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(AEI Ideas)   How to turn Obamacare into FreeMarketcare in 4 easy(-ish) steps   (aei-ideas.org) divider line 119
    More: Interesting, FreeMarketcare, obamacare, sliding scale, health savings account  
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2394 clicks; posted to Politics » on 03 Dec 2012 at 11:36 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-12-03 12:25:37 PM
The author talked about deregulation, then used an example of it working successfully, that required a much greater amount of regulation. These Obamacare articles seem to keep doing this. Am I totally missing something here?
 
2012-12-03 12:28:00 PM
An "idea" from the American Enterprise Institute?

Let me guess...
 
2012-12-03 12:28:33 PM
Interesting. I seem to recall that during the health care reform debate that Republicans were mostly just screaming "NO WE DON'T WANT IT," while Democrats were trying to get something passed that might look bipartisan. The Democrats didn't pass single payer like their base wanted, but enacted something that Republicans might have crafted 20 years earlier when they seemed to think they were elected to govern. So now we see conservates wanting to negotiate. How about 'no.'
 
2012-12-03 12:29:02 PM

iccky: Flab: nekom:
4. Move Medicaid patients into the exchanges.
How is this different than #2? Is this idea so novel that it needed mentioned twice?

It's exactly the same as #2.

Actually Medicare and Medicaid are different programs. Medicare is old people, Medicaid is poor people (including poor old people).


I know they're different programs. I was responding to Nekom's question. The AEI is against Medicaid for the same reason as Medicare: It's government-run.
 
2012-12-03 12:29:58 PM
So half the solution to the problem of PPACA being a massive government takeover of healthcare when it could be a free market system is to force two programs that are nearly half a century old into it? The fact that the old, disabled, and poor were covered didn't make the old system socialist too?

And the dirty little secret of the PPACA is that it will move more people away from employer-based coverage just by virtue of the fact that employers will have less negotiating power than the exchanges will have (many employers who keep insurance coverage will find it best just to do their plans through the exchanges) and the more agressive stance on companies using loopholes to get out covering certain employees has led to many saying that paying a fine is preferable to complying with the law.
 
2012-12-03 12:31:25 PM
Healthcare is an industry that is supposed to provide for the well-being of the citizenry. It is regarded as an essential service (like water or police/fire), in that it must be provided to everyone equally all the time or people will die.

To privatize healthcare into competing fiefdoms for profit rather than public services for the benefit of the public, is to invite untold suffering, misery, confusion and death.
 
2012-12-03 12:35:21 PM

lennavan: 1. Deregulate the state exchanges, while capping subsidies.
2. Slowly shift Medicare patients into the exchanges.
3. Let more people buy insurance on their own rather than through their employer.
4. Move Medicaid patients into the exchanges.

It's actually 3 steps, as 2 and 4 are the same. Also, steps 2 and 4 have nothing to do with Obamacare. Medicare existed before Obamacare.

As for #3, does the author think people are prevented from purchasing insurance on their own? Of course not, what the author really meant was "don't force employers to give their workers health insurance." It seems the author thinks an employer who saves $10,000 a year on health insurance costs is just going to pay that person $10,000 more a year. They won't. They'll keep it for themselves.


Of course, they'll keep it for themselves. And that's exactly what the AEI wants.
 
2012-12-03 12:35:38 PM

The Reverend Smith: make me some tea: ObamaCare is already FreeMarketCare.

Not in the least.


Nah, FreeMarketCare is what we had before ObamaCare. And we saw how farked up that got.
 
2012-12-03 12:42:15 PM

HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.


Not in the least.
 
2012-12-03 12:45:01 PM

The Reverend Smith: HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.

Not in the least.


It's what Somalia has.
 
2012-12-03 12:45:17 PM

uksocal: The author talked about deregulation, then used an example of it working successfully, that required a much greater amount of regulation. These Obamacare articles seem to keep doing this. Am I totally missing something here?


No.
 
2012-12-03 12:50:20 PM

pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.


Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.
 
2012-12-03 12:56:01 PM
I think the most important thing is to make patients aware of actual costs. None of the costs are advertised or rarely stated up front, it's all handled by insurance. You can't have a free market if people are unaware of the economics.
 
