Should Government fix Healthcare?

[maat55]

This is an interesting view of how government fixing healthcare led to the mess it is now.

How Government Solved

[jIM_Ohio]

The fix is simple- only offer HDHP policies and make EVERYONE pay the same for health care.

Not a co-pay, but the real cost (up to some limit, like $3000 or $4000 per year). Premiums paid would then go down, giving the insurance companies less money to corrupt the systems.

The problem is the insurance companies have too much control over health care and that people want good health care, but are NOT willing to pay full price for it.

[maat55]

The fix is simple- only offer HDHP policies and make EVERYONE pay the same for health care.

Not a co-pay, but the real cost (up to some limit, like $3000 or $4000 per year). Premiums paid would then go down, giving the insurance companies less money to corrupt the systems.

The problem is the insurance companies have too much control over health care and that people want good health care, but are NOT willing to pay full price for it.

If companies stopped paying for insurance and the people had to provide their own, they would likely go to the HDHP policy. I was on one before my wife got ours through her work.

[Joan.of.the.Arch]

I'm thinking maybe government should fix insurance companies.

[disneysteve]

The fix is simple- only offer HDHP policies and make EVERYONE pay the same for health care.

Not a co-pay, but the real cost (up to some limit, like $3000 or $4000 per year).

That would probably need to be tiered by income somehow since paying 4K out of pocket if you earn 200K is much different than doing so if you earn 30K.

You are absolutely right that people want care but aren't willing to pay for it. The problem is that when they have to pay for it, they are much more likely to forgo necessary care. That ends up costing more money down the road. Making folks responsible for the first 4K would likely lead into that problem.

[LivingAlmostLarge]

Yep, consider how many people would rather buy a new car than preventative healthcare or dental? Then they would blame everyone else later.

Sounds great to get everyone a HDHP. But truth is they would still expect top notch care and NO one would die. No one would have to say grandma should die because she's 85 and chemo is harsh.

When we get around that, maybe we can reform the system. Until then we'll want extraordinary measures for free.

So I'm for just making it socialized so people just pay up front. We'll pay anyway with an HDHP. Just more because people won't buy it or the insurance company will skirt paying for it, and people will demand services.

[jIM_Ohio]

That would probably need to be tiered by income somehow since paying 4K out of pocket if you earn 200K is much different than doing so if you earn 30K.

You are absolutely right that people want care but aren't willing to pay for it. The problem is that when they have to pay for it, they are much more likely to forgo necessary care. That ends up costing more money down the road. Making folks responsible for the first 4K would likely lead into that problem.

Preventative care is free with my hdhp, so the cost of preventative care should not be a huge issue.

[disneysteve]

Preventative care is free with my hdhp, so the cost of preventative care should not be a huge issue.

What counts as preventative care? Is that just an annual physical or does it also include bloodwork, mammogram, PAP smear, colonoscopy, etc.

I actually wasn't thinking about preventative stuff but actual treatments. Look, I've got plenty of patients who have good insurance who don't comply with treatment advice even though doing so would cost them little to nothing. Make them pay for that same treatment and what do you think will happen to compliance?

[MonkeyMama]

I agree with the comments.

Since we are privately insured (always have been. 75% of small business employers do not offer health coverage - can't afford it or get group policies & whenever I have had insurance offered - it sucked).

Anyway, when private insurance was our choice over employer coverage I never came across anyone who would shop around. They would take it for free even if it sucked and only saved them $20/month. Having always paid for our own health insurance I don't quite *get* the current system. PEople are unwilling to shop around and unwilling to pay more than a few dollars for medical care. It's absurd to me.

On the flip side, whenever the subject comes up, when people here how much we do pay for our medical insurance, they assume I am all excited about Obama and a possible government health plan.

Um, no. As long as I can afford private insurance I am keeping it. I have a lot of friends in the military and a lot of friends in Canada. They are a lot like Americans. The only good thing they can say about it is that it is free! Plus I am not naive enough to think that if it comes from the government it is free. Then it comes from our tax dollars. Then I will lose my choice. But seriously, Canada's healthcare has some SERIOUS issues. Try finding a doctor, for one.

Something has to be done, for sure. Government fixing it? Ugh.

HDHP has bee a little "too good to be true" since we don't mind paying for care when we use it. I love it, because we have savings, etc. We just paid $85 for a doctor visit for our son who was having an issue. A relative said "That was $20 well spent!" We just rolled our eyes. Pffft. I haven't paid $20 for a doctor visit since I was under my parent's insurance in college. But yeah, people freak out when you say you spent more than $20 at the doctor. I don't mind paying $85 for a DOCTOR. I am more concerned that our insurance premiums go up 10-40% every year. But so many people under the bubble of their employer don't *get* that.

