Health care - the answer

[wdfifteen]

I have thought long and hard about a workable, fair, and constitutionally compliant health care system. This is what I think.

We need a universal, government run system that you can opt out of if you choose. If you opt in you pay premiums to the government and get the benefits of a fully paid health insurance plan including emergency room care. If you opt out and choose to go it alone, you don't pay a premium to the government. Your health care is totally between you and the provider. ERs are no longer required to treat you, government doesn't force doctors to do anything they don't want to do. Every year as part of your tax form you explicitly choose to opt in or out for that year.
If you opt in when you are 20 your premiums begin low - $500 or so a year, and rise slowly every year until you are, say 65 at which time they are level. If you opt in at 30 your premiums start at 2 to 3 times that of a person who opted in at 20. At 40 they are 10 times. By the age of 50, if you have never had health insurance, the cost of a government policy would be astronomical, but it's been your choice all along. Go get private insurance. At 65 forget it - if you aren't in the government system you will have to go with a private insurer. If you hit hard times and can't buy insurance for a year, you get credit for the years you did pay (unlike current private insurers). All along you have the opportunity to use a free market solution or a government one.
There will be rationing in the government system. If you don't want your health care rationed you can buy private insurance. Or you can buy private insurance to cover what the government program won't - like say a heart transplant at the age of 70.
It would be great if a private insurer would start such a system and play the role of the government. We wouldn't need a government system at all.

[Zeke]

It would be a lot simpler if a huge portion of revenue didn't get sucked up by a corrupt billing system and legal costs were nil. Next would be to work on the cost of medical supplies. Not only does a hospital charge 4 dollars for a Band-Aid, they pay too much for same.

Any government involvement whatsoever is not going to reduce costs and that's all that's wrong. If you lived in a small island nation with a decent economy, you would build medical facilities and hire staff. Your system would be designed to cover cost. Nothing wrong with public sector financing, but the administering should be private and non profit.

[pavulon]

Not to threadjack but...the legal part of the problem is significant.

Last week my employer's insurance "lost" a jury trial (60%/40%) where a patient (also a hospital employee) fell in a bathroom after having a colonoscopy. He claims to have hit his head on the sink and to have lost his sense of smell. Filed a claim for $2M. Jury took it to $800K and awarded 60% of that. The guy will see maybe $200K (already telling people "I'm rich!!)...his ambulance chaser atty will see significantly more. Just one of the simple issues some how lost on the Jury....there is no sink in that bathroom.

[gchappel]

I wish it was a simple as you described. Your idea somehow assumes that if you do not pay for it, you do not get healthcare. It does not, and can not work that way.
Let us say you are in a bad car accident- you are implying that if you have not paid for insurance they are going to let you lay on the road until someone you know comes and picks you up? You did not pay for insurance, so the ER does not have to treat you- what are you saying they should do? Someone who is 65, and never purchased health insurance- and presently has no money- shows up in the ER with chest pain. Your grand idea has us refusing treatment and sending them on their way- not going to happen. On the other side of the coin, let us say you paid for insurance and are in a bad accident- but you do not have your id and insurance card with you- do you get care??
Rationing care sounds like the answer- until it involves you or your family. When someone decides that it is too expensive to care for your wife or child, suddenly rationing has a different feel to it as well.
This is a complex process, that can not be approached or solved easily.
Gary

[wdfifteen]

Originally Posted by gchappel

I wish it was a simple as you described. Your idea somehow assumes that if you do not pay for it, you do not get healthcare. It does not, and can not work that way.
Let us say you are in a bad car accident- you are implying that if you have not paid for insurance they are going to let you lay on the road until someone you know comes and picks you up?

Yes - and this is a liberal talking. Somehow we have to get over this tacit belief that there is some kind of benevolent "something" that is going to take care of us. When we were in smaller communities we took care of each other - I was once a volunteer fireman. These days, the idea that someone, somehow, will take care of us is still there, but fewer are taking responsibility for doing the pro bono care taking. As much as I dislike Ayn Rand's version of utopia, we are approaching her vision. You pay or you don't play. Who pays for the ambulance? Who takes responsibility? At some point we have to start taking responsibility for ourselves by paying ahead of time with cash or investing our time or not getting the benefits.

[Gogar]

Your plan will not work unless Americans can socially accept the sight of someone dying on the curb in front of a hospital.

Last week, a kid got arrested and charged with a felony for running over a duckling in a McDonalds parking lot.

In many parts of America you can be charged for not administering aid to a dying pet animal, much less a human.

So . . . . . . I'm not thinking it's going to happen any time soon.

[wdfifteen]

Originally Posted by gchappel

Your grand idea has us refusing treatment and sending them on their way- not going to happen.

