A Modest Proposal (Think Jonathan Swift) on Health Insurance and Health Costs

[JBG]

Admittedly an "out of the box" and radical idea that I entertain occasionally.

Back in the day, before insurance was prevalent, medical service administration and bills were far lower. Basically you walked into an office, sat down in the waiting room and the doctor came out when he was ready to see you. My pediatrician bill, in 1963 was around $6. So even adjusting for inflation (and prices have not gone up six-fold) that would be $36 or less. As for reaching the doctor you would call and he would return calls between 5PM and 7PM except for emergencies.

Adult matters may be a bit more complex. However, I can't believe that the armies of paper-pushers are free, or needed. I wonder if we'd be better off eliminating employer-paid insurance, and perhaps recasting Medicare as insurance, for all people, against true catastrophes, such as complex cancer or heart disease, or muscular dystrophy. Much of the GDP is now going towards "health care" or more likely overhead. Insurance also distorts employment relationships. Since employer-paid premiums are deductible and the employees' share is paid in pre-tax dollars, too much money is allocated to insurance.

Insurance if for the spreading of unaffordable risk. For example most auto drives end safely but some are a catastrophe. Most people cannot afford to replace their cars if something happens. Health insurance should cover only truly unaffordable catastrophes. Anything else just inflates its cost and is redistribution of wealth, whether intended or unintended.
The net result of this is that no one is satisfied. Doctors are unhappy and not doing well. Patients are often stuck in "voice mail jail" dealing with insurers or medical care groups. And life spans have been expanded well beyond the ability of many people to work. Even if I can continue working (I'm a lawyer) can a pipe-fitter who goes into sewers or construction workers who go onto scaffolding often work into their 80's? Maybe some can. But not many. All and all I think we'd be better off with far less insurance.

 

[Polishprince]

Makes sense to me. The Abortion racket has kept their prices in order, this is a service which is very often cash-and-carry with pregnant dames relying on their boyfriends and pimps to pay. Reducing the amount of things covered by insurance would reduce the cost of the insurance as well as th cost of the underlying service being insured.

 

[1srelluc]

Here's a scam nearly all medical systems are involved in as far as billing goes.

I'm retired and have Medicare and .gov BC/BS. They way it's supposed to work for retirees who are on Medicare is Medicare is the primary for billing then BC/BS picks-up the rest as secondary.

What they do is reverse it (like you are still working) so that when BS/BS kicks it back they are charged a "processing fee" (2-3%) by the medical system.

The patient never notices the scam because the bill is paid in full but the medical systems make hundreds of millions a year off of it.

 

[Grumblenuts]

Medicare4All is neither "out of the box" nor "radical." None were ever even asked to vote for employer based "health care" let alone have a few massive, corporate leeches suck our blood from every direction for the private profit of a relative few billionaires. We currently, effectively vote (fulfill our civic duty) to perpetuate corrupt, duopolistic rule. We can't have Medicare4All. We're outgunned. Screwed.. until we can figure out how to get together and remove money from politics.

 

[dblack]

Health insurance should cover only truly unaffordable catastrophes. Anything else just inflates its cost and is redistribution of wealth,

Great post. I've been saying this for years. Our problem isn't a lack of insurance. It's too much insurance.

 

[JBG]

Great post. I've been saying this for years. Our problem isn't a lack of insurance. It's too much insurance.

Exactly. I was looking on my phone through my photos last night. Our medical centers in Westchester are palatial.

 

[dblack]

Exactly. I was looking on my phone through my photos last night. Our medical centers in Westchester are palatial.

And of course, with ACA (and insurance lobbyists whispering in their ears), Congress went in exactly the opposite direction.

 

[initforme]

We have under insurance right now. A serious illness should cost zero.

 

[dblack]

We have under insurance right now. A serious illness should cost zero.

The illness generally does cost zero. It's health care that costs money. Are you saying doctors and nurses should work for free? Or that someone else should pay for your health care?

 

[initforme]

The illness generally does cost zero. It's health care that costs money. Are you saying doctors and nurses should work for free? Or that someone else should pay for your health care?

