DescentBB

Pandora wrote:How do you imagine a health insurance system without a middleman?

From several messages back: (Dang this has been a LONG thread!)

Kilarin wrote:A system that would eliminate this would be nationwide implementation of a reasonable medical savings account system. One that every citizen could have access to. You would pay in a monthly fee, and most of that fee would simply go into the account, from that account you pay your medical bills, direct to the doctor or hospital. No middle man. A small percentage of the fee goes to purchase a high deductible umbrella insurance policy that covers in case you have some disaster that exhaust your savings account.

Now the reason this system will work so well is two fold. In the first place you eliminate the middle man for most medical expenses. People dealing directly with doctors and hospitals will save the doctors and hospitals paperwork, AND will force doctors and hospitals to try and be competitive, because when I am paying the bills myself, I'm going to shop around a bit.

The other reason this will work is that people are, on average, healthiest while they are young. If you don't spend all of the money in your medical savings account in one year, you let it roll over to the next year. As the savings account grows larger, you can keep increasing the deductible on the umbrella policy and therefore decreasing the amount of money that isn't going directly into your saving account. A few generally healthy years and young people could build up a substantial savings fund to cover most medical expenses, while still resting comfortable knowing that if they have a disastrous illness, the umbrella policy will kick in.

Let people pay the doctors directly for the vast majority of medical expenses and the cost will go down because of competition. Not to mention that people will have a financial incentive to use medical services reasonably, and to stay as healthy as possible. This system would benefit the poor most of all, because with a few years of decent health, they could actually REDUCE their spending on insurance. Our entire medical system would become less corrupt and more efficient. That doesn't happen if you have a middle man.

Kilarin: So basically that is self administered health insurance. How do you account for those born with defects so that their account never has a chance to go into positive territory? And I suppose that those with no income would have to have their account paid into by government or be handled the same way that they are now by Medicare.
If 4% of the users cost you 50% of the cost of health care then it would appear that catastrophic illness is your major expense anyway and so as the population ages your umbrella fund would be stressed just as Medicare and Medicaid will be.
The idea is not without merit and similar schemes are often bandied about here in Canada as we struggle with the cost of health care too.
As the wealthiest country in the world I don't actually accept your statement that you can't afford the coming cost of health care. I just don't think you are willing to be taxed to pay. All the nations with government run health care are facing the same bubble of age and earning issues but the level of panic about the cost is not as pronounced as it seems to be in the U.S. I guess there is always the fall back of opening the doors to immigration so that the newcomers take up the tax burden as they take over the position of creators and consumers of wealth.

Ford Prefect wrote:How do you account for those born with defects so that their account never has a chance to go into positive territory? And I suppose that those with no income would have to have their account paid into by government or be handled the same way that they are now by Medicare.

Those born with defects would presumably be covered by their parents accounts. But yes, there would be people with incomes so low that they required charity or some other program to assist in their coverage. The medical savings account idea isn't perfect, but I think it's a move in the right direction. And be reducing medical cost in general, it would help EVERYONE, even those who fell through the gaps.

Ford Prefect wrote:If 4% of the users cost you 50% of the cost of health care then it would appear that catastrophic illness is your major expense anyway and so as the population ages your umbrella fund would be stressed just as Medicare and Medicaid will be.

Not AS stressed. If you've greatly reduced the non catastrophic medical expenses, and probably reduced the cost of catastrophic care somewhat as well, you've reduced the stress on the entire system. It's a step in the right direction, whereas socializing healthcare takes us towards MORE red tape and MORE expense.

Ford Prefect wrote:As the wealthiest country in the world I don't actually accept your statement that you can't afford the coming cost of health care. I just don't think you are willing to be taxed to pay.

Everyone seems very willing to tell the U.S. how to spend all of it's money.
Yes I AM unwilling to pay more taxes. Heck, I'm unwilling to pay the taxes I'm already paying. But that's beside the point. We are dealing with three serious issues here that have a consequence I don't think most people are grasping.

