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CDZ Some ideas about how to revise health insurance coverage

320 Years of History

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We grow ever closer to the point at which doctors can tell us exactly what we are "generally" at higher and lower risk of "getting" as go illnesses. Why not have health insurance that charges by the actual risk category. For example, some things -- pancreatic cancer -- for example can be experienced by men, women, young and old. That sort of stuff belongs in all policies; however, if a person is willing to forgo coverage for pancreatic cancer, they should be able to "opt out" of it and have their premium reduced accordingly. Similarly, no man will ever get cervical cancer, so policies for men should not include a fee for that covered risk.

Another provision I'd like to see is one that allows policyholders to, at will, opt in and out of coverage types. For example, if one is going to a place where dengue fever happens with some degree of regularity, one might be able to log onto the insurance company's site, add the dengue fever coverage, pay the premium bump for doing so, go on the trip, and and then drop it a month or two after returning. Lots of coverable conditions should work that way.

What do you think?

NOTE:
This is NOT an Obamacare thread, or even a political thread. Do not discuss what's wrong with O-care. Discuss and/or present only solution proposals for making the actua health insurance itself and how people may add or remove the coverage better.
 

Onyx

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Healthcare will be at its best when all healthcare solutions are eradicated.
 

Boss

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Here's MY proposal...

Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

Step 2: Allow interstate insurance competition.

Step 3: Allow tax-free health savings accounts.

Step 4: Cut red tape and regulations on new drug research.

Step 5: Cut red tape and regulations on new procedures.

Step 6: Allow alternative medicine options to be covered by health insurance.

Step 7: Allow hospitals to claim tax credits for all indigent care losses.

Step 8: Allow health insurance plans to be completely voluntary.

Step 9: Remove all requirements for minimal levels of health insurance coverage.

Step 10: Establish a pool for catastrophic-only health insurance coverage.

Step 11: Repeal pre-existing illness mandates.

Step 12: Tax incentives for premiums paid when insurance is unused.
 

Damaged Eagle

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upload_2016-10-31_21-17-28.jpeg


Nope! If it's the will of the progressives that it's "to promote the general welfare" as they say that Constitutional statement means then the health care industry needs to be completely nationalized, instead of forcing people to purchase from a private business which is unconstitutional.

*****CHUCKLE*****


:)
 
OP
320 Years of History

320 Years of History

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Here's MY proposal...

Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

Step 2: Allow interstate insurance competition.

Step 3: Allow tax-free health savings accounts.

Step 4: Cut red tape and regulations on new drug research.

Step 5: Cut red tape and regulations on new procedures.

Step 6: Allow alternative medicine options to be covered by health insurance.

Step 7: Allow hospitals to claim tax credits for all indigent care losses.

Step 8: Allow health insurance plans to be completely voluntary.

Step 9: Remove all requirements for minimal levels of health insurance coverage.

Step 10: Establish a pool for catastrophic-only health insurance coverage.

Step 11: Repeal pre-existing illness mandates.

Step 12: Tax incentives for premiums paid when insurance is unused.

My thoughts re: your proposals:

  1. Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

    Not keen on this, and I don't think it's the first thing that we need to achieve in an overall effort to revise health care delivery and payment processes, but whether this goal is implemented is not a deal breaker for me.

  2. Step 2: Allow interstate insurance competition.

    I think this is a good idea.

  3. Step 3: Allow tax-free health savings accounts

    Contributions to them already are 100% income tax deductible and when used to pay for qualified health care expenses, so are the withdrawals. How much more tax free can they be?

  4. Step 4: Cut red tape and regulations on new drug research.

    Okay. What regulations strike you as the most important ones to alter? What aspects of "red tape" strike you as the most important ones to alter?

  5. Step 5: Cut red tape and regulations on new procedures.

    I think you need to explain just what you have in mind here. Nobody thinks more "red tape" is better than less but what sorts of regulations and "red tape" have you in mind? Make sure to identify only those that are governmentally imposed as contrasted with those that are stipulated by companies selling health insurance.

  6. Step 6: Allow alternative medicine options to be covered by health insurance.

    As far as I know, it's insurance companies that refuse -- as a business decision -- to cover alternative treatment modalities and medications more so than the government prohibiting them from doing so. I suppose one can legislatively, or via the regulatory process, require insurers to cover those sorts of things, but based on prior conversations with you, I don't think you'd cotton to that. Would you?

  7. Step 7: Allow hospitals to claim tax credits for all indigent care losses.

    This would be helpful to corporate hospitals; however, of the ~4900 community hospitals in existence, some 3900 of them (79%) are already tax-exempt. The thing is that "hospitals that provide higher levels of quality and access are ... more likely to be nonprofit than for-profit."

    That being so, I'm not at all keen on the idea of "rewarding" for-profit hospitals in advance of their demonstrably besting (or at the very least matching) the performance standards set by the non-profit peers. I didn't increase my kids' allowances prior to their demonstrating they deserved it. I see giving tax credits to hospitals in much the same context.

    I'd be okay with offering tax credits to for-profit hospitals once they achieve a performance measures that best those of non-profits. (The level would have to be a "one-way" thing; that is it can only be increased, not ever decreased.)

  8. Step 8: Allow health insurance plans to be completely voluntary.

    Explain please because what you've written seems like "tits on a bull" to me. I'm not entirely sure what it means for a "health insurance plan to be voluntary." I have no reason to think health insurance plans are not currently voluntary. Nobody forces companies or individuals to engage in the provision of health insurance or not be members of the health insurance industry. Entry and exist are 100% voluntary.