That's the problem, isn't it Gary? These rugged, free market individuals who don't want to pay for health care until they need it depend on the morality of those of us who won't let someone die of their own stupidity to take care of them. Our morality is bankrupting us.
Having them sign their name to their own, "F-you, F-the government, I can take care of myself" plan once a year seals it. Refusing treatment is their choice, not ours. At that point we can say, "This is YOUR plan. No health insurance? No cash? No contribution to the system? No ER! We laid it out, gave you every chance to be involved and you said 'no.' Your ejection into the street is the result of YOUR decision. Ignorance is no excuse."

[Noah930]

Wow. wd15 is now channeling P-O-P.

[Brando]

Originally Posted by wdfifteen

[...] We need a universal, government run [Health care] system [...]

I have highlighted the flaw in your idea.

[gchappel]

Originally Posted by wdfifteen

That's the problem, isn't it Gary? These rugged, free market individuals who don't want to pay for health care until they need it depend on the morality of those of us who won't let someone die of their own stupidity to take care of them. Our morality is bankrupting us.
Having them sign their name to their own, "F-you, F-the government, I can take care of myself" plan once a year seals it. Refusing treatment is their choice, not ours. At that point we can say, "This is YOUR plan. No health insurance? No cash? No contribution to the system? No ER! We laid it out, gave you every chance to be involved and you said 'no.' Your ejection into the street is the result of YOUR decision. Ignorance is no excuse."

Have you ever worked in health care- it does not sound like it.
Presently we treat all, and although that is wrought with problems, I personally could not imagine letting people go without care because of money.
I laughed when you called me a liberal- I am about as conservative on most issues as anyone, but I do have a heart. We collect on less than 25% of cases we take care of through the ER. Do I wish I got paid for all of them- of coarse. Would I even vote for a system that limited access the way you propose- no way. I hope you are personally never in the position that you do not get the best care possible because you do not have the correct card, or money. This is easy to talk about- but when push comes to shove I hope we will never let a person suffer because they can not pay.
Gary

[wdfifteen]

Originally Posted by gchappel

Have you ever worked in health care- it does not sound like it.
Presently we treat all, and although that is wrought with problems, I personally could not imagine letting people go without care because of money.
I laughed when you called me a liberal- I am about as conservative on most issues as anyone, but I do have a heart. We collect on less than 25% of cases we take care of through the ER. Do I wish I got paid for all of them- of coarse. Would I even vote for a system that limited access the way you propose- no way. I hope you are personally never in the position that you do not get the best care possible because you do not have the correct card, or money. This is easy to talk about- but when push comes to shove I hope we will never let a person suffer because they can not pay.
Gary

I called myself a liberal, and I am one. I didn't say a thing about you.
Your attitude is exactly what the conservatives count on. They won't fund health care adequately - they'll lean on people like you to take care of folks for free and call it free market capitalism.
I'm ready to call them out. If they think pay for service is a great idea then do it - all the way. Pay or die. We can pay as a society or pay individually, but quit relying on the soft hearts of liberals to take up the slack while vilifying us as "socialists."
My point is to get everyone on record as choosing whether to pay or not. If you can not pay there are options available even now. But if you can pay, but choose not to, don't rely on those who pay to save your azz.

[Gogar]

Damn. I hope you're not in charge of the spelling and grammar department of the ER. Thanks for chipping in, though!

[Porsche-O-Phile]

America today is far too wussified and squeamish to ever accept the true brutality of a truly free "free market". Hell, we can't even have a real free market for things like gasoline or soda pop or college educations without someone throwing a fit over it because it supposedly unfairly excludes them, and invariably some meddlesome politician willing to appease them by dragging the government into it. It would NEVER happen with h/c even though it would (brutally, admittedly) solve all of the inherent problems in the system related to unsustainability.

[LUFTMAN]

i think we should have the same plans available as the politicans and goverment people have some of the largest amout of people that had insurance but now is too expensive should all be in the same group and that is a lot of people. many married people choose the cheaper or better plan(they think) between either of them have and do not care that single people have to take what is offered if they work for the same co. as them. because if you go out on your own there is nothing affordable or covers a lot. it is like car insurance if you never have a claim for 40 years and some one hits your car and it is sitting all by itself insurance co. will pay you what they want to but collected your money for 40 years. the point is even if you have insurance you never know what it covers till you use it and then it is too late. we need insurance co. reform and drug co. reform some drugs have a 1000% mark up .

[Tobra]

Are you joking or clueless about the matter?

No leftman, not you, the OP

[wdfifteen]

Originally Posted by Tobra

Are you joking or clueless about the matter?

No leftman, not you, the OP

I am totally serious. Care to elaborate on why you think it's a joke?

[Noah930]

We live in a country that doesn't allow death or suffering (let alone preventable death or suffering). Your model, while well-intended, would never work. If you truly think it might, you're deliriously out of touch with reality.

[Tobra]

Noah sums it up nicely.

Clearly you don't have good understanding about how things are now, and what you could persuade doctors to do.

Setting aside personal injury attorneys and their lackeys in the legislative and executive branches, your idea does not have a solid basis in reality.

I apologize for the above.

