quote:Only one in 250 of those filing private insurance claims file for more than $50,000 a year. But these one-in-250 account for 20% of private insurance payouts. HMOs and insurance companies have incentives to keep their customers healthy so they don't incur large health bills, yes. They have incentives to induce their customers to get their preventive care, yes. But they have much bigger incentives to figure out how not to be holding the bag when somebody gets really sick--to make sure that those really sick who cost them 50 times the average and more are insured by somebody else, or not insured at all. Ratcheting up the bottom-line pressure on HMOs and insurance companies will also ratchet up their incentive to avoid covering sick people, and they will find a way (and they have found ways) to do so.
The second problem is on the consumer side. If you purchase health insurance, you are charged full freight--including the cost of treating you if you should get really, expensively sick. If you don't purchase health insurance and you get really sick, it is still very likely that somebody will pick up the tab. If you don't own a house and have few other assets people can come after, and if you are relatively young and healthy, buying health insurance can seem like a sucker's game--it's expensive, and although you get a little extra help for small bills the large bills the insurance really covers are bills you weren't going to pay anyway. Ratcheting-up the bottom-line pressure on the system creates big pressures on consumers to simply drop their coverage--unless, of course, they have good reason to believe that they are likely to get very sick...
But now the Kerry campaign has dusted off and brought forward a very clever idea from Brandeis's Stuart Altman to not eliminate but at least diminish the magnitude of these two ways that market-based health-care reforms self-destruct. The idea? Have the government take its task of social insurance seriously, and reinsure private insurers and HMOs: construct a 'premium rebate' pool to pay annual health-care bills over $50,000. This greatly diminishes the cost to insurers and HMOs of covering the really sick. The cost of treating the really sick will then be on the taxpayer rather than on the insurance-purchasing consumer. Insurance rates will fall. And the incentive for the young without many assets to go naked and uninsured will diminish as well.
Thus two of the big problems with our health care system become smaller problems. If this plan is enacted, we will no longer have to worry as much (i) adverse selection--the enormous financial incentives HMOs and insurance companies have to figure out some way not to cover the sick people--and (ii) cost shifting--the fact that those who buy insurance have to pay not only their own routine costs and their own catastrophic costs but the catastropic costs of others and the uninsured as well. The first means that--often--those who need health care the most have a hard time getting it. The second means that--often--those who could afford or would buy insurance if it were priced at its fair actuarial value don't because of this cost shifting.
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If the insurance companies have enough competition to lower their prices to the adjusted market level, after the huge expensive client is removed, this plan could shift the burden from individual policy holders and small-businesses to the government. It seems to be a balanced and innovative approach.
posted
I consider myself a fairly good Republican, but if something like this can help us avoid a full-blown Canadianesque socialized health care system, then it's a compromise I'd willingly make.
Posts: 5264 | Registered: Jul 2002
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posted
Not brilliant, not perfect, but a damn good step. There will be some details to work out -- do all 30 million Americans suffering from heart disease get a free transplant now? -- but using markets as a useful but manipulatable tool like this is my kind of pragmatism. And I'm not even a pragmatist.
[ June 25, 2004, 03:50 AM: Message edited by: Richard Berg ]
Posts: 1839 | Registered: May 1999
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posted
Even if this step is taken there still needs to be a limit to the amount for which the government as insurer is liable for.
This plan essentially proposes to put taxpayers on the hook as the insurer of last resort. As was mentioned previously, unless there is a lifetime limit this means that basically all chronic, severe cases which require organ transplants etc would have the ability to go ahead with their expensive operations at government cost.
This is a very delicate issue, obviously. However, the fact remains that there simply are not enough resources to pay for every procedure a person would like to perform. A lifetime maximum benefit indexed to the inflation rate would have to be established.
Posts: 4548 | Registered: May 2001
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posted
Again the healthy people will have to pay, but this time they will not be able to find a cheaper supplier of health care because the government will tax them.
posted
The sick people apologize for being such a horrid drain on society. We'll do our best to die off quickly.
