The 1990’s saw an attack on Medicare from the right wing – said Newt Gingrich, the program was “Soviet-style health care, too bureaucratic, too centralized, too dominated by government.” Gingrich is a smart man, but is blinded by ideology. Anyone who can compare private health insurance to government-run and say the latter is “too bureaucratic” is missing the big picture.
The primary thrust these days from the right are HSA’s – health savings accounts. The objective is to counter what insurers call a “moral hazard” – the idea that people use too much health care when it is provided by others. HSA’s force people to save for their own care, making them cautious about spending, thereby making only medically necessary expenditures.
HSA’s are appealing to younger, wealthier people. These people have fewer medical problems, and are attracted to the idea that they can accumulate cash in an IRA-like fashion that could later be converted to an IRA account. But medical costs are like the angel of death hovering over all of us, affecting only a few at a given time. A major medical problem quickly wipes out an HSA, and the owner becomes part of the larger scheme again. The overall thrust of HSA’s is to segregate the population into sick and healthy, forcing larger costs on the sick, negating the benefits of large insurance pools of healthy and unhealthy alike. That’s a moral hazard.
HSA’s face another moral hazard – the fact that financial institutions are drawn to the deposit and fund-management aspects of the program. Their main objective is to build up deposits, but HSA’s also offer opportunity for fees for account processing. As with mutual funds, these fees draw down asset accumulation and income stream over time – a subcommittee of the Senate Finance Committee found that mutual funds on average lose 26% of their accumulation to fees. (Social Security drain: 3%.)
People do tend to spend less on medical costs when they are dependent on HSA’s. The problem is that most of us don’t have a crystal ball, and don’t know what’s important, what is not. HSA’s end to decrease the chance for early detection, meaning later and more expensive treatment of diseases and conditions. Furthermore, poor people are most likely to scrimp on expenditures, meaning that they would, as with the current insurance system, get the short end of the stick.
The above are condensed thoughts from Jill Quadagno and J. Brandon McKelvey from an essay entitled “The Transformation of American Health Insurance”, not available on the web. (The 26%/3% figures come from a Sen Max Baucus aide on the Senate Finance Committee whose name eludes me. He was here in Bozeman to address seniors are part of the Wonderlust program.) Here’s an interesting excerpt:
In the past few years, Congress has enacted measures that have given private insurers a larger role in Medicare, most recently with the Medicare Modernization Act of 2003, which created Medicare Advantage, a private insurance option. There is already evidence that inserting private insurance into a social insurance program exposes beneficiaries to the risk of abuse. The private insurers who run Medicare’s new drug benefit program and offer other private insurance options encouraged by the Bush Administration have used deceptive sales tactics and improperly denied claims to thousands of beneficiaries. The problems include improper termination of coverage for people with HIV and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls. In 2007, Medicare imposed more than $770,000 in fines on eleven companies for marketing violations and for failing to notify beneficiaries about changes in costs and benefits in a timely fashion. Many of the marketing abuses occurred in sales of the Medicare Advantage product.
Sounds like we need to deregulate.
But seriously, folks, private insurers and patients are at odds with one another, one seeking health care, the other benefiting only when that care is denied. It’s a system in conflict with itself, and doomed to fail. Yet it is the only one that free-market types can fathom for us.
It is probably best to jettison the free-market types. They are a moral hazard.
Piece of Mindful 
Single-payer – not to be confused with single-provider -can best address inflated costs to consumers. Negotiating price is what Wal-Mart does to to deliver savings to consumers. Imagine the leverage of 300 million people in one “pool.” Until prices are made affordable, no plan will deliver what Americans want – a plan like the one Congress has.
LikeLike
In 2008 the CBO estimated Medicare Fraud at $33 billion against a budget of $454 billion or 7.2%.
In Missoula a Medicare participant cannot find a new doctor who will accept them (the DRG tables don’t cover the cost of services.)
Because the U.S. does not impose tort limits on medical malpractice – for either public or private systems – the cost of “defensive medicine” increases the cost of care by about 9% of total health care costs. Extrapolation that to the Medicare budget means that roughly 18% of Medicare billings are superfluous charges for defensive medicine.
