"3rd party payer plans had an 80/20 rule, with a cap on total out of pocket."
In today's medical arena, that 20% would break many people financially.
They had a limit typically, it was $1000 total out of pocket (above the deductible or including deductible). Perhaps an adjustable copay. 80% for the first $10,000, 15% for the next $10K, 10% for the next $30K and 5% for everything else.
It would retain the protection form bankrupting illnesses and inspire some responsibility. That $50,500 bill for the $1M hospital stay seems like a good deal and pretty daunting at the same time.
"People with heart conditions and with Manic Depression will choose very different plans."
You may be running up against pre-existing condition preclusions.
My point was that while both conditions demand ongoing health care, then stretch different parts of most insurance coverages. Mental disorders are often capped in annual and/or lifetime coverage. Heart procedures are often called experimental by insurers to avoid having to pay.
"there will always be those who will find a way to "game the system."
Yes.
"group administrators respond to the market."
Insurance companies have long been highly adept at skating out of their contractual obligations to their policyholders, if only by wearing them down. It used to be called "bad faith."
As long as Insurance Companies are the sole police force for limiting medical care, they will feel justified in using artificial restraints to limit their exposure. If you make the insured bear part of the expenses, they may be more interested in limited expenses.
"Big bucks lure in people motivate by money. Recall Britain and Canada both have socialized medical systems, and both have shortages of doctors."
Not at all! Somewhere back on this thread or the on Quack thread, I posted that the US of A had long limited medical school admissions, while leaving its borders wide-open to vast numbers of physicians from other lands to come here and hang out their shingles. Meanwhile, our homegrown docs-to-be have flocked to foreign medical schools.
I was aware that Law schools graduate unlimited lawyers; I did not know that medical schools limited admissions. Yes, many Americans rejected by American medical schools go overseas, and many foreigners use their medical education as a ticket to a high paying American medical career. As long as earnings of American Doctors remain high, this situation will remain.
"skyrocketing medical costs along with a general decline in the quality of medical care can be directly traced to the involvement of third-party payers. If insurance companies were truly market driven, the opposite would have happened. Kaiser-Permanente, with all its faults, and other pre-paid medical plans are, I think, the direction I think we should be taking."
The TPP system may be partially responsible for the increases. The increased standard of living in America is partially responsible. The surge in wealthy individuals with money for direct payments has contributed. The rise and fall of Social Security has contributed.
The second part deserves more discussion. I am not convinced yet. One problem of the K-P type plan is that you incent the system to deny you expensive care. They already have your money, and so expenses cut into profits. |