  9. Step 9: Remove all requirements for minimal levels of health insurance coverage.

    What exactly do you mean here? Are you of a mind that everyone should not necessarily have health insurance of some sort? Are you of a mind that folks should be able to a la carte choose what they want to be covered for? Something else?

  10. Step 10: Establish a pool for catastrophic-only health insurance coverage.

    Okay. Who do you envision defining/establishing that pool (group?), that is, who gets to define what constitutes a "catastrophic health event" that would be covered under such a policy? I think what be a "catastrophic health event" can vary. For some folks, a paper cut is potentially catastrophic. For others, getting pregnant is. For pretty much everyone, breaking a bone or contracting appendicitis is a catastrophe. A catastrophe has multiple dimensions, for example, an element of lack of willful intent, temporal and situational surprise, an emergent or urgent need for amelioration, actual or potential impact on the person's life, etc. Under the right circumstances, pretty much any health-related malady can be catastrophic.

  11. Step 11: Repeal pre-existing illness mandates.

    Okay. Why? I'm not 100% opposed, but I'm not about to jump "on board" with this idea. The idea that I might develop a chronic ailment while I work at ABC and then I change jobs, thus insurers, and now that ailment is deemed pre-existing thus my new insurer won't cover it -- even though were I to contract that ailment after joining the new insurance plan, it would be covered -- is just preposterous and just wrong to me.

  12. Step 12: Tax incentives for premiums paid when insurance is unused.

    What incentives and who would receive them?
 

Boss

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My thoughts re: your proposals:

  1. Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

    Not keen on this, and I don't think it's the first thing that we need to achieve in an overall effort to revise health care delivery and payment processes, but whether this goal is implemented is not a deal breaker for me.
I don't care what you're keen on. I am proposing something that would dramatically lower the cost of health care. If you're not going to take measures to lower the cost of health care, you'll never lower the cost of health care. That seems like a no-brainer.

  1. Step 2: Allow interstate insurance competition.

    I think this is a good idea.

  2. Step 3: Allow tax-free health savings accounts

    Contributions to them already are 100% income tax deductible and when used to pay for qualified health care expenses, so are the withdrawals. How much more tax free can they be?

  3. Step 4: Cut red tape and regulations on new drug research.

    Okay. What regulations strike you as the most important ones to alter? What aspects of "red tape" strike you as the most important ones to alter?
If you're going to ask me for specifics I can't really tell you because I don't know them all. I just know that it takes a ridiculous amount of time (and money) to bring new life-saving drugs to the market. Again, if we are going to address the cost of health care, things like this are going to have to be revisited. We have layer upon layer of regulations and mandates applied by government over the years which are driving up the costs of health care.

  1. Step 5: Cut red tape and regulations on new procedures.

    I think you need to explain just what you have in mind here. Nobody thinks more "red tape" is better than less but what sorts of regulations and "red tape" have you in mind? Make sure to identify only those that are governmentally imposed as contrasted with those that are stipulated by companies selling health insurance.
Same as the last answer... I don't know, we have to revisit all of this if we're going to bring down costs. There are literally tens of thousands of regulations, standards, mandates and requirements that have to be met before a new drug or procedure can be introduced to the public and this cost has to be recouped.

  1. Step 6: Allow alternative medicine options to be covered by health insurance.

    As far as I know, it's insurance companies that refuse -- as a business decision -- to cover alternative treatment modalities and medications more so than the government prohibiting them from doing so. I suppose one can legislatively, or via the regulatory process, require insurers to cover those sorts of things, but based on prior conversations with you, I don't think you'd cotton to that. Would you?
Again, my motive is to bring down cost of health care. If an insurance provider can pay less for a customer receiving homeopathic care as opposed to traditional care, why would they not want to do that? Now I can see how the insurance company doesn't want to be paying off snake oil salesmen for phony treatments that have no medical value on top of what they are already providing so this would have to be a refined solution. Still, I think reasonable actions could be taken if it lowers the cost of health care.

  1. Step 7: Allow hospitals to claim tax credits for all indigent care losses.

    This would be helpful to corporate hospitals; however, of the ~4900 community hospitals in existence, some 3900 of them (79%) are already tax-exempt. The thing is that "hospitals that provide higher levels of quality and access are ... more likely to be nonprofit than for-profit."

    That being so, I'm not at all keen on the idea of "rewarding" for-profit hospitals in advance of their demonstrably besting (or at the very least matching) the performance standards set by the non-profit peers. I didn't increase my kids' allowances prior to their demonstrating they deserved it. I see giving tax credits to hospitals in much the same context.

    I'd be okay with offering tax credits to for-profit hospitals once they achieve a performance measures that best those of non-profits. (The level would have to be a "one-way" thing; that is it can only be increased, not ever decreased.)
Now you're getting off in the weeds with this envy of capitalism crap where you don't think health care professionals ought to profit. I fundamentally disagree with such logic. Indigent care is mandated by law... hospitals must treat you regardless of ability to pay. This cost has to be recouped somehow and currently, it is recouped through charging the paying customer more. It seems to me, a tax credit would alleviate some of that cost and again, bring down the cost to the paying consumer or insurance provider.

  1. Step 8: Allow health insurance plans to be completely voluntary.

    Explain please because what you've written seems like "tits on a bull" to me. I'm not entirely sure what it means for a "health insurance plan to be voluntary." I have no reason to think health insurance plans are not currently voluntary. Nobody forces companies or individuals to engage in the provision of health insurance or not be members of the health insurance industry. Entry and exist are 100% voluntary.
ACA mandates you have health care coverage of pay a fine. I believe, when this is the standard, it causes the cost to skyrocket because it's mandated, you have no other option. When you are forced to purchase a product, that;'s not free market capitalism.