2012-12-03 12:59:36 PM
The guy basically wants to roll Medicare and Medicaid into Obamacare's mandated, subsidized, and regulated exchanges. It's not likely to save much money. But it will greatly change the role government plays in insurance. Right now, private insurance reimbursements are typically based on a percentage of Medicare reimbursement rates. If Medicare is privatized, reimbursement rates start being negotiated in a totally different, more chaotic, and not necessarily better way.

However, the basic idea that insurance should be de-coupled from employment is sound. I think Obamacare will get us there eventually, however the way pre-2009 Republicans (plus Democrat Ron Wyden) were offering was better and faster in this sense.
 
2012-12-03 01:02:21 PM
I would love for them to put in #3 anyway. My employer plan sucks. Give me the tax benefit directly and let me buy my own plan.
 
2012-12-03 01:03:01 PM
Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.

Not one.

so they say something stupid like

"All of them. Derp derp."

And I ask, even those that assure safe high quality medications?

They are so frigging dumb that they don't even know what they oppose.
 
2012-12-03 01:14:02 PM

maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.


Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link
 
2012-12-03 01:14:43 PM

Philip Francis Queeg: Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

So you propose a massive increase in worker pay and Social security payments so that individual can afford all non-catastrophic medical costs out of pocket?


No, a single payer system seems like a better way to handle the things everyone needs. The single payer can then put pressure on the providers to keep costs low.

Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

We should focus on what people need -- health care, and use the most effective means to pay for it (of which health insurance is only one possible mechanism). Once you are sick you don't need health insurance, you need health care, and the insurance company is only a drag on the system at that point.
 
2012-12-03 01:17:08 PM

entropic_existence: The Swiss system that they compare to in the article (I'm not sure the author of TFA really understands the Swiss-model, since deregulation isn't in line with how the Swiss do it) doesn't fit any of those three groups and is considered Universal coverage. Residents are mandated to buy insurance by law, the kicker is that in order to provide health insurance a company has to be registered with the proper Swiss authorities, and by law the "basic" coverage, which they must offer, can not have a profit. So many of the insurance companies are actually non-profits in Switzerland. You are allowed to build "premium" packages that offer more amenities, etc. And those can make a profit.


i2.kym-cdn.com
 
2012-12-03 01:18:31 PM

Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.


How would single payer remove the need for the victim of malpractice to be compensated?
 
2012-12-03 01:18:40 PM

Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.


This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.
 
2012-12-03 01:20:22 PM

lennavan: maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.

Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link


I've also had a lot of good responses asking them to define their terms.

"Obama is a ______!"
"What do you mean by ______?"
"...he's a _____!"
 
2012-12-03 01:21:29 PM

austerity101: pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.

Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.


You mean doctors? Cause I doubt Congress will take the time to pass a bill for your colonoscopy or any other retarded thing you think they have to do in order for your doctor to do his/her job.
 
2012-12-03 01:23:32 PM

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


I think what he's saying is that preventative medicine shouldn't be so expensive that you need insurance to get it.
 
2012-12-03 01:28:27 PM

pippi longstocking: austerity101: pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.

Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.

You mean doctors? Cause I doubt Congress will take the time to pass a bill for your colonoscopy or any other retarded thing you think they have to do in order for your doctor to do his/her job.


I think austerity101 was being facetious, but in general "the government getting between you and your doctor" is one of the chief slogans of the anti-single payer group. Of course, the alternative is the insurance company bureaucrat getting between you and your doctor.
 
2012-12-03 01:28:47 PM

Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care.


DEFINE catastrophic a little better, please?

Does my aunt's Multiple Sclerosis count? She's been living with that for years, so it's not some surprise. But, the average annual cost of her care is roughly the most she's ever made in a year (so, yeah, from a financial optimization POV, she'd be better off dead).

Does my nephew-in-law's muscular dystrophy? I mean, it was a surprise when he was diagnosed with it, but not so much now.

Does the fact that I have a genetic 1-in-4 chance of the late-40s kidney cancer my mom had count as catastrophic? Since I can maybe sorta predict it?

The problem is there is no line. You can't divide out 'catastrophic' in any meaningful sense other than saying "okay, we'll set a $10k or $15k annual deductible". Which millions of Americans are already have, to no measurable salutary effect on the nation's health care cost issues.
 
