senators to have the laws changed further to their favor, they’d only have to bribe a handful of state senators.
And pass the savings on to us?
To insurance companies, savings comes from not treating sick people. They make more and more money each year already, but their rates keep going up.
I don’t see how there can ever be a positive outcome when it is in a company’s best interest to not give people medical treatment. It’s pretty simple. Companies want to make money. Insurance companies make money by not paying for people’s medical expenses. Unless someone wants to create a nonprofit insurance company, I don’t see how we can ever win.
I favor the following:
- Competition across state lines
- Insurance NOT being tied to employment
- HSA for everyone, and a simplification of the tax code to allow this
- Universal Catastrophic High Deductible insurance for those on a sliding scale, and a Freddie Mae/Mac type loan for people caught up in bad times
- Entitlements for people with permanent disabilities, I would probably include dialysis, and other severe chronic illnesses; but exclude things like prescription eyeglasses, allergy medicine, etc.
- Increase the role of generics and government purchasing of them, to allow patent holders to charge the premiums they need to for investment. I would probably increase the patent life a little, too.
Just off the top of my head.
Conservative (at least for SDMB purposes) here:
Give EVERYONE the same tax advantages that corps have - all medical expenses are a deduction, regardless of income.
Combine all Federal programs (Medicare, Medicaid, Tricare) into one program that is the program of last resort. Allow anyone to buy in, with a sliding scale based on income (poor = free, up to rich = flat monthly rate based on actuarial data). This program provides the floor for our citizens.
Allow people to buy better service if they wish. That means that if my Doc sees me under Medicare but Medicare does not pay for a particular service, I can still buy that same service directly from the Doc for cash or from another override policy.
Oh come now, this is ridiculous. You can say the same about *any *business: Car companies would make more profits if they took your money but didn’t give you a car. Restaurants would make more profit if they took your money but didn’t give you any food. Lawyers would make more profits if they took your retainers but didn’t bother showing up for court.
But nobody does this, of course, because you would go elsewhere! Competition, in other words. It will work in the insurance business just like anywhere else, as long as the market is left free to compete.
And that means the government needs to butt out, with both cheeks.
I’d think tort reform could save quite a bit more than 1%. If done right, it could reduce the propensity of doctors towards unnecessary (but butt-covering) tests, or situations where expensive surgeries won’t actually help much, but the doctor feels forced to make every possible effort, instead of saying ‘This really won’t help.’
Because I am not effectively forced to change jobs if I want different car insurance?
What portion is directly related to lawsuits?
Suuuure they will.
You might have a point, except you don’t. Insurance money is taken as premiums, and thus isn’t as clearly tied dollar-for-service to the actual medical care as, well, nearly anything else. When they deny you “service”, they’re denying you money - and you can’t exactly demand your money back for it.
And, of course, this is what kills the “go elsewhere” angle as well. The insurance industry is built on the presumption that you will stay their customer continuously and not switch around at will. The pre-existing condition thing is the part of this they enforce - you can’t wait to get sick and then buy insurance. Plus, of course, it’s rather trickier to change insurances at the drop of a hat than it is to demand your money back and go to the restraunt nextdoor.
The conservative philosophy is one word: Greed.
If you can show a conservative he will benefit, then he’ll be for a plan no matter how many of children and grandparents are left without coverage.
But insurance companies can take your money and not give you coverage.
Few have that option, not in real life, and even if they did, the other guys are just as bad.
So the problems with the system are due to too much regulation? Dropping customers, or avoiding covering them in the first place, if they have something expensive wrong with them is the fault of too much regulation? Employers offering only one provider is the fault of too much regulation?
Greed, and malice. Given a choice, they’ll choose the option that hurts people even if doing so hurts themselves.
I’m in favor of more competition among health insurance companies (how exactly is it that they’re being prevented form competing?), but yeah, I don’t see the health insurance industry as one that attracts a lot of brand switching thru aggressive marketing and price slashing. People often don’t understand what they’re getting–or not getting, and of course, most Americans get their coverage via their employer and thus have little opportunity to go marketing.
And isn’t it the case that the premiums paid by employers are usually a lot less than an individual would have to pay on his own? Bringing down the cost of insurance somewhat does not do much to address the fact that a lot of people will still be going without coverage because they can’t afford it.
An of course, the amounts charged by providers keeps going up, so there’s only so much insurers can do to control costs.
Your second paragraph is due to the fact that large employers to shop around, and have HR people whose full time job it is to keep after insurance companies and to compare prices and benefits when a contract has expired. My insurance has changed twice since I’ve been in this job. Clearly an employer is not going to let a new insurer pull the “pre-existing condition” gag when changing. More volume means more power means better prices, which would go away without employer coverage.
The health insurance exchange proposed should add to competition, especially if there is a public option the insurers will have to compete against.
Some of these points have been covered before, but I’m going to jump in anyway. My solution to tort reform would be to limit punitive damages to 25 percent of actual damages. This puts a ceiling on awards. Doctors have and will continue to make mistakes, and people should have an avenue to have those mistakes addressed and be compensated for them. However, there has to be an upper limit. Without one, an OB/GYN will pay enough malpractice insurance per year to buy a house. Does anyone honestly think they absorb that cost? It will also cut down on “defensive medicine”. If a doctor orders a test just so he or she can say it was done on the off chance of a lawsuit later, it’s not helping anyone medically. Texas has enacted a version of tort reform and doctors are reportedly flocking there.
I would also remove the “state line” limitation for insurance companies. This would reduce thier administrative costs and expose them to competition. It would not be a panacea, but it would be a factor.
What can the government do? Prevent non-coverage for pre-existing conditions. Require insurance for everyone to prevent medical providers from trying to make up losses on cash customers and to make preventive medicine easier to access. Require employers to offer health insurance at a cost cap and not allow them to “price people out” of their insurance and force them to opt out and depend on the government. Provide help to people under a certain income level who lose coverage due to job loss or who can’t get it in the first place due to part-time work…but take the cost of that out of thier earned income credit or tax return. Fund research and change the patent rules so generics hit the market faster. Allow states to negotiate for bulk rates for medicine. Increase the investment in the training of doctors and the program of forgiving some of their debt if they practice in underserved areas. Do the same for nurses in anticipation of the baby boomers requiring geriatric care.
If the above policies resulted in a decrease in the amount people have to pay for employer-provided health insurance, it would enjoy popular support. But as things stand now, the majority of people do not trust the government to run a massive health care bureaucracy any better than they have run medicare or social security.