Issue 1: If you had a catastrophic illness in the year 1800, about the most expensive thing you could end up paying for was a round the clock nurse and a lot of doctor visits. There just wasn't that much else they could do. But now, every year the limit of what "CAN" be done goes up. Now it's quite possible to blow a million dollars working on someone with a catastrophic illness. In some cases that treatment will actually restore them to health, but in many cases it is just prolonging their death. It's an ethical dilemma because we still feel that if we CAN help, we should, no matter what the cost. And the cost keeps going up every year. Getting rid of inefficiency and corruption can help with this, but it won't stop the general trend.

Issue 2: We are extending the lifespan. Considerably. The average life expectancy in the U.S. in 1900 was 47 years, it is now around 77 years. That means people spend longer and longer in the "retirement" zone now. And because of the idiocy of Social Security, most retired people do not have enough savings to live on, they must live off of the "pay as you go" system, which means the current taxes of the current wage earners.

Issue 3: There are just a gosh awful lot MORE Baby Boomers than there are anyone else. And those boomers are about to retire. They will stop earning wages, and start collecting social security, Medicare, Medicaid, and whatnot.

Put together, these three issues: increased cost of what is medically possible, increased lifespan, and increased retired population; spell disaster.

It's not just a matter of raising the tax rate on everyone. It's a matter of MANY more people going onto the side of the ledger that draws out more from taxes than they put in. Fewer wager earners paying more and more taxes to try and support an increasingly elderly society.

If we had planned for this properly 30 years ago, if we had money set aside, we could get through it. But Social Security is bankrupt, Medicare and Medicaid are falling apart, and the government has shown no signs whatsoever of reversing the trend of spending more money than they have. I think they have waited to long. In just a few years they will realize that they simply do not HAVE enough wage earners to support the non wage earning population. Then things are going to get nasty. Especially since the non wage earning population will outvote the wage earners.

Ford Prefect wrote:I guess there is always the fall back of opening the doors to immigration so that the newcomers take up the tax burden as they take over the position of creators and consumers of wealth.

That WOULD be an excellent solution. I am in favor of open borders, just so long as the people coming over do it legally and agree to become citizens.

Issue #1- I agree. I have been involved in the end of life decisions of two family members. A 76 year old uncle with dementia, delirium, and failing kidneys and my 93 year old father with a serious infection. In both cases we decided to let nature take it's course and lost loved family members within months instead of years. Quality of life took precedence over length of life in both cases and both times we were supported by the medical professionals involved.
Issue #2- I have an 83 year old mother and my father died as I said at 93 less than a year ago. Neither was or is kept alive by medical intervention but then I guess I just chose my parents wisely.
Issue #3- Hey! As a 56 year old who has paid his taxes uncomplainingly for over 35 years of gainfully employed life I resent your characterization of me as an economic liability to my nation. I don't necessarily disagree. I just resent it.
In the 1980s Canada sucked it up and faced some tough financial decisions. We rationalized a federal manufacturing tax system and replaced it with the much hated but necessary Goods and Services Tax (GST). Our Employment Insurance scheme benefits were scaled back and it is now so much in the black that it's surplus can be used to support social services, our federal pension system deductions were bumped up and the system is now in decent shape and the federal government as well as most of the Provinces have been running budget surpluses for over a decade.
It's not too late for the U.S. but you guys need to face the economic truth and cut back on military adventures, cut back on your dependence on cheap imports (that means a loss of overall standard of living)to correct your export deficit and collect as much in taxes as you spend. If the U.S. economy tanks it will take Canada with it as 80% of our exports go south so get with it before I come down there and make you.
I also don't consider it to be immigration unless it is registered and citizenship is at least encouraged if not actually required. (I have to be careful here as my wife of 23 years is a Landed Immigrant but still a U.S. citizen )

Ford Prefect wrote:As a 56 year old who has paid his taxes uncomplainingly for over 35 years of gainfully employed life I resent your characterization of me as an economic liability to my nation. I don't necessarily disagree. I just resent it.

Heh, yep. It's a bum wrap. It's not like the baby boomers are liabilities because they didn't pay their taxes. They are liabilities because we spent more money than we took in, all the while telling people that the Soc Sec fund was fat and happy. Well, it's a fat and happy piece of paper with IOU written on it. <sigh> Any company that tried to keep it's books the way the U.S. Government does would be brought up on criminal charges.

Ford Prefect wrote:It's not too late for the U.S. but you guys need to face the economic truth and cut back on military adventures, cut back on your dependence on cheap imports (that means a loss of overall standard of living)to correct your export deficit and collect as much in taxes as you spend.

