[ZASHAGALKA]

Originally Posted by spacenurse

I fail to understand how paying for one man to make more than $120 million in one year is cost effective.
What am I missing?
HOW can the profit motive work so very well?

Good luck with the "Blues" if you actually suffer a disabling expensive illness.


HSA can run out quickly when you can no longer work.

That's not the 'profit motive', neither is it competition. The big insurance companies can only do these kinds of things because of the ANTI-FREE MARKET interference of gov't.

The gov't has protected their markets and allow them to act in what is an incredibly non-competitive way.

They don't need to compete. YOU aren't their customers. The government has seen to that. It did so in 2 ways.

First, it gives tax breaks to subsidize your employer to provide your insurance, thereby transferring choice away from you.

2nd, it loads up so many mandates into health care plans that most people cannot AFFORD to buy their own policies; they must buy into their gov't subsidized employer plans.

This was done on purpose. The result: the neo-mercantile lobbyists get to make 120 million a year, and your Congressman gets all the donations he could ever want.

You seem to suggest this is a failure of the free market. NO. NO. NO. This is a total failure of the REGULATION of the free market, by gov't.

Get USED to JUST this kind of action if nationalized health care passes (it won't). The lobbyists will get theirs, Congress will get theirs, and you will be an afterthought. Think Haliburton, in charge of your health care.

~faith,
Timothy.

[jjjoy]

[quote=Jolie;2694080]

Originally Posted by jjjoy

If the problem is the inability to get patients to pay at any level for their ER visit, then I don't see that MSAs or subsidized health insurance coverage helps. It would STILL be cheaper to just get the *free* service.

But the service can't continue to be "free"! Individuals must be required to contribute to their own healthcare costs, or we will never reign in costs.

The MSA exists to give individuals an effective method to plan, budget and cover their expenses up to the deductible. If they spend it wisely, they can obtain more services.

When I said *free* I meant perceived as free to the person who doesn't pay for ER visits. I realize that other people end up paying. My point was that if the choice is between $150/month to pay for subsidized health insurance which you pay whether you get sick or not and where you still have co-pays or deductibles versus going to an ER and getting *free* service, it's understandable why someone would opt to take their chances.

It seems that a person can go to the ER and leave without paying a dime but it also seems that that's not the case at low-cost clinics. How is that? Because if they could get *free* care at either facility, why go to the ER? Do even low cost clinics refuse to give service if someone doesn't pay up front (unlike the ER)? Is the low-cost clinic even more crowded than the ER? Is it not open all hours so that working folks with odd hours can access any time?

By getting third party payors out of routine healthcare. My doc bills $60 for a physical with labwork if you pay out of pocket at the time of service. She gets the money immediately and her staff spends no time filing claims. She bills over $400 for the exact same service to insurance, since she has to send specimens to the lab of choice of the insurer, wait months for payment and pay her office staff to file claims.

I hear you there! But how to go about getting third party payors out? It's so entrenched it almost seems easier to garner support for a massive change like UHC than to try to untangle private health plans from private health care. I'm not saying it's impossible, I just don't see a clear way forward to make that happen. Again, I understand the reasoning but I don't see HOW to make the change. Any thoughts?

[Jolie]

Originally Posted by jjjoy

When I said *free* I meant perceived as free to the person who doesn't pay for ER visits. I realize that other people end up paying. My point was that if the choice is between $150/month to pay for subsidized health insurance which you pay whether you get sick or not and where you still have co-pays or deductibles versus going to an ER and getting *free* service, it's understandable why someone would opt to take their chances.

We can't continue to give people the choice not to pay for their healthcare. I realize you understand that healthcare is not free. My point is that we must hold recipients accountable for the services they utilize. We have to stop enabling deadbeats who take advantage of the ER, walk away without paying, and stick the taxpayers with the bill. The way to do that is to provide coverage that requires them to pay for the services they utilize. If they go unnecessarily to the ER, they pay big time. If they go to the clinic for more appropriate services, they pay a little. They don't get to walk away from either place without paying. They will either come to realize that services really aren't needed (for a cold), or that going to the clinic for a minor complaint is a better option than the ER where their financial responsibility will be much higher.

We can't force people to do the right thing (utilize the ER only when necessary), but we can and should take away the incentive that currently exists to do the wrong thing (utilize ER and other expensive services unnecessarily)! We remove the incentive to do the wrong thing when we hold individuals accountable for their healthcare spending.

But how to go about getting third party payors out?

The first step in getting 3rd party payors out is exactly what I've outlined. Couple higher-deductible plans with preventive care and medical savings accounts. That makes healthcare spending very predictible and easy to plan and facilitates budgeting. When patients plan their routine and preventive care in advance it is easy to negotiate discounts, just like my family doc and her $60 yearly visits. Once providers see more individuals shopping for care, they will be forced to compete for cost and quality services, something they don't have to do now. Insurance will still exist to cover emergency and catastrophic costs.

[HM2Viking]

My reading of the literature just does not support MSA as a tool to achieve effective evidence based medical care and patient outcomes. Patients are just not very good at choosing which care can be economized. In other words they are just as likely to skip a BP pill as they are to skip a "worried well" medical appointment.

We can achieve far greater savings through tackling administrative costs.

[Jolie]

Viking,

I simply don't buy the notion that the vast majority of competent adult Americans are incapable of making sound decisions regarding their healthcare services. There will always be some who are penny-wise and pound foolish, skipping cost-effective care to save a buck. But that happens now, supposedly because people lack coverage and access to services. At least with the coverage I have suggested they would have the means to obtain services. If they choose not to do so, that is their perogative, not a fault of their coverage.

[Nurse4years]

The cost of health care will not level out- it will continue to rise. How do you add the constant escalation of cost into uhc?

[HM2Viking]

It is just too darn expensive to not design plans that encouage management of chronic disease....After the patient has a stroke who pays for rehab? It is the other people in the pool. It is far wiser to provide first dollar coverage for evidence based care for patients with chronic conditions....

[HM2Viking]

Simplifying administrative costs could achieve savings of:

In 1999, health administration costs totaled at least $294.3 billion in the United States,
or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration
accounted for 31.0 percent of health care expenditures in the United States

and 16.7 percent of health care expenditures in Canada.
...

The gap between U.S. and Canadian spending on health care administration has grown
to $752 per capita. A large sum might be saved in the United States if administrative costs

could be trimmed by implementing a Canadian-style health care system.

http://www.pnhp.org/publications/nejmadmin.pdf

This is probably enough to provide first dollar coverage for case management for the patients with chronic conditions including medications and medical management.

[HM2Viking]

[HM2Viking]