Which will end up costing less, full comprehensive insurance that pays for almost everything, or just having high-deductable health insurance, and then paying out-of-pocket for everything else? Because with the mandated health insurance legislation in the USA ("Obamacare" as some call it), which will require everyone to buy comprehensive insurance, I wonder whether it will just cause costs to drastically increase. When you actually have to pay for the treatment yourself, you are far less likely to use medical treatment that you feel is not necessary or not effective enough to justify its cost. When the insurance is paying for everything, you are far more likely to use whatever the insurance will cover, whether you think it is worth it or not. When you utilise treatments you do not absolutely need, it just unnecessarily raises the costs for everyone else paying insurance rates. Even if there is a small co-payment, this is often not enough to discourage the patient from utilising unnecessary treatment, since the patient may imagine in his mind that he is "getting a bargain price". And then there is all the bureaucracy and paper work of dealing with an insurance company, particularly if there is a dispute. Then lawyers have to get involved and that really raises the costs. When the insurance company gets sued and has to pay for the plaintiff's legal expenses, that raises the premium rates for everyone else. Doctor's do not like dealing with insurance companies; all the paperwork takes up too much of their time. Many doctors actually pay an outside medical billing company 10% of their revenues just to deal with the insurance companies and proper medical coding and billing procedures. Again, this ends up costing the patient in higher costs. With high deductable insurance, there is typically much less trouble, for several reasons. Firstly, all the numerous small medical costs will not go through the insurance company, and secondly, the insurance company is less likely to suspect the treatment is unnecessary, because the patient had to pay so much out-of-pocket. But on the other hand, routine check ups and preventative treatment can prevent more serious and much more expensive problems later, yet patients who pay out-of-pocket are typically reluctant to pay for this which they do not perceive as necessary. This is often why health insurance companies want to pay for check ups or encourage certain groups to obtain preventative treatments, because they know it will statistically save them more money in the long term. The patient is not always in the best position to know what treatments are effective and worth the money. But both the insurance company and doctor often have incentives which are not in the best interest of the patient. The insurance company often does not want to cover treatments that the patient needs, and the doctor often wants to give the patient treatment that the patient does not need, both to maximise their profits. Ideally, perhaps, the entity giving the medical advice should be a third-part entity without a stake in the outcome, and without any influence from anyone else with a stake (such as an HMO, insurance company, or pharmaceutical sales agent, or for-profit hospital). And the patient's treatment needs to be reviewed on a case-by-case basis, not just some rigid guidelines. Another strategy that is sometimes used is to balance the incentives of the insurance company against those of the doctor, such as in a preferred provider organization. My quick thought on the healthcare legislation in the USA is that the requirements of the current version should be changed. The insurance plans that people have to buy should only include the most cost effective check ups and preventative treatment, and cover high deductable costs for medical situations that are very unlikely to happen, but for which a typical person would not be able to afford. And to keep costs of the mandated insurance down, it should not have to cover treatments that would cost more money than the patient's life is worth, based on age and quality of life considerations. There should also be some sort of independant third entity with doctors to review patient cases in the event there is a dispute between the doctor and the insurance company over whether to cover the costs of something.
Switzerland moved to a plan in a way like the ACA the one difference is they ghey fixed the costs of the basic insurance using the power of the government to negotiate and that is the same price everyone pays. The insurers cannot make a profit at all on that package but can offer extras such as add a plan that offers a private room or alternative medicine. My main case against the PPO sort of plan is what about people with chronic medical nees they could be nickel and dimed to the point they won't get care? And the plan in the US has plans in the design to help the poor and a large part of the middle class get care with subsidies so it is more affordable. In fact if your earning a modest wage your likely going to pay very modestly for the premiums and out of pocket costs.
But sometimes these chronic conditions are so expensive, we really have to ask ourselves whether it is worth the rest of society having to pay to save the patient's life, particularly when the quality of life will not be very good anyway. But it just does not seem to make much sense to make the people with higher incomes be forced to buy comprehensive insurance. It will be more of a headache for them, and very likely cost them more money. If you cannot afford to pay out-of-pocket for the little commonly occurring things, how are you going to be able to afford to pay the premiums on the insurance that provides this?
If memory serves, high deductible plans will be banned under the exchanges. There will only be 3 basic types of comprehensive plans, regardless of which insurance company you buy it from in the exchange. So under Obamacare, there is not much future for the high deductible option.
