WSJ: Ten GOP Health Ideas for Obama

[spursncowboys]

By NEWT GINGRICH AND JOHN C. GOODMAN

'If you have a better idea, show it to me." That was President Barack Obama's challenge two weeks ago to House Republicans regarding health-care reform. He has since called for a bipartisan forum, not to start over on health reform but to "move forward" on the "best ideas that are out there."


The best ideas out there are not those that were passed by the House and Senate last year, which consist of more spending, more regulations and more bureaucracy. If the president is serious about building a system that delivers more quality choices at lower cost for every American, here's where he should start:


• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.



• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.




• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.


Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.


We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.


• Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.


So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.


• Don't cut Medicare. The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.


• Protect early retirees. More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.


• Inform consumers. Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.


• Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.


• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.


• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.
The solutions presented here can be the foundation for a patient-centered system. Let's hope the president has the courage to embrace them.

[Drachen]

A couple of honest questions:
First, regarding the 500 billion dollar cut. Since this doesn't go to benefits for those on Medicare, would you (anyone who agrees with these proposals) be willing to cut that payment while not lowering Medicare tax. Take this money and sock it away so that Medicare remains funded?

Also regarding removing red tape, I am not sure that I like this since as currently cons uted, many people still get sick and die from drugs that pass all of that red tape. Lowering the bar seems to increase the likelihood of such things.

I like the idea of self administration of meds. When I was younger I had asthma and though it wasn't really bad, it would get bad in some parts of the year and I required a shot. The doctor allowed my mom to administer it, but we did have to go in if there was a change in the amount. I want to do that allergy immunotherapy which requires a shot once a week. I want to do this, but it will cost me $25 a week for each "specialist visit." Unfortunately I am unable to do this.

I don't have too many problems with the rest of the proposals, but do feel some things have been left out. Make HSAs go in perpetuity. If I contribute 2k to my HSA this year, and spend 1500. That means I have to go crazy in december trying to find something to buy (I spent $182 on December 30th, 2009 at CVS, so that my money wouldn't vanish). There is no reason this money shouldn't carry over for a year when I may need 3k from my HSA.

Also, what suggestions are there for those who after these are enacted, still can't afford health insurance? Expanded Medicare?

Lastly, what about those who are idiots and still don't get medical insurance? Do you fine them? I don't want to continue to pay for their ER visits (through my taxes) especially when they go to the ER for something that could be taken care of much cheaper (like the flu). I know that this is a contentious point with the current proposal because of those who want to exercise their freedom to not buy insurance. Could we give three choices or four: Get insurance, prove that you have X amount in your HSA with which to cover any catastrophic illnesses (which increases as you age), get fined, or have some kind of demarcation that you arent allowed ER access (I would rather not let the last one be an option).

I like the idea of health care coverage for all, and think it should be a goal, but I want to listen to both sides. I also don't mind the idea of my taxes going up, but initially only to pay down the debt. This is why I had such a problem with the Bush tax cuts. It was like "WE finally have money to pay down the de... oh never mind." I dont want that last statement to spark a "repig v dumbocrap" thing here, I just didn't like that policy.

Anyway, I would appreciate some (thought out and eloquent, not a bunch of shouting and idiotic) answers if yall have the time.

[coyotes_geek]

• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

Yes Newt, we'd all like to make insurance more affordable. But tax credits don't do anything to change the internal workings and cost structure of the industry. All tax credits will do is trade off a health care cost problem for a government defecits problem.

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

The bit about being able to purchase insurance across state lines is a good idea. I hope that happens. The bit about portable insurance also sounds good in concept, but how good it would actually be depends on what it would take to "encourage" employers to participate. If that encouragement involves the government giving away money to someone, that's not accomplishing anything.

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.

That sounds all warm and fuzzy, but there's not really any substantive ideas in here.

• Allow doctors and patients to control costs. Doctors and patients are currently trapped by government-imposed payment rates. Under Medicare, doctors are not paid if they communicate with their patients by phone or e-mail. Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison shop on the Web. In short, they get paid when people are sick, not to keep them healthy.