Step 9: Remove all requirements for minimal levels of health insurance coverage.

What exactly do you mean here? Are you of a mind that everyone should not necessarily have health insurance of some sort? Are you of a mind that folks should be able to a la carte choose what they want to be covered for? Something else?

I think insurance companies should be able to tailor plans for younger people who are relatively healthy and don't need comprehensive health care coverage. You know how auto insurers give safe driver discounts to people who haven't filed a claim recently? Something like that would be good to have with health care.

Step 10: Establish a pool for catastrophic-only health insurance coverage.

Okay. Who do you envision defining/establishing that pool (group?), that is, who gets to define what constitutes a "catastrophic health event" that would be covered under such a policy? I think what be a "catastrophic health event" can vary. For some folks, a paper cut is potentially catastrophic. For others, getting pregnant is. For pretty much everyone, breaking a bone or contracting appendicitis is a catastrophe. A catastrophe has multiple dimensions, for example, an element of lack of willful intent, temporal and situational surprise, an emergent or urgent need for amelioration, actual or potential impact on the person's life, etc. Under the right circumstances, pretty much any health-related malady can be catastrophic.

Well, I have not sat down and worked out some 2,000-page comprehensive health care plan. You keep asking me for specifics and details and I don't have those. I am merely making suggestions off the top of my head that would help lower the cost of health care, In my opinion, catastrophic would mean anything that would require an extended hospital stay... a heart attack or being hit by a bus. The parameters could be worked out but basically the insurance coverage would be for things that are unexpected and require long stays in the hospital. Routine procedures and doctors visits wouldn't be covered. People could pay for those things out of their health savings accounts.

Step 11: Repeal pre-existing illness mandates.

Okay. Why? I'm not 100% opposed, but I'm not about to jump "on board" with this idea. The idea that I might develop a chronic ailment while I work at ABC and then I change jobs, thus insurers, and now that ailment is deemed pre-existing thus my new insurer won't cover it -- even though were I to contract that ailment after joining the new insurance plan, it would be covered -- is just preposterous and just wrong to me.

Again, do we want to bring down the cost of health care or not? I know that it was a problem before ACA that insurance companies would weasel out of paying for things on the basis of "pre-existing" conditions, and I have no problem with measures to limit their ability to do that but I also understand the nature of how insurance works. You can't go buy car insurance after you've totaled your car... you can't buy fire insurance after your house burns down.

Step 12: Tax incentives for premiums paid when insurance is unused.

What incentives and who would receive them?

Taxpayers would receive them. In other words, you pay $x per year for insurance but you didn't file a claim... that money you paid should be rewarded with a tax credit or incentive of some kind to encourage healthy lifestyles. You're rewarding people for not using their health care insurance coverage. This means more people would use their insurance less and that means insurance providers could provide coverage for less.

Again, all of my suggestions are intended to bring down the cost of health care and health care coverage. Until we start trying to return things to the free market system, we'll continue to see unreasonably high costs associated with health care. You can't just shift the burden around to insurance companies, hospitals or government. The cost has to be dealt with in pragmatic ways that allow free market solutions.
 
OP
320 Years of History

320 Years of History

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My thoughts re: your proposals:

  1. Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

    Not keen on this, and I don't think it's the first thing that we need to achieve in an overall effort to revise health care delivery and payment processes, but whether this goal is implemented is not a deal breaker for me.
I don't care what you're keen on. I am proposing something that would dramatically lower the cost of health care. If you're not going to take measures to lower the cost of health care, you'll never lower the cost of health care. That seems like a no-brainer.

  1. Step 2: Allow interstate insurance competition.

    I think this is a good idea.

  2. Step 3: Allow tax-free health savings accounts

    Contributions to them already are 100% income tax deductible and when used to pay for qualified health care expenses, so are the withdrawals. How much more tax free can they be?

  3. Step 4: Cut red tape and regulations on new drug research.

    Okay. What regulations strike you as the most important ones to alter? What aspects of "red tape" strike you as the most important ones to alter?
If you're going to ask me for specifics I can't really tell you because I don't know them all. I just know that it takes a ridiculous amount of time (and money) to bring new life-saving drugs to the market. Again, if we are going to address the cost of health care, things like this are going to have to be revisited. We have layer upon layer of regulations and mandates applied by government over the years which are driving up the costs of health care.

  1. Step 5: Cut red tape and regulations on new procedures.

    I think you need to explain just what you have in mind here. Nobody thinks more "red tape" is better than less but what sorts of regulations and "red tape" have you in mind? Make sure to identify only those that are governmentally imposed as contrasted with those that are stipulated by companies selling health insurance.
Same as the last answer... I don't know, we have to revisit all of this if we're going to bring down costs. There are literally tens of thousands of regulations, standards, mandates and requirements that have to be met before a new drug or procedure can be introduced to the public and this cost has to be recouped.

  1. Step 6: Allow alternative medicine options to be covered by health insurance.

    As far as I know, it's insurance companies that refuse -- as a business decision -- to cover alternative treatment modalities and medications more so than the government prohibiting them from doing so. I suppose one can legislatively, or via the regulatory process, require insurers to cover those sorts of things, but based on prior conversations with you, I don't think you'd cotton to that. Would you?
Again, my motive is to bring down cost of health care. If an insurance provider can pay less for a customer receiving homeopathic care as opposed to traditional care, why would they not want to do that? Now I can see how the insurance company doesn't want to be paying off snake oil salesmen for phony treatments that have no medical value on top of what they are already providing so this would have to be a refined solution. Still, I think reasonable actions could be taken if it lowers the cost of health care.

