The republicans are going to get government out of the insurance business. They will allow sale of catastrophic insurance and higher levels in HSA. That will encourage compe ion among all non-emergency/catastrophic procedures and drive down prices (no insurance middleman). Buy your cheap catastrophic insurance (in case of cancer, brain tumor, major accident) and comparison shop/pay out of HSA for routine stuff. C'mon, boutons, this is right up your alley - BigInsuranceCo will be neutered except for catastrophic/hospital-related stuff. Everything else could be done at doctor's office, (discount) blood labs, critical care/outpatient/imaging centers where you pay directly from your HSA debit card after comparison shopping from posted prices.
This is where I advocate allowing others to contribute to each other's HSA if there is a need - instead of a GoFundMe page, anybody could contribute to anyone's HSA. Wouldn't that unleash the power of giving/charity and desire to help others?
Do You realize that 60% of Americans health insurance is part of their compensation package provided by their employers? Now subtract the people on Medicare and Medicaid. For the pipe dream you described above to work, you need to shift away from employer based health insurance. This would be a fundamental shift and a death knell to the insurance industry which is the same reason the single payer failed and the dems settled for the ACA. Good luck with that.
I don't think it would. As a matter of fact, charity is what people used to look for before ACA, when they didn't have insurance. That or straight to an emergency room for urgent care (which was oftentimes government-paid charity too). That system left almost half of Americans without health insurance and was responsible for almost half of all bankruptcies.
People bringing charity have no idea of the cost of healthcare in the US and charity itself does nothing to bring down that cost. It's the same old question of 'how are we going to pay for this?' when the first question should really be 'why does this cost that much?'
You have to address cost. After that, we can start talking how to pay for it.
The reason it costs so much is because of the way insurance is set up - no transparency in prices, prac ioner hikes up price, submits to insurance company, insurance company pays certain amount, etc. - extra personnel on both sides to handle authorization, payment, etc. Cut out insurance for all but major/hospital-related (catastrophic) stuff. No insurance for everything else, post your prices like they do for lasik surgery and people will shop for mammograms/ultrasound ($80 without insurance), annual ($90), sick visit ($75), blood tests ($99 for CWP - $69 in Dec). We have become conditioned to going to a prac ioner and not knowing what it's gonna cost and being at the mercy of insurance/getting a bill later (even though you paid your co-pay) that patient is responsible for $x. IMO, we should shop for these services like we do for our cel phones/plans. The prices I have posted are real, direct-pay prices from last year when dh was out of a job for 5 months - not the jacked up hundreds of $ anything involving insurance is. Even for surgery see https://surgerycenterok.com for posted prices which are probably cheaper than the jacked up insurance prices at your local hospitals.
What I'm advocating is with the understanding that you have catastrophic insurance for the big things. The small things (if there isn't enough in the HSA) or the deductible on the catastrophic insurance (where the insurance takes over) is what I'm referring to. They could allow people to get HSA$ from parents, (adult kids), relatives, friends, people at work (btw, Google has something similar for time off - if you need extra time to take care of a relative, co-workers can donate their time to you).
Sorry - can't edit my post
https://surgerycenterok.com/pricing/
Did you notice/follow all the asterisks on those prices? Make sure to read the fine print.
I don't disagree about the market distortion on prices and lack of pricing transparency. That's one problem out of a plethora of them. I don't particularly have the time right now, and I hate it because I think it's a topic worth discussing, but let me tell you that I'm certainly one of those people that would like to see a working health system in America for once. Both on the access level and that compares relatively favorably on the health spending per capita with those of other developed nations.
To tackle that (and going back to charity), you have to reduce costs. There's no other way around it. Once the actual prices even out, then we can discuss charity or anything else that can deal with the actual figure. With the current (and previous) system and costs, charity is nowhere near enough.
Yes, I see the asterisks. The point is if you bypass the insurance, these are the prices. If it involves insurance, it's a lot more. The majority of procedures at that OK center would be covered by catastrophic insurance so I don't know why I even included it - serves me right for posting so late at night.
As seen by Vermont and Colorado, taxpayers are going to balk at single-payer. Why not try to cover everyone with catastrophic insurance and pay out of pocket/HSA for the routine stuff? It's just too expensive for everyone to have full-coverage insurance. I'm not stuck on the charity - it's just a suggestion borne out of the Google example above.
agian, the majority of Americans are on full coverage employer sponsored health insurance which is part of the employees' compensation package. What is the strategy for eliminating the employer sponsored health insurance, which is key to making your compe ion driven market work? Note that your plan completely neuters the private insurance industry. The same way the dems didn't have the political capital to kill that industry, the republcans won't either.
