Saturday, December 08, 2007

Medical Insurance Madness

It's very interesting how one of the primary reasons why those who oppose a national health care plan is because of the believed increased costs and taxation that will go with it. But most people don't seem to realize that per capita the US government already spends more on health care than most other developed countries, including England, France and Canada. It's beaten only by Iceland, Norway, Monaco and Luxemborg (2004 figures). That money comes from your tax dollars and it covers only covers 45% of total health care costs. That's right. You are already getting taxed more than those other nations and are getting only 45% of their return.

On top of that, total US expenditure for the rest of that 55% comes from private insurance, out of pocket, etc. So the total per capita costs in America are 50% - 100% more than what they pay total in other developed nations. You are getting doubly reamed for a medical service that nationally has poorer showings in many respects than those other countries.

In essence, you are already paying the same (or more) taxes for socialized medicine as other nations but are not getting the benefits from it.

Private insurance systems are for profit and do not work for your interests. Additionally, people who cannot afford simple, cheap care for medical problems will do without and will then wait until they need to go to the ER when their costs can be absurdly high. Who do you think foots the bill there? Either US governments who pay for it through taxes or rising medical costs which get passed to you anyway.

As long as we're living in a society which isn't really willing to refuse people medical care, then you are de facto living in a socialized state. You just pay for it in an incredibly inefficient way which raises medical costs, worsens public health and has the private insurance people laughing all the way to the bank as they skim significant administrative costs off the top.


Another big issue that people take are with are with wait times. They hear horror stories of waiting periods in the months for simple medical tests. Now while these are sometimes true, they are most often exaggerations and are typically for optional medical procedures. But in any case, the correct way to look at the issue is essentially through a moral view. Obviously there are limited medical resources so the question is how they get parsed out. In a system like ours, wait times are often kept to a minimum because poor people just aren't getting the care they need. They don't even get on line. It's only because poor people are suddenly are in the waiting rooms that richer people find they have to wait a little longer.

So essentially, the choice is between giving poor people health care or keeping it from them. Wait times are the inevitable effect of having more people able to acquire medical care.

Now, I'm not arguing that having a single-payer system is without its drawbacks. It does invite over-use of the system because if it's free then people will be more eager to use it - even when they really don't need to. It also invites higher expenses in the system in some respects because when given an option between a cheap proven drug and the new expensive one, if people aren't paying for the difference then they're far more likely to choose the more expensive one.

But these are not incredibly difficult deal breaking issues. They can be dealt with in other ways, but the overall view of the US medical system in view of economics and morality seems to fall heavily on the side of a single-payer system. The for-profit insurance companies work at cross-purposes to actual medical care since they only care about profits while, simply, good medical care can be expensive. And a lot of people in need are either given the run around to save costs, are dropped from service or simply cannot get coverage in the first place. Competition for medical insurance drives up costs for administration, advertisement and political "gifts" that have nothing to do with medicine. It's simply a bad system.

33 comments:

Anonymous said...

What did you think of the movie Sicko?

Orthoprax said...

I think that Moore's style is often unfair and one-sided, but nevertheless, he made plenty of valid points in the film.

resh lakish said...

There isn't a binary either-or dichotomy between single-payer and the present system. A number of countries have two-tier systems, with room for both private and public provision. Although no system is perfect, a number of those do work pretty well, and often avoid the excesses of either single-payer or insurance-company-dominated systems.

Orthoprax said...

RL,

I have no problem with that, but I don't understand why anyone would choose to pay for medical insurance that they would otherwise get granted through the government.

Then again, people have private libraries and schools too.

Anonymous said...

"That money comes from your tax dollars and it covers only covers 45% of total health care costs. That's right. You are already getting taxed more than those other nations and are getting only 45% of their return."

That's not right. If it covers only 45% of our heath costs, it doesn't mean we're getting only 45% of their return. You are assuming per capita expenses are equal, or that all countries cover the same things and to the same degree. That's not the case.