So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and reprice their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.

Nice concept, but as above, a substantive idea on how to accomplish this goal is missing.

• Don't cut Medicare. The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.

Newt stresses the importance of ignoring the medicare problem. No idea on how to fix it, just don't cut it.

• Protect early retirees. More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.

If an employer wants to do something like that for the benefit of their employees, great. But the burden of protecting early retirees falls solely on the person wanting to retire early. If you can't afford to provide health insurance for yourself in that in between phase then you can't afford to retire early. Simple as that.

• Inform consumers. Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible. Sources like Medicare claims data (stripped of patient information) can help consumers answer important questions about their care. Government data—paid for by the taxpayers—can answer these questions and should be made public.

Good idea.

• Eliminate junk lawsuits. Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken. States across the country—Texas in particular—have already implemented key reforms including liability protection for using health information technology or following clinical standards of care; caps on non-economic damages; loser pays laws; and new alternative dispute resolution where patients get compensated for unexpected, adverse medical outcomes without lawyers, courtrooms, judges and juries.

Obviously a hot topic for a lot of people. How much this would actually reduce costs is highly debateable, but even if it is just a small step in the right direciton, it's worth doing IMO.

• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

at the notion of the government stopping fraud.

• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.
The solutions presented here can be the foundation for a patient-centered system. Let's hope the president has the courage to embrace them.

This will take care of itself. The companies making the medical breakthroughs want them to be accessible to patients. Nobody wants to make a product that nobody can use.

[coyotes_geek]

A couple of honest questions:
First, regarding the 500 billion dollar cut. Since this doesn't go to benefits for those on Medicare, would you (anyone who agrees with these proposals) be willing to cut that payment while not lowering Medicare tax. Take this money and sock it away so that Medicare remains funded?

That $500 billion cut was nothing more than a gimmick to make a $1.5 trillion dollar program look like it only costs $1.0 trillion. It's the federal government wussing out and making the individual states decide how to cut benefits or raise taxes.

Also regarding removing red tape, I am not sure that I like this since as currently cons uted, many people still get sick and die from drugs that pass all of that red tape. Lowering the bar seems to increase the likelihood of such things.

Point taken, but just to play devils advocate there are also people who get sick and die from not having access to drugs that are still stuck in the process of getting through that red tape. There is a balance to be struck.

I like the idea of self administration of meds. When I was younger I had asthma and though it wasn't really bad, it would get bad in some parts of the year and I required a shot. The doctor allowed my mom to administer it, but we did have to go in if there was a change in the amount. I want to do that allergy immunotherapy which requires a shot once a week. I want to do this, but it will cost me $25 a week for each "specialist visit." Unfortunately I am unable to do this.

Agree on the self med. My wife went through something similar.

I don't have too many problems with the rest of the proposals, but do feel some things have been left out. Make HSAs go in perpetuity. If I contribute 2k to my HSA this year, and spend 1500. That means I have to go crazy in december trying to find something to buy (I spent $182 on December 30th, 2009 at CVS, so that my money wouldn't vanish). There is no reason this money shouldn't carry over for a year when I may need 3k from my HSA.

It would be nice to be able to carry over something. But if you make it too big then I'd think you'd start running a risk of HSA's being abused as tax shelters.

Also, what suggestions are there for those who after these are enacted, still can't afford health insurance? Expanded Medicare?

Lastly, what about those who are idiots and still don't get medical insurance? Do you fine them? I don't want to continue to pay for their ER visits (through my taxes) especially when they go to the ER for something that could be taken care of much cheaper (like the flu). I know that this is a contentious point with the current proposal because of those who want to exercise their freedom to not buy insurance. Could we give three choices or four: Get insurance, prove that you have X amount in your HSA with which to cover any catastrophic illnesses (which increases as you age), get fined, or have some kind of demarcation that you arent allowed ER access (I would rather not let the last one be an option).