  1. Step 7: Allow hospitals to claim tax credits for all indigent care losses.

    This would be helpful to corporate hospitals; however, of the ~4900 community hospitals in existence, some 3900 of them (79%) are already tax-exempt. The thing is that "hospitals that provide higher levels of quality and access are ... more likely to be nonprofit than for-profit."

    That being so, I'm not at all keen on the idea of "rewarding" for-profit hospitals in advance of their demonstrably besting (or at the very least matching) the performance standards set by the non-profit peers. I didn't increase my kids' allowances prior to their demonstrating they deserved it. I see giving tax credits to hospitals in much the same context.

    I'd be okay with offering tax credits to for-profit hospitals once they achieve a performance measures that best those of non-profits. (The level would have to be a "one-way" thing; that is it can only be increased, not ever decreased.)
Now you're getting off in the weeds with this envy of capitalism crap where you don't think health care professionals ought to profit. I fundamentally disagree with such logic. Indigent care is mandated by law... hospitals must treat you regardless of ability to pay. This cost has to be recouped somehow and currently, it is recouped through charging the paying customer more. It seems to me, a tax credit would alleviate some of that cost and again, bring down the cost to the paying consumer or insurance provider.

  1. Step 8: Allow health insurance plans to be completely voluntary.

    Explain please because what you've written seems like "tits on a bull" to me. I'm not entirely sure what it means for a "health insurance plan to be voluntary." I have no reason to think health insurance plans are not currently voluntary. Nobody forces companies or individuals to engage in the provision of health insurance or not be members of the health insurance industry. Entry and exist are 100% voluntary.
ACA mandates you have health care coverage of pay a fine. I believe, when this is the standard, it causes the cost to skyrocket because it's mandated, you have no other option. When you are forced to purchase a product, that;'s not free market capitalism.

Step 9: Remove all requirements for minimal levels of health insurance coverage.

What exactly do you mean here? Are you of a mind that everyone should not necessarily have health insurance of some sort? Are you of a mind that folks should be able to a la carte choose what they want to be covered for? Something else?

I think insurance companies should be able to tailor plans for younger people who are relatively healthy and don't need comprehensive health care coverage. You know how auto insurers give safe driver discounts to people who haven't filed a claim recently? Something like that would be good to have with health care.

Step 10: Establish a pool for catastrophic-only health insurance coverage.

Okay. Who do you envision defining/establishing that pool (group?), that is, who gets to define what constitutes a "catastrophic health event" that would be covered under such a policy? I think what be a "catastrophic health event" can vary. For some folks, a paper cut is potentially catastrophic. For others, getting pregnant is. For pretty much everyone, breaking a bone or contracting appendicitis is a catastrophe. A catastrophe has multiple dimensions, for example, an element of lack of willful intent, temporal and situational surprise, an emergent or urgent need for amelioration, actual or potential impact on the person's life, etc. Under the right circumstances, pretty much any health-related malady can be catastrophic.

Well, I have not sat down and worked out some 2,000-page comprehensive health care plan. You keep asking me for specifics and details and I don't have those. I am merely making suggestions off the top of my head that would help lower the cost of health care, In my opinion, catastrophic would mean anything that would require an extended hospital stay... a heart attack or being hit by a bus. The parameters could be worked out but basically the insurance coverage would be for things that are unexpected and require long stays in the hospital. Routine procedures and doctors visits wouldn't be covered. People could pay for those things out of their health savings accounts.

Step 11: Repeal pre-existing illness mandates.

Okay. Why? I'm not 100% opposed, but I'm not about to jump "on board" with this idea. The idea that I might develop a chronic ailment while I work at ABC and then I change jobs, thus insurers, and now that ailment is deemed pre-existing thus my new insurer won't cover it -- even though were I to contract that ailment after joining the new insurance plan, it would be covered -- is just preposterous and just wrong to me.

Again, do we want to bring down the cost of health care or not? I know that it was a problem before ACA that insurance companies would weasel out of paying for things on the basis of "pre-existing" conditions, and I have no problem with measures to limit their ability to do that but I also understand the nature of how insurance works. You can't go buy car insurance after you've totaled your car... you can't buy fire insurance after your house burns down.

Step 12: Tax incentives for premiums paid when insurance is unused.

What incentives and who would receive them?

Taxpayers would receive them. In other words, you pay $x per year for insurance but you didn't file a claim... that money you paid should be rewarded with a tax credit or incentive of some kind to encourage healthy lifestyles. You're rewarding people for not using their health care insurance coverage. This means more people would use their insurance less and that means insurance providers could provide coverage for less.

Again, all of my suggestions are intended to bring down the cost of health care and health care coverage. Until we start trying to return things to the free market system, we'll continue to see unreasonably high costs associated with health care. You can't just shift the burden around to insurance companies, hospitals or government. The cost has to be dealt with in pragmatic ways that allow free market solutions.

"Why pay less, when you can pay more" is an axiom by which I suspect no one lives. Of course, lowering the cost of health care is desireable. What's more plausible is a slowing of cost increases, but whatever.

Thank you for your reply and participation in the thread.
 

Boss

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"Why pay less, when you can pay more" is an axiom by which I suspect no one lives. Of course, lowering the cost of health care is desireable. What's more plausible is a slowing of cost increases, but whatever.

Thank you for your reply and participation in the thread.

Well, lowering the cost of health care is the whole entire point, I thought. It's plausible if we take a measured approach at peeling back some of the bureaucratic layers of regulations that have effectively killed free market incentives. But what we have are the same exact people who have largely been responsible for creating the crisis, lobbying for more of the same kinds of changes that got us here in the first place.