[MonkeyMama]

My healthcare plan is good about covering preventitive things, or only charging like $10 for those. For example I don't think we paid much at all out of pocket during my pregnancies. The kids' checkups are always "free" as are their shots. Stuff like that. My experience of late is more pregnancy/kid, so I Can't speak to much else.

[LivingAlmostLarge]

I believe that if we paid like you MM, less people would go and be more pissed.

Sounds good in principal, but when it's actually applied people would whine and bitch about it.

Truth is that like pensions, employer provided coverage is what society expects. And they expect insurance to cover everything. Keep me alive at any cost!

Until we accept it's not financially possible either way, we won't be able to move to a free market healthcare or government healthcare.

Both paths require people to accept they can't have everything paid for. One because you are too poor to afford it, and the other because it's not cost efficient.

But I watched a John McCain interview in December, he said we're in a perfect storm for healthcare. Watch as people lose jobs, lose health insurance. Then they are uninsurable or can't afford care. Suddenly they will either want socialized medicine OR they will feel that everyone should pay out of pocket.

Who knows which way it will go. But until you are in the boat of not affording care, most of us have no sympathy. But when we are, suddenly we want all the government help we can get.

[jIM_Ohio]

What counts as preventative care? Is that just an annual physical or does it also include bloodwork, mammogram, PAP smear, colonoscopy, etc.

I actually wasn't thinking about preventative stuff but actual treatments. Look, I've got plenty of patients who have good insurance who don't comply with treatment advice even though doing so would cost them little to nothing. Make them pay for that same treatment and what do you think will happen to compliance?

my wife's entire visit with her OB was covered at 100%
shots for kids are covered at 100%
well visits are 100%- I haven't used any of this yet, but its advertised as covered 100%

[jIM_Ohio]

I agree with the comments.

Since we are privately insured (always have been. 75% of small business employers do not offer health coverage - can't afford it or get group policies & whenever I have had insurance offered - it sucked).

Anyway, when private insurance was our choice over employer coverage I never came across anyone who would shop around. They would take it for free even if it sucked and only saved them $20/month. Having always paid for our own health insurance I don't quite *get* the current system. PEople are unwilling to shop around and unwilling to pay more than a few dollars for medical care. It's absurd to me.

On the flip side, whenever the subject comes up, when people here how much we do pay for our medical insurance, they assume I am all excited about Obama and a possible government health plan.

Um, no. As long as I can afford private insurance I am keeping it. I have a lot of friends in the military and a lot of friends in Canada. They are a lot like Americans. The only good thing they can say about it is that it is free! Plus I am not naive enough to think that if it comes from the government it is free. Then it comes from our tax dollars. Then I will lose my choice. But seriously, Canada's healthcare has some SERIOUS issues. Try finding a doctor, for one.

Something has to be done, for sure. Government fixing it? Ugh.

HDHP has bee a little "too good to be true" since we don't mind paying for care when we use it. I love it, because we have savings, etc. We just paid $85 for a doctor visit for our son who was having an issue. A relative said "That was $20 well spent!" We just rolled our eyes. Pffft. I haven't paid $20 for a doctor visit since I was under my parent's insurance in college. But yeah, people freak out when you say you spent more than $20 at the doctor. I don't mind paying $85 for a DOCTOR. I am more concerned that our insurance premiums go up 10-40% every year. But so many people under the bubble of their employer don't *get* that.

What MM said.
People think $20 co-pays is a way to keep the system functioning. Some of our doctor visits for the kids are $200 if they get sick, but I am willing to pay that fee (we have $7000 budgeted for healthcare this year). Some of visits are free (the ones where they get shots).

[disneysteve]

Some of our doctor visits for the kids are $200 if they get sick, but I am willing to pay that fee (we have $7000 budgeted for healthcare this year).

That's great, but you have to realize that you are not the norm. A great many people are not able to do that. They don't have $200 to spend for a sick kid. A lot of problems are going to go untreated and allowed to get worse if folks can't (or won't) spend the money to see the doctor.

I remember when most HMO copays were very low, like $2. That was ridiculous because it encouraged patients to see the doctor for everything and anything. A $20 or $30 copay is reasonable. It is high enough to create some deterrent to frivolous visits but not so high as as to deter legitimately needed care. Make the price tag $200 and there will be lots of problems, or lots more folks clogging the ER with minor problems.

I don't pretend to have the solution, but making people pay out of pocket for everything certainly isn't it.