If we want to be serious about reducing health care costs, then some level of denying treatment to those who can't pay for it has to be part of the solution. The longer we pretend that we don't have to make that tough choice, the longer it will take to solve this problem.

[RandomGuy]

That sounds all warm and fuzzy, but there's not really any substantive ideas in here.

/thread.


.. he says, tongue in cheek.

Pretty much sums up the "ideas" put forth. I, for one, would be delighted, in a schadenfreude sense, to impliment every single one of these GOP ideas, toss out any Democratic ideas, and watch how dismally they fail to address the true scope of the problem.

The party of No Ideas has fully lived up to its sarcastic moniker.

[spursncowboys]

/thread.


.. he says, tongue in cheek.

Pretty much sums up the "ideas" put forth. I, for one, would be delighted, in a schadenfreude sense, to impliment every single one of these GOP ideas, toss out any Democratic ideas, and watch how dismally they fail to address the true scope of the problem.

The party of No Ideas has fully lived up to its sarcastic moniker.

What is the problem?

[RandomGuy]

• Stop health-care fraud. Every year up to $120 billion is stolen by criminals who defraud public programs like Medicare and Medicaid, according to the National Health Care Anti-Fraud Association. We can help prevent this by using responsible approaches such as enhanced coordination of benefits, third-party liability verification, and electronic payment.

ooh some bad phrasing here, if not a wee bit misleading.

Let's get a bit more accurate here:

Every year up to $120 billion is stolen by criminals who defraud both private insurers and public programs like Medicare and Medicaid.

The National Health Care Anit-Fraud Association gets its data in places like the 2007 FBI report on financial crimes.

http://www.fbi.gov/publications/fina...007.htm#health

That private insurance also gets defrauded doesn't quite fit in with the "Big wasteful government, booga booga booga!" narrative, so that small detail gets left out to make it appear that the scope of the problem is somehow limited to the big bad goverment, "but oh by the way, don't cut those programs, because that is our other "big" idea". Don't know whether to laugh, cry or roll my eyes at that one.

[coyotes_geek]

The party of No Ideas has fully lived up to its sarcastic moniker.

We're trapped between the party of no ideas and the party of bad ideas.

[TeyshaBlue]

/thread.


.. he says, tongue in cheek.

Pretty much sums up the "ideas" put forth. I, for one, would be delighted, in a schadenfreude sense, to impliment every single one of these GOP ideas, toss out any Democratic ideas, and watch how dismally they fail to address the true scope of the problem.

The party of No Ideas has fully lived up to its sarcastic moniker.

So pricing transparency and insurance portability are not ideas?

[Drachen]

That $500 billion cut was nothing more than a gimmick to make a $1.5 trillion dollar program look like it only costs $1.0 trillion. It's the federal government wussing out and making the individual states decide how to cut benefits or raise taxes.



Point taken, but just to play devils advocate there are also people who get sick and die from not having access to drugs that are still stuck in the process of getting through that red tape. There is a balance to be struck.



Agree on the self med. My wife went through something similar.



It would be nice to be able to carry over something. But if you make it too big then I'd think you'd start running a risk of HSA's being abused as tax shelters.



If we want to be serious about reducing health care costs, then some level of denying treatment to those who can't pay for it has to be part of the solution. The longer we pretend that we don't have to make that tough choice, the longer it will take to solve this problem.

HSA's: They could become tax shelters, but those who use them as such better have a ton of medical expenses at the end of their lives on which to use this enormous tax shelter. If someone wanted to get that money back to use on non-health related purchases, give it to them taxed at the highest tax rate + some fine. If you want to avoid that, however, one could also look at the average cost of healthcare for a certain age (say 25) allow that person to put the average + X% into their HSA untaxed, then the rest (if they so choose) is taxed at their regular rate.