No. Not at all. I'm about ensuring health insurance is accessible for our poorest people as well as the Uber filthy wealthy.

 

[dblack]

No. Not at all. I'm about ensuring health insurance is accessible for our poorest people as well as the Uber filthy wealthy.

Ahhh "accessible". That's lib code for "get other people to pay for it", right?

Here's the thing. I don't necessarily mind a safety net for the poor. But lets be honest, that's not really what you're after, is it?

 

[hadit]

Admittedly an "out of the box" and radical idea that I entertain occasionally.

Back in the day, before insurance was prevalent, medical service administration and bills were far lower. Basically you walked into an office, sat down in the waiting room and the doctor came out when he was ready to see you. My pediatrician bill, in 1963 was around $6. So even adjusting for inflation (and prices have not gone up six-fold) that would be $36 or less. As for reaching the doctor you would call and he would return calls between 5PM and 7PM except for emergencies.

Adult matters may be a bit more complex. However, I can't believe that the armies of paper-pushers are free, or needed. I wonder if we'd be better off eliminating employer-paid insurance, and perhaps recasting Medicare as insurance, for all people, against true catastrophes, such as complex cancer or heart disease, or muscular dystrophy. Much of the GDP is now going towards "health care" or more likely overhead. Insurance also distorts employment relationships. Since employer-paid premiums are deductible and the employees' share is paid in pre-tax dollars, too much money is allocated to insurance.

Insurance if for the spreading of unaffordable risk. For example most auto drives end safely but some are a catastrophe. Most people cannot afford to replace their cars if something happens. Health insurance should cover only truly unaffordable catastrophes. Anything else just inflates its cost and is redistribution of wealth, whether intended or unintended.
The net result of this is that no one is satisfied. Doctors are unhappy and not doing well. Patients are often stuck in "voice mail jail" dealing with insurers or medical care groups. And life spans have been expanded well beyond the ability of many people to work. Even if I can continue working (I'm a lawyer) can a pipe-fitter who goes into sewers or construction workers who go onto scaffolding often work into their 80's? Maybe some can. But not many. All and all I think we'd be better off with far less insurance.

If we really want to be practical, it would behoove us to have society cover preventive care such as exams and tests, because even fatal diseases are often treatable when caught at an early stage. That would actually provide a return on investment, and I believe we would see more people getting checked out instead of ignoring problems that would ultimately kill them.

Then true insurance would kick in and would be far cheaper because it would cover truly catastrophic illnesses, as you outlined.

Here's an idea, go to your doctor at the beginning of the year and offer him a cash payment for each member of your family to get a physical exam and blood workup each year. He would probably jump at it because he wouldn't have to wrangle anything with an insurance company, and you'd get a big discount. Then you could get a catastrophic care insurance plan that would cost a lot less.

 

[dblack]

If we really want to be practical, it would behoove us to have society cover preventive care such as exams and tests, because even fatal diseases are often treatable when caught at an early stage. That would actually provide a return on investment, and I believe we would see more people getting checked out instead of ignoring problems that would ultimately kill them.

But why does society need to cover that (apart from a welfare program for the poor)? That kind of stuff isn't that expensive, and as you mention below, if people are paying cash, it will be even cheaper.

Then true insurance would kick in and would be far cheaper because it would cover truly catastrophic illnesses, as you outlined.

Here's an idea, go to your doctor at the beginning of the year and offer him a cash payment for each member of your family to get a physical exam and blood workup each year. He would probably jump at it because he wouldn't have to wrangle anything with an insurance company, and you'd get a big discount. Then you could get a catastrophic care insurance plan that would cost a lot less.

Yep. A previous employer of mine offered a fully funded $5k HSA for the year, to cover the deductible for catastrophic insurance. You paid for routine health care with the HSA - literally a checkbook. Doctors loved not dealing with insurance and - the kicker - if you didn't use all of your HSA, the money was yours to keep.

 

[hadit]

But why does society need to cover that (apart from a welfare program for the poor)? That kind of stuff isn't that expensive, and as you mention below, if people are paying cash, it will be even cheaper.