U.S. patients file 3.5 times more malpractice suites than do Canadians. The cost of malpractice coverage and payments per capital is twice what the Canadian system pays. Canada has a nationalized malpractice insurance pool and tort limits are set at $350,000. Canadian tort claims are adjudicated by a panel of M.D.s as opposed to court trials.
Although it’s true that medical malpractice insurance and settlements only accounts for about .5% of total health care costs in the U.S. it’s obvious that the other costs I’ve mentioned are not taken into account in most analysis.
It seems that moral hazard is pervasive and pernicious.
LikeLike
>>>>It is probably best to jettison the free-market types. They are a moral hazard.
Tsk. Your Che shirt must be a little tight.
There are two issues here I think you would do well to keep separate: the high cost of insurance, and the high cost of health care. You indicate that health insurance costs are higher than they should be. Yes, but even if we squeeze them down to the minimum, we are still faced with our high cost monopoly health care system. There is not much of a market there, there is not much ability to shop for a better price deal.
LikeLike
I agree that health care costs in the future are a huge problem, and that rationing will be the only answer. We’ve simply gotten too good at it, curing so many things, using overpriced drugs as a permanent treatment for minor conditions. The outlook is bleak.
The solutions from the right – the moral hazard of overuse and malpractice, are nonstarters, more a defensive maneuver than anything approaching a real solution. If you cling to markets as the solution to all problems, and market solutions are the problem, you’re on a dead end.
I know of the problems with medical reimbursement. I also know that providers have incentive to defraud Medicare, and that problem in ongoing. Private insurers look to legally and illegally shortchange consumers – at least with Medicare fraud, the risk is spread evenly among us. Individual patients are mostly protected from fraud.
Medicare is underfunded, but at least its problem is not bureaucratic or profit driven.
Huge problems ahead, and no solutions from your quarter.
LikeLike
>>>>If you cling to markets as the solution to all problems, and market solutions are the problem, you’re on a dead end.
I don’t see where markets are the problem. Anytime you trade for goods or services, you have a market. Some markets are better than others. Health care has a lot of costs mandated/dictated by government and the courts which drives up costs. Many health care decisions are made on the basis of emotion, not money, and this drives up cost.
>>>>Private insurers look to legally and illegally shortchange consumers
Well, for the most part they obey the law. That is a bit gratuitous on your part. They push some gray areas. If they are consistently shortchanging consumers, in a competitive marketplace someone can step in and gain business with better service. There’s your next business, Mark. Start a health insurance company that treats people like you think they should be treated. You will have people flocking to your door.
>>>>the moral hazard of overuse
Not necessarily “overuse”, just “use”. If everyone knows there is a $100,000 coupon sitting at the emergency room, guess what: some are going to cash in. I don’t have a problem with people using medical services, but I think they should pay their share.
LikeLike
These statements are broad enough to be useless. Deal with the essential problem: The business model is to attract healthy clients, and deny coverage as much as possible.
I’d soon be out of business. Are you beginning to understand? The market and health are at odds with one another – the only way the insurance companies can survive is to avoid sick people and minimize payout. It’s a failed model.
[sigh] – you who touts the 80/20 rule – in health care, there’s a 1/22 rule – 22% of costs are consumed by 1% of the population. Health emergencies – accidents and serious illnesses, are the thing that absorbs the bulk of the costs. They float over all of us, can hit any one of us and wipe us out. Hence the concept: risk sharing through insurance.
High costs due to illness are most likely to affect seniors. That’s why the insurance companies dumped them on the government, along with the poor, who were not profitable.
Are you seeing now – insurance companies are a leech on the system.
LikeLike
“The solutions from the right – the moral hazard of overuse and malpractice, are nonstarters, more a defensive maneuver than anything approaching a real solution.”
