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In regards to medical care, what would happen if. . . . .

By maxwell edison ·
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..... the Magic Santa snapped his fingers and made all "comprehensive" insurance coverage (see note) just vanish from the face of the earth (or for the sake of this question, from the USA), and all medical insurance sold was for catastrophic coverage only (acknowledging that catastrophic coverage will have to be defined), while the every-day, run-of-the-mill medical care was paid for out-of-pocket by the consumer (anything from normal check-ups, to cuts and scrapes, to broken arms); and the premiums previously paid for by one's employer (or one's own self) suddenly became income for the employee - but it was tax-free income to be placed in a medical savings/spending account, which could be carried-over from year to year, out of which the aforementioned every-day, run-of-the-mill medical care and catastrophic insurance coverage could be paid for; and, for those folks who required catastrophic medical care, but who either could not or would not buy catastrophic-only medical insurance - or who could not even afford every-day, run-of-the-mill medical care - could apply for "medical financial aid" (similar to college financial aid) - the funding for which is a side-issue - and be evaluated as to their ability to pay, perhaps being granted the aid, or perhaps being denied aid because they have the means (either present or future) to pay for the medical care received (again, similar to college financial aid); and, there was legislation passed for significant tort reform so that the competent medical providers did not have to pay exorbitant fees for malpractice insurance, and/or exorbitant settlements, and/or not be forced to provide what might be called "CYA" care; and, considering all the aforementioned conditions, the medical providers in question were free to set their own rates, not being dictated to by third-party payers, and the consumer could choose to either pay such rates or not, perhaps shopping around for better price and/or value?

Note: Comprehensive medical insurance coverage is defined as that which will pay for ALL medical care delivered (minus deductibles, co-pays, etc.), regardless of what it might be, or regardless of how large or small, or regardless from whom or what it's received - usually paid for by a third-party payer, either an insurance company or the government.

"Medical financial aid", as a side-issue: How might it be funded and/or administered? (Keeping it similar to college financial aid, the only difference, perhaps, is that it might be - indeed, probably would be - applied for after the fact instead of before, but not necessarily always being the case.)

Define "catastrophic coverage", in regards to both delivery and insurance coverage.

Considering that question (or questions), what might happen to the cost, the affordability, and the availability of medical care for most, if not all Americans, if the consumer and medical providers were the decision makers, per se, instead of the insurance industry and/or some other third-party payer?

(I think that might be the longest question I've ever written!)

Edited only for the following:

Merry Christmas to all my TR peers!

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Well, Max

by NickNielsen In reply to In regards to medical car ...

When you ask a question, you really ask a question.

Definitions aside, I think it would work if given a chance. At first glance, the only people who come out on the short end are the insurance companies and their CEOs. But that's only my first glance. I'll have to take some time with a more in-depth answer.

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Nick - at "first glance", I would agree with you.

by maxwell edison In reply to Well, Max

Moreover, do you think it's a good start to presenting a viable alternative to what's being debated in Congress today?

The premise being this: the consumer and/or the individual, and/or the free-market system is the better facilitator of providing medical care than any government controlled - or insurance controlled - system? (And a government, by the way, is one being controlled be either political party.)

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The tough question is the gray area

by TheProfessorDan In reply to Nick - at "first glance", ...

If I comprehend your post correctly, what you are saying is that maybe what we should have is insurance that only covers catastrophic events. If that is what you are saying, I do agree that people do abuse their coverage. As much as I hate paying them, the co-pays do work as a deterrent from those people that go to the doctor because their toe hurts or because they need pain pills. The issue is how do you deal with preventative medicine things like mammograms and prostate checks? It has been proven that there are many steps that can be taken to prevent medical issues like colon and breast cancer. Or how do you deal with people that need to have things monitored? My wife has a blood condition that requires her to see a doctor to be monitored or she could potentially throw a blood clot that could kill her.

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See my post below

by NickNielsen In reply to The tough question is the ...

for what could/could not be covered.

http://techrepublic.com.com/5208-6230-0.html?forumID=102&threadID=323209&messageID=3219141&tag=content;leftCol

The advantage to having everybody pay for preventive tests such as mammograms, cervical smears, or PSA tests, is that the prices can probably be set lower since there will no longer be those who don't pay. The disadvantage, of course, is that some preventive tests (colonoscopy, for example) cost a good bit more than others.

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P.S. " . . . .the only people who come out on the short end. . . . "

by maxwell edison In reply to Well, Max

"..... are the insurance companies and their CEOs".....

..... AND the government know-it-all nannies who want to ride roughshod over both our lives and the whole system.

Agree or disagree?

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I agree

by TheProfessorDan In reply to P.S. " . . . .the only pe ...

I think that the center of all of the public frustration is that we have watched the government screw up over and over and we don't want to watch it anymore. I find it amazing that there has been such a public outcry against healthcare reform and our "representatives" are doing it anyways. I read somewhere that this will probably cost Harry Reid his seat and I feel that it should. Your constituents told you no. Do they really think that this would go unnoticed? The sad part is that the senators and members of the house that lose their seats will be put up as Martyrs instead of the piles of crap that they are.

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It's late, I'm wiped, and I will read this more carefully in the morning

by Tig2 In reply to In regards to medical car ...

But I am currently living with the failure of this country to comprehend that solving the medical insurance issue is significantly deeper than legislating pie in the sky solutions- like the ones we were given by the Senate for Christmas.

I live with someone whose care will completely destroy every dime he has saved and invested for over 30 years. What are the choices? Well, after he is destitute, we might be able to get some support- but we have to be homeless and cash out every dime we own first. Even then, the support we MIGHT be able to get will be based on his ability to live for a set period of time after receiving care. Lovely system.

Here's the thing- the problem wouldn't have reached a crisis point if tort reform as regards medical care had only been addressed long ago. It wasn't and the "Medical Reform" ca-ca doesn't bother to address that.

I am not saying that someone legitimately injured as a result of faulty medical care shouldn't have the ability to be compensated. But while we have that ability today, I am forced into a system where, if I am not a complete b*tch most of the time, my partner stands the VERY good chance of being irreparably harmed. I am CONSTANTLY told BY OUR HEALTH CARE PROVIDERS that we have no choice but to be our own advocates.

It sucks when you have to tightly question a doc to ascertain if what he is practicing is medicine or DEFENSIVE medicine- often not covered, even poorly, by insurance. I want the best possible care for my loved one but I am swiftly developing more current knowledge in the area of his disease than the specialists. Frankly, had I not insisted on discontinuing one med and reducing another by half, he'd be dead and malpractice would not have been an option because "best practices" were being followed.

Max, as usual, you field no easy questions. That I have a high level of emotion regarding this one is a given. But the current system is seriously flawed and the crap they are beating to death on the House and Senate floors will NOT remotely solve it. Realistic expectations would go a whole lot further.

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If you're sure about that

by DelbertPGH In reply to It's late, I'm wiped, and ...

If you're positive he will be wiped out financially by medical bills, and will then proceed to Medicaid, there's a way or two to shelter some of that money.

Medicaid allows you to keep your house and your car (on the grounds it would be unfair to throw you out of your home, and you need a car to get a job, if you are ever to work again.) Assuming he has a mortgage and/or a car loan, he could pay off a bunch of the principal. He can also pay down credit cards. If you pay off debt and go broke, it's better than paying doctor bills and going broke, because you have a better balance sheet at the end.

If you're down to choosing between crummy outcomes, it may be reasonable. Good luck.

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Cable TV Model

by TheChas In reply to In regards to medical car ...

Max,

Merry Christmas and best wishes for a great New Year.

Aside from not being able to conceive that some of your postulates could ever happen, I think a deregulated medical industry would soon devolve to the cable TV model.

That is, some company would move in and consolidate all of the medical services in an area get control of key medical resources and set some pretty high prices. In order to assure a revenue stream, they would likely set up some sort of subscription model where subscribers pay a monthly fee and get reduced charges for services.

Still, all in all the overall cost for health care would rise for all.

True, those who had no need to use the health care system would see the value of their HSA rise. But, what would happen to that money if they never used it?

Finally, what happens to the people who show up in the hospital ER with no coverage and no means of paying?

Would you allow hospitals and health care providers to deny treatment to an accident or crime victim who could not pay?

How about someone suffering a heart attack or other life critical health event who had no coverage or means to pay when they are wheeled into the ER?

I think the number that has been thrown about is that around 40% of workers in the US have no employer sponsored health coverage. Unless they qualified for your aid grants, they would have no source of additional income to fund their HSA accounts.

Do I think our present system or the health care reform legislation making it's way through Congress is a perfect or even the best solution? No in either case.

One thing missing from your proposal is meaningful limitations on mergers and consolidation of services. Unless there is significant competition in all areas of health care the cost will rise dramatically for services.

Even under the present system, you have situations where if a doctor is not part of a specific group he cannot treat his patients if they are in that groups hospital. If a company were to control all or even just the for profit hospitals in an area that would all but eliminate the concept of an independent physician.

It would also be interesting to see how this would work for the people who strive to spend down any benefit provided. What new health care options would be created so that people who want to spend down their HSA each year would be able to?

There is no perfect health care system. What works best for you is apt to be very different from what would work best for me or even more so my extended family.

Looking just 1 layer deep in my extended family, only 3 out of 15 working age people would benefit from your plan versus the present system.

Chas

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Chas - Merry Christmas to you too

by maxwell edison In reply to Cable TV Model

I agree with you. The chances of anything I outlined seeing the light of reality lies somewhere between slim and none - and as the saying goes, Slim is hurriedly packing his bags, as we speak, to leave town. There are simply too many people (politicians) who have worked too long and hard to gain control over the population and the medical care system, and too many others (voters) who have willingly given it to them. The trend is not likely to reverse any time soon.