I don't know if it's too late or not, but I think I can agree whole heartedly with all the rest of it. I would ALSO add some more things that need to be cut, of course...

I'm not sure what the whole debate is about now. Does a national healthcare scheme work? yes.

Does it have it's problems? of course, but that's simple human nature.

but it still works.

yeah thread it HUGE i dunno what's going on!

Hey, Kilarin, sorry for not responding. Really busy at work. Your idea sounds interesting ... have to think about it for a while.

Kilarin, I can see the advantages of your idea. However, I would be worried that the disadvantages it introduces are much more severe on a societal level. The most important problem I see is that it necessarily turns certain decisions that should exclusively be based on moral aspects into economical decisions --- and this will happen particularly for the poorer people.

Imagine, for isntance, a family who are not well off, and who need all their money to keep their business going. Now, one of them recognizes that he has some worrisome symptoms. Does he go to the doctor immediately as he should, even though he knows that, if it is serious, it will ruin his family? Or will he wait for a bit longer to see if it does not go away by itself? What if it is their child that develops the problems? So, in the long run, you will have a lot of problems health proplems in the poorer parts of the population for whom it is advantageous save their money instead of having their health taken care of. The delay between first occurence of symptoms and effective treatment would also give any new disease a big head start to spread through the population.

Imagine, also, a family finding out that their child has a disability. When they are poor (and they already have problems keeping their health savings account balanced), they might not be able to \"afford\" such a child because it would ruin them, and they might be forced to give it away. Or they might decide to keep the disability untreated, even though it could be effectively removed. Again, you will introduce a bias towards untreated disabilities in the poorer parts of the society. --- one minor example for this process is the incredible amount of missing or rotten black teeth among the British. Dentistry is exactly what is not covered effectively by the public health system.

Same for old people. The things you and Ford discuss above are the \"easy\" cases, for which it is more or less clear what should be done morally. But what about the majority of old people that are perfectly happy, and live a good life, but who might need constant - and expensive! - medical care (e.g. dyalysis systems for kidney patients). If they're health saving account is empty, they know that evey year they live their lifes costs money that would otherwise benefit the education of their grand children. Thus, again, particularly in the poorer people you drive up the number of unhealthy old people, and possible the number of voluntary deaths. You also create tensions or disrupt the links between the different generations.

What it comes down to is if you can live with such decision taking place on a daily level in your society. I don't. I like a system where there is a common box of money in which everybody pays in, the rich more than the poor, so that everybody contributes to the quality health support for all members of the society, no matter if they could afford it otherwise.

I see that socialized health care has (big!) problems, but the alternatives seem to me even less desirable. Or do you have ways to address these problems?

Pandora wrote:I see that socialized health care has (big!) problems, but the alternatives seem to me even less desirable. Or do you have ways to address these problems?

No, I think these problems are inevitable. They will occur no matter HOW you work your health system. They occur in both privatized AND socialized systems. The only question is, who makes the economic decision?

In a privatized system with improved health savings accounts, you can make the decisions for your own family. Do I get these symptoms treated, or do I wait and see if they get more serious? It's your choice, and you can make the decision knowing that you've got the health savings account, as well as the umbrella policy to cover if your health savings account is exhausted. The choice is yours.

In a socialized system, the choice is the governments. They decided if you can be treated, or not. And for exactly the same reason. They only have so much money to spend. Actually, they have LESS money to spend, because they are inefficient and the system is inherently prone to corruption.

One of the specific reasons costs skyrocket under our current insurance system and under socialized medical systems is that their is no direct economic deterrent to using the medical system. The system becomes clogged with unnecessary doctor's visits because the people have no incentive NOT to go to the doctor and request the maximum treatment.

The government has to try and curb this cost overrun just like private citizens and insurance companies do. And they do it by regulation.

You believe your kid needs an important surgery, but the decision is not strictly up to you and the doctor, it's up to the government. And unless you believe that the government is very wise and very benevolent, this is NOT a good thing. The choice has been removed from you and given to someone else.

NEITHER answer is perfect, I don't believe there are any perfect answers. But in an imperfect world, I'll choose the system that reduces costs overall and maximizes personal choice. Because I believe that system will serve everyone best.