Had just finished a procedure on a frail elderly gentleman with a very charming, very experienced tech, who probably had never done one of what we just did, found the family right about the time I get a call about this other non-compliant, tattooed, hepatitis infested pro bono patient, so I take the call. Give him my opinion, track the family down, give them the low down on the him. Go to the lounge to grab some ice tea, sit down, log on with you mugs and phone rings about tatted wonder again his phone really did go out, expect him to call back on a land line anytime now

Case I just finished will illustrate one point. When you do a trans metatarsal amputation, you want to lengthen the Achilles tendon, as it is a strong plantarflexor and when you cut off someone's toes, you lose a lot of tendons that oppose the Achilles.

If you fail to do this, they will get an ulcer under the stump of the 5th metatarsal. I don't think I have ever been paid for doing this when I did the amp. I still do it every time, because it is the right way and will save me and my patient a great deal of grief. If you let the bean counter make the call, they get their leg off, the person has a much poorer quality of life and it costs a lot of money.

How about this, everybody pays for whatever care they need, and the gubmint, based on the person's income, subsidizes the fee. You could have panel of doctors deciding on what needs to be done, treatment wise.

That way we can screw Hugh over coming and going. We tax the he11 out of him, then make him pay full boat for all the healthcare for him, his wife, and mother in law. Sorry about that Mr R.

Problem I see with any system you come up with is going to come from the bureaucracy that is going to be attached to it. I think whatever happens, the individual patients have to bear a significant portion of the expense, have skin in the game, so to speak. This will serve to push the utilization down, which will help rein in cost. People now are quite removed from what healthcare actually costs to provide. To accomplish what needs to be done, with the resources available, will require some unpalatable choices in the not too distant future.

[Noah930]

Listen, I didn't mean my above comment in any snide way. It's just that we live in a society that thinks everyone should be granted everything, because we can. Well, maybe we can in terms of technology, but that doesn't mean we can, logistically and financially. I see you recognize that last point. But you're missing the part of societal expectations/norms.

Then, there all sorts of practical problems: What happens when a non-emancipated minor needs medical care but they have parents who opted out of your system? F 'em? What happens when someone is brought in to an ER without ID/proof of coverage? Tough day to forget your wallet at home, huh? How about non-responsive people? What happens when, faced with the reality of a potentially serious/fatal medical condition, a person suddenly cries out that they want care after all? What happens when people fake their finances to get that emergent/urgent care, and then sneak away without paying the bill?

Your plan is somewhat based upon people making rational, logical, well thought out decisions. Guess what? People make stupid personal decisions all the time. But we live in a society that tries to socialize responsibility. Your plan goes in the face of that. I think that's why it fails to reflect our national consensus.

[wdfifteen]

Originally Posted by Noah930

Listen, I didn't mean my above comment in any snide way. It's just that we live in a society that thinks everyone should be granted everything, because we can. Well, maybe we can in terms of technology, but that doesn't mean we can, logistically and financially. I see you recognize that last point. But you're missing the part of societal expectations/norms.

We have a spectrum of societal expectations. On the socialist end they want "someone" to take care of everything for them. On the conservative end they want to control their lives themselves. The system I propose provides a large enough pool for the socialists to adequately function and it gives an incentive to the young and healthy to start paying into the system against future needs. It also allows the conservatives to opt out of a shared-risk system.

Originally Posted by Noah930

Then, there all sorts of practical problems: What happens when a non-emancipated minor needs medical care but they have parents who opted out of your system? F 'em? What happens when someone is brought in to an ER without ID/proof of coverage? Tough day to forget your wallet at home, huh? How about non-responsive people? What happens when, faced with the reality of a potentially serious/fatal medical condition, a person suddenly cries out that they want care after all? What happens when people fake their finances to get that emergent/urgent care, and then sneak away without paying the bill?

I doubt the constitutionality of the current law which makes everyone buy health insurance and I expect the savings from a large pool of participants isn't going to happen, but I do think it would be constitutional to create a law that required you to take care of your children.
If you come to the ER without ID/proof or unresponsive you would of course be treated at the discretion of the hospital. Leaving without paying or without making an arrangement to pay is theft of service. It would be equivalent to taking a car on a test drive and never bringing it back. It's a felony and it's not handled by bill collectors, it's handled by the police. You go to jail and liens are put on your property.

Originally Posted by Noah930

Your plan is somewhat based upon people making rational, logical, well thought out decisions. Guess what? People make stupid personal decisions all the time. But we live in a society that tries to socialize responsibility. Your plan goes in the face of that. I think that's why it fails to reflect our national consensus.

You are absolutely right that we live in a society that tries to socialize responsibility and that is one of the problems. Irresponsibility is at the heart of the current problem. We can't simply keep cleaning up after irresponsible people. We have to make an effort to get them to think about getting sick before it happens. With my plan each adult has a clear opportunity every year to decided to pay into a universal system, go it alone, or buy his own insurance and it can be made very clear to him that whatever he decides is his decision for the next year and he will be held to it. We won't break people away from it without resolve on our part.