No, Mark, these are actual problems which you don’t address. How do we solve these under any system? I have brought up the issue of malpractice several times and you dismiss the issue. As I said, non-health damages in Canada are limited to $350K. France recently adopted a Canadian style tort system to take complaints out of their courts and into an medical review panel. They limit non-medical payments to Euro 750K. Do you think we need tort limits under a single payer system or not? Do you really think that the issue of medical malpractice is, as you say, a non-starter or could it be just one part of a more comprehensive restructuring of our medical system?
“Private insurers look to legally and illegally shortchange consumers – at least with Medicare fraud, the risk is spread evenly among us.”
I guess two wrongs make a right. I like the thought: if we’re going to get screwed lets make sure everyone gets screwed! From the minds of egalitarians.
Canada, Australia, Germany and England are facing rather severe shortage of doctors. Medical Fraud in Canada costs Canadian taxpayers roughly $4 to $10 billion per year. England’s health care system is so overstretched that they are now considering not treating fat people and smokers – rationing to those who only take their health seriously.
Germany focuses their system almost entirely on private mandated insurance as well as private ownership of medical practices. For those who do not own private insurance there is a state pool. This pool is paid directly out of payroll taxes of the insured members. The cost is 13% of gross wages. Germans are satisfied with the quality of care but complain about the high cost of coverage more than do other European countries.
Last, but not least, under a single payer payer plan “markets” do not go away. There will still be a profit motive and market dynamism will still play an important part in countless parts of the health care system.To think otherwise is naive.
LikeLike
>>>>High costs due to illness are most likely to affect seniors.
Someone was telling me that there is an interesting S shape to the medical cost curve: after about age 75, people start rejecting costly procedures and are more apt to “let nature take its course”. He said people with bad genes are usually gone by age 70, so we see a decline in health care costs after that age.
>>>>Start a health insurance company…I’d soon be out of business…The market and health are at odds with one another
In your world the market and _____ are always at odds with one another. There are always shortages and the discomfort they engender. Better policy is not always available.
>>>>the only way the insurance companies can survive is to avoid sick people and minimize payout. It’s a failed model.
We have to let the companies avoid the most egregious risks. Rationing, in other words.
This all rests on the basic premise that people should pay for their own care. If someone has an amazingly expensive disease, they have their own resources and charity, but after that I don’t see a categorical imperative for the body politic to fund treatment.
LikeLike
Fred – you’re simply out of touch. Your model – each man for himself, is not even worth commenting on.
Dave – There are many models out there for health care – the French is most efficient, the US most inefficient. Britain’s system is the cheapest by far, to the point that it is underfunded. That is at the heart of their problem – they spend less than France, Canada, Germany, Taiwan – of course they are faced with more rationing than the rest. But more rationing is in the future for all of us. I trust public systems to be fair about it, private systems to be extremely unfair.
If countries face a shortage of doctors, they should 1) train more, and 2) pay them more. Cuba has no shortage of doctors. Part of the problem is the lucrative salaries of the terribly inefficient US system, which drains other countries. I have little regard for physicians who are driven more by private enrichment than patient well-being. Let them go to the US and become part of our problem.
Medical fraud in Canada – $4-$10 billion a year in a system that spends 10% of its GDP on health care (US -16%), $120 billion total. That’s 3-8% – our overhead alone is triple that. It’s not trivial, but no reason to jettison the system.
Health care problems are severe and need addressing. Industry and politicians have fallen back on diversions – tort reform and overuse.
Regarding overuse, it isn’t much of a problem as most health care costs are absorbed by large expenditures on a small portion of the population – Fred’s 80/20 rule, and the 22/1 rule – 22% of health care costs absorbed by 1% of the patients. Overuse pales in comparison. Further, experience says that when people pay the small costs that so trouble you out-of-pocket, they do indeed spend less, and cut back an necessary as well as unnecessary costs. The result is less early detection, and more and higher long term costs. In other words, we’ve got a patient that is bleeding profusely out of a major artery, and you want to put a Band-Aid on a paper cut. No help here at all from you.
Regarding tort reform and malpractice insurance, it’s natural that the issue is at the forefront, as the corporations that don’t like being sued also happen to own our media. They want to be free of consequences of their own actions, and so have created an emergency, and part of the propaganda campaign has been to demonize lawyers who represent clients without resources. Nice strategy.
