How would you change the medical care delivery / insurance system in the US?

[tjl]

They (the sickly) are either capable or not of acquiring for themselves health services. Should they fail to do so by means of responsible consumerism (or should such be rendered impossible via health insurance by the restrictions imposed by companies) - too bad, so sad. Why should I, a healthy individual who (albeit fairly recently) takes what I consider to be an adequate level of responsibility for his health, be required to subsidize those who are not and do not?

It is likely that the medical insurance market will function poorly as a free market. Because medical treatment is often ongoing, where costs are spread out over a period of time, and are also fairly predictable, a medical insurance company will drop the customer as soon as it has any indication of expensive treatments needed in the future (insurance companies that do not follow this practice will be at a competitive disadvantage compared to others). In which case, medical insurance would be rather worthless, since it will not cover much (basically up to the doctor visit where you are diagnosed with the condition).

A completely free market system without regulation would likely mean that everyone would have to self-insure. Not necessarily a bad thing in many contexts, but the possibility of uninsurable high medical expenses that would bankrupt all but the wealthiest 5% of the people may result in more people going bankrupt, as well as other possible changes in consumer behavior due to uninsurable possible expenses.

There are other issues, like what if the emergency room cannot find the patient's insurance card or other indication that s/he can pay for the emergency room treatment? Currently in the US, emergency rooms have to treat the patient anyway, but that just spreads the costs of covering the uninsured to everyone else.

 

[[Focus]]

It is likely that the medical insurance market will function poorly as a free market. Because medical treatment is often ongoing, where costs are spread out over a period of time, and are also fairly predictable, a medical insurance company will drop the customer as soon as it has any indication of expensive treatments needed in the future (insurance companies that do not follow this practice will be at a competitive disadvantage compared to others). In which case, medical insurance would be rather worthless, since it will not cover much (basically up to the doctor visit where you are diagnosed with the condition).

Responsible consumers would swiftly bankrupt any company that behaved in such a manner. Once again, the whore would be kept in line, or be replaced by one who better understood and was better willing to do the job.

A completely free market system without regulation would likely mean that everyone would have to self-insure..

Unlikely for any prolonged duration. See above. To clarify, there is no such thing as a system without regulation - once again, the onus would be on conscientious subscribers to prevent health insurance companies from ruining everything. Were they unable to do so, another should and will take its place and, presumably, do better. If it is to survive.

There are other issues, like what if the emergency room cannot find the patient's insurance card or other indication that s/he can pay for the emergency room treatment? Currently in the US, emergency rooms have to treat the patient anyway, but that just spreads the costs of covering the uninsured to everyone else.

It follows from my previous post that in such cases the patient would be turned away; I don't see how the effected decrease in nonessential government spending would constitute a problem.

 

[tjl]

Responsible consumers would swiftly bankrupt any company that behaved in such a manner. Once again, the whore would be kept in line, or be replaced by one who better understood and was better willing to do the job.

However, most consumers are not particularly careful or responsible, especially when it comes to relatively complex things like medical insurance. And medical insurance companies will do their best to hide how much they drop customers as soon as the first doctor visit that indicates expensive treatment in the near future, so that even careful and responsible consumers will have a hard time using that as a basis for selecting an insurance company.

It follows from my previous post that in such cases the patient would be turned away; I don't see how the effected decrease in nonessential government spending would constitute a problem.

Then you got the problem of someone who is adequately insured or self-insured, but just happens to not have his/her insurance card or information, and may not be conscious enough to say anything to the emergency room people.

For example, an ambulance brings in an alive, but unconscious, person with a gunshot wound to the emergency room. S/he has no identification or insurance card; it is likely that s/he is a victim of a robbery and the robbers took his/her wallet with identification and insurance card. Should the emergency room treat this person?

 

[NoLoveLost]

One thing that needs to be thought about is that if insurers were not allowed to exclude or charge higher premiums for pre-existing conditions, then coverage would have to be made universal and mandatory, in order to avoid adverse selection, where some people may voluntarily go uninsured, but buy insurance just when the doctor says "you have ____ which requires ___ expensive treatments over the next several months." That would be analogous to knowing when you will have a car crash or house fire and buying car or house insurance the day before.

Then that leads to the problem of some people not being able to afford the mandatory insurance, which would mean some sort of government subsidy, voucher, or something like that so that everyone could have it.

well I think there is a difference between someone who smokes and then gets insurance because they have been diagnosed with lung cancer, and those like my kids who were born autistic and dx'ed with FXS (also born with, but discovered later) diagnosed later after testing had been done.

