They took the tax deduction. The worker pays the taxes for single payer with insane tax rates while having NO say in how their medical dollar is spent or what kind of treatment they will get.
But we do need to talk seriously about how we’re going to get health costs under control, enhance American competitiveness abroad and make it possible for Americans to be productive without worrying about whether catastrophic health care expenses will jeopardize their families’ future.
My thoughts on the topic.
In a free society, health care choices are necessarily individual, but given the uneven chance that an individual will incur catastrophic healthcare expenses, individuals must pool resources to fund health coverage, usually by means of insurance.
When healthcare was funded by a single family, funds were necessarily limited; a family would not starve its children to treat the sick or aged. The amount of effort to save a single life that could be spent has changed for two reasons:
1. Technology has vastly increased the amount that could be spent on any one case.
2. Pooling healthcare resources has vastly increased the money available to be spent on any one case.
In effect, the “family” now paying for the service is the entire insurance pool. That pool, or its agent, the insurer, then has a say in what they will fund, just as the family once did. So now, instead of a family refusing to starve, we have an insurer refusing to go broke. It's a tradeoff. We have more funds available for any one individual, but less control over how they are spent. As long as technology is increasing the upper bounds of what might be spent, we, as a pool, face hard choices about what we can afford. When a moral imperative to make an infinite commitment to save any one life meets a technical ability to bankrupt the pool, somebody MUST lose in the pursuit of saving that one life.
As the pool enlarges to a global perspective, the moral problem takes on a new dimension, and "the least of mine," takes on a whole new meaning. The money spent on Terri Shiavo could feed, clothe, medicate, and educate ten thousand children who otherwise will die. So as long as it's the family's money, that's OK, but when it becomes your money and the power to take it is outside your control, that's quite another thing.
We have to find ways to make hard moral choices in order to contain costs. It's inescapable.
Seventy percent of your medical dollar (or nearly eight percent of the national economy) is spent upon people who die within six months. Meanwhile, pregnant mothers still don't get decent prenatal care that would prevent life-long medical expenses and aliens enter the country carrying hepatitis, parasites, and antibiotic-resistant strains of infectious diseases that go untreated. Hospitals are on the verge of bankruptcy caring for the indigent. Private insurance rates bear much of that cost as a hidden tax in hospital charges.
Distorted treatment priorities are only part of the picture. The system provides few financial incentives to promote health. Proper diet, regular exercise, and annual check-ups do not reduce the price of coverage. Similarly, there are few penalties for high-risk behavior.
The system is insane. Government is the problem and socializing medicine will make it worse.
In a free market, there are usually two underlying factors determining the scope of coverage:
1. How the costs were incurred: whether the medical problem was no fault of the insured person's own choices or whether it was the result of an irresponsible and avoidable choice.
2. The cost-effectiveness and extent of the adjustment: whether it's risky or experimental or if less expensive substitutes exist.
The cost of coverage is determined by the scope of covered risks, the probability of a claim, and the average expense of the treatment. The price of coverage is offset by investment returns on the cash in the coverage pool. For example, insurers may charge more to cover high-risk activities such as smoking or skydiving. A policy may also limit the extent of elective procedures such as certain forms of cosmetic surgery. Unfortunately, pricing many other distinguishing risks is not allowed because the State enlarges the pool paying into the system to the point of the absurd. It closely regulates the terms of the contracts based upon the political power of the groups at risk: those seeking to get others to subsidize the cost of their choices.
It doesn't matter if the risk is riding a motorcycle without a helmet, not taking prescribed medication, or bare-backing in a bath-house, high-risk individual choices cost the insurance pool that pays for the treatment and poses additional risks to the public at large. A State-financed or regulated system, heavily influenced by political interests, is unlikely to assess those risks objectively.
Once those risks are assumed, there is the additional unnecessary legal overhead associated with malpractice settlements. Since humans will probably never know everything about their bodies, there always will be uncertainty and risk associated with the delivery of medical products and services. The assumption that anything less than a perfect cure constitutes medical malpractice is one expensive fantasy. At some point, the choice exercised by those who make healthcare choices must bring its own responsibilities.
The insurer may have reason to lose that lawsuit. First, the settlement is often less than the cost of a court battle. That means that more such cases will be brought because a new precedent, whether due to the cause of the loss, the size of the settlement, or the type of restorative measures demanded, means that all such cases must be covered the same way by all insurers. They must then raise rates and the total industry cash flow then increases. Insurers make money on that cash flow, as well as on investments in companies that treat covered losses. If that sounds like a conflict of interest, it can be.
