Peter, " . . . most 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.
"A caveat is that once the limit is reached, once again everything seems free."
Yes, but that 20% just ate a healthy chunk out of your life savings.
"People with heart conditions and with Manic Depression will choose very different plans."
You may be running up against pre-existing condition preclusions.
"In a world where everyone has the same coverage, it becomes easy to game the system."
Not everyone has the same coverage--not even through the same employer. No matter what is done, there will always be those who will find a way to "game the system."
"The key here is that group administrators respond to the market."
You and I both know that insurance companies have long been highly adept at skating out of their contractual obligations to their policy holders, if only by wearing them down. It used to be called "bad faith." I can cite horror stories, but would rather not.
"If you think that, then you probably think that medical school should be shorter and more accessible. 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.
One of the reasons medical costs have spiraled upward at a multiple of inflation is that "someone else" is paying the bills. Patients became nearly completely insulated and isolated from the costs of treatments, tests, and procedures. Of late, free-standing clinics have sprouted up here and there, which do not accept insurance and operate strictly on a fee-for-service basis. I understand their prices are quite reasonable and affordable.
"An intermediate solution might include Osteopaths and NPs. Their lower investment in certification would mean savings in medical care to the point that the average person might afford their care."
Doctors of osteopathy (DOs) are on equal footing with their MD counterparts. Do not be surprised if you find that the cardiologist or vascular surgeon performing your catheterization is a DO. In many venues, NPs and PA-Cs are increasingly taking over treatments and prescribing which once were solely in the domain of physicians.
"Insurance Companies respond in a market driven way to the system that they work within. Get rid of all of the restraints, and things will get better over time. Return to personal responsibility instead of third party payer (TPP), especially unfunded TPP. Social security is reimbursing medical professionals less for the same procedures every day. Medical professionals have to make money some where. They turn to paying customers for their profits. Insurance Companies behavior is a symptom of the larger system IMO."
I agree with most of the above; however, I still maintain that 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.
I know also that if and when the economy fails, the insurance companies will be the last ones down the tubes. <g> - Holly |
