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To: Road Walker who wrote (136257)	5/29/2001 3:26:02 PM
From: willcousa	Read Replies (1) \| Respond to of 186894

A proxy for how it could have been is auto insurance.

To: Road Walker who wrote (136257)	5/29/2001 3:28:51 PM
From: AK2004	Respond to of 186894

John re: Most of the doctors I've talked with see things getting worse larger portion of medical expenses go toward docs comp so I do not see how is it getting worse for them. Is it expensive for them to get medical coverage as well? <gggg> Regards -Albert

To: Road Walker who wrote (136257)	5/29/2001 4:08:18 PM
From: ptanner	Read Replies (1) \| Respond to of 186894

OT // John, Re: "Most of the doctors I've talked with see things getting worse, and can't think of a solution to the mess." I didn't really mean to start a long OT discussion but fortunately Intel news is quiet today and others seem interested. My brother-in-law is a family doctor and he and I talked about the idea of medical co-ops which would basically take the insurance company out of the mix; he said there were some of these but the majority of business is the traditional form which includes the insurance company. I think that something like 40% of health insurance premiums go to something other than providing health care which is what the whole program should be about in the first place. This type of inefficiency reminds of the $150B and millions of hours invested annually in order to try and comply with and/or minimize costs with respect to our current tax system nightmare. (Oh, no, another loaded OT subject - can we just let this idea go with: things should be simpler?) I am one of the few folks with a high deductible health insurance plan and a medical savings account. The great MSA experiment is suffering from a lack of competition, however. It is amazing to me that if I go to the doctor and offer to pay cash so there will be no insurance paperwork overhead I will have to pay from 30 to 40% more than if the doctor had to deal with the insurance company overhead. The real losers in this system are the folks that unfortunately do not have coverage of any kind so cannot realize the benefit of the bulk prices afforded by the insurance company contracted rates. -PT EDIT: I also agree with your idea that there is a lack of an effective market in which the consumers have clear price signals to the consequences of their choices (ie. diet, exercise, and preventative care).

To: Road Walker who wrote (136257)	5/29/2001 4:15:27 PM
From: GVTucker	Read Replies (4) \| Respond to of 186894

OT, health insurance. Most of the doctors I've talked with see things getting worse, and can't think of a solution to the mess. Sure doctors can't think of a solution, that's because they're a major cause of the problem. Tax policy initially created the problem. Health insurance cost is not deductible for an individual. It is deductible for corporations. Thus, individuals could not compete effectively with their employer. This made individuals dependent on their employer. As fewer individuals took out health insurance on their own, that drove up the insurance companies' costs even more, as they couldn't spread their risk as well. Initially, any care provided by a doctor was deemed essential, and costs charged by doctors was taken at face value. Doctors took horrible advantage of this situation. People had zero incentive to price shop their health care. The cost of insurance for corporations went up far faster than the rate of inflation up until the 80's. The pendulum had swung too far, and health care costs took far too great a percentage of corporate earnings. Corporate America struck back, and HMOs were their weapons. The control of the health care gradually shifted from supply (doctors) to demand (employees in the form of HMOs). Doctors had abused the former system so bad that they were powerless to stop the changes. HMOs cut costs in every way imaginable. Most of the fat was on the doctor end, and that was where most of the fat was cut. Physician earnings weren't keeping up any more. Alas, when a pendulum swings too far in one direction, it inevitably swings too far in the other direction. While HMOs (with the authorization and blessing of the insurance companies) were taking a well deserved bite out of the physician's fat, they also took rather large bites out of the patients' fat. They went too far also, resulting in a lot of the problems that Amy J talked about. Those problems are once more driving the pendulum back in the other direction, and given that there is actually the possibility of a shortage of doctors around the corner, it will be interesting to see the next development. Odds are, one of the net results is much higher health care costs. John, you suggested a good solution, a true free market with no tax incentives that force us to get insurance from our employer. There's a big problem with that solution, though. In the current United States, there is a belief that the poor shouldn't be subject to inferior health care or health care rationing. Any changes in the current system needs to include some sort of system that actually improves the situation for people like the unemployed and disadvantaged. A free market makes this problem worse, not better. Woodrow Wilson said it best when he called our economic system heartless. A heartless free market health care system isn't consistent right now with a populace that is unwilling to throw those less successful to the wolves. Some government program for the poor and disadvantaged along with a free market system would probably work and still might pass all the hurdles. Creation of a the huge new bureaucracy that would be needed would be next to impossible politically right now, given the budget mess that Medicare is right now.

To: Road Walker who wrote (136257)	5/29/2001 5:03:13 PM
From: geoffrey Wren	Read Replies (1) \| Respond to of 186894

The start of the Health Care Fiasco: was when government put wage controls in place circa WW2. To make employment more enticing, employers offered health care as a fringe benefit. Kaiser Shipyards in the Bay Area started Kaiser Permanente. Kaiser Permanente still exists; Kaiser shipyards are defunct. At the start Government decided not to tax this fringe benefit. The real issue is the availability of health insurance. If you are not on a group plan, you are on a insurance pool plan. Healthy people leave the pool casually; the sicker tend to stay because they cannot get other insurance. Rates go up for those in the pool, driving the healthy away (because they can easily get other insurance). Those left pay more and more. Insurance companies are constantly trying to shed the less healthy. They constantly juggle their plans; they have their ways. A doctor who has been with a specific plan for a long time will have a higher percentage of sicker patients (sick patients tend to stay put); so the plan may abruptly drop a medical group. It's a game of musical chairs, with doctors and insurance companies seeking capitation with healthy patients, and seeking to shed sick patients. Sadly, it is the insurance companies that are good at this little exercise that make money. My thought is that every company that offers insurance should be forced to offer the same insurance to all at the same price, adjusted for age only, maybe smoking, and allowing a discount of up to 10% for group enrollment (due to lower administrative cost). To guard against those that wait until they are sick to pay for insurance, say anyone who has a lapse of insurance has to pay 50% more for the first year, and cannot have treatment of pre-existing conditions for the first year.