Free Health Care
Healthcare services don't come free; somebody has to pay for them. While central planning in healthcare works no better than it did in the Soviet Union, the United States, torn between socialized medicine and corporate welfare, has some of the finest care available, but by far the most expensive. While the US bears much of the research and product development costs for the rest of the world, in no way can it be considered a cost-effective system by world standards. There is a lot that can be done to improve its efficiency without resorting to the mediocre treatment characteristic of socialized medicine.
When the level of free service is equivalent to what can be purchased by private parties, there is then no reason to invest in private care. Socialized medicine makes all healthcare policy decisions political thus masking the cost of individual decisions by placing the burden for their consequences upon everybody. That's why AIDS research is starving the search to cure cancer even though the latter clearly costs society far more, which destroys the wealth that funds AIDS research. Government intervention into free-market risk management distorts the cost assessments that help industry identify costly health risks to invest in eliminating them. Treating medical problems is a human need capable of virtually infinite costs, simply because life is fatal. As medical technologies proliferate no insurance pool will be able to afford all the treatments its users could desire.
The best way to reduce the cost of treatment is to prevent the need, a focus upon which our physician-dominated system is lacking. These activities include personal habits that preclude problems (exercise, diet, posture, marriage, oral hygiene), mitigating measures designed to keep a problem from getting worse (special diets, spinal correction, dental care), and diagnostic tools to detect potential problems.
Many nutritional supplements don’t get onto the market as substitutes for prescription drugs because food is not patentable. Decades later, expensive drugs are qualified by the FDA that have side effects the natural products don't have! The fix starts with private property rights. Many of these nutrients are only in unique local habitats. In that respect, the combination of resources and processes that support production of a particular nutrient should be patentable just like a mining claim. It certainly provides reason to understand and care for that habitat instead of ruthlessly exploiting it. You saw it here first.
It is within the preventative realm that the market has operated with relative freedom, but it has suffered from the distortions of treatment costs downstream. New preventative technology usually lacks physician or insurer acceptance, has high initial costs, or suffers from the perverse result of providing insurers reason to cancel coverage as is the case with diagnostic equipment. This is because minimizing total cost to the patient does not drive the profit motives to coverage providers, indeed, quite the opposite.
Only patients can have their own best interests at heart. That's why individual payment systems are the least expensive in delivered cost across total populations as long as each patient understands and is motivated to adopt the least cost option.
Unfortunately, the patient has no idea what a competitive price for most medical services might be, in part because of the distortions due to the buying power of large pools. HMOs, MediCare, and hospital bills (padded to cover the cost of services to the indigent) have absolutely destroyed the patient's ability to weigh competing prices of medical services. Have you ever looked at an Explanation of Benefits form? Did the prices bear any resemblance to reality? Have you ever asked your physician what he or she might take for the service in cash? If so, were you surprised at the difference? So how can anyone objectively judge what is in their own best interest?
You now know why the system is insane.
The Deep End of the Pool
Treatment of the medically indigent is totally dependent upon the insurance pool of last resort: the taxpayer. Although minimal free healthcare services cost taxpayers, confining infectious diseases and preventing lifelong problems in children saves taxpayers money in the long run. There is an obvious peril, however, in making free health care services available to anyone.
Controlling healthcare costs thus faces an inherent conflict, regardless of whether healthcare services are private or socialized: A high price at the initial point-of-service inhibits people from seeking help early, when most medical problems are less expensive to confine or treat. Conversely, pricing medical care free of charge would make containing costs impossible. The key to resolving that paradox is in managing the triage function in a manner that serves more purposes than the system does now.
Triage is the process of evaluating patients and determining what kind of diagnostic work or treatment they need. It is done by firemen or EMTs in an emergency. It should be performed a qualified technician or nurse before any person makes it into an emergency room. Any person who doesn't qualify for emergency treatment could then be directed to an urgent care facility or asked to make an appointment.
Triage should be free. The provider must have no relationship to any downstream medical provider. They would provide pricing information on the various alternatives in the process, whether a visit with a doctor, chiropractor, nutritionist, or purchasing lab tests. Triage would thus be little different than walking into a store and deciding what to buy, if anything.
