For liberals asking for an alternative.

[editec]

First..............there is no reason for the government to spend the amount of tax dollars on healthcare costs it does currently and under this plan would spend a fraction of what they currently do, specifically once my plan would go into affect over time. Following would be the steps I would introduce to eventually insure/cover all medical costs for everyone and do away with Medicaid/Medicare.

1) Do away with the states defining what a basic insurance plan needs to cover and do away with not allowing people to buy insurance across state lines.
2) Allow states to set up high risk pools for people that have tried (and have documented proof) that they cannot obtain insurance on their own...............in these high risk pools the state will operate the plan and the individual will pay a monthly premium based on their risk, much like in the private insurance. The individual will still be responsible for copays, a likely large deductible, and co-insurances for services rendered.
3) Tort Reform.
4) Health savings accounts managed by a firm of the individuals choosing. THIS IS THE BASIS FOR MY PLAN. Your contribution to this can go as high as you want but at a minimum 2% of your pay will be withheld. You may be asking how this is different than social security or the individual mandate, and they are much different, in fact, have very little in common. The two percent will not go to the government but a private account of your choosing. It can be invested in the stock market, bonds, savings accts, or you can simply have it put in a box in a bank and you can view your balance through whatever financial institution you choose to work with whenever you want. THE MONEY CAN ONLY BE USED FOR MEDICAL PURPOSES. THE MONEY GROWS TAX FREE AND IS PULLED OUT TAX FREE. YOU CAN PASS IT DOWN TO YOUR CHILDREN INTO THEIR OWN HSA TAX FREE. Your employer can also contribute/match if they choose as they are likely to see savings on the insurance side of things with this scenario. To illustrate how this will eventually do away with Medicaid/Medicare and possibly all insurance (or at least everything but major medical see below). It may take a few cycles but eventually everyone will be on their own dime.


Husband HSA upon death
$200,000
Wife HSA Upon death
$100,000
which they had three children
Child 1,2, and 3 inherit 100k each into their HSA and they pass their HSA which have had over 77 years to grow even more say husband and wife have 600k and 300k and have two children. Their children will now inherit almost 450k each into their HSA's. And so on and so forth. You can see that in generation 3 or 4 how this can happen.

I haven't ran into one liberal yet that can argue this system with me and it is pretty obvious this can be achieved not spending 1 trillion dollars and using funny math to show BS savings. (10 years revenue vs. 6 years spending) So there you go what it took the dems 2500+ pages to tear down I have re-done in a couple paragraphs and bullet points. I look foward to you libs trying to refute the above plan.

That plan would work very well for people with incomes high six or in the low seven figures, I suppose.

But for families living on 50 thousand pre tax dollars a year?

2% of that amount to $1000 a year.

Kid, have you priced medicine, lately?

Apparently not.

 

[midcan5]

I was listening to Chris Mathews recently and he was defending the doctors against the old blame of 'waste and corruption.' I like Chris but sometimes you wonder what world he lives in. My mom has been in a local hospital recently and while we can debate calling it corruption, she had more tests and scans than remotely necessary. Medicare gets ripped off same any other plan that allows the money recipients to call the shots. Not all are dishonest, but waste exists because of people and that old cardinal sin greed. Mom finally told them she had had enough and was going home. But that said medicare is one of those truly great things government can do and a society can and should provide for all its citizens, it is the honest management piece that is tough.

 

[jillian]

First..............there is no reason for the government to spend the amount of tax dollars on healthcare costs it does currently and under this plan would spend a fraction of what they currently do, specifically once my plan would go into affect over time. Following would be the steps I would introduce to eventually insure/cover all medical costs for everyone and do away with Medicaid/Medicare.