Personally, I don't believe health care was as big of a crisis as liberal democrats made it out to be. If you have read Saul Alinsky's Rules for Radicals, you will find the #1 "measure of control" to bring about a Socialist state is to control health care. They have pushed for nationalized health care for the past 60 years because when you control health care, you control the people.

But I entertain these type of debates to make the point that, yes, there ARE things we can do... we can roll back this ever-increasing government encroachment into what should be a free market enterprise. Return health care to the free market and the free market will provide low cost solutions through competition.
 

2aguy

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Here's MY proposal...

Step 1: Tort reform- limitations on the amount any medical facility or professional can be sued for.

Step 2: Allow interstate insurance competition.

Step 3: Allow tax-free health savings accounts.

Step 4: Cut red tape and regulations on new drug research.

Step 5: Cut red tape and regulations on new procedures.

Step 6: Allow alternative medicine options to be covered by health insurance.

Step 7: Allow hospitals to claim tax credits for all indigent care losses.

Step 8: Allow health insurance plans to be completely voluntary.

Step 9: Remove all requirements for minimal levels of health insurance coverage.

Step 10: Establish a pool for catastrophic-only health insurance coverage.

Step 11: Repeal pre-existing illness mandates.

Step 12: Tax incentives for premiums paid when insurance is unused.


And right there in your post...we have American healthcare fixed and ready to be the best system in the world and again leading medical innovation and finding miracle cures....like we used to...
 

Mac1958

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Ol' Mac's Health Care Act of 2017

Based on what I think would be obvious:
  • It is insane to have seven (7) different health care delivery/payment systems, none of which talk to each other. Talk about inefficient.
  • Early and regular preventive/diagnostic/drug coverage before conditions get worse saves significant health care dollars
  • A healthier populace is good, smart economics.
  • Allowing insurance companies to compete for business by creating and offering attractive upgrades is good, smart economics.
  • Freeing employers from costs and regulations of providing health coverage is good, smart economics.
  • Opening the door to the industry that specializes in preventive/diagnostic services, motivating these clinics to pop up faster than Starbucks™, is good, smart economics.
So:

...Scrap this insane, archaic seven-piece system (Individual, Group, VA, Medicare, Medicaid, Worker's Comp indigent) for one two-tier plan for all
...Tort reform that addresses not only the cost of malpractice insurance, but the even higher cost of preventive medicine
...A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis:
...Strong preventive/diagnostic/drug coverage for all to detect problems earlier and keep them from appearing in the first place
...Adoption of Value-Based Insurance Design, VBID, look it up
...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone
...Open up a massive, 330 million person customer base to insurance companies via Medicare Supplements and Medicare Advantage plans
...Take a huge administrative monkey off the backs of private insurance companies by eliminating most basic care coverage
...Allow insurance companies to choose between national coverage or state-by-state
...Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals
...Maintain a significant and critical free market competition environment through the supplemental plans
...Watch preventive/diagnostic clinics spring up faster than Starbucks, decreasing the load on doctors and ER's
...Assistance on supplemental plans for low income, assuring even more business to competition-based private insurance companies
...Calculate net costs and add to current Medicare Tax - while freeing businesses and employees from the massive costs & regulations of group plans

Run it for two years and look for tweaks.
.
 

JoeMoma

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Healthcare will be at its best when all healthcare solutions are eradicated.
Huh? Solutions are good. We don't want to eradicate solutions.
 

oldsoul

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We grow ever closer to the point at which doctors can tell us exactly what we are "generally" at higher and lower risk of "getting" as go illnesses. Why not have health insurance that charges by the actual risk category. For example, some things -- pancreatic cancer -- for example can be experienced by men, women, young and old. That sort of stuff belongs in all policies; however, if a person is willing to forgo coverage for pancreatic cancer, they should be able to "opt out" of it and have their premium reduced accordingly. Similarly, no man will ever get cervical cancer, so policies for men should not include a fee for that covered risk.

Another provision I'd like to see is one that allows policyholders to, at will, opt in and out of coverage types. For example, if one is going to a place where dengue fever happens with some degree of regularity, one might be able to log onto the insurance company's site, add the dengue fever coverage, pay the premium bump for doing so, go on the trip, and and then drop it a month or two after returning. Lots of coverable conditions should work that way.

What do you think?

NOTE:
This is NOT an Obamacare thread, or even a political thread. Do not discuss what's wrong with O-care. Discuss and/or present only solution proposals for making the actua health insurance itself and how people may add or remove the coverage better.
That's how my homeowners and auto insurance policies work, why not for health coverage as well? Seems pretty reasonable to me. Why should a woman have to pay for coverage for testicular cancer? The likelihood of her contracting such a disease is incredibly low.
 
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We grow ever closer to the point at which doctors can tell us exactly what we are "generally" at higher and lower risk of "getting" as go illnesses. Why not have health insurance that charges by the actual risk category. For example, some things -- pancreatic cancer -- for example can be experienced by men, women, young and old. That sort of stuff belongs in all policies; however, if a person is willing to forgo coverage for pancreatic cancer, they should be able to "opt out" of it and have their premium reduced accordingly. Similarly, no man will ever get cervical cancer, so policies for men should not include a fee for that covered risk.

Another provision I'd like to see is one that allows policyholders to, at will, opt in and out of coverage types. For example, if one is going to a place where dengue fever happens with some degree of regularity, one might be able to log onto the insurance company's site, add the dengue fever coverage, pay the premium bump for doing so, go on the trip, and and then drop it a month or two after returning. Lots of coverable conditions should work that way.

What do you think?