I'm all for removing middle-man, tbh... but remember that HSAs are another form of middle-man: the banks. Honestly, if you could actually have the power to basically get rid of the health insurance industry (a claim extremely dubious, at best), you should probably go all the way and remove employment-tied health coverage too. The thing here though, is that we still have the same problem: providers charge to what the market will bear, and at least in the US, the average health services consumer can pony up a pretty penny. So, that's really the elephant in the room when it comes to cost. But then again, capping somebody's earning (even though we do that with insurance companies) it's unlikely to happen.
In economic terms, it makes zero sense to run single-payer at the State level. The reason, economically, it's really simple: the Federal government controls the currency, the States do not. That's why to run Medicaid States need federal funding (be it what it is now or block grants). People in the hard-to-insure group are a sunk cost. Taxpayers pick it up either through one of those programs or paying back the hospital when they show up in emergency rooms there. So the question is what's preferable (or cheaper), since taxpayers are paying for it one way or the other.
All the quoted prices above are side-by-side with employer sponsored insurance from last year. I simply Googled, called and asked for the cash/direct pay price. Iirc, was it 101A who also got a very good price for treatment for his daughter when he was in between jobs? We don't have to eliminate employer sponsored insurance to do this (that would be political suicide to try) - we just have to get it more mainstreamed (so that prac ioners post prices - instead of us having to call/compare). Even now that we have employer sponsored insurance, I always ask whichever doctor I go to what the cash price is and it's usually half what the insurance price is.
And if the Repubs do raise the HSA amount - enough for it to make financial sense (it is in essence a tax sheltered savings vehicle) and one is relatively healthy, even people on employer sponsored insurance will choose high deductible health plans. Then young people would able to build up HSAs so that they have a nice buffer available for later years and imagine (I know it's a pipe dream) allowing the exchange/giving of HSA$ among family/friends.
See above
Doesn't this apply to all "federal" government programs - not just Medicaid but with Medicare/SS/etc. too? the ability of the feds to print $, to lump together and run at a loss - something states cannot do (most have to have a balanced budget)? To me, the reason why it won't work is because the state cannot control who comes within its borders so when some one is (seriously) sick, he/she can go live in that state and be covered. And if it's like the proposed California plan (also covering illegals), taxpayers are going to balk at supporting so many.
To me, try for catastrophic coverage for everyone and instead of the feds putting money toward subsidies/Medicaid for able-bodied people, put that toward high-risk/hard-to-insure people. I don't have any ideas for keeping these people out of the emergency room but that was happening before (and iirc, went up with Obamacare) except for the charity and trying to steer them away from hospitals toward cheaper care (critical care, physician office).
I'm not particularly against HSAs, I just don't think they're realistic in this market, for a number of reasons. First of all, the vast majority of people that will require the most care are Boomers/Gen-X, which they just can't start now with an HSA. Those people will need the Medicare/Medicaid.
The second issue is that HSAs don't do anything about cost. Almost half of America is living paycheck to paycheck. How do you tell those people they need to pay catastrophic insurance and on top of that put money on their HSAs?
- If you force them to put money on their HSAs, then it's no different than a tax.
- If you don't force them, then they'll end up bankrupt in the emergency room just like they did before. Catastrophic doesn't kick in until, well, it's catastrophic. And still costs a pretty penny (upwards of $300/mo where I live).
- The cost of care raises way faster than inflation. For HSAs to work, it's not an amount problem, it's an interest problem. The compound interest (provided you didn't have to spend more money from it than the interest payment) has to be higher than the raise in the cost of care. While that might sound like a given, it really isn't for people that need care the most (since they actually spend their HSA money, thus the compound part of the interest doesn't necessarily applies).
So there's a lot of assumptions about HSAs, especially that people will generally be healthy and won't be tapping into that until they're old. But if they do need to, they're kinda ed.
That said, they're certainly a valid option when trying to figure out how to pay for care. They just won't address the fact that the US overpays extremely for the same services with same or worse outcomes than other places. And I really think that's the real elephant in the room, and until we address that head-on, we're really just circling around the same problem.
Pretty much. It's not "federal programs" though, it's the fact that the States don't control the currency. You know when politicos compare the economy with a household economy? Well, that certainly DOES apply to States. They either get it from revenue or by issuing debt (much like paying with a credit card). Arguably, they CAN go bankrupt (unless daddy Federal govt comes in and bails it out).
However, it drives me up a wall when the case is made with the Federal government, because it simply does not work that way. Yes, the federal can print $, and yes, there's such a thing as printing too much (which ends up in inflation, not bankruptcy). But effectively, there's not a single check the federal government issues that cannot be cashed. Now, I'm actually all for fiscal conservatism (you don't want that high inflation, or hyperinflation. You never lived through it, but I have. You don't want to get to know it), but understanding these kind of differences are important when talking about programs with a sunk cost. Once you have a program like that, the discussion should center on how to reduce the cost, because that's always going to be there (as I was saying, taxpayers end up paying for it one way or the other, and while you don't want to print a lot, you do want to be able to handle any es).