What will cost less is destroying the pay for service model which incentivises wasteful spending, gives us the best diagnostic medicine in the world, and the worst preventative medicine in the 1st world! ******* idiots!
I always go with the high-risk plan which is as close to insurance as one can get. Insurance is indemnity for unexpected expenses. To apply the term "insurance" to a maintenance package for anything is incorrect. It would be fraud to buy insurance knowing that you are going to make a specific claim against it. Unless I break something, or come down with a debilitating disease, I'm out of pocket for everything. Such a plan should cost almost nothing, but it's still $300/month for the wife and I. I'm far more likely to hit someone with my car and do tens of thousands in damage, though I've not ever caused an accident, and yet my car insurance is lower than my health care "insurance."
I always go with the high-risk plan which is as close to insurance as one can get. Insurance is indemnity for unexpected expenses. To apply the term "insurance" to a maintenance package for anything is incorrect. It would be fraud to buy insurance knowing that you are going to make a specific claim against it. Unless I break something, or come down with a debilitating disease, I'm out of pocket for everything. Such a plan should cost almost nothing, but it's still $300/month for the wife and I. I'm far more likely to hit someone with my car and do tens of thousands in damage, though I've not ever caused an accident, and yet my car insurance, which includes my wife and son, is lower than my health care "insurance."
Why can't there be some way of forcing insurance companies to just provide preventative medicine along with high deductable coverage, without anything in the middle? Or better yet, why doesn't the government just pay for preventative medicine for everyone, since the cost is suppossedly so low? The insurance premiums would be much less if it were not for people that overutilise services, filing a claim with the insurance company for costs they should just be paying themselves. And then there is the threat of ridiculous lawsuits against the insurance company. Some judge and jury are going to feel sorry for some woman that gets into an accident and cannot provide for her family, then hand out some ridiculously huge award. The problem is that everyone else has to pay for this through higher insurance costs. I do not think people should be forced to buy anything other than a high deductable insurance plan (possibly with preventative treatment included though). Doing otherwise is essentially socialising health care plans, forcing people to go through an insurance company for things they should not have to. Besides the argument for preventative medicine, high deductable insurance is the least expensive most practical form of insurance, and is the one that makes the most sense.
What is really stupid is that, with the government making all the decissions, there is not even any good purpose to having private insurance companies! The government tells the insurance companies exactly what they have to cover, how much they have to pay for treatments, and who they have to accept as customers. The private insurance companies will essentially just be there to soak up profits. But proponents of Obamacare apparently had to do this so the insurance lobbies would support them.
The cost of preventive medicine isn't low, in aggregate. Most of the time, the prevention is more expensive than what is prevented. The purpose of preventive medicine is to help people live happy, healthy lives relatively unaffected by major disease. It's not to save on healthcare costs.
Because the pay for service model is how the people who actually provide services get paid. If you don't re-align their interests with preventative medicine, you can't fix the problem. This is how this works. Guy in Camden NJ, goes to the ER over 300 times in one year. This has been going on for years. Why is he going to the ER 300 times a year? Because he needs glasses, and can't administer the right dosage of insulin, and ends up costing millions of dollars, because no one is paid to talk to this patient. The pay for service model goes like this: You schedule an appointment, go to see your doctor. Your doctor only gets paid for providing a prescription, referral, scheduling a test, or providing a procedure. This is PAY for SERVICE. We need pay for service/preventative care. We need to let doctors decide what is best for their patients, without having to calculate what is best for their wallets first. Our doctor's have been incentivised to do nothing but generate costs by using his pay structure. No program, or tweek to the system can compare to the profit motive.
What? http://www.examiner.com/article/hot-spotting-high-utilizers-of-health-care It's not how much, its how. I would have hoped a Gary Johnson supporter was asking better questions.
I'm open to legitimate alternatives to fee for service but it doesn't look like you have any. "You schedule an appointment, go to see your doctor. Your doctor only gets paid for providing a prescription, referral, scheduling a test, or providing a procedure. This is PAY for SERVICE. We need pay for service/preventative care. We need to let doctors decide what is best for their patients, without having to calculate what is best for their wallets first." That's not really an accurate description of what happens. When you say, "let doctors decide what is best for their patients" you aren't really saying anything as a legitimate alternative to the current model.
