I am in favor of widely available catastrophic health insurance (high deductible) and letting people pay small expenses out of pocket.

That’s murder on any sort of preventive care, but it would be a step forward from the current situation. Right now, we actually do have a kind of basic universal health care (since it is illegal for a hospital to turn away an emergency patient due to inability to pay), we just don’t have universal health coverage.

One thing – aren’t we ignoring the issue of the under-insured, or people who did buy health insurance that turned out to be woefully inadequate when an actual health care crisis emerged? Exact numbers aren’t present in the way that the uninsured numbers are, but there have been several studies like the one CNN references here, where you have a very high fraction of bankruptcies due to medical costs – and out of those, the overwhelming majority had health insurance. It’s not enough simply to get the uninsured covered – we need to make sure that people can actually get covered for the care they need, whether currently insured or not.

Hospital charges $200,000 to an uninsured young woman. IF she had been covered by Medicaid the hospital would have been paid $10,000.

Customer with ‘80/20’ coverage gets test. Nominal price of test is $1200. Customer pays hospital $240. Contracted price of test with insurance company is $200. Hospital credits the excess $40 received from the patient to the insurance company. Customer paid an insurance premium, plus the full cost of the test, plus $40. All because the price that he would have been charged if uninsured was a fantasy number the hospital never expected to get.

We could do a lot for the uninsured and those with high deductibles by regulating that care providers must not charge self pay patients more than they charge insurance companies for the same service. Also, requiring providers to publish prices would provide the marketplace with better ability to make cost effective decisions. Normal market forces are undermined by the lack of clarity and reliable information about pricing.

Providing health care to all will ultimately mean that the responsible folks like me (that manage my health by always eating properly, don’t smoke, exercising daily, heeding the advice of my MD by paying attention to weight etc.) end up paying for the irresponsible folks that do not do such things. While I do believe that health care should be affordable, I also believe that a large number of people do will continue to do what they want unless it personally costs them. This is why I believe there should be catastrophic plans only ($10k/Ind, $25k/family) and let individuals shoulder some of the costs of their poor decisions. This will also limit demand since anything that is almost free creates unlimited demand. Just ask a Canadian what the result of that is.

This coverage should not be handled by business either and minimal, if any, tax deduction should be allowed for premiums. Currently the IRS allows business to deduct all “insured” plans premium costs. As a result, some companies buy plans that cover every dollar for their executives and dependents and then offer a second more unfavorable plan to everyone else. This should eliminate this practice.

Our government can help us my demanding (legislating) this type of catastrophic coverage, allowing all of us regardless of where we live, to purchase any plan sold in the US (open the markets to all carriers), addressing the cost of providing care (yes, government controlled pricing just like with Medicare, and requiring all citizens to have care. Anyone that cannot afford care/insurance, should receive the same coverage but with the cost picked up by the government. I have worked in the health insurance business as a broker for 30 years. With only a handful of carriers left in most states, Insurers need to have more competition for both pricing and quality. If the government creates a comparable plan to compete with Insurers, Insurers will cry foul,since they believe it will be mean the government will end up covering everyone. I do not buy into this theory: whenever government is involved in anything, it usually means a lot of people are getting paid more than the private sector and there is more waste. So, if the government can do it for less, then something is wrong. In the final analysis, why should Americans pay more that they have to for any service?

I would also hope that our government would stop mandating that health plans cover poor lifestyle decisions, like stomach surgeries. I would rather the government invest in stem cell and cancer research than cover these things. Also, as previously suggested, the government needs to look at the cost/benefit of every new medicine or medical technology and manage health care. Otherwise we will never solve this problem. There is a limit as to when medical care advances are worth the cost.

Why have a National Healthcare system, which (insert sarcasm) yeah, I’m so happy that the Pres says I can keep my business-provided healthcare when the national system is rolled out, but whose to say my business will still be providing it since the business knows I can get the national program now?

you deserve health care that is good as Members of Congress get

I’d rather have the power to direct earmarks.

Incidentally, is it actually the case that healthcare, on a hedonically adjusted basis, has been getting more expensive? If we simply said “government will provide 20-year old healthcare, using newer drugs and technologies only when they are cheaper than what they can replace (not ‘augment’)”, how much would that cost? (If you imposed that on current medicaid and medicare patients, how much of the cost of anything new would thereby be freed up without tax hikes or other benefit cuts?)

I assert that the law of exponents dooms all government entitlement programs to eventual bankruptcy. However small each program starts out, built into it is some rate of growth that virtually guarantees, in the fullness of time, its growth to gargantuan levels. From what little I know of it, Medicare would seem to be a classic example of this.

The essence of the health care debate can be reduced to two choices: hospitals are required to provide care to all who come, therefore the government must mandate that all citizens share in the costs; or, since all citizens are free to live their lives as they wish, hospitals must also be free to deny services to those who cannot pay.

That’s a l-o-n-g time ago

Do you really think they are valid?

I worked for a semiconductor company in the 1980-1990s and a company involved in paying health care bills in about 8 years ago. I was constantly frustrated in the health care company by the widespread acceptance of bad practices. I was reminded of my semiconductor company in the early 80s when we had no competition. We delivered a product when we got around to it, at a high cost and quality was poor. Then Japanese started to clean our clock. It was extremely painful, but we learned that we could survive in a competitive world but we had to completely change our way of thinking. We had to provide innovative parts at high quality with on-time delivery and at a constantly declining cost.

This attitude is completely lacking in health care

Just one example. In manufacturing we measured quality in failures per million. In health care they accepted claim errors on the order of parts per dozen. When I tried to put in place systems to reduce error rates I met with apathy. Why bother, our error rate is the same as Aetna’s or some such. We will just correct errors later.

The question is how to introduce competition? I have some hope for the doc-in-a-box model married with catastrophic insurance. There are docs who would prefer to forgo dealing with insurance companies and just get a lower payment paid at the time of service.