1) Do away with the states defining what a basic insurance plan needs to cover and do away with not allowing people to buy insurance across state lines.
2) Allow states to set up high risk pools for people that have tried (and have documented proof) that they cannot obtain insurance on their own...............in these high risk pools the state will operate the plan and the individual will pay a monthly premium based on their risk, much like in the private insurance. The individual will still be responsible for copays, a likely large deductible, and co-insurances for services rendered.
3) Tort Reform.
4) Health savings accounts managed by a firm of the individuals choosing. THIS IS THE BASIS FOR MY PLAN. Your contribution to this can go as high as you want but at a minimum 2% of your pay will be withheld. You may be asking how this is different than social security or the individual mandate, and they are much different, in fact, have very little in common. The two percent will not go to the government but a private account of your choosing. It can be invested in the stock market, bonds, savings accts, or you can simply have it put in a box in a bank and you can view your balance through whatever financial institution you choose to work with whenever you want. THE MONEY CAN ONLY BE USED FOR MEDICAL PURPOSES. THE MONEY GROWS TAX FREE AND IS PULLED OUT TAX FREE. YOU CAN PASS IT DOWN TO YOUR CHILDREN INTO THEIR OWN HSA TAX FREE. Your employer can also contribute/match if they choose as they are likely to see savings on the insurance side of things with this scenario. To illustrate how this will eventually do away with Medicaid/Medicare and possibly all insurance (or at least everything but major medical see below). It may take a few cycles but eventually everyone will be on their own dime.


Husband HSA upon death
$200,000
Wife HSA Upon death
$100,000
which they had three children
Child 1,2, and 3 inherit 100k each into their HSA and they pass their HSA which have had over 77 years to grow even more say husband and wife have 600k and 300k and have two children. Their children will now inherit almost 450k each into their HSA's. And so on and so forth. You can see that in generation 3 or 4 how this can happen.

I haven't ran into one liberal yet that can argue this system with me and it is pretty obvious this can be achieved not spending 1 trillion dollars and using funny math to show BS savings. (10 years revenue vs. 6 years spending) So there you go what it took the dems 2500+ pages to tear down I have re-done in a couple paragraphs and bullet points. I look foward to you libs trying to refute the above plan.

other than spouting rightwingnuttiness, do you know what percentage of health insurance costs occur because of malpractice suits?

i'm all for limiting liability when doctors limit the damage they cause.

I'm a right wing nut because I belive in personal responsibility and have created a better plan than your messiahs that does not include government involvement? In regards to tort reform, I know the estimates aren't high but there is no reason not to include it and any savings are worth putting in there. However, maybe the estimates are wrong and the savings are much larger. Didn't Pelosi and the Messiah go with "you will have to pass it to know whats in it" approach.

So I will make a note that you are on record stating that tort reform will not save trillions. You have unsuccessfully tried to dodge the meat of the plan. Should I make note that you have been owned or can you debate any other part of the plan.

if you believed in "personal responsibility", you would want doctors accountable for their malpractice. The only reason for tort reform is to protect insurance companies which already have the second highest industry profits. So you aren't a rightwingnut because you believe in "personal responsibility".

I looked at your "plan". There isn't anything really worth discussing once i see the words "tort reform" because that tells me i am dealing with someone who spouts the party line and isn't engaging in independent thought. It also tells me you know nothing about the process of bringing a malpractice case to trial and the protections already built into the system which protect doctors from frivolous suit.

You might change my mind in terms of you being worth engaging on these issues. We'll see.

 

[Herbie Hancock]

Added competition=lower prices.

In this instance, that's not necessarily true. There are a few very important things that determine your premiums: things like the utilization of health resources by your risk pool, the composition of your risk pool (i.e. how many sick people are in it), and how high are the reimbursements your insurer has to pay providers of health care services.

The kind of deregulation you're talking about may be effective at shifting the composition of some risk pools by making it easier to reject or jettison the sick (note that this stands in opposition to the goal of achieving universal coverage), but it potentially gets into a bit of a bind when you consider the insurer-provider relationship. Providers obviously want to negotiate higher reimbursements for their services, which trickles down into higher premiums for you.