The problem is that the emergency rooms are FORCED to see him, or the government will refuse to pay Medicare reimbursements for patients that go to the entire hospital. In some states, such as California, the hospitals are forced by law to provide emergency care to anyone who cannot pay, even if the hospital stopped accepting Medicare, no matter how many how many times each patient keeps coming back. In many poor regions in California, the burden of being forced to treat patients that cannot pay has simply driven many hospitals out of business. But then the problem just gets pushed outward to the adjacent hospitals, leading to both a cascading failure effect, and extremely long ambulance times for the people in the area who actually do pay. Imagine if you lived in a poor area and died of a heart attack before the ambulance was able to drive two hours to the closest hospital because all the deadbeats overloaded the emergency room at your local hospital and forced it out of business. When hospitals are forced to provide emergency treatment for those who cannot pay, it drives up health care costs and makes it more unaffordable for everyone else who does pay, because the hospital has to pass along the costs to someone. Now you may ask, why do hospitals have to accept Medicare? Every person in the USA pays Medicare taxes out of their pay check. The idea is that they will eventually get all these taxes back when they get older and begin to have serious health problems. If the hospital stops accepting Medicare, it means you cannot get all those taxes you paid into the system back. In fact, one of the reasons you probably can't afford to pay out-of-pocket when you get older is because all those Medicare taxes cut into your life savings! These are your Medicare dollars, that you are entittled to. Yet the government is siphoning them off to give excessive (often unwarranted) emergency room treatment to deadbeats. Often these dead beats just go to the emergency room for routine medical treatment, or even just when their children get a severe cold, rather than go to the county clinic and (God forbid!) have to fork out $20 or $30. When you try to price-fix a service (which is what this really is, forcing emergency rooms to give free treatment to those who do not pay), you get long lines and shortages. And that is exactly what has been happening. In some of the lower income areas people have died while waiting 5 hours in line to get into the emergency room! Things have gotten so bad that some hospitals have even begun to stop accepting Medicare, despite the huge increased costs to older patients (who make up most of the people receive treatment), but again even this is not an option in some states. I agree, preventative medicine can potentially save money and lead to better health in the long term. Preventative medicine could even be compared to an "investment in health". But this new mandated comprehensive health coverage is much much more than just preventative medicine, so where is the justification for forcing people to get insurance for everything else? For people who actually can pay, doctors already have plenty of incentives of preventative medicine. In fact, many health analysts say they perform too many diagnostic tests, because they are so lucrative. You know, one of the biggest reasons so many Americans do not have health insurance is because the unfair trade agreements allowed all the factory owners to outsource to China where they can greatly cut costs by not having to give health care coverage to their employees. In order for an American to compete with the Chinese, he has to be willing to work without getting health care coverage from his employer. In fact, the biggest single cost of manufacturing a car in America is giving health care to the auto workers. I might also add that excessive immigration is another of the big reasons so many people cannot afford health care. When you add so many poor people to the population, and there are not enough decent paying jobs for everyone, what do you expect? Obamacare is the cost of taking in tens of millions of undocumented immigrants over the last 3 decades. Obamacare is a healtcare solution for the poor, being forced upon everyone else.
Well this is one of your better posts I have read. As far as Medicare, you need to remember that every state in the union has a law that says you must provide medical care to a person who's life is in danger. This comes down to the American people being lied to about our choices. We can pay a lot more for medical care, and say every person has a right to treatment, this requires compulsory payment such as Obamacare or Medcare. Or we can say it is each person's responsibility to pay for their own HC, and if you can't, than you die. There is no in between solution, we have two crappy choices to choose from. Its every person that lies, and claims we can pay less, and not let people die that is the problem. The fact is that we aren't going to let people die in this country, which really only leaves compulsory participation. This isn't to say I back the ACA though, as it made it compulsory to participate in a system with no price integrity!
LOL, I explain what pay for service is, and you jump to the conclusion that I can't offer another alternative? Well there are about 20 other functioning models that we know work better than our system, how about we take what is best from each of those systems, and do what America used to do, and that is actually lead the world, instead of making excuses and fear mongering!
Did you ever consider that the price of land might have a big part to do with the high costs of medical care in the USA ? Most patients live in cities with higher costs of living. Medical workers have to be paid more to afford the higher price of housing, whether they rent an apartment or buy a house. Indeed, all the "shortages" of nursing are at hospitals in areas with really unaffordable housing prices, where someone with a nurse's salary would struggle to be able to afford rent.
I wouldn't say it has no effect, but I would say it is dwarfed by the fact that medical insurance is the only industry in the US that is exempt from anti-trust laws.
Well how about supply one alternative that will "let doctors decide what is best for their patients, without having to calculate what is best for their wallets first."