So-called Tort Reform is marketing – nothing more, a way of letting insurance companies off the hook and restrict the rights of ordinary consumers to obtain redress through the courts. That other countries have done it? Fine. Doesn’t mean we have to, especially since it’s not a large part of our cost.
Malpractice insurance is another diversion – the best I could do are rates through 2002: Link –
I don’t have anything more recent, but I doubt trends have changed much – in other words, deal with the problems at hand, and stop trying to divert attention to matters of little consequence as a means of avoiding debates about market inefficiency versus government efficiency.
Finally, I said “Private insurers look to legally and illegally shortchange consumers – at least with Medicare fraud, the risk is spread evenly among us.” – you said “two wrongs make a right”, sarcastically. Fraud is unavoidable, especially in a system like Medicare, that simply reimburses private contractors. The door is wide open. Reform is needed, with the VA as a model. Out of reach, I suspect. But my point was that you don’t inflict individual disasters on unwitting individuals when the cost of fraud is spread out over everyone. Medical fraud in the private sector destroys individuals and families.
LikeLike
>>>>…stop trying to divert attention to [other matters] as a means of avoiding debates about market inefficiency versus government efficiency.
I think the “market inefficiency” you tout here is less than you think. Our health care costs are higher than Europe et al in large part because we do more: we have more procedures and more machinery. I suspect if they did what we do, the costs would be the same.
I’m suspicious of squeezing doctor’s salaries to save money. A quick check said this accounts for 20% of health spending, and after overhead take home pay is 10%. Worth pursuing but I don’t think it is a magic answer.
>>>>Malpractice insurance is another diversion
I suspect J Robert Hunter is soft-pedaling things a bit. Marginal costs of this and defensive medicine drive a lot of decision making, not all of it quantitized in the studies.
>>>>Further, experience says that when people pay the small costs that so trouble you out-of-pocket, they do indeed spend less, and cut back an necessary as well as unnecessary costs.
Well, I would hope people undertake necessary costs.
I don’t see why health care should be exempt from the economizing we find elsewhere in society. Instead of having first dollar payment, let people know what things cost, and give them some shopping options. I’m willing to bet consumers could find a cheaper alternative to the $300 saline IV.
>>>>Your model – each man for himself…
At some level each of us reaches into our wallet, or we each have less done on our behalf by the central authorities who are spending our funds. We shouldn’t pretend there is a vast pile of money that can be spent for our benefit with no consequence.
LikeLike
Mark, obviously you didn’t read the part about defensive medicine.
There is no diversion in my comments. My point is that this is an incredibly complex system and you boil the problem down to insurance. It seems to me that it’s you who is deflecting to only those issues that are important to you. But what you don’t do is offer any “solution” other than spreading risk and getting rid of overhead. As I’ve clearly pointed out, those fixes alone will not solve the health care problem.
And you need also to do a bit more comparison of the other “models” that you assert are better than ours. What we don’t need is a bollixed up system that doesn’t fit the needs of the people. And in the process shouldn’t we look to find the best of both worlds? What about mandated risk pooling to avoid adverse selection? What about standardizing claims management like the French and Germans to reduce overhead?
LikeLike
You don’t know this, and I doubt it is true.
Once again, you’re making unfounded assumptions. You don’t know these things. Hunter says defensive medical costs are “negligible”. I don’t know of any precise studies done to measure the effects of defensive medicine. I do know there’s a lot of sloppiness, as doctors will undertake tests they know are insured. I’m not blind to that.
I could not agree more.
Check this out. Unfortunately, the people involved are married to the private model, and unwilling to look at successes in other countries.
Regarding expanded risk pools, you’re on the right path.
LikeLike
Actually, as 2007 study by Price Waterhouse Cooper estimates the price of defensive medicine at $210 billion per year. A 2005 study published in the JAMA found that 93% of physicians practice defensive medicine.
The Massachusetts Medical Society recently reported”
A 2002 review of total tort costs by Duke University’s Center for Health Policy showed the cost of U.S. defensive medicine at about 5% of total health care spending.
