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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Lady Lurksalot who wrote (940)	6/4/2005 11:43:30 PM
From: Peter Dierks	Read Replies (1) \| Respond to of 42652

...cannot HSAs pay deductibles as a solution. HSAs can be part of a long term solution. They can extend the problem. They may do both. When I was younger, most 3rd party payer plans had an 80/20 rule, with a cap on total out of pocket. If HSAs could be used to buy a plan like that, it could restore some responsibility into the system. When people have a stake in controlling their costs, they will shop around and look for procedures that can be skipped. A caveat is that once the limit is reached, once again everything seems free. Today, most people are able to join only group health insurance plans, as individual medical insurance plans are highly restrictive as to who they will allow in their doors and for what procedures they will reimburse the policy holder. There is high variability in quality and scope of coverage among the myriad group and individual plans. Variability is an important element to a lasting solution. Different costs for different coverages. People with heart conditions and with Manic Depression will choose very different plans. Singles, married couples and families with kids will choose very different kinds of plans. Low earning, middle income, and high earners will choose very different kinds of plans. In a world where everyone has the same coverage, it becomes easy to game the system. I remember reading several years ago about a guy with a big yacht named after the game he devised to bill Medicare more. MC clamped down, but he and his clients had made millions. Time was--and not too long ago--dialysis was considered as "experimental," or some such; thus, this costly but life-saving procedure was not covered by private insurance, and those unfortunate patients had to sign up for state and federal aid at exorbitant costs to them. Bone-marrow transplants, among others, are another example of the above. It can be a game the Ins Co plays, prudence, or a cost control measure. The key here is that group administrators respond to the market. If the cost is too high, the shop for cheaper plans; these generally are more restrictive. If the coverage is too bad, employees leave. The company Ins Admin has to balance cost versus coverage. I think the solution may include offering different coverages within a single group. costs of various medical procedures must be rolled back to what the average working person can afford to pay--with or without medical insurance--as was the case before the insurance companies found their lucrative niche in the health care industry. In those golden olden days, patients and physicians and hospitals prospered. 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. 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. Another important point is that one of the drivers of reasonable medical cost was egalitarianism. Barter and write offs of charges were common in a world where that was the safety net. Doctors had a Hippocratic Oath, and tended to everyone. Now we have replaced the egalitarianism with Medicare et al. The previous system was congruent with Republican ideals; the current one is congruent with Democrat ideals. IMHO we need people to once again accept responsibility for their own actions. If you think I regard the insurance companies as one of the major villains in today's sorry state of health care delivery, I would say you are a very perceptive person. 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.