NOTE:
This is NOT an Obamacare thread, or even a political thread. Do not discuss what's wrong with O-care. Discuss and/or present only solution proposals for making the actua health insurance itself and how people may add or remove the coverage better.
That's how my homeowners and auto insurance policies work, why not for health coverage as well? Seems pretty reasonable to me. Why should a woman have to pay for coverage for testicular cancer? The likelihood of her contracting such a disease is incredibly low.

Sort of off topic:
I know what the reasons are with regard to the current paradigm for how health insurance is provided. I don't particularly agree with those reasons, but I do know why they are applied in the design and offering of health insurance policies. I'm not going volunteer those reasons because I'm not going to give fodder to people who want to oppose my point of view on the matter. I'll offer a rebuttal if someone presents them on their own.

That's just sound debate strategy: never air a position for which one is not as well aware of the counterargument as is one of one's own argument. Or put another way, unarmed individuals are wise to eschew battles.
 
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Freeing employers from costs and regulations of providing health coverage is good, smart economics.

...Calculate net costs and add to current Medicare Tax - while freeing businesses and employees from the massive costs & regulations of group plans

Red:
Since you put the same idea in two places....

Businesses today voluntarily take on the costs associated with offering group health insurance policies/coverage to their employees. What you're proposing exists now. Don't offer the coverage and the costs won't be incurred. Health insurance employers offer is a benefit the companies elect to make available, but they don't have to make it available.

The beneficiaries/users of health insurance coverage don't have much choice about being indirectly subject to the costs resulting from regulation of group insurance plans.
Blue:
Can you explain what you mean by that, please?

Opening the door to the industry that specializes in preventive/diagnostic services, motivating these clinics to pop up faster than Starbucks™, is good, smart economics.

Red:
By "opening the door," do you mean reducing barriers to entry? If so, which of the current barriers to entry strike you as most onerous, being thus the ones that should ideally be removed first?

...A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis:
...Strong preventive/diagnostic/drug coverage for all to detect problems earlier and keep them from appearing in the first place
...Adoption of Value-Based Insurance Design, VBID, look it up
...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone
...Open up a massive, 330 million person customer base to insurance companies via Medicare Supplements and Medicare Advantage plans
...Take a huge administrative monkey off the backs of private insurance companies by eliminating most basic care coverage
...Allow insurance companies to choose between national coverage or state-by-state
...Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals
...Maintain a significant and critical free market competition environment through the supplemental plans
...Watch preventive/diagnostic clinics spring up faster than Starbucks, decreasing the load on doctors and ER's
...Assistance on supplemental plans for low income, assuring even more business to competition-based private insurance companies
...Calculate net costs and add to current Medicare Tax - while freeing businesses and employees from the massive costs & regulations of group plans

Format/punctuation clarification question:
Do you intend that all the items that follow the first one are elements of the theme articulated in the first statement? The colon suggests you do, but the format suggests you do not and that instead they each should be considered independently. I would like to be clear on which you intend before I endeavor to consider the individual proposal elements within the context of the Medicare framework you mention rather than just thinking of them as standalone proposals.​

...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone

Is the coverage two which you refer the share of provider fees as set/billed by the provider or do you mean it to be the share of insurer-provider negotiated payment rate. To illustrate:
  • Provider Fee: Dr. Green charges $400/hour for his services.
  • Negotiated payment rate: Dr. Green and Insurer X have agreed that the doctor will accept $200/hour for his services when patients having coverage through Insurer X obtain services from him.
Assuming an Insurer X-covered patient received 10 hours of service from Dr. Green, how much should the total compensation Dr. Green receives?
  • $2000 because the negotiated rate between Insurer X and Dr. Green transfers to them and there are two hours of uncovered services received?
  • $2400 because two hours of Dr. Green's services are not covered thus not subject to the negotiated rate for the covered services?
Note that one of the kinds of regulations that affect health insurance policies and the delivery and payment for health care services is regulation that governs whether Dr. Green is due a total of $2000 or $2400.

...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone
......Take a huge administrative monkey off the backs of private insurance companies by eliminating most basic care coverage

Those two proposals don't strike me as being consistent/compatible. Do you care to explain how, in your mind, they are?

...Allow insurance companies to choose between national coverage or state-by-state

They already can do this. A company that offers coverage in all 50 states is one that offers national coverage. The variability in state laws is what determines whether the terms of the policies differ by state, but even though they may so differ, the insurer is nonetheless offering national coverage and the policy will have applicability no matter where the insured obtains care.

...Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals

They already do this. Call your doctor what his/her rate is for a given service provided to patients who are not covered by an insurance policy the doctor accepts ("rack rate") and then look at the reimbursement statements you receive from your insurer for that service and you'll see that the insurer pays at a lower rate than the "rack rate" the doctor lists. Both figures -- the "rack rate" and the negotiated rate -- may even appear in the statement.

...A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis

What are the two tiers?

...Tort reform that addresses not only the cost of malpractice insurance, but the even higher cost of preventive medicine

Please explain how tort reform "addresses" the cost of preventive medicine?


Run it for two years and look for tweaks.
.

This is a good idea. There's no way any initial implementation will be free of missed opportunities and other shortcomings.
 
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Why has nobody yet mentioned the "two ton gorilla" that governs everything about how and why health insurance is offered, purchased, delivered, etc? Insurance differs from almost all other products/services one might buy: it's something we pay for that we don't actually want to use. The demand for insurance derives from the cost of that which insurance coverage allows us to avoid paying for out of pocket.

