OK, to begin with, the whole system is a mess. Anyone who says we couldn't do better is delusional. And anyone who says that the government is completely inept is also not paying attention to Medicare. Truth is, by the time we pay for private health insurance from our pocket, private health insurance by our employer, Medicare tax, fund Medicaid with federal money, pay local taxes for ER care for those who no other option, we pay plenty on health care in this country.
The problem is that the free market is almost non-existent in health care. I grew up in a rural area in the Midwest in the middle of a sizable Amish community. Between the Amish and low income working people there were a LOT of uninsured Americans. If you walk into the local bar, coffee shop or grocery store there is a flyer about every month for a fundraiser to pay for someone's uninsured medical expenses. It is not that they were denied medical treatment. They weren't. They got treatment. Maybe not optimal treatment from the best doctor/hospital buy they got medical care. What they didn't have was money for the extra 'AFLAC' type of expenses for travel, time off work, follow up physical therapy, and the medical bills they could not pay. It is a sad situation but of all those problems, unpaid medical bills is at the bottom of the list.
The Amish are a different and very interesting study. They purposefully don't participate in medical insurance groups or pay Social Security or Medicare taxes. They are a self insured group. But they are very savvy consumers about any type of elective treatment. (note: They get the cash price noted below. Or go to Mexico/Canada for certain procedures or look alternative medical treatment).
Need an MRI? What is the cost? (This is not a specific example- only an illustration based loosely on my general reading)
Insurance A? $1,500.00
Insurance B? $950.00
No insurance list price? $2,000.00
Medicare/Medicaid? $550.00.
Paying cash in advance? $350.00
Local government 'free' care? $250.00
Why does the same procedure have FIVE different prices with the only difference being the payer?
THAT is the real problem with our health system.
Advocates of universal health care point to Medicare and its pricing system and tell us that the GOVERNMENT is the answer. But these people couldn't anticipate a curve in the road with blinking lights, barricades and five yellow signs.
If ALL care was government care? Innovation would die. Customer service would become non-existent. And many patients would unnecessarily die because of undue waits and sloppy health care. Because one of the necessary features of Universal care would be the loss of accountability by your health care provider.
I actually think that the ACA was a good step forward. The problem was it fashioned the government as THE answer, not the facilitator of the ANSWER.
Let me use an example of regulated homeowner insurance and auto insurance. Each state creates a basic uniform policy that is standard for all licensed insurers. Endorsements and riders add or subtract from the basic policy and, of course, policy limits differ based on the insured. But all insurers offer virtually the same coverage and are competitive in pricing. They differentiate themselves and make their money on marketing, customer service and claims adjusting.
The problem is that every insurance policy differs by state because the McCarran Ferguson Act specifically delegates insurance regulation to the states. So State Farm has 50 standard polices for each of the 50 states. The same is true for health insurance which is a REAL money waster given the number of people who work in one state but live or receive treatment in another state.
But what if the McCarran Ferguson Act was amended to provide that the federal government would prescribe standard insurance policies? with these features?
Gold, Silver and Bronze policies with different riders.
NO group polices although a group could negotiate a management contract/premium based on their group. So, you may select a Bronze policy from your employer, who may receive a 20% group discount, but you could keep it and not be cancelled even if you left your employer.
Bronze would be the basic minimum policy and the government would subsidize and pay for this policy for those unable to do so themselves. To fund these policies the government would use the pool of taxes from Medicare taxes and local taxes that are dedicated to health care but would pay PRIVATE managed companies/insurers.
Chronic illnesses like diabetes, hypertension and respiratory problems would have generic drugs like insulin and blood pressure medication that would be available in generic form at low cost. Want a newer, possibly more effective drug? Buy the Silver or Gold plan?
Premiums would be set in prescribed ranges based on criteria like age, gender, BMI but not on individual health histories. So there would be no pre-existing condition exclusion.
The system would have strong incentives for prevention of chronic disease and healthy lifestyle. By the same token, analysis would be made of all treatments, often end of life, for the cost versus effectiveness of the treatment. Hard decisions would be made about the reimbursement of certain treatments.
Pricing for procedures, drugs and treatments would be transparent based upon quality and effectiveness.