Also if you have private insurance, then you usually aren't being covered by the US govt. i'm sure tha much of what the US govt. spends on health care goes to the military, and the VA, and Medicare. So what you are mentioning might be due to military medical expenses, or for expenses for the elderly, a segment of the population that has greater per capita medical needs than the non-elderly.

Ichabod Chrain

Orthoprax said...

IC,

"That's not right. If it covers only 45% of our heath costs, it doesn't mean we're getting only 45% of their return. You are assuming per capita expenses are equal, or that all countries cover the same things and to the same degree. That's not the case."

Per capita expenses should be about equal and all the countries that matter do cover basically the same stuff. Quibbling about the numbers for a few percent here and there doesn't change the fact that the US system is incredibly inefficient. We could not change taxes at all and theoretically have a system with more per capita money in it than France or England.

"So what you are mentioning might be due to military medical expenses, or for expenses for the elderly, a segment of the population that has greater per capita medical needs than the non-elderly."

So? The other countries have militaries and old people too. They manage to cover all of them and the rest of the population too for less than we pay for just those groups.

resh lakish said...

Per capita expenses should be about equal and all the countries that matter do cover basically the same stuff.
Simply not true -- I have plenty of anecdotal, as well as systemic, evidence otherwise. Try getting an elective procedure in Canada or the UK, or one in the US. See which takes longer. See which system is more likely to cover expensive chemotherapy for an elderly relative with cancer (has ve'shalom): the money to life trade-off in the US is not as tough as it is in almost any other country.

The other countries have militaries and old people too.
Absolutely wrong. America's defense program subsidized many of the European social welfare systems during the Cold War. Other than the UK (and possibly France), no western European country maintained credible armed forces. Without that, their social budgets would have been far more constricted.

resh lakish said...

I have no problem with that, but I don't understand why anyone would choose to pay for medical insurance that they would otherwise get granted through the government.
Many reasons. Because of the inievitable rationing in the public system, elective surgeries and the like get taken care of quicker in the private system, and hospital conditions are nicer.

Orthoprax said...

RL,

"Try getting an elective procedure in Canada or the UK, or one in the US."

Well, yeah. I noted that in my original post.

"See which system is more likely to cover expensive chemotherapy for an elderly relative with cancer (has ve'shalom"

I honestly don't know. I suspect both systems have limits.

"Absolutely wrong. America's defense program subsidized many of the European social welfare systems during the Cold War. Other than the UK (and possibly France), no western European country maintained credible armed forces. Without that, their social budgets would have been far more constricted."

Yes, I know that. But that's not particularly relevant. I don't believe that army expenses raise national medical costs that much. Indeed, according to my calculations - with VA expenses being ~30 billion - per capita is about $100. That's a drop in the bucket of the government's total per capita expenses of +$2700.

The two of you are quibbling over details and not seeing the big picture.


"Many reasons. Because of the inievitable rationing in the public system, elective surgeries and the like get taken care of quicker in the private system, and hospital conditions are nicer."

Fair enough. Like I said, I don't have a problem with private insurance existing as such.

resh lakish said...

I'm not disputing the larger point that the American health care and insurance industry is massively flawed, I am disputing your analysis as to the obviousness of a single-payer model as an alternative. I also don't see this as trivial quibbling: this is all about the details.

You missed my point regarding military spending. My point was not that the military drives up medical costs, but that the enormous costs of the American military historically made it almost impossible for the US to provide social benefits at a level comparable to the wealthier countries of western and northern Europe (even had that been the will of the electorate, which is debatable). For most of the Cold War, US military spending was over 10% of GDP -- and generally constituted an absolute majority of all federal government discretionary spending -- much higher than for America's NATO allies, who were in effect subsidized by America:
http://www.truthandpolitics.org/military-relative-size.php
Even now, the US spends about 4% of GDP on the military, whereas the rest of the developed world typically spends 1-2% (see http://en.wikipedia.org/wiki/Image:Military_expenditure_percent_of_GDP.PNG). This made, and still makes, a huge difference to financing government.

Orthoprax said...

RL,

And yet still, US gov't medical expenses are more per capita than all those other countries. Even with those European countries' increased ability to spend more money on health care - they actually aren't. So I don't think your point has any relevance.