The one problem with putting triage in front of a physician visit is that when most people get sick they want to see a doctor right away. The way to meet that demand is by automating the triage function. Many people have the education to make confined medical choices. An insurer could provide qualified subscribers access to online diagnostic information that would help them research their medical problem, select the appropriate specialist, make an appointment, or communicate about problem to a triage specialist. The software might also test the users' comprehension by which to qualify for the option to make more decisions for themselves. They could schedule diagnostic tests so that a physician could make a decision without a visit. Putting test and treatment protocols online thus would improve both patient education and physician accountability.
Such testing also assesses the effectiveness of the educational tools by which to market better services, reason to research, develop, and improve the quality of online education tools. If copyright for such information bundling and testing were confined for, let's say, five to seven years, the provider has reason to invest in improving proprietary tools, while the benefits are not retained from the public at large for an unreasonable period.
Increasing use of nurse practitioners to screen incoming patients would save both time and money as well as handle the indigent patient fairly. Here we come to the manner in which the scope of patient care for the indigent must be confined to a rational minimum. We have a right to be free, but we don't have a right to free care. The only way to manage the cost of medical treatment for the indigent is to define what kind of services they may have very carefully. It is a political decision.
Where the healthcare industry is truly responsible to the public is in informing our representatives of the relative cost of various healthcare options by which they can then define the scope of coverage in budgetary legislation. Providers should effectively give us a budget for what they can accomplish for a given amount of money, what would be effectively indigent healthcare for bid. Most healthcare purchases today are not made by the user, but by an interest without accountability for acting as the user's agent: their employer. To combine the benefits of pooling with visible pricing means more than making the purchase price of healthcare options visible, it is to return to the user control of the buying decision. We need to expand the concept of the Medical Savings Account to include pretax purchase of healthcare on the part of the employee and end employer purchase of healthcare.
One way to resolve that customer alienation from reality, and provide private providers a way to contain costs, would be to market coverage from a menu of narrowly defined policies. Consumers would combine these policies into a package to suit their individual preferences. By defining coverage pools according to the choices people make, those behaviors that unnecessarily cost the total system would be borne by those who choose to incur those costs.
For example, people who don't want extreme measures taken to save their lives or don't need coverage to treat STDs, obesity, infertility treatments, or caring for children, wouldn't have to pay for them. Those who don’t want elective cosmetic surgery wouldn't buy that policy. If getting regular exercise assured a lower cost of coverage it would motivate the sedentary to start working to qualify for that pool. Forcing people to confront the cost of their choices is an important way to prevent expensive problems. That process reduces the total cost of the entire system. Pricing each distinct need focuses research dollars to fix the problems that have the most potential, whether glamorous university-research or a simple educational tool.
It may be true that America's research is carrying much of the rest of the world stuck with socialized medical care, but it is product development that pays for it. No political system is as efficient at optimizing competing demands on capital as is the marketplace.
There will still need to be restrictions on customized customer pools for the sale of health insurance to preclude exclusion of people who had no choice in their ailments, such as those who suffer congenital diseases. That such groups exist does not discount the value of pricing services by behavior because it motivates healthy decisions that increase the total wealth that ultimately must pay for those who can't.
The taxes are supposed to fund universal access. But as we know from the Canadian experience, it hasn't guaranteed it or ensured optimal outcomes. No health care system is going to be perfect. But you don't hear Canadians wanting to return to what they had before.
My thoughts on the topic.
In a free society, health care choices are necessarily individual, but given the uneven chance that an individual will incur catastrophic healthcare expenses, individuals must pool resources to fund health coverage, usually by means of insurance.
Private insurance is often duplicate, wasteful and generates a lot of paperwork because doctors and hospitals have to deal with different companies to pay them. And they still must look anyway to the government as a provider of last resort in the case of the indigent. Medicaid is essentially single payer for the indigent in America.
When healthcare was funded by a single family, funds were necessarily limited; a family would not starve its children to treat the sick or aged. The amount of effort to save a single life that could be spent has changed for two reasons:
In the old days, life was far simpler and people could make decisions about their health care all by themselves. Its vastly different today.
1. Technology has vastly increased the amount that could be spent on any one case.
The best technology increases costs. People want the best health care for themselves and their loved ones - its human nature. Even with the best of intentions, this is part of health care its very difficult to get under control. And as health care technology improves, so do the available choices health care consumers face.