The American Association of Osteopathic Surgeons estimates that the per capita costs of defensive medicine is about $2,000 excluding litigation costs.
And my point, none of this changes under single payer health care unless we revise the tort system. that is to say that a savings of 5% here and 10% there make real differences in the cost side of the equation. Standardization of claims processing is goof for about another 10% to 20% (Look a the French and German systems.)
And if your objection is that there’s not enough conclusive data, well first, I disagree and secondly, maybe we should find out before we build something that cannot be “unbuilt.”
But what I see in your argument is a false choice. How about a law that prevents price discrimination. Currently Blue Cross/Blue Shied pays about $800 for an MRI. The patient without insurance pays over $2,500.
LikeLike
Now that medical malpractice has been set aside as a significant factor in the runup of health care costs, we move on to a new argument – defensive medicine. By its very nature it’s hard to measure – the $210 figure is but one side and the high end of a many-sided debate – are additional tests a good thing, is patient care better because doctors are on guard? None of that is considered – it’s just tests willy-nilly run for the sake of covering asses. I don’t buy it.
The argument is marshaled by the “tort reform” crows (the term itself propagandistic and probably originating in an ad agency). The thrust is to protect corporations and insurance companies from lawsuits and award settlements – period, by putting an arbitrary cap on them. We would inflict much more harm by limiting settlements to worthy individuals than claims on insurance companies. But that’s not your lens.
If indeed 5% of medical costs are defensive in nature, what is the outcome of that 5% (much less than $210 Billion – more like $115)of spending? You don’t know, neither do those doing the study. They just project, based on surveys of doctors, that that amount of testing was done, and the assumption is that it was all unnecessary.
Administrative costs: France, 10.6%, Private US, 31%. Medicare – 5%. Is claims processing 20% of their cost? Seems irrelevant. French health outcomes are better than ours, everyone is covered, and they spend half per capita of what we do.
The patient without insurance likely doesn’t get an MRI. Most uninsured people go to emergency rooms, where the only mandate is to stabilize them – not diagnose. But insurers do squeeze the balloon.
LikeLike
“The patient without insurance likely doesn’t get an MRI”
Well, I have, not one, but two adult children without health insurance who had unnecessary MRIs within the last two years.
Now who’s making assumptions.
As for the French have better health outcomes… Is that based on that highly flawed WHO study? Could lifestyle account for differences? How does France measure “viable births”? Why is that the French paradox exists?
This is what I get out of you. You’re really unwilling – or perhaps unable – to think outside of the typically prattle of collectivism. It might be refreshing if you could think outside the box a bit.
Did you know that both the German and French private insurance systems outlaw exclusions for pre-existing conditions? The French system also provides doctors exclusive authority on which treatments to administer. If a standard of claims processing was set in the U.S could we not get that cost down to 20%? It’s not nothing. It’s not irrelevant.
I haven’t once in this debate excluded anything. What I’ve done is provide the best empirical evidence I can find. You, on the other hand, nay say what studies are available and fall back on your tired old trope that this is all propaganda.
Get serious, would you? Even if you think things like moral hazard and defensive medicine are overblown they do exist to some level. But you look at them as nothing more than an excuse.
LikeLike
The WHO study is not “highly flawed” – this sort of prattle goes on whenever someone undermines prevailing American assumptions – right away the body presenting the data is attacked. Please. US is 37th. We don’t cover 47 million people. That’s hard to overlook, though WHO critics have tried.
Your two children don’t have health insurance? Don’t you just love this system? I’ll have to see more data than that. But I’ll give you that point anyway.
Somewhere we lost track of this debate – there was a time when you argued that if we could just jettison employer-based insurance (tax it as compensation), and eliminate mandated coverages (under-insure everyone), that the private sector would fulfill its obligations in our health care system. You don’t talk like that anymore. Now you’re touting the French system, where they have outlawed preexisting condition exclusions (my wife and I both have them and are uninsurable). What would happen if they did that here? We’d have a massive system failure, as people would be let in the system who are sick and need care. That’s beyond the scope of the intended function of our system – to privately profit from selling insurance to healthy people. Our system is meant to exclude people. It’s no accident.
