Healthcare Reform Thread II

[KrazyHorse]

It's been a really long time since I've seen an intelligent, non-partisan political point made on the internet. By all means, you think highly enough of yourself already, so normally I'd try not to complement you. But you earned it here.

Go **** yourself, you prat.

[KrazyHorse]

Oh and I am a partisan. It's a party of one, and we're always right.

[Jon Miller]

I am suspicious that the US high costs come from a combination of a large number of factors, none of which make up greater than 30% of the difference.

JM

[notyoueither]

I am suspicious that the US high costs come from a combination of a large number of factors, none of which make up greater than 30% of the difference.

JM

I keep having to remind myself that the uninsured and the under-insured are counted in the overall expenditure number.

Either they get critically ill and are paid for under some government plan, or they go bankrupt paying the bills.

To me, the real issue would be those people who do not get much if any benefit from the way things are done now. I'd be putting the gap in life expectancy slightly in front of the expenditures.

[Jon Miller]

Well, there is dumping. Actually, Michelle Obama was the one who introduced dumping to a Chicago Hospital a few years ago. And getting 'life critical' care 5 years later because you couldn't afford the care you needed at the time isn't reasonable. It is likely to be more expensive, and do less for you (you won't live as long, and will be less healthy for the time you are alive).

http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

Three main areas are cited for reasons why our medical costs are growing more than is expected:
1. Admin costs for private insurance are >7% while medicare is <2%. This means that medicare is more efficient as far as admin costs go.
2. Expenses due to 'new' treatments/etc, this is what KH blames.
3. Aging population and chronic disease. Note that these don't have to be related, but are for us. This could be changed by lifestyle changes (less obesity, less liver damage, less lung damage, etc). Aging population doesn't have to play such a big role.

Note that they don't mention medical education. Was that 10% or 5% did we figure? Medical malpractice was <5% I think we figured.

JM
(Dumping is where they take the patient who can't pay, but needs lots of continued treatment, to a homeless center and dump them there. It is a cost cutting mechanism for hospitals.)

[Drake Tungsten]

There's a good piece in the Atlantic on the underlying problems in the American healthcare system.

http://www.theatlantic.com/doc/200909/health-care

[Arrian]

It is a good article, and I'm interested in the idea of getting health insurance to look more like normal insurance (though normal insurance isn't ONLY catastrophe coverage: you have auto glass coverage on your auto insurance, for instance), but I think the consumer will always have major problems with having enough information to make an intelligent decision about their care and actually making calm, rational decisions in the midst of a medical problem.

-Arrian

[Jon Miller]

"Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves."

This is what I was suspicious about and what I think it a major problem.

It might be true though, that making insurance not required for normal operation (yearly checkups, pregnancies, etc) and only needed for catastrophe and that provided by the government.

JM

[Drake Tungsten]

Why would the government need to provide catastrophic health insurance? You don't have a problem with private life, auto and home insurance, do you?

[Jon Miller]

Well, maybe not government doing it. But it needs to be mandated, like car insurance.

20 yearolds would 'risk it' and end up causing more inefficiency by not being covered overall.

JM

[Drake Tungsten]

Agreed.

[Arrian]

Mandated & regulated, with government stepping in to fill gaps the private insurers otherwise wouldn't. There are drivers who would be "uninsurable" but their are state pools. Ditto people with those pesky pre-existing conditions.

But no, there is no particular reason the insurance has to be governmental (or non-governmental). It's just a payment scheme.

-Arrian

p.s. properly defining "catastrophe" in a medical sense strikes me as the devilish detail here.

[Jon Miller]

The article suggested something like 50k$ one time cost or a series of costs totally 50k$ in 5 years.

I think it could conceivably be lowered to 20k$. He is probably right in that most people should be able to find 'normal' sources of credit for 20k$ though. It is just that those sources might be less willing to give it to a 'ill' person.

Maybe 50k$ with down to 20k$ 'insured', this means that if there is bankruptcy or death that the 'catastrophe' insurance will pay back any lender?

JM

[Arrian]

He suggested some sort of financing scheme attached to HSAs, and he also suggested getting rid of the "use it or lose it" element to HSAs (which has tax implications, of course). Sounds good, though actually implementing such things might be trickier than he thinks.

-Arrian

[Ramo]

Strengthening HSA's means that more of health care expenditures are tax sheltered. That takes cost control in the opposite direction.

What I want to see is some kind of baseline plan subsidized. As a matter of politics, simple redistribution is difficult to enact and maintain, so I'd like to see that as an entitlement. Beyond the baseline, I don't see a point in subsidies.