Posts: 14745 | Registered: Dec 1999
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quote: Yeah. God forbid you should live longer, suffer less disease, and be more content with your healthcare system.
This flies in the face of what I have heard. All the Canadians I have spoken with about their health care system had nothing good to say about it.
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posted
The Canadians did a huge survey of their health care system. Results showed they ARE satisfied with it. I'm sure CT will have links.
Posts: 14745 | Registered: Dec 1999
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quote:This flies in the face of what I have heard. All the Canadians I have spoken with about their health care system had nothing good to say about it.
That hasn't been my experience with the Canadians I know - they have certain gripes, but appreciate not having the kind of system we have here.
Maybe it would be best to ask the Canadians you know this question:
Which is worse? To deal with the Canadian healthcare system or to be poor (or middle-class)and uninsured here in the U.S. and try to get the care you need?
quote:To deal with the Canadian healthcare system or to be poor (or middle-class)and uninsured here in the U.S. and try to get the care you need?
Another apples and oranges question: Would you rather be in the upper class in Canada, yet still have to pay 45% income tax to pay for insurance you could get cheaper if it were a free market, or would you rather be kicked in the groin by a mule?
Posts: 5264 | Registered: Jul 2002
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most of the people I know who are familiar with both systems don't see it as an "apples and oranges" question. But most of the people I know in both countries are either in the groups of "poor" or "struggling to get by" - or they work with those groups.
Those in the upper middle class and above tend to get what they need no matter what system they're in.
Posts: 4344 | Registered: Mar 2003
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posted
So many Americans talking about how much Canadians hate their health care system.
Have you been following the elections up here? The most important promises? The most important issues to Canadians? Do you actually know any Canadians or are you just pretending?
posted
For the record, I never meant to insinuate that Canadians hated their system, only to insinuate that I do. Posts: 5264 | Registered: Jul 2002
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posted
(why isn't there a normal lauging smiley? I'm not "ROFL" nor am I pointing and laughing... *gripes about lack of normal smiley but is still over-all content *)
I thought it was more of an Alpha Male system where men vie for leadership positions by showing off their skill at taking down moose with hockey sticks?
Posts: 5264 | Registered: Jul 2002
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quote: The sick people apologize for being such a horrid drain on society. We'll do our best to die off quickly.
quote: And if you go over that limit, I'm sorry, you have to die now.
See, here's the thing: there are lots of really good things all competing for the same resources. What do you think is better: "Sorry Mr. Smith, you have exceeded your lifetime benefit limit so we can't perform that operation unless you raise the funds yourself" or "We're sorry children, the healthcare system has drained all of our tax dollars so there will be no new textbooks, paper, teacher's raises etc."
As long as there is a limit to resources there MUST be a limit to benefits.
Posts: 4548 | Registered: May 2001
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quote: "Sorry Mr. Smith, you have exceeded your lifetime benefit limit so we can't perform that operation and you will die unless you raise the funds yourself" or "We're sorry children, the healthcare system has drained all of our tax dollars so there will be no new textbooks, paper, teacher's raises etc."
posted
What would be the point of teaching the children if they were to develop a disease requiring expensive treatment and were denied healthcare because they've exceeded the limit?
Educated dead people are still dead.
Posts: 14745 | Registered: Dec 1999
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quote:"Sorry Mr. Smith, you have exceeded your lifetime benefit limit so we can't perform that operation unless you raise the funds yourself" or "We're sorry children, the healthcare system has drained all of our tax dollars so there will be no new textbooks, paper, teacher's raises etc."
Pardon me, but limiting the choices to two things like that is arbitrary.
Could be the choices might be more like:
Do we have a lifetime benefit for people? OR
Do we keep giving huge sums of money to pharmaceutical companies for research, with which they develop drugs with exclusive patents and then charge us more for those drugs than they do anyone else in the world?