2012-12-03 01:31:45 PM

Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?


Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.
 
2012-12-03 01:33:42 PM

Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.


I don't know if that's true. You can still sue a doctor even if
 
2012-12-03 01:34:50 PM

qorkfiend: lennavan: maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.

Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link

I've also had a lot of good responses asking them to define their terms.

"Obama is a ______!"
"What do you mean by ______?"
"...he's a _____!"


My favorite I posted from that site awhile back was a woman who said something like "Obama is a Muslim. Obama is an atheist. Obama follows his zealot church pastor Rev. Wright." "What do you mean by that?" He's all three!
 
2012-12-03 01:36:41 PM
Alright, I may as well continue after I hit the wrong button.

qorkfiend: Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.

I don't know if that's true. You can still sue a doctor even if


You can still sue a doctor for malpractice, even if your insurance covers 100% of the costs, right? Wouldn't that be the same thing here?
 
2012-12-03 01:36:41 PM

Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.


That's not how liability works.
 
2012-12-03 01:37:20 PM

qorkfiend: Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.

I think what he's saying is that preventative medicine shouldn't be so expensive that you need insurance to get it.


That's probably an even worse idea, if true. Preventantive health should not have to be a factor into most people's budgets; their plans (and a national plan) should absolutely take care of this for them. There is no universal savings of costs anywhere like robust preventative health.
 
2012-12-03 01:37:39 PM

MasterThief: entropic_existence: The Swiss system that they compare to in the article (I'm not sure the author of TFA really understands the Swiss-model, since deregulation isn't in line with how the Swiss do it) doesn't fit any of those three groups and is considered Universal coverage. Residents are mandated to buy insurance by law, the kicker is that in order to provide health insurance a company has to be registered with the proper Swiss authorities, and by law the "basic" coverage, which they must offer, can not have a profit. So many of the insurance companies are actually non-profits in Switzerland. You are allowed to build "premium" packages that offer more amenities, etc. And those can make a profit.


Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.
 
2012-12-03 01:39:04 PM

Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?


The purpose of payment to a victim is 3-fold:
1. cover the cost of the future medical care required as a result of the malpractice
2. punish the perp (or provide a disincentive for them to commit malpractice, if you prefer)
3. compensate the victim for actual lost time, suffering, etc

Universal health care (however it is provided) would eliminate the need for #1; so then you can rely on the administrative action (fines, loss of license) or criminal charges to cover #2

#3 can either be part of some optional insurance someone buys, or still handled through civil courts. Since #1 and #2 are generally the largest components of malpractice suits, the cost of malpractice insurance would drop substantially.
 
2012-12-03 01:40:21 PM
I support eliminating Medicare and Medicaid and forcing these people to buy insurance through the exchanges because such an idiotic policy would quickly bankrupt private insurance resulting in a national single payer system.
 
2012-12-03 01:44:08 PM

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


Single Payer, Socialized Medicine, and medical savings accounts, and payment out of pocket are all health plans than do not involve insurance.
 
2012-12-03 01:45:01 PM

entropic_existence: Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.


Even worse when the 'states rightsers' start getting involved.

In the US, credit cards were (until 2009 anyway) almost entirely regulated at the state level. But could be sold anywhere in the nation. The upshot is that virtually every credit card in the nation was issued in either South Dakota or Delaware (combined, they are about 0.5% of the nation's population, roughly PEI::Canada). Cards based outside those states simply don't exist. Citibank alone had more lobbyists in Pierre, South Dakota than there were South Dakota state legislators. Meanwhile, 99.5% of the nation had no voice in Pierre or Dover whatsoever.

Not surprisingly, this is exactly the model that many Republicans have said will somehow solve the nation's health insurance woes.
 
2012-12-03 01:47:59 PM

entropic_existence: MasterThief: entropic_existence: The Swiss system that they compare to in the article (I'm not sure the author of TFA really understands the Swiss-model, since deregulation isn't in line with how the Swiss do it) doesn't fit any of those three groups and is considered Universal coverage. Residents are mandated to buy insurance by law, the kicker is that in order to provide health insurance a company has to be registered with the proper Swiss authorities, and by law the "basic" coverage, which they must offer, can not have a profit. So many of the insurance companies are actually non-profits in Switzerland. You are allowed to build "premium" packages that offer more amenities, etc. And those can make a profit.

Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.


Conservatives want free-market insurance. Liberals want single-payer. It is like one side wants to go swimming and the other side wants to mountain climbing so the natural compromise is either go swimming in your mountain gear or climb the mountain in a bathing suit.
 
2012-12-03 01:49:58 PM

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


Sorry, In my earlier response I meant to add that I agree that preventative care is one of the most important parts of any health plan.

But since everyone needs it, and everyone gets it, what does insurance add? Only a middleman with profit motive who adds costs. They don't provide the health care, they just add overhead.

A single payer system is a far better way to handle things that everyone needs.
 
2012-12-03 01:57:01 PM
It's only free market if poor people die in the street of preventable causes. If they deserved to live, they'd have more money.
 
2012-12-03 01:57:49 PM

Lawnchair: Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care.

DEFINE catastrophic a little better, please?

Does my aunt's Multiple Sclerosis count? She's been living with that for years, so it's not some surprise. But, the average annual cost of her care is roughly the most she's ever made in a year (so, yeah, from a financial optimization POV, she'd be better off dead).

Does my nephew-in-law's muscular dystrophy? I mean, it was a surprise when he was diagnosed with it, but not so much now.

Does the fact that I have a genetic 1-in-4 chance of the late-40s kidney cancer my mom had count as catastrophic? Since I can maybe sorta predict it?

The problem is there is no line. You can't divide out 'catastrophic' in any meaningful sense other than saying "okay, we'll set a $10k or $15k annual deductible". Which millions of Americans are already have, to no measurable salutary effect on the nation's health care cost issues.


You can define the line medically and financially. How about this:

Imagine a universal single payer system has a list of routine checkups and things they expect everyone (or near enough as to not matter) will need. There should also be a list of uncommon but inexpensive things. That is all covered for free.

In addition, there is some kind of per person allocation per year for everything else. Maybe it's $10k, to pull a number from my nether regions. Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.
 
2012-12-03 02:05:33 PM

pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.


It's a philosophy ingrained into our society. Left over from the Cold War. Capatalist vs Communist.

Then we won. So now profit is the only "proven" way of wining fights.
 
2012-12-03 02:06:03 PM

mrshowrules: Conservatives want free-market insurance. Liberals want single-payer. It is like one side wants to go swimming and the other side wants to mountain climbing so the natural compromise is either go swimming in your mountain gear or climb the mountain in a bathing suit.


I think liberals want affordable Universal coverage, but not necessarily single-payer. There is definitely a large-component that prefer single-payer, as the obvious model that they see to compare against is Canada's, but it has never seemed to me that they are generally 100% set on that model.
 
2012-12-03 02:09:52 PM

Zasteva: Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.


Seems... unnecessarily complicated. Would you mandate community rating for that supplemental insurance? (Because nobody *wants* to sell insurance to the MS aunt, and very likely would rather not sell insurance to me with a possible genetic timebomb). And, what would you do with people who run up multi-hundred-thousand-dollar bills and haven't bought said insurance? Let them die? Go for the same crazy writeoff/cost-inflation model we have now?

I think what you may be proposing is something in the high-deductible-plan/HSA model. Which, again, a quarter of the nation is now on, and we haven't seen significant benefits. We've seen some better benefits in Singapore (who has a similar plan), but there are lots of other variables there. Like, doctors are capped on what they can charge for various procedures. And fully half the working population are 'guest workers' from abroad who pay in in their 30s but are kicked out in their early 50s.
 
2012-12-03 02:12:46 PM

Zasteva: Sorry, In my earlier response I meant to add that I agree that preventative care is one of the most important parts of any health plan.

But since everyone needs it, and everyone gets it, what does insurance add? Only a middleman with profit motive who adds costs. They don't provide the health care, they just add overhead.

A single payer system is a far better way to handle things that everyone needs.