People have these issues with the insurance companies. So I have to change insurance because my job changes, but they won't cover the kids because they have a dx of autism, even though their old insurance covered it? what then?

There has to be some instances where this has to be addressed. It's ridiculous the ignore people who can't help what they have. It's another when they can.....

 

[[Focus]]

However, most consumers are not particularly careful or responsible, especially when it comes to relatively complex things like medical insurance. And medical insurance companies will do their best to hide how much they drop customers as soon as the first doctor visit that indicates expensive treatment in the near future, so that even careful and responsible consumers will have a hard time using that as a basis for selecting an insurance company.

Well, yeah. This is why we have 'watchdog's. Trick is making sure they too are doing their jobs, but that's another matter.

Regardless, none of those considerations are problems in my model - anyone who can't be bothered to know what they're paying for gets ripped off.

If this should mean the majority, as it usually does, then it's up to the brave few to bring it to the attention of the public and convince them to act or to devise an alternative that does not fall victim to the unwashed masses (an NPO springs to mind) or whatever other solution is viable at the time.

Then you got the problem of someone who is adequately insured or self-insured, but just happens to not have his/her insurance card or information, and may not be conscious enough to say anything to the emergency room people.

For example, an ambulance brings in an alive, but unconscious, person with a gunshot wound to the emergency room. S/he has no identification or insurance card; it is likely that s/he is a victim of a robbery and the robbers took his/her wallet with identification and insurance card. Should the emergency room treat this person?

No.

That person should have elected for or devised some means of identification in the event of such an occurrence. An ounce of prevention is worth.. your ass.

 

[tjl]

If this should mean the majority, as it usually does, then it's up to the brave few to bring it to the attention of the public and convince them to act or to devise an alternative that does not fall victim to the unwashed masses (an NPO springs to mind) or whatever other solution is viable at the time.

NPO?

The more likely result when the majority of consumers are uninformed or easily duped is that good plans catering to informed consumers will be crowded out of the market because not very good plans will dominate. Consider the markets for gyms and cell phones, where most people are dissatisfied with the business practices of both types of companies, and "good" services are often hard to find in many areas.

That person should have elected for or devised some means of identification in the event of such an occurrence. An ounce of prevention is worth.. your ass.

What would you do to prepare for this situation (needing emergency room treatment, but your medical insurance card or other indication of ability to pay is lost or stolen or not with you when you are brought in unconscious by ambulance)?

 

[[Focus]]

There has to be some instances where this has to be addressed. It's ridiculous the ignore people who can't help what they have. It's another when they can.....

I understand this is probably a sensitive issue for you (and for most others, I imagine, come to think), and I apologize if I seem entirely callous here.

To clarify a little, what I personally am saying is not at all that your kids don't deserve insurance, but that I disagree with them enjoying a much higher product/service obtained : cost than I myself for example would. What this would entail is essentially forced charity, and (while I believe it is every citizen's duty to do charitable works as they can) that is not the place government.

I like to think that in a free system providers would eventually be stratified such that different classes would emerge of insureds and insurers. Which will of course mean that those who are least healthy or have the highest regular costs must pay considerably more, but shouldn't they?

And it would be my hope that costs in the case of persons such as your children who are merely unlucky (in the sense of having higher than usual medical expenses through no fault of their own) would receive ample support from charitable institutions (as I believe they should and would). Whereas those who are unhealthy due to a glaring disregard for their own well-being would, I expect, receive no financial assistance at all.

 

[[Focus]]

NPO?

Non-profit organization.

The more likely result when the majority of consumers are uninformed or easily duped is that good plans catering to informed consumers will be crowded out of the market because not very good plans will dominate. Consider the markets for gyms and cell phones, where most people are dissatisfied with the business practices of both types of companies, and "good" services are often hard to find in many areas.

This is probably true, but the proliferation of apathy and ineptitude are unfortunate (and at this stage in our evolution I think unavoidable) side-effects of freedom. Or that all the irresponsible folk die off due to inadequate medical care.

What would you do to prepare for this situation (needing emergency room treatment, but your medical insurance card or other indication of ability to pay is lost or stolen or not with you when you are brought in unconscious by ambulance)?

Off the top of my head: belong to a provider that maintains an easily accessible database that hospitals know to peruse in order to id me by say fingerprint or retina scan (obvious solution); failing that, have my information tattoo'd on multiple and distal areas of my skin; failing that, have a device implanted which is tracked by an infallible machine that will notify any hospital I enter of my details upon my entering.