I'm just trying to remove any obstacle that prevents people from getting checked out and catching diseases while they're still treatable.

Yep. A previous employer of mine offered a fully funded $5k HSA for the year, to cover the deductible for catastrophic insurance. You paid for routine health care with the HSA - literally a checkbook. Doctors loved not dealing with insurance and - the kicker - if you didn't use all of your HSA, the money was yours to keep.

HSA's are awesome and use common sense to fund healthcare.

 

[dblack]

I'm just trying to remove any obstacle that prevents people from getting checked out and catching diseases while they're still treatable.

But won't that drive health care inflation - as described in the OP?

HSA's are awesome and use common sense to fund healthcare.

Yeah. Unfortunately, ACA piled requirements on the catastrophic policies and now they cost too much for the HSA strategy to make much sense.

 

[hadit]

But won't that drive health care inflation - as described in the OP?

That's always a danger, but it would be less than the inflationary pressure from full-blown socialized medicine and could prevent more expensive care later on. We know that, no matter what we do, there will still be a lot of people with expensive health care needs and no way to pay for them.

Yeah. Unfortunately, ACA piled requirements on the catastrophic policies and now they cost too much for the HSA strategy to make much sense.

That's usually what happens when government gets hold of a good idea. They usually mess it up.

 

[Dadoalex]

Admittedly an "out of the box" and radical idea that I entertain occasionally.

Back in the day, before insurance was prevalent, medical service administration and bills were far lower. Basically you walked into an office, sat down in the waiting room and the doctor came out when he was ready to see you. My pediatrician bill, in 1963 was around $6. So even adjusting for inflation (and prices have not gone up six-fold) that would be $36 or less. As for reaching the doctor you would call and he would return calls between 5PM and 7PM except for emergencies.

Adult matters may be a bit more complex. However, I can't believe that the armies of paper-pushers are free, or needed. I wonder if we'd be better off eliminating employer-paid insurance, and perhaps recasting Medicare as insurance, for all people, against true catastrophes, such as complex cancer or heart disease, or muscular dystrophy. Much of the GDP is now going towards "health care" or more likely overhead. Insurance also distorts employment relationships. Since employer-paid premiums are deductible and the employees' share is paid in pre-tax dollars, too much money is allocated to insurance.

Insurance if for the spreading of unaffordable risk. For example most auto drives end safely but some are a catastrophe. Most people cannot afford to replace their cars if something happens. Health insurance should cover only truly unaffordable catastrophes. Anything else just inflates its cost and is redistribution of wealth, whether intended or unintended.
The net result of this is that no one is satisfied. Doctors are unhappy and not doing well. Patients are often stuck in "voice mail jail" dealing with insurers or medical care groups. And life spans have been expanded well beyond the ability of many people to work. Even if I can continue working (I'm a lawyer) can a pipe-fitter who goes into sewers or construction workers who go onto scaffolding often work into their 80's? Maybe some can. But not many. All and all I think we'd be better off with far less insurance.

Problem 1: Medical Conglomerates
How many of you have doctors who are wholly independent as opposed to being part of some big practice or and even bigger medical group like Humana, Tri-Health, or Kettering Health? The stand alone doctor is a rarity nowadays but, more important, in the current environment the provider is not a doctor but a revenue provider and patients are revenue sources.

This means that the doctor is held responsible for revenues not medical outcomes. Which means that the patient pays more and receives less doctor time for his money.

Problem 2: An aging/unhealthy population
As a population we are getting older and older people demand more medical services. Increase demand and prices increase. Additionally, from a dietary and exercise perspective we eat badly and exercise rarely. Obesity is national problem. Type 2 diabetes. These things increase demand for services and health care costs.

Problem 3: Extremely expensive chronic medication
Seen any ads for a pill that cures whatever ails you in one dose? I'm sure you haven't and you won't. I take mega-doses of aspirin as an anti-inflammatory. The risks are identical to any nsaid but every doctor/nurse/PA I've seen over the last 15 years has gone on and on about the risks of aspirin.

The truth is you can't make money prescribing aspirin or making pills that cure in one dose.