2. Pooling healthcare resources has vastly increased the money available to be spent on any one case.
In effect, the “family” now paying for the service is the entire insurance pool. That pool, or its agent, the insurer, then has a say in what they will fund, just as the family once did. So now, instead of a family refusing to starve, we have an insurer refusing to go broke. It's a tradeoff. We have more funds available for any one individual, but less control over how they are spent. As long as technology is increasing the upper bounds of what might be spent, we, as a pool, face hard choices about what we can afford. When a moral imperative to make an infinite commitment to save any one life meets a technical ability to bankrupt the pool, somebody MUST lose in the pursuit of saving that one life.
Whether the payer is private - like an insurance company or public - like the government, there is always going to be rationing. Resources are finite. People can accept it if they know every one else plays by the same rules. Who do they want to be the health care system's umpire? There is going to be a gatekeeper and with the health system as complex as it is today, there no quick fixes to the issue of the distribution of health care resources. That is a given.
As the pool enlarges to a global perspective, the moral problem takes on a new dimension, and "the least of mine," takes on a whole new meaning. The money spent on Terri Shiavo could feed, clothe, medicate, and educate ten thousand children who otherwise will die. So as long as it's the family's money, that's OK, but when it becomes your money and the power to take it is outside your control, that's quite another thing.
There are trade-offs. Given how the government handled the Terri Schiavo case, I would there is a great deal of distrust among conservatives over handing a sensitive area of life to the purview of government. And my view without rules in place to prevent abuses, its a long time before single payer happens in this country.
We have to find ways to make hard moral choices in order to contain costs. It's inescapable.
I already mentioned rationing. There are going to be restrictions on specialist care. Now, that's not what I would prefer but some things are going to happen to hold costs in line.
Seventy percent of your medical dollar (or nearly eight percent of the national economy) is spent upon people who die within six months. Meanwhile, pregnant mothers still don't get decent prenatal care that would prevent life-long medical expenses and aliens enter the country carrying hepatitis, parasites, and antibiotic-resistant strains of infectious diseases that go untreated. Hospitals are on the verge of bankruptcy caring for the indigent. Private insurance rates bear much of that cost as a hidden tax in hospital charges.
That's exactly the argument for single payer care. The private insurance system not only imposes hidden taxes, it can no longer shoulder the load of the health care system. If the taxpayers are going to be asked to pick up the tab for health care costs, they want something to contain costs, that is easy to understand and that works. There is no consensus now on how a single payer system should be structured so in the meantime we'll muddle through with what we've got.
Distorted treatment priorities are only part of the picture. The system provides few financial incentives to promote health. Proper diet, regular exercise, and annual check-ups do not reduce the price of coverage. Similarly, there are few penalties for high-risk behavior.
There are also lawsuits against doctors which serve to drive up costs. Our system is incentivized to make people wait until they get sick and when they do get sick, they either don't have insurance due to pre-existing conditions or the government ends up picking the cost for what they can't afford to pay. Now that is insane and every good conservative would say the ideal health care system would allow doctors to do the best job they can regardless of the patient's ability to pay, cut lawyers out of the health care system and get people to stay healthy in the first place. Now that all of that is just common sense.
The system is insane. Government is the problem and socializing medicine will make it worse.
Doctors still face a paperwork problem. Do they want to collect from multiple insurers or get paid by one payor? Simplfying the paperwork morass would rationalize the system and besides ending the wastage of time on paperwork, it would assign clear accountability. There is none in the health care system today for no one - not doctors, not patients and not the public at large, knows how much health care costs in this country. That is insane!
In a free market, there are usually two underlying factors determining the scope of coverage:
1. How the costs were incurred: whether the medical problem was no fault of the insured person's own choices or whether it was the result of an irresponsible and avoidable choice?
If its a pre-existing condition, then its no fault of the person who has it - it may not even be known at the time to the patient. On the other hand, drug abuse, smoking and alcoholism - well they result from personal choices that are costly to society and individuals. Yet we punish the former and elect to treat the latter as a "free rider" problem. If that is an example of how the market works, its exactly how the market shouldn't work in the first place.
2. The cost-effectiveness and extent of the adjustment: whether it's risky or experimental or if less expensive substitutes exist.
The cost of coverage is determined by the scope of covered risks, the probability of a claim, and the average expense of the treatment. The price of coverage is offset by investment returns on the cash in the coverage pool. For example, insurers may charge more to cover high-risk activities such as smoking or skydiving. A policy may also limit the extent of elective procedures such as certain forms of cosmetic surgery. Unfortunately, pricing many other distinguishing risks is not allowed because the State enlarges the pool paying into the system to the point of the absurd. It closely regulates the terms of the contracts based upon the political power of the groups at risk: those seeking to get others to subsidize the cost of their choices.