Let's face it. No one really desires health insurance; what folks want is either good health or treatment for an ailment, yet what we buy to obtain either of those two things is insurance. We don't pay for shirts to receive something other than shirts, even when we may on occasion hope to receive something in addition to the shirts. Sooner or later, therefore, effective health care reform will have to address the fact that what we pay for and what we actually want to receive are two totally different things.
 

Onyx

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Let's face it. No one really desires health insurance; what folks want is either good health or treatment for an ailment, yet what we buy to obtain either of those two things is insurance. We don't pay for shirts to receive something other than shirts, even when we hope to receive something in addition to the shirts. Sooner or later, therefore, effective health care reform will have to address the fact that what we pay for and what we actually want to receive are two totally different things.

I would be content never possessing health insurance, but that is against the law with the institution of the PPACA.

The probability of health insurance paying itself off before I am a senior citizen is low, and I resent the idea of becoming another old windbag on life support when I reach that age.
 

oldsoul

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Standing with Covington Kids
Why has nobody yet mentioned the "two ton gorilla" that governs everything about how and why health insurance is offered, purchased, delivered, etc? Insurance differs from almost all other products/services one might buy: it's something we pay for that we don't actually want to use. The demand for insurance derives from the cost of that which insurance coverage allows us to avoid paying for out of pocket.

Let's face it. No one really desires health insurance; what folks want is either good health or treatment for an ailment, yet what we buy to obtain either of those two things is insurance. We don't pay for shirts to receive something other than shirts, even when we may on occasion hope to receive something in addition to the shirts. Sooner or later, therefore, effective health care reform will have to address the fact that what we pay for and what we actually want to receive are two totally different things.
If the "two-ton gorilla" you are referring to is the actual cost of health care, wouldn't that be off topic? We are discussing health insurance, not the cost of health care, are we not?
 
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Why has nobody yet mentioned the "two ton gorilla" that governs everything about how and why health insurance is offered, purchased, delivered, etc? Insurance differs from almost all other products/services one might buy: it's something we pay for that we don't actually want to use. The demand for insurance derives from the cost of that which insurance coverage allows us to avoid paying for out of pocket.

Let's face it. No one really desires health insurance; what folks want is either good health or treatment for an ailment, yet what we buy to obtain either of those two things is insurance. We don't pay for shirts to receive something other than shirts, even when we may on occasion hope to receive something in addition to the shirts. Sooner or later, therefore, effective health care reform will have to address the fact that what we pay for and what we actually want to receive are two totally different things.
If the "two-ton gorilla" you are referring to is the actual cost of health care, wouldn't that be off topic? We are discussing health insurance, not the cost of health care, are we not?


Red:
The "gorilla" is that the basic economics applicable to insurance aren't those of standard supply and demand. How that works out to be so is fully explained (at least for the purposes of readers here) in the content linked.

Blue:
We are discussing health insurance. The "gorilla" has to do with how the equilibrium price for health insurance is determined. The economic principles of substitute goods and elasticity work very differently for insurance than they do for most other goods. The "good" supplied is part of a gambling proposition, the outcome of which is roughly well known: the supplying gambler can be assured that eventually they will "lose" because people get sick and injured, thus the supplier is gambling against time, not the actual outcome itself. The buyer of insurance is in effect wagering that s/he will at some point need more medical care than s/he paid for via insurance premiums because were s/he to know that the sum of premium payments made would exceed the fees owed for care, the buyer would simply put the money in a savings account and wait. Additionally, for iinsurers to "win" often enough to be profitable, they need health care providers and medical equipment producers to keep their prices high. In other industries, that doesn't happen.
 

Mac1958

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Freeing employers from costs and regulations of providing health coverage is good, smart economics.

...Calculate net costs and add to current Medicare Tax - while freeing businesses and employees from the massive costs & regulations of group plans

Red:
Since you put the same idea in two places....

Businesses today voluntarily take on the costs associated with offering group health insurance policies/coverage to their employees. What you're proposing exists now. Don't offer the coverage and the costs won't be incurred. Health insurance employers offer is a benefit the companies elect to make available, but they don't have to make it available.

The beneficiaries/users of health insurance coverage don't have much choice about being indirectly subject to the costs resulting from regulation of group insurance plans.
Blue:
Can you explain what you mean by that, please?

Opening the door to the industry that specializes in preventive/diagnostic services, motivating these clinics to pop up faster than Starbucks™, is good, smart economics.

Red:
By "opening the door," do you mean reducing barriers to entry? If so, which of the current barriers to entry strike you as most onerous, being thus the ones that should ideally be removed first?

...A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis:
...Strong preventive/diagnostic/drug coverage for all to detect problems earlier and keep them from appearing in the first place
...Adoption of Value-Based Insurance Design, VBID, look it up
...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone
...Open up a massive, 330 million person customer base to insurance companies via Medicare Supplements and Medicare Advantage plans
...Take a huge administrative monkey off the backs of private insurance companies by eliminating most basic care coverage
...Allow insurance companies to choose between national coverage or state-by-state
...Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals
...Maintain a significant and critical free market competition environment through the supplemental plans
...Watch preventive/diagnostic clinics spring up faster than Starbucks, decreasing the load on doctors and ER's
...Assistance on supplemental plans for low income, assuring even more business to competition-based private insurance companies
...Calculate net costs and add to current Medicare Tax - while freeing businesses and employees from the massive costs & regulations of group plans

Format/punctuation clarification question:
Do you intend that all the items that follow the first one are elements of the theme articulated in the first statement? The colon suggests you do, but the format suggests you do not and that instead they each should be considered independently. I would like to be clear on which you intend before I endeavor to consider the individual proposal elements within the context of the Medicare framework you mention rather than just thinking of them as standalone proposals.​