Problem 4: Unnecessary surgeries
Hip replacements for an 87 year old? Expensive and dangerous but there's a Medicare provided check for $75K. Medically not serving the patient's best interest but making a ton of money.

The problem is greed and the profits required to meet the greed.

What if we removed profit from health care?
What if doctors just treated patients rather than worrying over how many patients they see to meet a quota?
The same for hospitals, pharmacies, and other medical services?

There is a solution.

 

[dblack]

Problem 1: Medical Conglomerates
How many of you have doctors who are wholly independent as opposed to being part of some big practice or and even bigger medical group like Humana, Tri-Health, or Kettering Health? The stand alone doctor is a rarity nowadays but, more important, in the current environment the provider is not a doctor but a revenue provider and patients are revenue sources.

This means that the doctor is held responsible for revenues not medical outcomes. Which means that the patient pays more and receives less doctor time for his money.

Problem 2: An aging/unhealthy population
As a population we are getting older and older people demand more medical services. Increase demand and prices increase. Additionally, from a dietary and exercise perspective we eat badly and exercise rarely. Obesity is national problem. Type 2 diabetes. These things increase demand for services and health care costs.

Problem 3: Extremely expensive chronic medication
Seen any ads for a pill that cures whatever ails you in one dose? I'm sure you haven't and you won't. I take mega-doses of aspirin as an anti-inflammatory. The risks are identical to any nsaid but every doctor/nurse/PA I've seen over the last 15 years has gone on and on about the risks of aspirin.

The truth is you can't make money prescribing aspirin or making pills that cure in one dose.

Problem 4: Unnecessary surgeries
Hip replacements for an 87 year old? Expensive and dangerous but there's a Medicare provided check for $75K. Medically not serving the patient's best interest but making a ton of money.

The problem is greed and the profits required to meet the greed.

What if we removed profit from health care?
What if doctors just treated patients rather than worrying over how many patients they see to meet a quota?
The same for hospitals, pharmacies, and other medical services?

There is a solution.

For each of these problems, you're blaming "profit". Yet the profit motive exists in every market and we don't see the kind of spiraling costs we see in health care. In a normal market, prices are kept in check by consumers who have an incentive to save money. But, as the OP points out, when it comes to health care we're over-insured. Insured health care consumers have no incentive to demand cheaper health care (because they're not paying for it). Arguably, they have the opposite incentive. If you're "covered", why not choose the most expensive option at every opportunity?

Our over-use of insurance is the principal driver for health care inflation, not greedy doctors or corporations.

 

[dblack]

That's usually what happens when government gets hold of a good idea. They usually mess it up.

Agree. Mostly. But I'm not really seeing where ACA was a "good idea" to begin with. The whole thing was a feeding trough for the health care / health insurance industries from the beginning.

 

[Dadoalex]

For each of these problems, you're blaming "profit". Yet the profit motive exists in every market and we don't see the kind of spiraling costs we see in health care. In a normal market, prices are kept in check by consumers who have an incentive to save money. But, as the OP points out, when it comes to health care we're over-insured. Insured health care consumers have no incentive to demand cheaper health care (because they're not paying for it). Arguably, they have the opposite incentive. If you're "covered", why not choose the most expensive option at every opportunity?

Our over-use of insurance is the principal driver for health care inflation, not greedy doctors or corporations.

You are, of course, wrong.

I had shoulder replacement surgery earlier this year. I've very good insurance through my employer. I was not offered a choice of what type of shoulder to install, what type of anesthetic, the shape of the scar, they size of the bed...

Why do you think there are PAs, Nurse Practitioners, Nurse Aides?
To reduce costs.
Do those reduced costs result in lower costs or higher profits?

In the town in which I used to live easily 80% of the doctors are part of a single group.
Any competition there?

Doctors refer patients to imaging owned by the same business that owns there practice.
Then doctors refer patients to surgeons within the same business.
Then the patient goes to a hospital owned by the same business.

Of course you don't see the problem because to you, unbridled capitalism is the solution to every problem when, in reality, GREED, which is a synonym of Capitalism, is the cause of most problems in the world.