Tuesday, May 1, 2012
Empowerment Care
I've changed my mind on health-care reform. I no longer have Dr. Ezekiel Emanuel's "Healthcare Guaranteed" model as my number one choice. Not that I no longer like that plan, mind you. I still consider it light-years better than Obamacare, single-payer, and obviously the present-day situation. I just happen to think now that health-care savings accounts replete with generous subsidies, minimum standards of care, and a catastrophic care provision would in fact be superior......................................................................................a) It largely eliminates the middle-man (i.e., the government and/or the insurance companies). b) It totally gets rid of this whole anachronistic health insurance tied to employment concept that quite clearly drags the economy. And c) there will finally be a huge incentive for people to actually start shopping around for a change..........................................................................................And, yes, folks, it's that third one that's really the key here. I mean, as it stands now, we basically have a system in which the patient rarely if ever even looks at the bills. The way that I see it, if the people themselves were the ones who were actually responsible for payment, they would finally start shopping around and, yes, this would absolutely prompt health-care providers to compete for a change.......................................................................................Oh, and, if you happen not to believe that this would lower the costs and also improve services, I ask you, just take a look at those procedures in which this is already happening; lasik eye surgery, hair transplantation, lipo, etc.. The cost for these procedures has actually been coming down and the technology better. When, people, was the last time that you were able to say that about a government monopoly. Markets, folks - they work. You just have to allow them.
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58 comments:
Will, you becoming a Ayn Rand advocate? You're really sounding like a free market government hands off kind of guy of late.
He's getting more Conservative.
Will: What place does for-profit insurance have in your plan?
Will and dmarks, health care savings accounts don't have to eliminate either the insurance companies or government (although they could). Many insurance companies already offer health care savings accounts.
My plan offers a savings account that my employer pays into first and that I can add to. Basically, they deposit about $3,000 into my account each year, and all of it can be used for my health care expenses, prescriptions, co-pays, etc.
Will, you're right to get on board. As much as insurance companies are demonized, they really are creating some innovative products like health savings accounts.
Will,
You say,
"It largely eliminates the middle-man (i.e., the government and/or the insurance companies)."
Are you suggesting that individual health care accounts be the only source of medical,payments? And are you suggesting the each of us negotiate prices with our individual health care providers, since neither the insurance companies nor the government would be available to do it for us...as they do now? And what about drugs? Do we negotiate price with the drug companies?
Without insurance companies or government, I'm not sure how your system works in actual practice. Do you know of any country using this system, or would we be the test case?
I'm not discounting your suggestions. Obviously our current system does not work well, and changes need to be made, but I don't see how you eliminate both insurance companies and government involvement.
Heathen: Is it really necessary for this to be tied to employers?
No it isn't, that was the point I was trying to make. Will made it sound like health savings accounts would eliminate the insurance company or government, but it wouldn't have to.
Ideally, we could all buy our own insurance plans at an individual level without the employer involved. We could then choose plans with a tax-deferred health savings account, high deductible, catastrophic coverage, whatever.
Employers could also offer these same plans. Government could even fund these plans instead of making direct payments and acting as the insurer.
The point Will makes is a good one: health savings accounts have a lot of benefits, not the least of which is exposing actual costs to the consumer of the health service. But they can be provided individually, through an employer, or through government.
I oppose any plan that involves further enriching the wealthy elites or the creation of (real) death panels (as opposed to the fictional ones the Republicans said ObamaCare would create). This is why I vociferously oppose health care savings accounts.
Single payer is the BEST way to go, IMO. Everyone is covered, we save a ton of money, and there are no death panels.
I challenge any fair-minded, nonpartisan individual to read what I've written here and conclude that this, in any way, resembles an orthodox conservative (or liberal, for that matter) proposal. Yes, it includes health savings accounts, but it also includes generous subsidies for poor people and a catastrophic care provision that would clearly kick in when that money runs out. It also reduces the power of the frequently maligned insurance companies and increases the power of the individual. I mean, I know that some people will never be satisfied until we hand over to the bureaucratic elites and dullards pretty much everything, but they're the lunatics.