Military spending is not cutting into medical spending at all.

Jeff said...

OP,

I agree with RL in regards to details, however, I feel as if the main point which you mentioned in your original post is being missed here.

Firstly, clearly the US system is flawed: We spend the most money per capita, and have some of the worst documentable health care stats such as infant mortality. How to fix this sytem is a noble endeavor, but I think not for this blog (sorry!).

You mention what are the moral obligations, and here I think our time is better spent. Is health care a human right? A Jewish right? I'm not so sure. From a humanistic and American perspective, I believe basic preventative care should be allowed for children, and obvious cost effective procedures for adults, such as appendectomies. But I feel even this is biased. Why should medicine be treated any differently than any service industry?

I think the best measure is the modified quality of life years from a medical perspective - but from a Jewish perspective, is not all life of equal value? Should all health care be free? If so, than should not all poor people have access to a personal trainer to help improve their physical fitness. Should health care be free to children? If so, how about life support for a baby born without a brain?

Orthoprax said...

Jeff,

As I said in my post, I think the issue is based on both economic and moral grounds, but I actually believe that a system more like the European ones are actually better healthwise _and_ wiser economically. That they manage to approximate our level of care and do it for less than half of what we pay is astounding.

Minor points about some special expenses in America or slightly better care here or there are essentially distractions from the big economic issue staring us in the face. I believe that we could provide basic care for everyone in America for _less_ than what we pay now for a fraction of the population. I believe it is _more_ cost effective that way.

And as a democracy I find it absurd that the powers that be are the wealthy insurance companies and not the voice of the people who would eagerly make health care equitable.

"Why should medicine be treated any differently than any service industry?"

Two reasons. One, because health is an invaluable good that people are willing to pay virtually anything to get. It does not lay itself out well to your typical service industry. People don't generally shop around different hospitals for the cheapest surgery rates when they need it.

Second, by law if a person walks into an ER then you have to give them treatment if they need it. Since we live in a society that isn't (generally) willing to throw poor sick people out on the street then you have de facto made the industry a special one that is not directed by market forces.

Now, as a future health care provider, I have some special interest here. And I understand that if you define it as a "human right" that makes people like me into forced servitude to others. Because who else is there to provide that "right"?

But I'm not arguing on the philosophical scale. I'm taking US policies that _already exist_ and showing how to make them more effective and more efficient.

Anonymous said...

-From Jeff,
OP,

I disagree. Health care is not invaluable, it only seems so when you need it suddenly. People make very conscious choices with their money & health care plan, and people do go to different networks & nowadays different countries for procedures. But again, I'm not really interested in this question. I am thinking more about whether basic healthcare is a moral and a Jewish obligation.

In the past I would have said yes, But lately I feel this is just an American socialist perspective. I think this is a good way to run a society, but not neccessarily moral on its own grounds.

So I know we can not lie idle while our neighbors blood is shed, but are we liable for making sure he has controlled hypertention, must we pay 1 million for his heart transplant?

Orthoprax said...

Jeff,

There are always going to be exceptions, but the fact is that people are willing to pay virtually _anything_ to keep themselves alive in an acute situation. Health is an invaluable good for most people.

Are some people going to search out better deals for the same or similar care? Sure. But the point is that generally people do not dicker about the dollars and cents when it comes to life and death.

"So I know we can not lie idle while our neighbors blood is shed, but are we liable for making sure he has controlled hypertention, must we pay 1 million for his heart transplant?"

Again, not from moral grounds, but from pure economy - I would argue that it's more efficient to treat a man's hypertension for a few hundred dollars a year than to wait until he develops cardiac failure or a stroke or renal failure which can cost in the millions. And not only that, but given the working years you've saved this guy from not being sick, through taxes the government probably makes a profit off of the hypertension investment.


But if you're really so interested in the specific moral dimensions of the issue then it's basically a conflict between the value of life vs the value of the dollar. Where people draw the line is an old question and Jewish views are likely split on the matter.

You tell me - what's your price for a human being?

Anonymous said...

