But when Obama and others talk about the need for healthcare reform to have a hope of balancing the budget in the future they are talking about exactly this. You aren’t going to cut waste from the system by just reducing payments, or raising taxes, or refusing coverage to the poor. Healthcare is so big, and so inefficient, that even relatively small cost savings can pay for a lot of this. Let it keep bloating and we’re all in big trouble.
I think that is close to what the public option is - but probably with somewhat higher premiums for those still working. It might not be exactly Medicare, but I have seen what you propose mentioned.
And insurance companies are incentivized to keep their size down?
You’d think that insurance companies would have a good reason to force the kind of reforms - like evidence based medicine - that are now being discussed. Some they do - in the past few years my preventative care is 100% paid also. But to a certain extent their profits depend on their volume, and reducing volume to the point of making doctors angry is going to make it harder to sell to companies who want a lot of doctors in the pool. High cost customers, like the OP, aren’t going to do as well, but it makes sense for the masses to get what they want, since if lots of people got refused they’d complain to their employers.
One of the world’s most private systems is also one of the least efficient. Are we really to believe that making it more private is going to help?
What’s the cost? Decent coverage is very expensive. Cobra insurance, which is crappy insurance is also very expensive. In your future. Ever increasing prices and whittled down care on a steady basis.
My brother has very good coverage and has not used Medicare at all. But he works in NYC for a Pharm. Company.
Think of it like a rebate. Did you ever look at those terms. If you want your $25.00 back you have to jump through hoops to get it. And if you mess one thing up, you’re screwed.
That’s the way the insurers operate. They will pay only if you do things exactly as they say.
Now this, off hand, seems resonable enough, after all they bear the cost, but when one is sick or possibly dying, people don’t think as clear as they should. There should be margin for error in claims. Not actually covering the claims but in filling forms and time to file, is what I’m referring to.
Another problematic part is many physicians don’t or won’t file claims as needed. I’ve had doctors that were horrible at filiing correct forms. I’ve had to press their office. Others know how to “play” the system and payment goes through like the wind.
So now the patient not only has the difficulty of finding a doctor who works well with them fnot only for medical issues, but billing issues as well
Medicare’s insolvency is due to the fact that they cover only the aged or chronically ill. As others have stated, if they could cover the ones that insurance companies “cherry pick”, they would balance out and become solvent. The over all cost would drop about 40 percent. Having good medical coverage will help people get some peace of mind. For many, financial insecurity is one medical emergency away. Over half the bankruptcies are medically driven. The insurance companies took my money for 40 years and when I got old ,they wanted no part of me. They took the money and ran.
It depends on what you think of as “modest”. If almost five trillion dollars over the next ten years strikes you as “modest”, then fine. But that is based on a projection that the economy will grow by 4.8% per year over the same period, which I rather doubt will be the case this year.
We will also have to either raise taxes by a trillion dollars a year, or cut spending by the same amount, to get back to a deficit that was as large as it was in 2007. Also note that this does not count increases in Medicaid, which is supposed to grow by 6.7%.
So all told, we will have to increase taxes on the wealthy by a “modest” two trillion dollars a year. IOW, we would need to increase taxes on the wealthy by about ten times as much as Bush cut them.
Most or all of these projections are from before the current recession.
Regards,
Shodan
Actually, I agree. Some areas now are spending way too much on unproven treatments, and that has got to go down if we are going to keep health expenditures in check. But let me ask you this: You have some disease, let’s say prostate cancer. Are you really going to choose a cheaper treatment, if someone else is going to foot the bill? Because that is going to be the incentive system working under government care.
If consumers are paying more out of pocket, then they are going to be more concerned about which treatments work and are cost-effective. Their incentives will then be aligned to keep down healthcare costs. If someone else is paying, whether it’s a low-deductible private insurance or government healthcare, you’re going to use as much as you can, even if the benefit is small. And as I said, I am skeptical about the government’s strength of will to resist paying for more and more treatment, when each voter counts and the costs are spread among all taxpayers.
Hence I favor, like Friedman, delinking employment and insurance be revoking the tax subsidy for employer health insurance. This will promote price and service competition among insurers, who will now have to compete for customers, not corporate programs. This will likely promote low-premium, high-deductible insurance, which will shift the incentives towards lower-cost medical treatment.
It doesn’t cost me anything (100% employer paid) but it looks like the market price would be about $350. Those same things mentioned would be available on a plan for about half that though.
Cobra doesn’t suck unless what you already had sucked since it is the same. The cost is higher because the employer is no longer paying part of it.
But that is exactly how it has been working today. Most of my medical care has a co-pay which is independent of the actual cost.
The patient shouldn’t be looking at cost, but at efficacy. They may consider a more expensive treatment to be better, and they might be wrong. Did you see the study that showed that people taking a more expensive placebo reported better results than people taking a cheaper one? The article also talks about kidney stones, where lots of people in McAllen went for a more expensive surgical option rather than a cheaper (but longer) drug treatment.