Posts: 4344 | Registered: Mar 2003
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posted
Lots of people die every day. It's life. (haha)
If we're gonna spend resources conquering death, I'd rather go the direction of trying to find an ultimate "cure" rather than helping people who roll their cars while talking on cell phones live to be 100. Posts: 5264 | Registered: Jul 2002
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posted
Sure does come from somewhere - taxpayers. All of whom will benefit from this use of their taxes.
Maybe some will object, but there are already people who object to their taxes being used to fund war efforts, space projects, education, and research grants to private corporations.
Objections will be duly noted and ignored, as in all other uses of tax dollars. Posts: 4344 | Registered: Mar 2003
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posted
Am I the only one who thinks this is a horrible idea?
I am not for bailing out insurance companies that casually use their revenue to "lower" premiums temporarily, forcing their competition out of business. And when this plan fails, they simply raise their premiums to make up for the losses they have been incurring during this "competitive" phase.
Insurance companies are not in need of financial assistance, and the American taxpayer should not be fiscally responsible for helping pay the bills of an insurance company.
Every major surgery, from open-heart surgery to transplants total in the hundreds of thousands of dollars. The only way I would support this effort were if the cap were much higher, say at least a million dollars. In fact, I'd feel much better if the cap were in the millions of dollars.
Posts: 1870 | Registered: Mar 2003
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Commonwealth Fund survey of international healthcare system comparisons (New Zealand, US, UK, Australia, Canada), via Harvard School of Public Health.
Nobody is happy with their healthcare systems overall, but nobody is less happy than the Americans.
*shrug I hear anecdotes all the time. My guess is that those who are happy take it for granted, those that aren't (or who wish to complain for other reason) are more vocal. Also, your contacts may well be a biased sample.
The only way to gather useful data for making generalizations is to do it scientifically, through well-designed surveys. What your friends told you may be correct for them, but it obviously isn't valid to generalize to the whole population. Doesn't mean they lied -- just means that they aren't a representative sample.
Posts: 14017 | Registered: May 2000
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posted
And hey -- don't kill the messenger. I just report the news.
Whatever anyone may wish to be true, Canadians as a whole are healthier, live longer, and are happier with their healthcare system than US citizens are. That's just ... true.
So it sounds like the better system to me. At least, the onus is on the contrarian to establish otherwise, as by the general measures we use to assess systems (not just individual preferences), this follows.
posted
Canadian healthcare is way better than paying $445/month for a health insurance premium to make sure your coverage doesn't lapse because of a pre-existing chronic illness. Posts: 14745 | Registered: Dec 1999
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posted
insurance is very weird to me. It's this complicated betting, optimism/pessimism bank system that I can't quite wrap my head around.
Which one is easier... finding out how to pay for all the health care, or finding out how to make health care cost less?
Are there hospitals that work more efficiently? Where does all the money go and why? How do you reconcile the importance of research and the price tag of new drugs? Which parts of the health care system (docs, support staff, research, insurance, etc, etc) get turned over to the govt and which parts should be private?
Posts: 1892 | Registered: Mar 2002
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posted
Heck, lets just start our own Hatrack Insurance Plan and have an actuary or two figure out the details and initiate our own non-profit organization to absorb it all.
Posts: 1870 | Registered: Mar 2003
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posted
CT is right about anecdotes...in general. However, one should be on the lookout for patterns in anecdotes that may indicate the need for a study. For instance, suppose we compared our anecdotes (unimportant in themselves) and discovered that Canadian patients with a specific kind of health problem were the minority doing the complaining? For instance, the survey admits that response time is better in the US--so it might be worth studying whether people who need care quickly get it in time in Canada (or are delayed by filling out tons of government paperwork... ).
It's also worth mentioning that satisfaction is not always, in every case, an accurate measure of quality. For instance, suppose that health-care costs are high in the US because a great deal of money is going to research new treatments. Other countries would benefit from these treatments as well, so no differential effect would be shown--but if the US initiated cost-control measures that prevented the expenditure, quality of care would be damaged across the board. (Remember--I'm not saying this is true; I'm saying it might be true and could be studied.)
Posts: 1114 | Registered: Mar 2004
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