-From Jeff,

OP,

Ok, I'm not interested, but I'll answer anyway because I like to debate ! :) I still disagree with you. A glass of water is invaluable when you're dying of thist, a gallon of gass is invaluable when you run out of gas in a blizzard. You can't use only one situation to view an entire problem. Again, the current market shows that many people chose cheaper or no healthcare in lieu of a bigger paycheck - of course they regret it when they have their first MI. I understand the de facto US issue of paying for it anyway, but this does not beat the issue of *specialness* of health carein the first place.

And of course I agree that standard preventative primary care is cost effective.

So what is the $ value of a human life. It is worth the entire world. But what about 1$ and you have to divide it by 2 people. This would bring us back to primary care stuff.

But to me, morally, is a jew obligted to pay the cost for primary care? Only for the poor? Everybody shares the cost for everybody? what about sliding scale, and what about in asystem like ours where (as above) the poor person chooses not to pay the cut rate cost, and spend the money on a nicer car.

My understanding is that a Jew is not obligated to pay these costs, and that food water shelter, and granting the ability to earn ones own living arr enough. My knowledge on this though is limited. Any opinions?

Orthoprax said...

Jeff,

"A glass of water is invaluable when you're dying of thist, a gallon of gass is invaluable when you run out of gas in a blizzard."

Indeed! But few people get into those situations. It is extremely common for people to spend huge amounts of money on healthcare to stave off death.

It is commonly cited that for many people, their highest healthcare expenses take place in the last few weeks of life.

If water was really that scarce then it could be similarly invaluable. If applied with ruthless market force then most people would die penniless and thirsty.

"My understanding is that a Jew is not obligated to pay these costs, and that food water shelter, and granting the ability to earn ones own living arr enough. My knowledge on this though is limited. Any opinions?"

Traditional Jewish views on social engineering are few and far between and as far as I know, they had no inkling of an advanced socialized/capitalistic type of economy where healthcare could exist as a national system. Jewish views are focused on the deeds of an individual, with the idea that each individual good will produce a good society generally.

And that would work. If every person gave 10% of their income to the poor and ensured they had food (through the equivalent of peah) then even poor people would probably be able to afford standard healthcare and the problem goes away.

But we don't live in that type of world and most people don't give that much to charity - so what is the right solution for the world we do live in? Taxes in this context are used as an enforced redistribution of wealth and an ensured universal healthcare system is just one efficient way of distributing it.

My point is that it's basically unfair to take a purely traditional Jewish view on the subject because the assumptions behind those views are not the reality we have before us. You have to take a meta-view of Jewish ethics and then apply them to the modern world.

Orthoprax said...

You should also note that when Jewish ethics were percolating through the ages, medical science wasn't much better than black magic so it wouldn't have been highly regarded or valued.

Jeff said...

OP,

"It is commonly cited that for many people, their highest healthcare expenses take place in the last few weeks of life."

Of course, and many of these people have insurance, and if don't or chose not too, why should society be responsible?

Our society is supposedly a democracy, and actually various degrees of socialist.

"And that would work. If every person gave 10% of their income to the poor and ensured they had food (through the equivalent of peah) then even poor people would probably be able to afford standard healthcare and the problem goes away.
"

Here, you are again assuming that universal health care is a good and natural right. Again,I think it a good think, but I'm not so sure its a moral obligation.

"You should also note that when Jewish ethics were percolating through the ages, medical science wasn't much better than black magic so it wouldn't have been highly regarded or valued."

Not true. Many of the most respected and prolific jews were physicians. Because of their medical knowledge, many of them held powerful positions under the kings of that time - kings who were otherwise not so nice to jews. The idea that that their expertise was not valued because in hindsight it was incorrect is simply false.

Surely there have been occasions in jewish history where some "essential life-saving medicine" was required, either cheaply, or at great expense. Whether or not it was truly effective is not important, only that they believed that it was. So I do think it is fair to use a jewish perspective.

Orthoprax said...

Jeff,

"Of course, and many of these people have insurance, and if don't or chose not too, why should society be responsible?"

That's fair, but at the same time are you really going to stand aside and do nothing when you could save a life? What kind of society would permit that?