...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone

Is the coverage two which you refer the share of provider fees as set/billed by the provider or do you mean it to be the share of insurer-provider negotiated payment rate. To illustrate:
  • Provider Fee: Dr. Green charges $400/hour for his services.
  • Negotiated payment rate: Dr. Green and Insurer X have agreed that the doctor will accept $200/hour for his services when patients having coverage through Insurer X obtain services from him.
Assuming an Insurer X-covered patient received 10 hours of service from Dr. Green, how much should the total compensation Dr. Green receives?
  • $2000 because the negotiated rate between Insurer X and Dr. Green transfers to them and there are two hours of uncovered services received?
  • $2400 because two hours of Dr. Green's services are not covered thus not subject to the negotiated rate for the covered services?
Note that one of the kinds of regulations that affect health insurance policies and the delivery and payment for health care services is regulation that governs whether Dr. Green is due a total of $2000 or $2400.

...Basic medical/hospital coverage at 80% of system rates as a foundation for everyone
......Take a huge administrative monkey off the backs of private insurance companies by eliminating most basic care coverage

Those two proposals don't strike me as being consistent/compatible. Do you care to explain how, in your mind, they are?

...Allow insurance companies to choose between national coverage or state-by-state

They already can do this. A company that offers coverage in all 50 states is one that offers national coverage. The variability in state laws is what determines whether the terms of the policies differ by state, but even though they may so differ, the insurer is nonetheless offering national coverage and the policy will have applicability no matter where the insured obtains care.

...Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals

They already do this. Call your doctor what his/her rate is for a given service provided to patients who are not covered by an insurance policy the doctor accepts ("rack rate") and then look at the reimbursement statements you receive from your insurer for that service and you'll see that the insurer pays at a lower rate than the "rack rate" the doctor lists. Both figures -- the "rack rate" and the negotiated rate -- may even appear in the statement.

...A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis

What are the two tiers?

...Tort reform that addresses not only the cost of malpractice insurance, but the even higher cost of preventive medicine

Please explain how tort reform "addresses" the cost of preventive medicine?


Run it for two years and look for tweaks.
.

This is a good idea. There's no way any initial implementation will be free of missed opportunities and other shortcomings.
Businesses today voluntarily take on the costs associated with offering group health insurance policies/coverage to their employees.
Only because they have to. In order to attract, motivate and retain good employees, employers know they have little choice but to at least consider offering health coverage because their competition is. My +/- 100 business owner clients struggle with both the costs of coverage and the cost of regulation/administration daily.

Calculate net costs and add to current Medicare Tax - Can you explain what you mean by that, please?
While the average costs of the plan would be brought down by all the younger participants (I've seen estimates of around 70% - 70% of our health care costs happen after age 62), it's possible (I'd say almost certain) that the overall costs of the program would require an increase in the Medicare tax, currently 2.9%.

Opening the door to the industry that specializes in preventive/diagnostic services, motivating these clinics to pop up faster than Starbucks™, is good, smart economics. -- By"opening the door," do you mean reducing barriers to entry? If so, which of the current barriers to entry strike you as most onerous, being thus the ones that should ideally be removed first?
The only real barrier to entry for these kinds of clinics currently is volume. If the plan were properly and fully utilized it would flood the neighborhood GP office. The demand for these kinds of clinics would increase necessarily, and there are the profits. Also, since they'd be specializing in basic services only, that would almost certainly streamline costs.

Allow insurance companies to negotiate provider contracts to keep reimbursement acceptable for doctors and hospitals -- They already do this. Call your doctor what his/her rate is for a given service provided to patients who are not covered by an insurance policy the doctor accepts ("rack rate") and then look at the reimbursement statements you receive from your insurer for that service and you'll see that the insurer pays at a lower rate than the "rack rate" the doctor lists. Both figures -- the "rack rate" and the negotiated rate -- may even appear in the statement.
There might be some examples of private pay on the periphery, but for the most part this plan would be based on contracts with all providers and provider groups. Currently, reimbursement schedules for Medicare and Medicaid are so low that providers have to "budget" a portion of their practice for those payment systems. Once they're "full", that's it. Seniors from coast to coast are already dealing with this. Reimbursements would have to increase across the board to all providers, compared to current Medicare and Medicaid levels.


A two-tier, portable, individual health care system based on the current Medicare/Medicare Supplement/Medicare Advantage chassis. Basic medical/hospital coverage at 80% of system rates as a foundation for everyone -- Is the coverage two which you refer the share of provider fees as set/billed by the provider or do you mean it to be the share of insurer-provider negotiated payment rate.
Under current Medicare law, everything is based on the "Medicare-approved amount" of the service. These figures are far lower than "retail" costs, which is why most providers "budget" only a certain portion of their practices to Medicare. So the 80% coverage is 80% of the Medicare-approved amount. I had a client get an MRI that would have cost $2,400 "retail", but she saw on the DOC that Medicare paid $400. That imbalance would have to be addressed from the provider reimbursement standpoint.


What are the two tiers?

Just as it is right now with the Medicare/Medicare Advantage/Medicare Supplement system: A foundational public piece for all (Medicare) and a free market "added value" piece to fill the holes left by deductibles, co-insurance and co-pays (Medicare Advantage and Medicare Supplements).

Tort reform that addresses not only the cost of malpractice insurance, but the even higher cost of preventive medicine -- Please explain how tort reform "addresses" the cost of preventive medicine?
As high as malpractice insurance premiums are, they pale in comparison to the costs of "preventive medicine", the over-testing and over-diagnosing done to protect the provider from a lawsuit down the road. If Tort Reform better protected the provider, average diagnostic costs would decrease, at least somewhat.
.
 
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