So I’m glad you agree, but the private system isn’t getting the job done today. I hope that a public option, with these reforms, might be so much cheaper than the private option that the private suppliers would have to adopt them to keep up.
Medical care isn’t like candy, where more is more fun. Except for the lonely old ladies who go to the doctor to have someone to talk to, a doctor’s visit is disruptive, boring, and not very pleasant. (And I go to a high class clinic in a good suburban location with Bach playing in the background.) I’m sure that there will be an increase in false alarms, but I think there would also be an increase in early detection which would save money in the long run.
I also agree with delinking employment and insurance, since companies are stuck with the choice of higher cost through insurance or screwing their employees. Now, we can force all employers to provide insurance, but it would be far better to put all people (employed or not) into one big pool for maximum efficiency, and through taxation eliminate the non-level playing field we have today.
From articles I’ve read, many of the low deductible high premium policies sold today are ripoffs, not paying very much even when the deductible is met. We can’t have the deductible include preventative care, since that will cost more in the long run. We also can’t make the deductible so high that it becomes a crisis for low income families.
I don’t think that many Americans can make a good tradeoff between cost and necessary treatment, especially if cost is a pressing issue. The tradeoff is really between quality of life and dollars. I’d rather devote more effort into saving money by reducing truly unnecessary and wasteful care (call it rationing, if you wish) than having a large segment of the population eschew necessary care due to cost.
Note that there is more than one way to have universal health care. Much of the opposition seems to be focusing on the disadvantages and “socialism” aspects of the British and Canadian systems, but Obama seems to be looking more towards the sucessful German and Dutch public/private insurance systems.
I think the crux of that article is that the medical culture in a given area can have a tremendous effect on the cost of care provided and the decisions made. If we had a single payer system, and the government was willing to make hard (but reasonable) decisions about courses of treatment and compensation, perhaps we could combat the “entrepreneurial” practice of medicine.
Just as in the financial crisis, economic decisions that make sense locally are disastrous globally. I think he was very careful to not demonize the doctors. That is exactly a situation where regulation is required.
The insurance companies will just collude. That is the capitalistic way. They will not compete. That would cut profits and that would be a big no-no. They will slice it up like a big pie.
How come no board Libertarians are stating that benefits are part of the pay package. The cost of an employees includes all benefits. The corporation does not pay for health. You do, and you have no say in how it is spent.
No, Medicare’s insolvency is due to them not charging enough to cover their expenses. If their clients are incapable of paying enough to cover their own risk, you should at least recognise what the problem is before trying to suggest solutions.
Only if you overcharge the new members to subsidise the cost of the others. And if you do that, why would anyone want to join?
I think you’ve nailed part of the problem right there: The financial aspect of the whole debate is only a part of it, but for a lot of those against UHC, it’s the only part.
Why do you think Medicare even exists? It is to cover those people who are almost certain to have higher expenses - by being old. That’s why we pay Medicare taxes when we are young, to more or less invest for when we are going to have to spend more on medical bills than we can afford. The deficit comes from the increasing cost of health care, as we’ve been discussing, and from people living longer.
You are invited to price health insurance when you are 80. It was clearly an issue 45 years ago when healthcare costs were a lot cheaper.
Agreed, reform is needed, but I don’t think a public option will achieve this. What do you think will cause the public option to be much cheaper? And if it’s possible without taxpayer subsidy, why isn’t anyone following that business plan now, and rolling in cash?
People here seem to believe that a public option will somehow be more humane than current insurance companies, by picking up high-cost patients and denying fewer treatments. But these all cost money; you can’t keep a plan cheap and cover more procedures at the same time. You many not see these arguments now, when advocates of a “public option” can say it’s all things to all people, but when the time comes to decide whether to tighten belts at the expense of treating people with powerful lobbying groups, the tradeoff may be apparent.
And of course, subsidizing the public option to keep costs down is hardly fair market competition.
One other issue, by the way, is malpracticefees. Today OB-GYNs payclose to $200,000 in malpractice insurance. The US has a much more expensive litigious environments than Canada and Europe, partly accounting for the differential in cost, both from the necessity of malpractice insurance and the practice of “defensive medicine” to cover doctors’ asses in case of lawsuits. However, trial lawyers are heavily Democratic and I do not foresee the Obama administration placing caps on damages, or any other reform that would hurt this constituency.
The public option by itself won’t result in savings - which is obvious since we already have the public option called Medicare. The public option combined with the reforms already mentioned will. If, say, it pays for only medically proven treatments, and saves money that way, the private insurers will have to follow suit or lose market share. There will certainly be room for an insurer who wants to charge an arm and a leg cover any old treatment, but I don’t think that is where the heart of the market is going to go.
As for subsidies, I’m in favor of subsidies to make healthcare affordable to everyone, but that can be separated from the rates in general. That should be making money after a short start up period. I’d also hope that for at least a brief time the private insurers can get their act together and beat the public option through efficiency. If competition drives prices down through efficiency, not through denying legitimate treatment to people, everyone wins.