"Our society is supposedly a democracy, and actually various degrees of socialist."

Socialism and democracy do not conflict. One is an economic system, the other a mechanism of forming government.

"Here, you are again assuming that universal health care is a good and natural right. Again,I think it a good think, but I'm not so sure its a moral obligation."

Where do you see me assuming it is a right? I very intentionally and specifically do not use that term or the assumptions behind it.

"Not true. Many of the most respected and prolific jews were physicians. Because of their medical knowledge, many of them held powerful positions under the kings of that time - kings who were otherwise not so nice to jews. The idea that that their expertise was not valued because in hindsight it was incorrect is simply false."

Those are much later personalities. I was referring to the time of the Mishnah and Talmud where numerous anti-physician statements can be found - including "the best of physicians are destined to Gehenom."

I'm sure they believed in the theory of good medicine but since it was mostly ignorance and quacks running the show, they had good reason not to just assume it as a strong moral obligation. Espeically since a medical system just didn't exist on a societal level. It didn't _exist_ for it to become an assumed social value. That's my point.

Modern medicine with its accessibility and often strongly reliable outcomes is simply not what they had back then.

They also believed in charms and magical cures. But, likewise, since the results were so unreliable it makes sense that they wouldn't value it so highly as something like food.

Al Knight said...

There is a simpler sadder point to be made. The rising cost of health care which is in turn causing companies to lower or drop their contributions to health insurance both for active and retired employees along with the indiviual contractors is recreating the middle class into "poverty" class when it comes to medical coverage.
I know of several cases where frum Jewish families have only the children covered and the middle age parents are exposed to medical catasrophies.

Jeff said...

OP,

"That's fair, but at the same time are you really going to stand aside and do nothing when you could save a life? What kind of society would permit that?"

No I won't, but all societies will as part of the nature of fixed resources.

"Those are much later personalities. ... "the best of physicians are destined to Gehenom."..I'm sure they believed in the theory of good medicine but since it was mostly ignorance and quacks running the show, they had good reason not to just assume it as a strong moral obligation. Espeically since a medical system just didn't exist on a societal level. It didn't _exist_ for it to become an assumed social value. That's my point."

Obviously, medical care wasn't even close to being the gargantuan it is today as it was then, but I think my point still holds. It was still a trade, based on a large amount of (mostly incorrect) knowledge, and when people were really sick, where do you think they went - for some help, even if it might not work.

In regards to the respect and amount of "physicians", one could argue that the priests served this role, as detailed quite a bit in the torah. granted, this was mostly isolation for skin conditions, but it also talks some about purification, etc. Whether or not you agree as to similarity of this to any kind of "health care", it at least shows that Judaism is concerned with sickness and its treatment - thus any relative lack of jewsish scholarship would imply its nonimportance.

I'd be interested in the place you found the Gehenom quote. On a technicality though, aren't all except the greatest of tzaddiks destined for some of this?

Orthoprax said...

Jeff,

"No I won't, but all societies will as part of the nature of fixed resources."

Yes, by necessity to a certain degree, but if the means are there with little cost to society at large then it would seem cruel to let a man die because he could not afford it on his own.

"It was still a trade, based on a large amount of (mostly incorrect) knowledge, and when people were really sick, where do you think they went - for some help, even if it might not work."

Yes, of course. But the point I'm making is that with all the uncontrollable uncertainties of that period's medicine, it could not have ranked as a social obligation, as such.

A doctor healing was like a non-Torah scholar teaching, great to have around and much appreciated when needed, but there is no call in the Talmud to build public libraries.

"Whether or not you agree as to similarity of this to any kind of "health care", it at least shows that Judaism is concerned with sickness and its treatment - thus any relative lack of jewsish scholarship would imply its nonimportance."

I don't see how that follows at all. Physicians are given huge Halachic leeway to practice their craft - specifically they could kill a patient accidentally and not be exiled - apparently for the public good. Because otherwise, no one would become a physician and treat people at risk. I think they recognized medicine as good, mostly, but entirely unreliable and therefore not a social obligation.

In our time of reliable medicine, perhaps their views ought to be reassessed.