Now you’re on to standard claims processing – centralized medicine. That’s something that single payer yields automatically. You’ve just discovered it?
I’m not the one with the box problem – I long ago discarded the market as a solution to health care – I got out of that one. I now look to our collective will using our government to provide solutions, and you to prevent these solutions in the name of some abstract notion of free markets. You think outside the box for once – ditch the market. look all about you, look at your two children, see that it has failed.
LikeLike
Mark, there is a lot of debate about the WHO study. The assumptions are based on the criteria set by the countries in question. Look at infant v child mortality rates. We have higher infant mortality because we attempt to deliver, and save, so many more premature births than any country in the world. Our definition of a live birth is radically different than what it is in Cuba. The French don’t consider a birth “live” if the baby is born before 7 months term. Cuba has several times the number of deaths between the ages of one and two as the U.S. yet that statistic isn’t even in the WHO study. I’ve been over the study with a fine tooth comb and there are so many apples to oranges comparisons in it that it’s not very valuable statically.
Although I still believe that employer based health insurance is both unfair and hopeless I don’t think I’ve ever taken a position on mandated coverage. But I think it’s nuts to mandate that employers are required to provide insurance for their employees. The insured should own the insurance for, at least, portability and how is it fair that employer covered individuals get a tax break when others don’t? It simply discriminates against a random group of people.
Secondly, I’m not touting the French system except to the extent that they have some good parts – which I’ve outlined. I don’t want there system per se. As a matter of fact I don’t think their system is implementable in the U.S. for the foreseeable future simply because of the earnings differential ($55K v $155K) between French and U.S. doctors. That’s not my issue but, rather, an issue of culture which cannot be easily changed.
And I don’t buy the notion that we can’t require real risk pooling in the market. I don’t see why some structured re-insurance system along the lines of what John Kerry proposed in ’04 wouldn’t work. Even a subsidy to launch that product would seem to be less expensive to the system than other options.
About my two kids… both of them could have afforded a health insurance policy but, like many young people, decided that things like music, cloths and cell phones were more important. In fact I got quotes for both of them and they can be insured for about $120/mo. But I’ll be damned if I’m going to pay for their insurance when they’re able to buy it themselves. Since then one of them now has coverage while the other still chooses to ignore the risks. I have four adult children and three of them have insurance – now.
Standardized claims processing is not centralized medicine. It’s a standard to promote efficiency like electrical outlets and phone jacks. We don’t need a single payer system to do that. And in systems that have it, like Medicare, should we put the cost of fraud into the processing equation? After all, part of the insurance processing costs go to ensure that claims are legitimate. It looks to me like all part of the same funciton.
As for ditching “the market” – that’s impossible and isn’t practiced anywhere in the world for health care except communist countries. All single payer health care is doing is controlling the market by creating a government monopoly in some sector. All developed countries’ health care systems are an amalgam of markets. The issue is where they apply controls. But I’m not convinced that rationing health care through price controls – which is what the Canadian system does – is the most efficient way to distribute scarce resources. And I wonder what that does to medical innovation. The U.S. is responsible for about 80% of the world’s medical technology innovation. The market is responsible for some part of that.
But instead of making radical changes to our system it seems to me that we need to be much more pragmatic to find a more optimal solution. for example, we need to outlaw price discrimination. We need to require price disclosure for providers. We need equalize the tax system to remove the arbitrary nature of the tax incentive.
We don’t have free market in health care and we haven’t had one since 1965. It’s illogical to say the market has failed when it’s not been tested.
One last thing, it doesn’t take any mental creativity to say that we simply need to copy another system to correct our problems. All economies have health care problems. What you propose is not new and would likely just result in importing another systems inefficiencies. We should be able to do better than that.
As I’ve outlined in the past. My favorite foreign system is the Swiss. It’s free market, high quality, administrative costs are at 13% and everyone is covered. But yet, I still think we can do better.