If you dilute the insurance market, the providers in your area gain clout in that negotiation. Which means the actual price of care (and thus the price of your premiums) can have upward pressure on it. In picture form, you may be starting at Point C but end up reach (or even overshooting) Point A, which might actually entail higher premiums:

If you happen to live in a high-cost area in Boston or New York, buying an insurance plan sold in Idaho doesn't guarantee you lower premiums because that insurer still has to pay the reimbursements to the providers in your area (if you intend to take a plane ride to Idaho any time you need care, disregard what I'm saying). And since the Idaho-based insurer presumably has precious few customers to offer your local providers, it's at a distinct disadvantage in negotiating reimbursements. Essentially you're always "out-of-network."

And that doesn't even get into the enforcement issues. The standard conservative across-state-lines proposal puts the impetus for handling any problems you have with your insurer on the state regulators in the state in which it's based. In other words, insurance regulators in Idaho become responsible for your problems and, indeed, they're expected to police their insurers' activities in potentially all 50 states.

Don't you see it as wrong that if you live in one state you don't have the ability to shop around and purchase a much cheaper plan that may suit you better in another state?

I don't have a problem with interstate sales of health in principle, though I think it requires a few extras to work--things like a baseline set of federal regulations and probably some kind of all-payer rate system to prevent different insurers from getting fleeced by a particular provider. But I wouldn't support deregulation all by itself.

Couple of items. One I just disagree that by allowing insurance companies to sell across state lines will not end up reducing costs. I also disagree, and this is part of the problem, that the fed/state government will set a baseline of what is acceptable. What happened to letting the person do their own research and choose the best plan for them. In regards to in-network vs. out-network stance is an interesting point. However, I would argue that if a company that traditionally isn't in NY and wants to extend services into NY would have to get providers under their plan if that want to be successful. If they don't people won't purchase that plan, if they do see my previous point about personal responsibility. It is not my fault they are morons. Also, in regards to reimbursement....it was my understanding that reimbursement is less reliant on the negotiations of providers/hospitals and more reliant on CPT coding/stacks or procedure codes that base reimbursement to an extent off Medicare reimbursement (which is a whole other issue/problem). Selling insurance across state lines would results in lower premiums and increased access, imo.

 

[Herbie Hancock]

other than spouting rightwingnuttiness, do you know what percentage of health insurance costs occur because of malpractice suits?

i'm all for limiting liability when doctors limit the damage they cause.

I'm a right wing nut because I belive in personal responsibility and have created a better plan than your messiahs that does not include government involvement? In regards to tort reform, I know the estimates aren't high but there is no reason not to include it and any savings are worth putting in there. However, maybe the estimates are wrong and the savings are much larger. Didn't Pelosi and the Messiah go with "you will have to pass it to know whats in it" approach.

So I will make a note that you are on record stating that tort reform will not save trillions. You have unsuccessfully tried to dodge the meat of the plan. Should I make note that you have been owned or can you debate any other part of the plan.

if you believed in "personal responsibility", you would want doctors accountable for their malpractice. The only reason for tort reform is to protect insurance companies which already have the second highest industry profits. So you aren't a rightwingnut because you believe in "personal responsibility".

I looked at your "plan". There isn't anything really worth discussing once i see the words "tort reform" because that tells me i am dealing with someone who spouts the party line and isn't engaging in independent thought. It also tells me you know nothing about the process of bringing a malpractice case to trial and the protections already built into the system which protect doctors from frivolous suit.

You might change my mind in terms of you being worth engaging on these issues. We'll see.