Of course, as I said earlier, Judaism in general doesn't concern itself with the ethics of society in itself. It concerns itself with the obligations man has to himself and to another. The attitudes from Halacha are that a person must maintain his own health and seek out aid when in need and that a doctor has an obligation to help, but not without renumeration.

The modern social political issue is just about creating the most efficient means for all of that to happen. Is it a strictly Jewish perspective? No. But I don't believe it is in any way contrary to the spirit of Jewish tradition.

"I'd be interested in the place you found the Gehenom quote."

Kiddushin 82a. Interestingly, one of the reasons Rashi gives to explain this statement is because physicians have the means to heal the poor but they fail to do so.

"On a technicality though, aren't all except the greatest of tzaddiks destined for some of this?"

Perhaps, but then why point out "the best of physicians" especially?

Anonymous said...

-From Jeff

OP,

I'm wondering if my point is important, but I think your view of medicine is incorrectly "presentocentric" (I know there's a real word for this!) If we look at medicine 100 or even 50 years ago, it was largely the study of placebo, yet they thought themselves far superior to the past as well. Yes many of the ill people in ancient times died, but if they lived, this would have been atributed to the great knowledge of their witch doctor. I still see little fundamental difference between the doctor patient relationship then & now.

I think their knowledge was considered with some awe, similar
as it is now. After all, it was power over life & death.

Another thought along the biblical priest/ doctor analogy I made: While the talmud might not obligate public goods such as a library, it does put primary importance on the building of a mikvah. I argue that this is both for spiritual and medicinal purposes - ?free basic health care in the bible? after all,even the poor had access to the priests and the mikvah.

Orthoprax said...

Jeff,

"I still see little fundamental difference between the doctor patient relationship then & now."

There may not be, but the point was regarding medicine as a social value. Many rabbis were distrustful of physicians, some even considered human medicinal intervention to be misguided or perhaps even sacreligious.

The medicine of the period was like segulahs of today. Some people take them seriously and believe them efficacious, others not so much, and still others think them akin to avodah zara. And similarly, there is no call for the public service of mekubalim.

"it does put primary importance on the building of a mikvah. I argue that this is both for spiritual and medicinal purposes"

Eh, I don't think so. You're pushing relationships into places they were never intended. The mikvah is needed for couples to have sex and make babies. If it was not available then it would lead to widespread sin.

madinwilly said...

What a waste of good cyber-space!! If only you applied some basic economics principles in your analysis, it would be worth refuting.

Orthoprax said...

Mad,

Why? Am I wrong that the US pays twice per capita what other nations pay for about the same level of care?

badrabbi said...

Here is a thought:

1. Eliminate the VA (Veterans Administration) system and keep the money (savings of about $50 billion).

2. Eliminate or sell public hospitals run by the state (such as Downstate or Stony Brook Medical) and keep the money (savings of $5 billion in NY alone)

3. Eliminate or sell public city hospitals (such as Bellevue or Kings County) (not sure of extent of savings)

4. Eliminate Medicaid and keep the money (I don’t have a good handle on total budgets of Medicaid, but it runs close to or more than $100 billion).

5. Cap all malpractice awards to $50,000. Instead, upon gross malpractice, review boards would have the right to revoke medical insurances (Savings on this proposal include the lowering of malpractice insurance costs, and a decreased interest of physicians to practice defensive medicine).

6. Streamline claim credentialing, claim submission, and payment systems for hospitals and physicians so that they would not need to hire armies of staff to do third party billing and collections. Instead, physicians and hospitals would submit their bills to one entity with uniform practices and methods. Most practices have about 10-15% cost associated with billing/collection efforts.

7. Increase copays for services significantly. Thus, every time a diagnostic study or a therapeutic service is performed, the patient should pay a significant sum ($100-200). This encourages the patient to take an active part in her care and to question frequent testing or treatment. This also lowers insurance premiums.