LikeLike
It was late last night when I responded (I should have waited) and I was irritable. I didn’t feel like doing any plowing. So I just shot off a few words. I do that a lot.
The thing that has always jumped out at me is the comparative cost of our system with other countries, despite the problems we all face with increased costs and new and better procedures and the need for rationing. It’s not small – we’re twice as high as other countries. Fred says that’s because we do more, but that’s throw-away stuff. Other countries manage to cover more of their people and have better health outcomes (longer life expectancies, infant survival, etc (Cuba aside)), and cancer survival rates equatable to our own. So something is very, very wrong with our system.
And that something is not hard to spot – we have a hodgepodge system of private insurers, government insurance, and government delivery of services. The most efficient system, VA, is government delivered.
I’ve talked a lot about the inefficiencies of private insurers, and think they ought to be jettisoned. They are not making our system better – they are making it worse by imposing bureaucracy and additional costs (profit) on top of an already-burdened system, and by segregating the market into healthy and insured, unhealthy and uninsured, poor and uninsured, and employed and insured to varying degrees. I look at other countries and see that they have either eliminated private insurance, or pushed it to the background. By comparison to what we have, that would be a better system. But I do not claim it to be a panacea.
Most people in this country favor universal coverage – other countries have demonstrated that it’s reasonably feasible. If we had a functioning democracy, we’d have it. But as Max Baucus and Hillary Clinton remind us, single payer is not “politically feasible”, meaning that the insurance companies, which have more influence than the population at large (campaign finance reform), will not allow it.
Yes, I would like to see the end of the employer-sponsored system, but I want to transition into single payer, where you want to take it into individual policies, with all of the tyranny of the private insurers intact. I would like to see American employees to be more like me, not tied down to a job they hate, free to move around – hell – free to take time off.
Other problems – overuse, malpractice, defensive medicine, and “tort reform” (limiting the ability of ordinary people to sue corporations) are recall enough, but I saw you ass wanting to divert the debate away from the big picture, the big problem, private insurers. (By the way, if you cap rewards at a low enough level, there’ll be no lawsuits at all, as trial lawyers will be unwilling to take on cases. Is that a worthy objective?)
LikeLike
“Recall” = “real”
LikeLike
Just a few points of fact. A liability case does not sue a corporation – it sues a doctor who is insured by a corporation.
Secondly, I cannot find a single health care system besides ours that does not limit non-economic damages. so it would seem that if you embrace what other countries have done with health care you would likely embrace that as well.
I also find it odd that you think that private insurance is more tyrannical than what a single payer system would be. Ask medical providers if Medicare is tyrannical and I’ll be you’ll find almost universal agreement it is simply by the payment schedule under the Diagnostic Related Groups (DRGs) under HCFA.
Last, but not least, France and Germany do not have single payer systems. The French system is an amalgam of three insurance institutions. Germany is about half private insurance.
LikeLike
I don’t recall saying that anyone besides Canada was single payer. If I did, I take it back.
You’re right about lawsuits.
I do regard private insurance companies as tyrannies. They make their living by denying clients, minimizing coverage, and dumping their costs on others. If they don’t do this, they don’t stay in business.
Efforts to limit economic damages in the US are directed at protecting corporations from lawsuits, and fall under the umbrella of tort reform in general. Malpractice damages are not a terribly significant part of our health care costs. It’s not being done to protect the system – it’s the corporations who seek to limit redress for grievances. .
Germany requires that all people below $47,250 Euros participate in the public insurance program – only about 10% of the population is exempt from the public system. Employees pay 7.5% of their salary for the public package, employers 6.6%. Children and non-working spouses are covered. People can indeed purchase private insurance to cover things like private rooms and have a greater choice of providers, but keep in mind that the public system provides the big ticket items and basic care that provides the umbrella under which private system functions. And of course, just like here in the US, and essential to staying in business, private carriers are free to turn down patients. They can cherry pick.
I don’t see where private care is viable in Germany without a public system that limits their exposure, and gives them the option to avoid adverse selection.
LikeLike