Later, I imagine most citizens will have a convenient id chip in them somewhere (this technology is not very far at all off the horizon, believe it or not) that will render this a non-issue. Regardless, the burden is on the individual, not the public. If the individual has not taken adequate precautionary measures, or has and is just catastrophically unlucky, well - sucks to be her!

 

[tjl]

Non-profit organization.

A non-profit organization medical insurance company faces many of the same problems that a for-profit medical insurance company faces, such as the adverse selection problem. And non-profit does not necessarily mean well run (they cannot disregard profit, since running at a negative profit for a while will put it out of business) or run with honorable business practices.

Off the top of my head: belong to a provider that maintains an easily accessible database that hospitals know to peruse in order to id me by say fingerprint or retina scan (obvious solution); failing that, have my information tattoo'd on multiple and distal areas of my skin; failing that, have a device implanted which is tracked by an infallible machine that will notify any hospital I enter of my details upon my entering.

Wouldn't that greatly limit your choice of providers (insurance companies and hospitals)? Also, if you are traveling to an area where the local emergency room does not have the fingerprint or retina scanner, what happens then? The tattoo idea means getting your tattoo erased and redone if you change insurance companies. On a large scale, it will likely make the market less flexible, as people will resist changing to a better plan due to the unpleasantness of changing tattoos. And what infallible machine will you be carrying at all times (or that every hospital will have)?

Later, I imagine most citizens will have a convenient id chip in them somewhere (this technology is not very far at all off the horizon, believe it or not) that will render this a non-issue. Regardless, the burden is on the individual, not the public. If the individual has not taken adequate precautionary measures, the individual is **** out of luck.

What if the ID chip is missing or non-functional when you are brought into the emergency room (for example, it was damaged because it was in a part of your body that was injured that caused you to be taken to the emergency room)? Also, many of the more libertarian types like you seem to be might be wary of such implanted ID chips as something that can be abused by a government or non-government organization. And, of course, the ID chip scanning device needs to be present in every hospital, and it must be able to quickly find out from the ID information what insurance or ability to pay the person has (if it is a centralized database, that may be a target for people of dodgy intentions; if it involves querying individual insurance companies, that may take more time; and either case may result in delays due to network problems).

Of course, another problem with applying pure market principles to the emergency room is that the buyer is unlikely to be in a position to make an informed decision when there are multiple possibilities of treatment, with different levels of effectiveness and cost. Even in asking the ambulance to go to a certain hospital when several are nearby may not be an informed decision, since people in emergency situations do not have the time to look up which hospital provides the best care (and at reasonable cost).

 

[[Focus]]

A non-profit organization medical insurance company faces many of the same problems that a for-profit medical insurance company faces, such as the adverse selection problem. And non-profit does not necessarily mean well run (they cannot disregard profit, since running at a negative profit for a while will put it out of business) or run with honorable business practices.

Didn't say they would. Merely implied that there would be less incentive to favor profit over service. Particularly, I expect, if their dealings were entirely transparent and closely watched, as, presumably, no for-profit organization's would be (or to your thinking, could be).

But that (NPO provider/s)'s no end all, and wasn't suggesting as one - merely an inchoate notion. The fact of the matter is, the organization would be accountable to the people directly rather than their "elected representatives", providing a capability on the part of the public for direct, and rather more immediate, corrective action. If, as you say, a company is (heavily) in the red, it cannot exist that way for long.

Wouldn't that greatly limit your choice of providers (insurance companies and hospitals)? Also, if you are traveling to an area where the local emergency room does not have the fingerprint or retina scanner, what happens then?

Yes, it would. Ideally, over time, all providers would make use of the system, cutting the tree at its root rather than at its branches. Until then, don't lose your ****, or go with the other options.

The tattoo idea means getting your tattoo erased and redone if you change insurance companies. On a large scale, it will likely make the market less flexible, as people will resist changing to a better plan due to the unpleasantness of changing tattoos.

A tattoo of something as basic as your insurance info wouldn't exactly be a huge hassle. It/they wouldn't even need to be of the permanent variety. You might reapply a fake one, or use henna, every couple of weeks, if you're so paranoid about losing your identification and/or insurance information. Until you figure out something better.

And what infallible machine will you be carrying at all times (or that every hospital will have)?

A basic gps device. The infallible machine would be whatever's on the other end watching out for where you are and ready to send the requisite information. Sort of like those toys some hikers have.