As far as the "sick and die before drugs are released", without the red tape many more could get sick and die because a drug shouldn't have been released. Additionally, that arguement could be used over and over again until there is no time between the development of a drug and its issue to the public. Due Dilligence shouldn't be cut. Perhaps there could be some way to open drug trials wider to allow far greater amounts of people to get into them, if they so decide, and if they sign a waiver stating that they know they may die and won't sue.

I am ok with the whole denial part as long as sufficient other options are given. If these options are turned down then there needs to be an active event that lets that person know that they will be denied care (like you sign a waiver stating that you have decided not to have medical coverage, and will not save for your medical well being). That way idiots who decide this KNOW that they have decided not to receive coverage.

Oh, and as far as medicaid/medicare (and any other such programs). There needs to be a sliding scale. It seems that currently these types of programs have a hard cap. For example, if this person makes between 0 and 30000 then they cant afford this service so we will provide it, but if they make 30001, they can. If those in the government believe that someone making 30001 can afford it, then the person making 30000 can fund at least, say, 85% with the government kicking in only 15% (I know it is more like 99%/1%, but I am allowing for brackets).

[RandomGuy]

Truth be told about fraud:

I will always exist under any program, private or public. Steps can and should be taken to mitigate it.

Given the billions we throw at the Department of Homeland Security after a few thousand of US got killed, surely we can probably save our economy a bit if we diverted a bit of money from that to fighting some of the financial fraud that threatens and kills us far more than nutjobs with box cutters or exploding underwear.

One of the issues with such fraud is that a good chunk of it has to be handled by the states, who have, to be generous, some resource problems for unsexy things like insurance fraud investigations.

I fully agree with the idea of stopping health care fraud. But if more "big government" solutions aren't the answer, as presumedly for the GOP they aren't, can some enterprising Republican step up and tell me what the alternatives are for fighting such fraud?

[TeyshaBlue]

Truth be told about fraud:

I will always exist under any program, private or public. Steps can and should be taken to mitigate it.

Given the billions we throw at the Department of Homeland Security after a few thousand of US got killed, surely we can probably save our economy a bit if we diverted a bit of money from that to fighting some of the financial fraud that threatens and kills us far more than nutjobs with box cutters or exploding underwear.

One of the issues with such fraud is that a good chunk of it has to be handled by the states, who have, to be generous, some resource problems for unsexy things like insurance fraud investigations.

I fully agree with the idea of stopping health care fraud. But if more "big government" solutions aren't the answer, as presumedly for the GOP they aren't, can some enterprising Republican step up and tell me what the alternatives are for fighting such fraud?

Pricing transparency. A uniform claims process.
Standardization of back office methodology. The latter 2 issues could easily be addressed by the Insurance companies themselves. A council of Ins. and Hospital professional should be able to work thru these issues given the resources to do so.

[DarrinS]

Until you answer the real question, "What drives up health care costs?", you will never be able to address the problem.


If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more compe ion. As it stands now, employers are picking up most of premium costs.


I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.


Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

[RandomGuy]

So pricing transparency and insurance portability are not ideas?

They are, hence the qualifier "pretty much" as opposed to "completely".

Don't get me wrong. I think we should achieve a lot of the goals/ideas here.

But I just don't see anything really altogether substantial.

Buying health insurance across state lines is one example, but that would have to entail some MAJOR changes in the way heath insurance, if not insurance overall, is regulated. Those major changes would cost a LOT of money, and is one of the "sounds good, but the devil is in the details" issues.

I would be all for doing these things, if I really thought they would work. Who knows, maybe they would. Let the GOP's ideas be incorporated into the Health care form bill, lock, stock, and barrel. That way they have to take ownship of and accept responsibility for the problem instead of just pissing and moaning that they hate the Democrats ideas like a bunch of whiny babies in order to gain political points for their party at the expense of actually, say, doing something for the public good.

[coyotes_geek]

HSA's: They could become tax shelters, but those who use them as such better have a ton of medical expenses at the end of their lives on which to use this enormous tax shelter. If someone wanted to get that money back to use on non-health related purchases, give it to them taxed at the highest tax rate + some fine. If you want to avoid that, however, one could also look at the average cost of healthcare for a certain age (say 25) allow that person to put the average + X% into their HSA untaxed, then the rest (if they so choose) is taxed at their regular rate.

I don't have a problem with any of that.

As far as the "sick and die before drugs are released", without the red tape many more could get sick and die because a drug shouldn't have been released. Additionally, that arguement could be used over and over again until there is no time between the development of a drug and its issue to the public. Due Dilligence shouldn't be cut. Perhaps there could be some way to open drug trials wider to allow far greater amounts of people to get into them, if they so decide, and if they sign a waiver stating that they know they may die and won't sue.

No doubt there's a balance to be found here. I guess it's really just an issue as to whether or not there is a way to speed up the process without cutting corners. Conceding a strong personal sense of cynicism of the governemnt, I do beleive that there are inefficiencies in the FDA process that we would benefit from eliminating.

I am ok with the whole denial part as long as sufficient other options are given. If these options are turned down then there needs to be an active event that lets that person know that they will be denied care (like you sign a waiver stating that you have decided not to have medical coverage, and will not save for your medical well being). That way idiots who decide this KNOW that they have decided not to receive coverage.

The question becomes what other options are there? You either buy coverage or you don't.

Oh, and as far as medicaid/medicare (and any other such programs). There needs to be a sliding scale. It seems that currently these types of programs have a hard cap. For example, if this person makes between 0 and 30000 then they cant afford this service so we will provide it, but if they make 30001, they can. If those in the government believe that someone making 30001 can afford it, then the person making 30000 can fund at least, say, 85% with the government kicking in only 15% (I know it is more like 99%/1%, but I am allowing for brackets).

I think something similar is inevitable. I also think some kind of age hike for eligibilty is coming.

[RandomGuy]

Until you answer the real question, "What drives up health care costs?", you will never be able to address the problem.


If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more compe ion. As it stands now, employers are picking up most of premium costs.


I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.


Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

Are doctors practicing "defensive medicine", or... are they simply reimbursed by the procedure, and maximizing their income by advocating only mildly useful procedures?

If people had to pay out of pocket for routine medical expenses, costs would go down.

Problem is that doesn't make economic sense. That would simply mean that people would simply avoid routine medical expenses. If you increase the price for any given product, you decrease the total amount of that product supplied to the market.

The idea that reducing the amount of routine medical expenses that might prevent much more costly curative care down the road would imply that there is a good chance of such a solution actually driving total systemic costs UP, not down.

One idea I have heard floated around to overcome this:

Pay doctors by the health care outcomes, not by the procedure.

[TeyshaBlue]

They are, hence the qualifier "pretty much" as opposed to "completely".

Yet you close with the absolute:

The party of No Ideas has fully lived up to its sarcastic moniker.

Buying health insurance across state lines is one example, but that would have to entail some MAJOR changes in the way heath insurance, if not insurance overall, is regulated. Those major changes would cost a LOT of money, and is one of the "sounds good, but the devil is in the details" issues.

I agree. The details is where the potential for fraud usually thrives. I can't think of any reason why the government cant task the insurers to develop this plan as a requirement. Face it, if we want to move forward with any meaningful reform, that does not involve completely dissolving the current, intermediary heavy system, then we need to involve these player and get some kind of buy in.

[ElNono]

We're trapped between the party of no ideas and the party of bad ideas.

[RandomGuy]

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

What about the private market shifting costs to medicare and medicaid through hikes in insurance premiums that force people and companies to drop coverage and join the ranks of the uninsured?

The uninsured, especially those that don't qualify for the government programs, shift THEIR costs to (surprise!) the insurance companies, who as paying customers, have to foot the bill for the uninsured hospital stays of everybody caught outside our current non-system.

Oddly enough, the uninsured also shift their costs to banks and other creditors, who have to eat non-productive loans when people are forced into bankruptcy.

There is a LOT of cost shifting going on, because we don't want to do the obvious thing and pay for everything up front and transparently. (single payor anyone?)