However, the premise of my plan (I suppose you could call it a plan) is two-fold. First of all, if I had to name the one thing that's contributed the most to all the current problems we see accessing and affording medical care, it would be that some third-party has been empowered to pay for its delivery - whether that third-party be insurance companies or government. If a third-party is empowered and/or obligated to pay for anything, then the only direction for costs to go is up, and the only direction for quality and access to go is down. I believe the history of our medical care system has shown this to be true.

The second thing is that it might force the medical care consumer to become more price conscious and price savvy. If we all had to pay for the smaller stuff out of our own pockets, we'd be less inclined to run to the doctor's office (or emergency room, in many cases) for every little thing, which only places a burden on the whole system. Moreover, it would generate price competition in the industry. The way it is now, the collusion between insurance companies actually sets the prices that can be charged. Sure, some doctors and clinics might try to initially charge prices higher than the previous limit, but that new savvy consumer wouldn't be so quick to be a paying customer. I believe the result would be fewer people using the over-all system. Just look at your GP's office. It's most likely overflowing with people who otherwise wouldn't be there if they had to pay for some minor aches or pains out-of-pocket instead of not caring what their insurance company is billed. (Okay, Mr. Jones, go home and take two aspirin every 8 hours. That will be $100, please.) Doctors would have to sell all those empty chairs in order to make a profit. They'd be clamoring and competing for the customer.

As to legitimate emergency room care, I wouldn't propose, as you suggested I did, that hospitals turn away accident or crime victims who could not pay, or someone suffering a heart attack or other life critical health event who had no coverage or means to pay when they are wheeled into the ER. I'm not suggesting that at all. To the contrary, I'm not opposed to the current laws placing a mandate that such emergencies be treated. Treat them first and consider payment options later is something that's fine with me. If, after the fact, the emergency patient is either unable to pay the bill and/or has not purchased the catastrophic insurance coverage, then request for payment goes to some sort of medical financial aid organization for consideration. (And as I said, the details and funding for such a thing is a side-issue.) That organization will pay the medical bill, but whether or not it should be repaid would be a matter for further consideration.

Have you ever applied for college financial aid for your kids? Regardless of the college in question or the amount of aid being sought, you have to submit all your personal financial information to a sort of clearinghouse, who then determines whether or not financial aid is warranted, and if so, how much. In theory, it could work in a similar way, but just after the fact instead of before. An engineer making 100k per year, for example, who ran himself into a tree while skiing in Aspen, and chose to not buy catastrophic insurance might have to repay the costs over a set amount of time. A single-mom waitress with three kids making only 30k who took a nasty tumble on the ice might be awarded full aid, not having to ever repay. Such a system could cover those who truly cannot afford catastrophic insurance, and it would be motivation for those who can afford it to actually buy it. I'd also concede that such a medical financial aid system would have to have the force of law behind it. That engineer WILL pay that money back - with interest.

I further believe that most doctors and medical delivery people are good, honest, caring, and compassionate people - in fact, I know it to be true. I think doctors would treat some people for free, and that free clinics would pop up in poorer neighborhoods. Why do you think many hospitals are called St. Something? Because they were initially created - and funded - by charitable religious organizations. St. Jude's never has, nor will it ever, turn away a needy child. There are such facilities in nearly every major city. I don't consider medical providers in this country greedy bastards, but rather caring and compassionate people. I personally know of doctors and nurses who volunteer their time for charitable causes. I want a system that will allow them to do it instead of one that forces everyone into an already flawed insurance-run system.

In my opinion, medical insurance companies (including government-run medical insurance) got us into this mess in the first place. As such, we need less of it, not more. If the collective consumer actually competed with the insurance companies - instead of being dictated to by them - I believe the cost of receiving medical care would plummet, and I believe access to care would open up to significantly more people.

Our current national debt is 12 trillion dollars and climbing fast. Out-of-control entitlement systems, in my opinion, bear 100 percent of the blame. Social Security and Medicare will eventually collapse under the weight of their own obligations. Expanding entitlement systems will only make it worse and cause the collapse faster. As the saying goes, if we keep doing what we've been doing, we'll keep getting what we've been getting. And it's time we stop this insane third-party payer system.

Contrary to what you've suggested, if we put more control, power, and responsibility onto the individual medical care consumer, in my opinion, we'd see lower prices, better care, more competition, and higher availability. And like you said, there is no perfect medical care system. What works for you may or may not work for another. As such, why are we trying to put all people under the same umbrella of care?

However, like we've both acknowledged, we're all on a run-away train we call the health care system, and while people like me are pulling like crazy on the brakes trying to slow it down, others are stoking the fire trying to maintain and expand a full and permanent third-party payer system. Unfortunately, the burden of facing the looming disaster will fall squarely on the shoulders of our kids - the ones who will assume all of this entitlement debt that we'll leave to them when us old farts are dead and gone.

(Edited to fix all those nagging apostrophizes and dashes that turned into question marks.)

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