Arguably similar outcomes can be achieved for a similar cost using different approaches. Again just compare the Swiss model, which is insurance-based, with say the Canadian model, which is single-payer. Similar outcomes, fairly similar costs, totally different approaches. Insurance-based isn't necessarily bad, but it needs to be tightly regulated. In the Swiss health-insurance market, in order to be legally allowed to offer health insurance you have to offer a government mandated "basic" package. This basic package is well-described and is your baseline universal coverage of everything. By law this package cannot be sold at a profit by the company. Insurance providers are then able to create all sorts of premium packages that do generate profit. But the premium packages don't really give you better care, or access to different treatments or shorter wait-times. They just make you more comfortable in hospital stays and things.

So it works, but you have to be willing to have tight regulations on the market.
 
2012-12-03 02:20:33 PM

qorkfiend: Alright, I may as well continue after I hit the wrong button.

qorkfiend: Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.

I don't know if that's true. You can still sue a doctor even if

You can still sue a doctor for malpractice, even if your insurance covers 100% of the costs, right? Wouldn't that be the same thing here?


Not quite.

In the US, you enter into a contract with a physician to get treatment, and get the insurance to cover the costs. In Canada, the physician enters into a contract with the government. Since the patient is not a party to that contract, it's more difficult to sue. You still can, but fewer people do. Particularly since a medical error is a lot less likely (barring gross neglect) to bankrupt someone, and the Canadian Supreme Court has severely limited the amount a person can claim as punitive damage, so unsurprisingly, lawyers are not as trigger happy as their southern counterparts.
 
2012-12-03 02:25:49 PM

Lawnchair: Zasteva: Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.

Seems... unnecessarily complicated. Would you mandate community rating for that supplemental insurance? (Because nobody *wants* to sell insurance to the MS aunt, and very likely would rather not sell insurance to me with a possible genetic timebomb). And, what would you do with people who run up multi-hundred-thousand-dollar bills and haven't bought said insurance? Let them die? Go for the same crazy writeoff/cost-inflation model we have now?


If as a society we decide we want to cover people in those circumstance (and I think we should cover them), then there are a number of ways to handle that. Requiring people to have health insurance and subsidizing those who can't afford it would be fine.

I think what you may be proposing is something in the high-deductible-plan/HSA model. Which, again, a quarter of the nation is now on, and we haven't seen significant benefits. We've seen some better benefits in Singapore (who has a similar plan), but there are lots of other variables there. Like, doctors are capped on what they can charge for various procedures. And fully half the working population are 'guest workers' from abroad who pay in in their 30s but are kicked out in their early 50s.

yes, the HSA/high-deductible plan is similar on the insurance side, because the insurance company is only on the hook for a much smaller number of payouts (rather than payouts for everyone), so the premium cost is much lower.

But the big difference is the HSA requires that people save out of pocket, and does nothing for those who can't afford it. Having single payer for basic care (Medicare for all?) with a limit gives you the best of both -- the low overhead of government for the part everyone uses, and the efficiency and risk distribution of private insurance for the more "exotic" stuff.
 
2012-12-03 02:25:51 PM

Flab: and the Canadian Supreme Court has severely limited the amount a person can claim as punitive damage


As have most state legislatures in the US, years ago. The punitive/pain-and-suffering cap in my state is only $200,000, and even the state AMA chapter thinks that's absurdly low (set over 20 years ago with no inflation adjustments) and is asking for it to go up.
 
2012-12-03 02:30:36 PM

Zasteva: and the efficiency and risk distribution of private insurance for the more "exotic" stuff.


Then answer... would you make that *extra stuff* universal issue? Would you force companies to sell at community-rated rates to everyone, including people who are or are likely to be sick?

If yes, I'm still at a loss for what this gives us over just going single-payer altogether and being done with it?

If no, then what the f are the actually chronically sick supposed to do?
 
2012-12-03 02:32:00 PM

make me some tea: ObamaCare is already FreeMarketCare.


No, it's not, and neither are TFA's suggestions or examples.

A free market means free of government influence, including financial assistance and special legislative protections. Even if you got rid of the PPACA, you still wouldn't have a free market in health care, mainly because of Medicare, as well as hundreds of thousands of regulations that already control health care to the finest detail.

Anyone who blames the free market for the problems the PPACA purports to solve might as well blame unicorns for causing cancer.
 
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