Jerry, HR, and dmarks, I don't know, I guess that I would prefer to have the people pay the providers directly and that that money would come directly out of the health savings accounts (though, yes, I'm obviously open to other suggestions). Perhaps the catastrophic care coverage can be purchased from private insurers and/or the government. I really gotta think about it a little more.
Will: "I mean, I know that some people will never be satisfied until we hand over to the bureaucratic elites and dullards pretty much everything, but they're the lunatics."
For them, it is all about increasing the power and privilege of the most powerful and privileged (the rulers). An agenda of concentration of government power that really has nothing to do with improving health-care.
It appears that it's either single-payer or bust with wd (this, as opposed to Jerry, who IS willing to listen and HAS proposed some alternatives).
dmarks: For them, it is all about increasing the power and privilege of the most powerful and privileged (the rulers).
I really don't know who you're referring to dmarks. I think these people you describe are imaginary. For me it's about increasing the power of "we the people", by handing off health care insurance to the elected representatives who are accountable to us... instead of the wealthy elites whose only goal is to increase their wealth (and for whom paying health care claims is secondary).
Will: It appears that it's either single-payer or bust with wd (this, as opposed to Jerry, who IS willing to listen and HAS proposed some alternatives).
I support it because I believe it's the most easily achievable. Simply open up Medicare to all. Requiring all health care insurers to go not-for-profit would, I think, be a much harder goal to accomplish.
Just for the record, my first choice is Medicare For All. Let insurance companies compete if they chose, and/or provide supplemental insurance for those that want additional coverage. I also have no problem with tax exempt health care savings accounts to pay co-pays and non covered services.
Handing off power to the ruling elites as you demand, WD, removes it from 'we the people'.
Yes. He comes to this as a hardline idealogue with an extreme view and reactionary outbursts against compromise. And he is the only one in this discussion who is like this.
dmarks: Handing off power to the ruling elites as you demand, WD, removes it from 'we the people'.
You have me mixed up with someone else. I "demand" the opposite of what you describe. Why not save your criticism for this other person, and use it when he (or she) shows up? It has nothing to do with me, so you addressing it to me is quite confusing.
dmarks: Yes. He comes to this as a hardline idealogue with an extreme view and reactionary outbursts against compromise. And he is the only one in this discussion who is like this.
I just said I thought the "private health care insurers be non-profit" might work... my main problem with it being I think the path to Single Payer would be easier.
As for Jerry's comment (which I assume dmarks takes as agreement), I'm not sure he's agreeing with what Will is proposing (he put some caveats on his agreement). It might be a stealth disagreement. I come right out and say I disagree... and I get hammered for it.
I'd say I'm less of a "hardline ideologue" than dmarks or Will Hart. They're both hardline Conservative ideologues.
If, for instance, I said "what about Fair Trade and Balanced Trade as a compromise to Free Trade", I'm sure dmarks and Will would reject my compromise. Yet it's just me with the "extreme views" and tendencies toward "reactionary outbursts".
In my comment about one person,
WD said: "...You have me mixed up with someone else...
And then "...just said I thought..."
Which cancels out your first statement. It was the same person I was commenting on.
dmarks: Which cancels out your first statement. It was the same person I was commenting on.
No, you've got me mixed up with someone else. I was pointing out why it couldn't be me you were referring to.
I'm a hard-line conservative ideologue? Wow, and all this time I thought that I was a moderate extremist ideologue.
Seriously, though, I really thought that this plan had a little something for everyone. It gets a lot of the power out of Washington which would make the conservatives happy. But it also gets a lot of the power out of the insurance companies which should in fact make the liberals happy.............And Medicare for all is a frigging terrible idea. I mean, at least now we have it so that the private insurance companies are able to shore up the differences that the crappy Medicare reimbursements provide. If you got rid of the private insurers, who in the hell would make up the difference/subsidize Medicare then? Plus the fraud, incompetence, etc.. America can definitely do better than that, I think.
Given that we pay twice the price for our healthcare than anyone else in the world, I am not too worried about the reimbursement level. Medicare at 5% overhead is preferable to private insurance with their, now limited to, 25% overhead. Hell, they even needed a supplement from the government to provide Medicare Advantage, the same coverage as Medicare only administered by them.