This is the problem with RomneyCare/Obamacare. It tries to marry the worst of two incompatible payment systems together without solving the drawbacks of either one. We either keep allowing private insurance companies to operate in a true market or if that's not what we want, the government should be the sole payor. At some point down the road, we have a decision to make about the future of health care in our country.
It doesn't matter if the risk is riding a motorcycle without a helmet, not taking prescribed medication, or bare-backing in a bath-house, high-risk individual choices cost the insurance pool that pays for the treatment and poses additional risks to the public at large. A State-financed or regulated system, heavily influenced by political interests, is unlikely to assess those risks objectively.
That's a valid objection but on the other side of the coin, no one knows how much the national health care bill is because no one sees it. If it was made a public one, much more attention would be paid to those costs. And when we look at how much government costs us today, why shouldn't it be part of the national conversation? Voters are generally rational actors.
Once those risks are assumed, there is the additional unnecessary legal overhead associated with malpractice settlements. Since humans will probably never know everything about their bodies, there always will be uncertainty and risk associated with the delivery of medical products and services. The assumption that anything less than a perfect cure constitutes medical malpractice is one expensive fantasy. At some point, the choice exercised by those who make healthcare choices must bring its own responsibilities.
That is addressed in the article. A system with no real accountability such as ours is open to graft, abuse and fraud. And we all end up paying for it in the form of higher insurance costs, unnecessary doctor treatments and in some cases in turning away patients seen as "lawsuit magnets."
The insurer may have reason to lose that lawsuit. First, the settlement is often less than the cost of a court battle. That means that more such cases will be brought because a new precedent, whether due to the cause of the loss, the size of the settlement, or the type of restorative measures demanded, means that all such cases must be covered the same way by all insurers. They must then raise rates and the total industry cash flow then increases. Insurers make money on that cash flow, as well as on investments in companies that treat covered losses. If that sounds like a conflict of interest, it can be.
If the government is the payor, it has sovereign immunity to lawsuits. Of course this is an example I can think of where two liberal constituencies - unions and lawyers are at loggerheads. I'd really like nothing better than to kill the liberal legal cash cow even if it means bringing the government in to make it happen.
Free Health Care
Healthcare services don't come free; somebody has to pay for them. While central planning in healthcare works no better than it did in the Soviet Union, the United States, torn between socialized medicine and corporate welfare, has some of the finest care available, but by far the most expensive. While the US bears much of the research and product development costs for the rest of the world, in no way can it be considered a cost-effective system by world standards. There is a lot that can be done to improve its efficiency without resorting to the mediocre treatment characteristic of socialized medicine.
The free market model is separate from who pays for the costs of the system. You can choose your own doctor and treatment and if you pay it out of your taxes instead of your insurance premiums, most people won't notice a difference when they go to see their doctor. They don't see a bill from a private insurer and they won't see one if the government pays their bill.
When the level of free service is equivalent to what can be purchased by private parties, there is then no reason to invest in private care. Socialized medicine makes all healthcare policy decisions political thus masking the cost of individual decisions by placing the burden for their consequences upon everybody. That's why AIDS research is starving the search to cure cancer even though the latter clearly costs society far more, which destroys the wealth that funds AIDS research. Government intervention into free-market risk management distorts the cost assessments that help industry identify costly health risks to invest in eliminating them. Treating medical problems is a human need capable of virtually infinite costs, simply because life is fatal. As medical technologies proliferate no insurance pool will be able to afford all the treatments its users could desire.
That brings us back to rationing. Someone is going to come in to control the costs. The best way wouldn't be through regulation, which we have too much of already but in paying the bill, we would get what we pay for. That is what we should reasonably expect regardless of the identity of the payor.
The best way to reduce the cost of treatment is to prevent the need, a focus upon which our physician-dominated system is lacking. These activities include personal habits that preclude problems (exercise, diet, posture, marriage, oral hygiene), mitigating measures designed to keep a problem from getting worse (special diets, spinal correction, dental care), and diagnostic tools to detect potential problems.
From a conservative point of view, its better to prevent costs up front by preventing diseases and treating them early then wait when its harder for the patient to recover and society faces burdensome health care costs.