Now, flush with the cash of all these savings, do the following:

1. Give all veterans Medicare. Then, these former soldiers can go to any doctor or hospital of their choosing (vets prefer it and the money savings would be enormous)

2. Give all people below a certain income threshold Medicare. The states would pay the federal government for this, and the states would determine what that threshold would be and pay accordingly. Again, low income patients can then go to any physician or hospital of their choosing, and would not have to be shoved to a city run clinic.

3. Make employers responsible for purchasing the health insurance of employees. Employers would get tax incentives should they opt for more luxurious insurance programs, but all employers would have to provide for basic medical insurance.

4. Compel all self employed workers to purchase medical insurance. Those who do not, would be taxed and insurance would be provided automatically by the state (Massachusetts set up a program like this)

5. All unemployed and destitute patients who can not for one reason or another qualify for Medicare, would get catastrophic insurance provided for by the Federal Government. Catastrophic insurance means that health care would be provided only for ailments that immediately threaten the life or limb of a given patient.

Orthoprax said...

BR,

That sounds like a plausible plan, although I admit I am no expert on what kind of unexpected consequences it could have. I also think it's rather complicated and the fact that you still maintain private insurance interests to dominate the industry is bothersome.

I'm also not sure why you'd bother closing Medicaid if you're really just going to extend service to the destitute. Might as well say that you're combining the service with Medicare.

In the end, I don't see the benefit of requiring wealthier people to go private instead of just taxing them for the same difference. And virtually the only way to do #6 simply is with a national single-payer system.

badrabbi said...

Private business generally (though not always) is better at conducting itself than government is. Given the choice of private medical insurance plans versus government run plans, gnerally the former is preferred.

You are correct that I advocate combining medicare with medicaid systems. Currently there are duplicate programs with duplicate administrations and requisite costs. Also, Medicaid tends not to be favored by physicians as its payment scheme heavily favors clinics rather than private practices.

Insurance plans, like any other products, such as cars and TV's, come in varieties. The wealthy can afford more expensive plans that offer more services and coverage. They may opt to buy more luxurious plans. Those who can not afford high premiums would get more basic plans. There aught to be choice in these matters and the wealthy should have the right to purchase more comprehensive plans if they so choose.

I do not think it is necessary to combine insurance companies in order to streamline the billing/collection payments. I agree that it would be very difficult to get the companies to cede power of reviewing the billing, but I think it is worthwile to try to get it accomplished.

As for unintended consequences, I agree that there will be numerous outcomes that I have not thought of. But this is true of any proposed system. I suppose that the plans should be studied further, as in any other proposal.

Orthoprax said...

BR,

"Private business generally (though not always) is better at conducting itself than government is."

Yes, but the problem with the insurance business is that the incentive is for the companies to pay as little as possible. This simply doesn't line up so well with the interests of their customers. There would have to involve significant government management into the system in order to ensure that the incentives line up more in favor of the consumer.

Once you double that with the same companies ceding their billing platform then these companies are mostly just a tool for the greater system.

In the end I don't think you're ideas are that different from mine except that I'd prefer compulsory medical insurance like there is compulsory education for minors. The public system should be open to the wealthy too. And maybe they could be given vouchers if they go with private insurance, just like private school.

badrabbi said...

Insurance companies, like any other business function to make money. Their goal is to maximize their profits. But this is no different than car companies or utilities. None of these companies necessarily are consumer oriented. There is a give and take, with the consumer trying to maximize the bang for his buck, and the company trying to maximize the buck for the bang. Granted that the business of taking care of people has it nuances but there are many nuanced business sectors.

The government tends to regulate business, with some businesses being regulated more than others. I think that there needs to be some regulation of the health industry, but not especially more than others.

Regarding your idea being similar to mine, it may be true. I am not certain exactly what you are advocating. Nevertheless, what I wish to preserve, are the following:

1. Medical care should be available to most people.
2. Medical care, like any other product or service has various degrees of quality. High quality medical care should cost more than lower quality care.
3. Not all people should have the ‘right’ to expect high quality care. There may be an argument that all people should have the ‘right’ to a minimum (or a standard) of care, but nothing more than that.
4. As much as possible, given that the health care system is a huge portion of the economy, should not be ceded to the government.

Elysia said...

Thanks for writing this.