Will: But it also gets a lot of the power out of the insurance companies which should in fact make the liberals happy.
I don't see how it does that. If you're giving subsidies to people to buy insurance why not just cut out the middle man and provide the insurance?
Jerry Critter: I have yet to understand how your plan gets either the government or private insurance out of health care.
Me neither. I also don't get how people "shopping around" magically creates competition given the fact that the health insurers are exempt from federal anti-trust laws.
I don't think that you understand here, wd. The patients are paying the providers DIRECTLY. There is no insurance middle man, period. People will put tax deferred money away every year and that money will be used strictly for medical issues. People who can't afford to do this will be given a generous subsidy from the government. AND if/when that money runs out, a catastrophic care provision (which people will purchase on a sliding scale annually) will kick in (you know, to prevent people from being wiped out due to an illness).............Jerry, I didn't say that it would get these entities out of the picture entirely. The catastrophic care insurance would obviously have to purchased from either the government or from private providers.............And, yes, competition DOES bring the costs down. I mean, just look at the examples that I've given to you here; lasik eye surgery, hair transplantation. The cost AND quality of those 2 procedures has actually gotten better over time.
I honestly think that this is a damn good plan. Perfect? NO. But it's clearly the best of the alternatives.
From the Healthcare Economist, Jerry - "Private Insurance on average has administrative costs of 16.7% (varying between 30% for individual policies to 12.5% for large group policies). Yet these figures are inflated. If we exclude taxes and profits, as well as sales commissions, then the total administrative costs decrease to 8.9% overall and 8.0% for large group policies. I do not agree that commissions should be deducted from this this figure but profits and taxes certainly should. Medicare does not pay taxes and does not make a profit so any fair comparison should exclude these items. Further, tax revenue from insurance companies adds to the public’s coffers; profits should be seen as a cost of capital."
Ditto - "Cost of Capital: Medicare incorrectly counts its cost of capital as 0. The true cost would take into account the direct cost of hiring IRS workers to collect the taxes which pay for Medicare as well as taking into account the distortionary effects of income taxation on workers labor supply decisions. For the private sector, the costs of capital is transparent: it is simply the interest rate."............And, yes, you also have to throw the massive amounts of fraud into the mix.
Will: But it's clearly the best of the alternatives.
That's your opinion, not a fact.
Will: The catastrophic care insurance would obviously have to purchased from either the government or from private providers.
There is a benefit to paying for health care via insurance you know. Your plan lowers the cost for some and raises it for others. And what if a person's money runs out and they need more (but it isn't due to a catastrophic illness?). Either the person is in serious trouble or this plan ends up costing the government a lot more.
Also if the catastrophic coverage is purchased from the government... that's a form of single payer. If from private insurers... then the profit problem still exists.
Will: And, yes, competition DOES bring the costs down. I mean, just look at the examples that I've given to you here; lasik eye surgery, hair transplantation.
I wouldn't say those two examples fall under into the health care category. I don't know anything about hair transplantation... but Lasik? Not that cheap the last I heard. It doesn't take that long and doesn't cost the provider much to perform. I fail to see how either of these two examples prove your point.
Will: I honestly think that this is a damn good plan. Perfect? NO.
I think it has some serious problems. Not to mention the fact that there is no Congress that would even consider it. It's a fantasy plan, in other words. I continue to support single payer. It isn't a fantasy due to the fact that we already have it. We just need to open up Medicare to all.
Well it IS certainly a fact you've bought the Leviathan farm concept hook, line, and sinker.
The single point, a accurate one too, that no congress would consider Will's plan in and of itself tells us something. It would likely be far better than the current system, ObamaCare, and single payer.
wd, the health savings account would be approximately the same as what an employer (or individual) pays now for insurance. The only way that that money would likely run out is if a person developed cancer or had a bad accident and then, yes, the catastrophic care provision would clearly take over.............And who in the hell do you think does these hair transplants and lasik eye surgery procedures, wd? I believe that they're called doctors and, YES, the cost and effectiveness to BOTH of them has gotten better (cost-wise and quality-wise) due to competition. It absolutely proves the point.............And my plan doesn't "lower the cost for some and raise it for others". Everybody would be eligible for the same minimum standards of care and those who couldn't afford this minimum coverage would be helped on a sliding scale by the government. Ditto on the purchase of the catastrophic care coverage.............And Medicare is hardly a panacea, either. It lowballs providers. It's ravaged by fraud and hidden administrative costs. And it continues to feed the bureaucratic beast in Washington. Enough already with big government solutions.