Many nutritional supplements don’t get onto the market as substitutes for prescription drugs because food is not patentable. Decades later, expensive drugs are qualified by the FDA that have side effects the natural products don't have! The fix starts with private property rights. Many of these nutrients are only in unique local habitats. In that respect, the combination of resources and processes that support production of a particular nutrient should be patentable just like a mining claim. It certainly provides reason to understand and care for that habitat instead of ruthlessly exploiting it. You saw it here first.
This is another discussion but the FDA does not regulate nutritional supplements while on the other hand it does regulate drugs. Why there is a difference no one has ever explained.
It is within the preventative realm that the market has operated with relative freedom, but it has suffered from the distortions of treatment costs downstream. New preventative technology usually lacks physician or insurer acceptance, has high initial costs, or suffers from the perverse result of providing insurers reason to cancel coverage as is the case with diagnostic equipment. This is because minimizing total cost to the patient does not drive the profit motives to coverage providers, indeed, quite the opposite.
If we eliminate the irrationality of the market, this would lower costs, prevent perverse outcomes and make sure the end concern is with the well-being of the patient rather than being concerned with overarching complexities of the system. Our national health care debate has lost sight of the patient.
Only patients can have their own best interests at heart. That's why individual payment systems are the least expensive in delivered cost across total populations as long as each patient understands and is motivated to adopt the least cost option.
Its easier than done with the overwhelming complexity of modern health care. The cheapest option is not necessarily the best. Unfortunately, the price-driven character of our present health care payment system is not necessarily in the best interests of the patient or society.
Unfortunately, the patient has no idea what a competitive price for most medical services might be, in part because of the distortions due to the buying power of large pools. HMOs, MediCare, and hospital bills (padded to cover the cost of services to the indigent) have absolutely destroyed the patient's ability to weigh competing prices of medical services. Have you ever looked at an Explanation of Benefits form? Did the prices bear any resemblance to reality? Have you ever asked your physician what he or she might take for the service in cash? If so, were you surprised at the difference? So how can anyone objectively judge what is in their own best interest?
No one wants to see a bill. People already have enough bills to pay that they don't want to be bothered by one more. Its human nature.
You now know why the system is insane.
Indeed.
The Deep End of the Pool
Treatment of the medically indigent is totally dependent upon the insurance pool of last resort: the taxpayer. Although minimal free healthcare services cost taxpayers, confining infectious diseases and preventing lifelong problems in children saves taxpayers money in the long run. There is an obvious peril, however, in making free health care services available to anyone.
Its just single payer by another name: Medicaid. It works reasonably well and many otherwise intelligent people just act like its the end of the world if the their own taxes would pay for their health care, too.
Controlling healthcare costs thus faces an inherent conflict, regardless of whether healthcare services are private or socialized: A high price at the initial point-of-service inhibits people from seeking help early, when most medical problems are less expensive to confine or treat. Conversely, pricing medical care free of charge would make containing costs impossible. The key to resolving that paradox is in managing the triage function in a manner that serves more purposes than the system does now.
If medical care is provided without regard to ability to pay, there are other ways to make the system efficient. Give people incentive to visit doctors often, pay them not to go to emergency rooms except as a last resort and so on.
Triage is the process of evaluating patients and determining what kind of diagnostic work or treatment they need. It is done by firemen or EMTs in an emergency. It should be performed a qualified technician or nurse before any person makes it into an emergency room. Any person who doesn't qualify for emergency treatment could then be directed to an urgent care facility or asked to make an appointment.
Changing the nature of the medical system from one that treats people when they are sick to one that treats them to stay healthy, there is already a consensus about needed reform. Let's hope we adopt it.
Triage should be free. The provider must have no relationship to any downstream medical provider. They would provide pricing information on the various alternatives in the process, whether a visit with a doctor, chiropractor, nutritionist, or purchasing lab tests. Triage would thus be little different than walking into a store and deciding what to buy, if anything.
I'd agree but I already pointed out, the medical system is too complex for people to understand and people have become accustomed to not seeing another bill. This is the selling point of single payer.
The one problem with putting triage in front of a physician visit is that when most people get sick they want to see a doctor right away. The way to meet that demand is by automating the triage function. Many people have the education to make confined medical choices. An insurer could provide qualified subscribers access to online diagnostic information that would help them research their medical problem, select the appropriate specialist, make an appointment, or communicate about problem to a triage specialist. The software might also test the users' comprehension by which to qualify for the option to make more decisions for themselves. They could schedule diagnostic tests so that a physician could make a decision without a visit. Putting test and treatment protocols online thus would improve both patient education and physician accountability. >
I'm all for simplifying a daunting process. Whether it can be done within the constraints of our present medical system remains to be seen.