Anyway, this is my health care plan. It is not Universal health care. The federal government is NOT insuring and negotiating with health care providers but only the price for basic care. But it would provide health care for all Americans and remove a lot of the pricing discrepancies and barriers to coverage of many Americans. And this is a very ROUGH draft for discussion purposes.
The problem is that the free market is almost non-existent in health care. I grew up in a rural area in the Midwest in the middle of a sizable Amish community. Between the Amish and low income working people there were a LOT of uninsured Americans. If you walk into the local bar, coffee shop or grocery store there is a flyer about every month for a fundraiser to pay for someone's uninsured medical expenses. It is not that they were denied medical treatment. They weren't. They got treatment. Maybe not optimal treatment from the best doctor/hospital buy they got medical care. What they didn't have was money for the extra 'AFLAC' type of expenses for travel, time off work, follow up physical therapy, and the medical bills they could not pay. It is a sad situation but of all those problems, unpaid medical bills is at the bottom of the list.
The Amish are a different and very interesting study. They purposefully don't participate in medical insurance groups or pay Social Security or Medicare taxes. They are a self insured group. But they are very savvy consumers about any type of elective treatment. (note: They get the cash price noted below. Or go to Mexico/Canada for certain procedures or look alternative medical treatment).
Need an MRI? What is the cost? (This is not a specific example- only an illustration based loosely on my general reading)
Insurance A? $1,500.00
Insurance B? $950.00
No insurance list price? $2,000.00
Medicare/Medicaid? $550.00.
Paying cash in advance? $350.00
Local government 'free' care? $250.00
Why does the same procedure have FIVE different prices with the only difference being the payer?
THAT is the real problem with our health system.
Advocates of universal health care point to Medicare and its pricing system and tell us that the GOVERNMENT is the answer. But these people couldn't anticipate a curve in the road with blinking lights, barricades and five yellow signs.
If ALL care was government care? Innovation would die. Customer service would become non-existent. And many patients would unnecessarily die because of undue waits and sloppy health care. Because one of the necessary features of Universal care would be the loss of accountability by your health care provider.
I actually think that the ACA was a good step forward. The problem was it fashioned the government as THE answer, not the facilitator of the ANSWER.
Let me use an example of regulated homeowner insurance and auto insurance. Each state creates a basic uniform policy that is standard for all licensed insurers. Endorsements and riders add or subtract from the basic policy and, of course, policy limits differ based on the insured. But all insurers offer virtually the same coverage and are competitive in pricing. They differentiate themselves and make their money on marketing, customer service and claims adjusting.
The problem is that every insurance policy differs by state because the McCarran Ferguson Act specifically delegates insurance regulation to the states. So State Farm has 50 standard polices for each of the 50 states. The same is true for health insurance which is a REAL money waster given the number of people who work in one state but live or receive treatment in another state.
But what if the McCarran Ferguson Act was amended to provide that the federal government would prescribe standard insurance policies? with these features?
Gold, Silver and Bronze policies with different riders.
NO group polices although a group could negotiate a management contract/premium based on their group. So, you may select a Bronze policy from your employer, who may receive a 20% group discount, but you could keep it and not be cancelled even if you left your employer.
Bronze would be the basic minimum policy and the government would subsidize and pay for this policy for those unable to do so themselves. To fund these policies the government would use the pool of taxes from Medicare taxes and local taxes that are dedicated to health care but would pay PRIVATE managed companies/insurers.
Chronic illnesses like diabetes, hypertension and respiratory problems would have generic drugs like insulin and blood pressure medication that would be available in generic form at low cost. Want a newer, possibly more effective drug? Buy the Silver or Gold plan?
Premiums would be set in prescribed ranges based on criteria like age, gender, BMI but not on individual health histories. So there would be no pre-existing condition exclusion.
The system would have strong incentives for prevention of chronic disease and healthy lifestyle. By the same token, analysis would be made of all treatments, often end of life, for the cost versus effectiveness of the treatment. Hard decisions would be made about the reimbursement of certain treatments.
Pricing for procedures, drugs and treatments would be transparent based upon quality and effectiveness.
Anyway, this is my health care plan. It is not Universal health care. The federal government is NOT insuring and negotiating with health care providers but only the price for basic care. But it would provide health care for all Americans and remove a lot of the pricing discrepancies and barriers to coverage of many Americans. And this is a very ROUGH draft for discussion purposes.
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