Les, I appreciate your open-mindedness on this and, yeah, you and wd are probably right. The dullards from both parties are highly unlikely to embrace it.
I think the more choices we have, the better. The more choices we have, the more competition there will be. And, according to conservatives, anyway, competition brings down cost. Ultimately, lower cost is what we all want.
So, let's open up Medicare to everyone. That doesn't mean everyone has to have it. Let private and nonprofit insurance companies compete. If they can provide a better product at a better value, great! That's what competition is all about. Let them provide supplemental coverage...as they do now.
I think healthcare accounts are great. I had one years ago when they were available. Medicare is a form of healthcare account. It is now being paid for by money I paid into it over my working life. Kind of like a healthcare account.
I am not suggesting that Medicare For All should be the only choice. But I do think it should be a choice. Let's have your plan too, Will. Let it compete. And let's have RN's plan, and Heathen's plan. Let' have them all. Let them compete and give people a wide range of choices.
While my preference would be to diminish the power of the government and private insurers, what you're proposing here is definitely better than Obamacare and single-payer. You can clearly put me in the category of persuadable.
Diminishing power is good, but we need to diminish the power of those that SET the price of healthcare, not only those that PAY the price of healthcare.
That's why I much prefer the consumer of the services to be the one who actually pays the bill. As long as the consumer is detached to the point where most of them don't even look at the bill, competition itself becomes seriously truncated.
Unfortunately, most healthcare is not like the typical consumer product. We don't often have the choice of not buying the service...without encountering dire circumstances. It is not like buying a loaf of bread. And you often don't have to ability or time to shop around. If you break your leg, it is too late to shop for the most cost effective surgeon to fix it. And an individual, alone, has the least power in negociating price, and that is not the type of power we are trying to limit.
You don't have to NOT buy the service. You buy the best service at the best price. No, it isn't always possible to shop around right after a car accident, say. But you can certainly research a specialist and the word will quickly get around. If competition can work for lasik eye surgery, it can absolutely work for other medical procedures.
And the individual a) doesn't have ANY overhead and b) certainly won't perpetrate fraud on himself.
I suspect the improved technology has had more to do with the improvement of LASIK surgery and reduction in costs than competition. I'd go with technology with hair transplants too. It has a higher success rate now because of improved technology, not competition. Higher success rate means more clients.
You expect expect everyone to research the best specialist at the best price for every possible emergency they might be subjected to during the course of their life and keep it up to date, and have it handy when suddenly there is an emergency?
I think someone needs a reality check.
Well, what about all of the other areas in medicine where the advances in technology have been just as impressive? The prices there (where ISN'T a competitive market) haven't gone down but UP. Medicine is the one area in which the market doesn't enhance an improvement in services and prices?......Jerry, I said that during an emergency you'd probably have to go to the closest hospital. But even there, if there are 6 hospitals in a city, the one with the best reputation for cost and service is probably the one where you're going to go to. I mean, I know ahead of time that I'm going to get a better deal for my generics at Walmart than I am at CVS. That gets incorporated into my mindset. The same would probably happen with doctors and hospitals.......And if people don't want to research and be engaged in their own health-care, they can just keep doing what they're doing. Nobody would be stopping that. But those people shouldn't be the reason for precluding me from my empowerment.
What is precluding you now from shopping around for the best price and service? Even with Medicare For All, you could still,shop around for the best service and price. HMOs are probably the most limiting in that area.
What percentage of the population lives in cities where there are 6 hospitals? There is ONE where I live. They're expanding (building an huge new complex across the street)... but that isn't competition.