Such testing also assesses the effectiveness of the educational tools by which to market better services, reason to research, develop, and improve the quality of online education tools. If copyright for such information bundling and testing were confined for, let's say, five to seven years, the provider has reason to invest in improving proprietary tools, while the benefits are not retained from the public at large for an unreasonable period.
System-wide reform is a huge undertaking. It won't get done by pushing diagrams around a chart. But you underscore very well more is at stake than simply deciding on the nature of the payor. Even if that ever gets settled, its only the least of our problems. Making our health care system comprehensible and accessible to everyone in truth is the biggest challenge we face.
Increasing use of nurse practitioners to screen incoming patients would save both time and money as well as handle the indigent patient fairly. Here we come to the manner in which the scope of patient care for the indigent must be confined to a rational minimum. We have a right to be free, but we don't have a right to free care. The only way to manage the cost of medical treatment for the indigent is to define what kind of services they may have very carefully. It is a political decision.
With universal health care, its also a political decision. Nothing in life is truly free, no matter who medical practitioners service. And at point, regardless of various opinions on this thread, one day in the future people are going to be faced with what kind of medical care we as a country decide to have and are willing to pay to get.
Where the healthcare industry is truly responsible to the public is in informing our representatives of the relative cost of various healthcare options by which they can then define the scope of coverage in budgetary legislation. Providers should effectively give us a budget for what they can accomplish for a given amount of money, what would be effectively indigent healthcare for bid. Most healthcare purchases today are not made by the user, but by an interest without accountability for acting as the user's agent: their employer. To combine the benefits of pooling with visible pricing means more than making the purchase price of healthcare options visible, it is to return to the user control of the buying decision. We need to expand the concept of the Medical Savings Account to include pretax purchase of healthcare on the part of the employee and end employer purchase of healthcare.
Ideally, a free market health care system would not be tied to employment. Your solution is the flaw in the ointment. Unless health care is portable and people can take it wherever they want without being tied down to their job, the politics will ensure we'll get single payer health care. To avoid that outcome, that we need to give people freedom from worry that they won't be able to take their benefits with them when they change jobs.
One way to resolve that customer alienation from reality, and provide private providers a way to contain costs, would be to market coverage from a menu of narrowly defined policies. Consumers would combine these policies into a package to suit their individual preferences. By defining coverage pools according to the choices people make, those behaviors that unnecessarily cost the total system would be borne by those who choose to incur those costs.
That's already a mandate. We're already talking about regulating of insurers' practices. And if they decide its not in their interest? Then we're right back where we started before.
For example, people who don't want extreme measures taken to save their lives or don't need coverage to treat STDs, obesity, infertility treatments, or caring for children, wouldn't have to pay for them. Those who don’t want elective cosmetic surgery wouldn't buy that policy. If getting regular exercise assured a lower cost of coverage it would motivate the sedentary to start working to qualify for that pool. Forcing people to confront the cost of their choices is an important way to prevent expensive problems. That process reduces the total cost of the entire system. Pricing each distinct need focuses research dollars to fix the problems that have the most potential, whether glamorous university-research or a simple educational tool.
There are thousands of prices. Which is the most important? Which aren't? How do consumers and patients deal with the information overload? It would be wonderful if we knew what choices people made. The market is not always good at anticipating it any more than central planners do. That is something that deserves further consideration.
It may be true that America's research is carrying much of the rest of the world stuck with socialized medical care, but it is product development that pays for it. No political system is as efficient at optimizing competing demands on capital as is the marketplace.
I'm in favor of the market but we realize the market can't handle everything. And American companies don't want to carry those costs any more. Conservatives and politicians as the article points out, should be prepared for that eventuality.
There will still need to be restrictions on customized customer pools for the sale of health insurance to preclude exclusion of people who had no choice in their ailments, such as those who suffer congenital diseases. That such groups exist does not discount the value of pricing services by behavior because it motivates healthy decisions that increase the total wealth that ultimately must pay for those who can't.
Dream on. There's a reason all politicians want to get rid of "pre-existing conditions." If the insurance companies resist, they're market dinosaurs. Any way you look at it - the world and American health care are going to change in the years to come, whether we like it or not.