[TeyshaBlue]

The idea that reducing the amount of routine medical expenses that might prevent much more costly curative care down the road would imply that there is a good chance of such a solution actually driving total systemic costs UP, not down.

One idea I have heard floated around to overcome this:

Pay doctors by the health care outcomes, not by the procedure.

I agree, this is likely to discourage visits in the short term. The potential exists, however, as doctors begin to see their schedules empty, that they begin to coax patients back with lower costs or some other incentive.

I'm still on the single payor bandwagon, and it's a lonely wagon to be on. But, I can see a hybrid approach where a single payor system can be resonsible for the routine office visits leaving the specialist and higher cost procedures in the hands of the current insurance companies. The companies dispense with an enormous amount of processing and other staff expenditures. In exchange, they would have to offer coverage with no exclusions and their premiums would be leveraged by the aggregate. Premium costs would also be required to be reduced and should be as a consequence of no longer paying routine visit costs.

[RandomGuy]

Here is a fun thign to think about:

Woman is on blood pressure medication. Woman loses insurance, but makes too much to qualify for government assistance.

She cannot afford the medication, so she stops taking it.

Within a few months, she has a stroke and other complications, heading into the emergency room, where they spend more money in emergent tertiary care in the failed attempt to save her life than it would have cost the big bad goverment to simply have paid for the medications for the rest of her life.

This is a true story told by an emergency room doctor advocating for health care reform.

I think the current paralysis on the part of congress will likely continue to play out. The GOP has no stake in helping the Democrats succeed, and see only political gain in opposing anything the president and his party propose.

Therefore, nothing will really be done, making the current problem of uninsured worse.

I wish it were otherwise, but I don't see anything substantive happening. I wish the president luck in doing SOMETHING.

[Drachen]

The question becomes what other options are there? You either buy coverage or you don't.

Heavily funded HSA's.

[ElNono]

If people had to pay out of pocket for routine medical expenses, costs would go down. People with insurance have low co-pays and tend to overuse health care. Also, if people payed out of pocket, they would shop around more and it would create more compe ion. As it stands now, employers are picking up most of premium costs.

No such thing. People would simply stop going to the doctor because they either can't afford it or because they think they're smart enough and will never get sick. It's exactly what happens with the uninsured right now. What ends up happening is you have a more sick society overall, and the cost eventually surfaces later on in the form of chronic conditions (diabetes, etc), for things that should have been completely avoided with a modi of preventive medicine.

I also think costs could be reduced if doctor's didn't have to practice defensive medicine. They have to have enormous malpractice insurance and they tend to do a lot of unnecessary tests in a CYA move. They pass these costs along to us.

Tort reform is supposed to address this. I wouldn't be against some sort of reform, but it's not the panacea people make it out to be.

Also, Medicare and Medicaid shift costs to the private market because they don't pay the same rates. I'm not quite sure what you do about this problem.

As already said by RandomGuy, there's a lot of cost shifting going on at multiple levels.

To me, prices are inflated. I understand doctors trying to charge $150 a visit, because there might be a market out there for that. Also, because insurance co's will only pay $80 back. The same guy works just as well receiving the fixed price of $48 from Medicare. The difference being that he won't end up driving a Benz or playing golf on saturdays.

Drugs are another major factor. The patent protection they enjoy need to be severely limited. I don't mind them recouping their investment, but right now they spend more on advertising than R&D. They enjoy a temporary virtual monopoly that far exceeds merely recouping investment.

[George Gervin's Afro]

What I haven't heard from the GOP is which of their ideas are they willing to compromise on. If they say none they then have zero interest in working with Obama. Before you dead enders respond keep in mind the moniroty party doesn't dictate any debate. The GOP should accept that not all of their ideas would be implemented and actually identify which one's they would be willing to compromise on.

[mogrovejo]

A few bad, big government ideas. Marginally better than the ideas coming off the gang of Chicago.

This would be an exponentially better article:

Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

Eliminate junk lawsuits.