I don't know what the % is, wd. But you have New York, Baltimore, Washington, Miami, Boston, Cleveland, Philadelphia, Kansas City, Los Angeles, San Francisco, Seattle, Atlanta, Phoenix, Dallas, Houston, Portland, Saint Louis, Memphis, San Jose, Chicago, Detroit, Milwaukee, San Antonio, Tulsa, New Orleans, Indianapolis, Louisville, Pittsburgh, Minneapolis, Denver, Jacksonville, Charlotte, etc. (watch, you're going to google each of those cities now to see if they have exactly SIX hospitals). However frigging many people live in those areas. And I believe that most people also have an automobile, wd.
Nothing at all is precluding people, Jerry. They simply don't give a shit because it isn't their money.
Most people who have insurance spend money on the insurance. Practically no one get free medical care. We all spend money on our medical care. To say
"They simply don't give a shit because it isn't their money."
Is simply wrong, and simply bullshit. It is nothing more than a rightwing talking point.
Will: watch, you're going to google each of those cities now to see if they have exactly SIX hospitals.
Why would I do that? So what you're saying is I need to spend hours on the phone "shopping around" and then drive hours to get to Memphis to save a few bucks?
Will: If you got rid of the private insurers, who in the hell would make up the difference/subsidize Medicare then?
So competition will bring down the costs, but the providers can't get the costs down in response to this? Profit is profit. If they can't innovate/get more efficient in response to lower reimbursement rates, how can they do it in response to competition?
No, Jerry, most people who have insurance a) get it through their employer and b) the insurance pays the bulk of a bill. And even the part that the person pays through a co-payment is THE SAME no matter who in the hell that they go to. How in the hell is it a right-wing talking-point to underscore the obvious reality that most people who have insurance are totally devoid of interest in the bill?
What proof do you have that most prople "are total devoid of interest in the bill"? I don't think that's true.
wd, I, like you, have just one hospital in my town. But there are well over a dozen other hospitals in less than a 25 mile radius from my house. And you don't just save a few bucks. You could potentially save a lot of money. And the same would be even evident with doctors and therapists. There are literally hundreds of them in a 25 mile radius. I say make them compete for my business.......The bottom-line here, wd, I want to empower the citizens of this country and you want to empower the bureaucrats.
Jerry, what's their motivation? They have a 20-30 dollar co-pay no matter who in the hell that they go to. And even the hospital bills, they pay their damn deductible and that be that. If it was MY money, I sure as hell would pay a lot more attention to how it was spent. You wouldn't?
In other words, you have no proof, just your opinion. Lots of people pay more than a 20 or 30 co-pay, and many still pay a percentage of the bill even after paying the deductible, and there are millions of people with no insurance that have to pay the entire bill. Do you think they don't care what it costs?
"What proof do you have that most prople "are total devoid of interest in the bill"? I don't think that's true."
Come on Jerry, you're not making sense. Will has made a logical conclusion; there is no proof.
If most people have their health claims paid by an employer/insurance company or the government, and they have no need to ask for the price of a service, it is logical to conclude that they have no interest in the bill.
I think you know this and you're being deliberately obtuse to try and win the argument with Will.
You may be right Heathen. When I need to find a new doctor or go to the hospital, I don't ask for recommendations for the cheapest doctor or hospital. I ask for recommendations for the best doctor or hospital...and I think that is the way it should be.
"Lots of people pay more than a 20 or 30 co-pay, and many still pay a percentage of the bill even after paying the deductible, and there are millions of people with no insurance that have to pay the entire bill. Do you think they don't care what it costs?" - I was talking about people who have insurance, Jerry. Those people probably don't look at the bills all that closely because it's the insurance companies who pay them. And the people who have to pay a shitload even after the deductible is paid, a lot of those people are called Medicare recipients. Just try getting really sick with just Medicare and no supplemental.
I have tried it. Both my wife and I have Medicare without supplemental coverage and it is the best insurance I have ever had...and I have had health insurance through a variety of companies and private insurance when I set up my own company and went to work for myself.
You're lucky. Between the only 80% reimbursement and the the fact that a lot of things Medicare doesn't even cover (ambulance rides, for example), a cancer diagnosis could totally wipe you out without a supplemental (my mother never went without one).
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