There could be a bunch of hybrid approaches to that (as a matter of fact, there are all around the world). The catastrophic single-payer is not a bad idea, at least you could basically give peace of mind. That has value.
Another idea would be the other way around: have government clinics for basic care, which is the vast majority of care, and require people to have catastrophic for when the really hits the fan. You control accessibility and costs that way because you have a "free" provider, and basic care isn't necessarily high-tech. A broken bone, the flu, a yearly physical. Those are not rocket science, and in any part of the world they're not expensive things. If you want to go to your private practice, with the doctor you know, and pay, go ahead. They'll be competing against the free option, so there's an incentive to charge a "premium value" but not go overboard. That also gives you peace of mind.
And there's a mul ude of other approaches. I just think if we don't question the rate at which cost has been increasing (a rate which for some reason largely only applies to America), we're only really addressing the symptoms, not the problem.
Appreciate the links, btw.
Insurance Company Celebrates 50 Billionth ing Over Of Customer
CANTON, OH—Overjoyed Cigna executives celebrated the health insurer’s 50 billionth ing over of a customer Thursday, personally surprising 56-year-old spinal trauma victim Clyde Gershon with champagne, confetti, and hundreds of multicolored balloons as they denied his most recent disability claim.
“We did it! We’ve completely and utterly ed over a customer for the 50 billionth time," exclaimed CEO David Cordani, drawing a vibrant round of applause as Gershon, gaunt and dejected, stared blankly off into the distance.
“Ruining this many lives is an accomplishment no one ever could have dreamed of back in 1982 when Cigna was founded.
And today, I can proudly say we have not only achieved it, but inflicted an incalculable amount of mental anguish along the way.”
“So congratulations, Mr. Gershon, you poor son of a ,” he continued, raising a flute of Dom Perigno.
“On behalf of myself and the rest of our 30,600 employees, I hope you find some other way to pay for your medical care, because you are now royally ed!”
http://www.theonion.com/article/insu...ocialMarketing
tangentially related, eye-opening, related to labor participation and the opioid epidemic:
https://www.commentarymagazine.com/a...-21st-century/You may now wish to ask: What share of prime-working-age men these days are enrolled in Medicaid? According to the Census Bureau’s SIPP survey (Survey of Income and Program Participation), as of 2013, over one-fifth (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent). And for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent.
By the way: Of the entire un-working prime-age male Anglo population in 2013, nearly three-fifths (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013.
Disability is the new way to game the welfare rolls. Get em on disability and they don't count anymore.
http://www.npr.org/2013/03/27/175502...-full-time-job
Nothing like years of taxpayer funded medical visits which eventually result in a diagnosis of fibromyalgia, so that they can get on disability benefits.
It's likely borne out of need rather than malice. Still, we'll see if Donald does anything to strip this "welfare" from his base.
Nearly 7 in 10 Americans have less than $1,000 in savings
http://www.usatoday.com/story/money/...tudy/91083712/
Gutting or getting rid of these programs gonna work out real well imo
It'lll work out great for Trump and his billionaire cabinet who can pay much less in taxes, and they're the only people that matter to him.
Oh no, the phishing is back! Just a little over a day of relief. Please, please undo whatever was done.
hmmm maybe I was onto something.
lies and bull and pussy grabbing are easy
Trash admits health care is really hard, complicated
even bas Bannon is worried about screwing too many people over health care, losing control of Congress
Last edited by boutons_deux; 02-27-2017 at 12:57 PM.
AFFORDABLE Care Act - what a joke.
Not DOUBLE digit increases but TRIPLE digit increases in Arizona
"Obamacare coverage" is the problem - men, children and post-menopausal women paying for maternity benefits and birth control pills, adults paying for pediatric vision and dental, Dems want full-blown, unnecessary what they consider "essential" coverage and those over the threshold paying >$1600 per month for family - that's more than my mortgage.
He mocks continuous coverage - what does he think employer-sponsored and COBRA plans require - that's right - continuous coverage - that is exactly what is needed - not this ability to hop in and out whenever they please knowing that if they get sick they can sign up during enrollment, get treated and drop after treatment.
That mandate is sure keeping "the young, healthy people in the system which is crucial to lower the cost for everyone" - don't think so.
And yes, it should be painful to get it again if you drop coverage and it should involve higher premium or threat of long waiting period or else where is the incentive to keep being insured. Spoilt - that's what this idea is that you can drop whenever you want, don't maintain coverage and expect to sign up when sick at the same price as someone who did maintain continuous coverage.
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