I do believe in personal responsibility but the current state of lawsuits is a joke. If the MD really does screw up than yes, but lets not forget they are human and do make mistakes. If you mess up in your job a customer gets a number 3 large size instead of a number 1 with a diet coke. If an MD makes a mistake it is a little more severe. I am not saying they shouldn't be held accountable. However, for you not to acknowledge that there are many suits brought about that are complete farses by trash just looking for a payday I can't help you. I am reminded of a doctor in my state that was being sued by a pregant woman on Medicaid. He was the on-call physician when she came into the ER and only saw here long enough to deliver her baby. She sued him for the stretch marks and wanted him to pay for the plastic surgery to turn her body back to what it was previously. While yes this was dismissed in court, somewhat suprisingly given what the courts have done at times, his insurance rates rose because he had a suit brought against him. BS in my opinion. This is what tort reform would hopefully fix. If my desire to not have suits like this brought against MD's makes my a right wing nut so be it.

 

[Greenbeard]

Couple of items. One I just disagree that by allowing insurance companies to sell across state lines will not end up reducing costs. I also disagree, and this is part of the problem, that the fed/state government will set a baseline of what is acceptable.

The key here is to encourage insurers to compete on the cost and quality of the product offered, not simply the composition of their risk pool. Deregulation looks good only because it enables them to dump risks or lock them into the pool at higher rates. That's a perverse kind of competition and it's certainly not good from an access point of view.

What happened to letting the person do their own research and choose the best plan for them.

A few months ago, in discussing an earlier version of Paul Ryan's proposal to voucherize Medicare, Austin Frakt made the following point, which I agree with whole-heartedly:

The whole point of a market-based system is to harness the power of consumer choice. But consumers can’t send meaningful signals if the market has an incomprehensible structure. One of the conditions for a competitive market is fully informed participants. The notion that seniors–or anyone–can meaningfully shop in a market with an unlimited number of plans that vary in all possible ways is ludicrous. (There is already evidence that beneficiaries don’t optimally select among the scores of Part D plans available now and that reducing the number of available plans would increase welfare.) The Medicare supplement (Medigap) market is a good model of competition within standardization. Making products more similar encourages competition. Allowing them to vary along a small number of dimensions helps consumers make sensible comparisons consistent with individual preference. Isn’t that the point?​

He's talking about Medicare-oriented exchanges there but the same principle is true for any exchange. The notion of the infinitely customizable insurance package may sound nice, but ultimately some degree of standardization (but with variation) doesn't just make shopping and choice easier, it makes it more meaningful.

In regards to in-network vs. out-network stance is an interesting point. However, I would argue that if a company that traditionally isn't in NY and wants to extend services into NY would have to get providers under their plan if that want to be successful. If they don't people won't purchase that plan, if they do see my previous point about personal responsibility. It is not my fault they are morons.

But my point here is that the premiums you pay for a plan will, to a large degree, depend on how much the providers in your area can get out of your insurer. If you choose an insurer that has virtually no market clout in your area (i.e. can offer very few potential customers to providers), then your insurer isn't likely to get a very good deal. The reason the insurer offers better rates than insurers in your area is related to the fact that it's not in your area.

This is a bit like assuming that if a property management company based in Skokie offers great deals on most of its apartments (in Skokie), that you can get an apartment in downtown Chicago from them at a much cheaper price than those charged by other renters offering apartments in Chicago. Obviously that's not how it works. It doesn't matter where they're based (unless you wanted to rent an apartment in that suburb), it matters where you want to rent.

Similarly, if you're going to be seeking health care in a high-cost area, trying to buy insurance from an out-of-state insurer that offers lower rates in the lower-cost area in which it sells most of its policies isn't necessarily going to help you as much as you seem to think.

Also, in regards to reimbursement....it was my understanding that reimbursement is less reliant on the negotiations of providers/hospitals and more reliant on CPT coding/stacks or procedure codes that base reimbursement to an extent off Medicare reimbursement (which is a whole other issue/problem).

I don't believe it's unusual to use the same or similar billing codes; the difference is that private insurers negotiate the reimbursement for each code with every hospital with which they interact (and thus different private insurers may be paying very different prices for the exact same service at a particular hospital--unless they're in Maryland). If you want a good introduction to the subject, I recommend reading this article: The Pricing of U.S. Hospital Services: Chaos Behind a Veil of Secrecy.