What if the ID chip is missing or non-functional when you are brought into the emergency room (for example, it was damaged because it was in a part of your body that was injured that caused you to be taken to the emergency room)?

What if the ambulance is hit by a bus at high speed? Too bad.

Also, many of the more libertarian types like you seem to be might be wary of such implanted ID chips as something that can be abused by a government or non-government organization. And, of course, the ID chip scanning device needs to be present in every hospital, and it must be able to quickly find out from the ID information what insurance or ability to pay the person has (if it is a centralized database, that may be a target for people of dodgy intentions; if it involves querying individual insurance companies, that may take more time; and either case may result in delays due to network problems).

Digital signatures and encryption. Also, I'll thank you not to call me a libertarian.

If your intention is to illustrate the fact that such systems will never be 100% reliable, wouldn't it be simpler to just say it? It is not my estimation that the trivial potential for the occasional victim of circumstance is a valid argument against the benefits of the system in which they would occur. Just as the occasional innocent man going to his death is not a good reason to keep an entire horde of monsters alive.

Of course, another problem with applying pure market principles to the emergency room is that the buyer is unlikely to be in a position to make an informed decision when there are multiple possibilities of treatment, with different levels of effectiveness and cost. Even in asking the ambulance to go to a certain hospital when several are nearby may not be an informed decision, since people in emergency situations do not have the time to look up which hospital provides the best care (and at reasonable cost).

Yes, and a lot of people shop at their local grocer because it's more convenient (by virtue of being closer) than going to the big chain. While not agreeable to my mind, or ideal, this is a perfectly legitimate function of the market. I refer you to my previous mention of the cost of freedom.

 

[NoLoveLost]

I understand this is probably a sensitive issue for you (and for most others, I imagine, come to think), and I apologize if I seem entirely callous here.

To clarify a little, what I personally am saying is not at all that your kids don't deserve insurance, but that I disagree with them enjoying a much higher product/service obtained : cost than I myself for example would. What this would entail is essentially forced charity, and (while I believe it is every citizen's duty to do charitable works as they can) that is not the place government.

I like to think that in a free system providers would eventually be stratified such that different classes would emerge of insureds and insurers. Which will of course mean that those who are least healthy or have the highest regular costs must pay considerably more, but shouldn't they?

And it would be my hope that costs in the case of persons such as your children who are merely unlucky (in the sense of having higher than usual medical expenses through no fault of their own) would receive ample support from charitable institutions (as I believe they should and would). Whereas those who are unhealthy due to a glaring disregard for their own well-being would, I expect, receive no financial assistance at all.

I didn't feel you were being callous Focus. I can understand that it would indeed seem that the cost of people like my children receiving medical attention would indeed be higher and thus would (and should) be more costly for the insured. However, I feel it isn't right for the insurance companies to be able to completely deny them any medical insurance, or deny them the benefits for which they have a pre-existing condition that was "fate". And they do that.

Cost is something many have to endure, and those who are normally healthy should not have to bear the burden of those who are "naturally" not. However, again, I feel that there has to be some sort of medical assistance available to them for their condition, without the discrimination being held against them because of something they cannot help.

The government provides medicare for many who are disabled, but you have to fall within a certain income bracket or age bracket. It should be that if you are disabled, have a condition that you did not bring on yourself, you should be able to receive medicare if you are not able to afford insurance independently.

For many years we struggled even with the help of the medical assistance we got thru the military. We made too much money to get medicare, yet, we could barely afford to get food. It was ridiculous. We scrapped by for YEARS and if it weren't for the help of family, we wouldn't have made it.

Thankfully did have family and we were able to get back on our feet and even flourish. But I know what it is like to struggle, and I don't believe that people should have to struggle at the hands of a bad health care system. There is no doubt, it is something that is dire need of "fixing".

This country has more than enough money to provide for the people who are here.....but bureaucracy prevents it........

 

[evolution]

Why would you waste good ink on getting a tattoo of your insurance company? Come to think of it, maybe we could pull off a nice Maori style FARMER'S INSURANCE right across my back.

 

[NoLoveLost]

Why would you waste good ink on getting a tattoo of your insurance company? Come to think of it, maybe we could pull off a nice Maori style FARMER'S INSURANCE right across my back.

crazy man...lol been missing your whippings??? :action6:

 

[evolution]

crazy man...lol been missing your whippings??? :action6:

I do miss you and your abuse.

 

[NoLoveLost]

I do miss you and your abuse.

AWWW sweetie, I'm always thinking how I can abuse you .... :love3::angry3: