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  1. #161  
    Quote Originally Posted by 1thing2add View Post
    Based upon that model, what is Jindal's plan for providing universal care?.
    Why is a plan needed if it's already there?

    Quote Originally Posted by 1thing2add View Post
    Those are your unfounded fears speaking for you. "Insurance as we know it" is primarily why healthcare is heading for bankruptcy.
    Man, this internet thingy is amazing, with all of its news, research info, general info, and discussion forums. This person has just learned that their fears are unfounded. Keep the government out of it, just move it to the internet.
  2. #162  
    Quote Originally Posted by 1thing2add View Post
    I gave a lead-in to the "whys" with the very next line regarding hospital readmissions. Ever wonder why a single heel ulceration easily costs $30-40k to properly treat? (No, it has nothing to do with tort reform, either. )
    How do you know some sort of tort reform can't help? Can the government properly "provide" this service for less (government's contribution coming from "the people" to begin with anyway). Are government dollars worth more than my dollars?
  3. #163  
    Quote Originally Posted by Technologic 2 View Post
    In Louisiana there is no reason for anyone to go without healthcare. We have a system of Charity Hospitals (they are teaching hospitals) that charge based on a sliding scale - a majority of patients do not pay anything. We have local public health units for checkups, immunizations, minor treatments. Again, if there is a charge, it is usually $5-$10. I don't know of anyone who CAN'T get healthcare locally.

    I have insurance because I like to choose my doctor I want and I don't like to wait. When I am sick, if my usual doctor can't see me today, I go down the street to another.

    My problem with a federal takeover is that it would be an end to insurance as we know it. It would limit my choices, and sure like our Charity system, if I am real sick, I can get care, but I may have to wait awhile and if they don't think I am worth treating, there won't be somewhere else to go for a second opinion.
    Let's see....who pays for your public health units? Who pays for the charity hospitals to be able to provide that $5 care that costs the hospital $150? Do you think that employees of the charity hospitals have families, and like to get raises, or should they work for free? Do you think that private entities like the Ochsner Clinic should be responsible for providing some care to people that don't have coverage? Do you think that city and state support of teaching hospitals for charity care is the most efficient use of your tax money and provides the best care for uninsured? Don't you think it might be a better idea to allow people some choice about where they are seen? You make it sound so easy....hey, all you have to do is walk into a charity ER. It's not that easy, efficient, or effective.
  4. #164  
    Quote Originally Posted by sblanter View Post
    How do you know some sort of tort reform can't help? Can the government properly "provide" this service for less (government's contribution coming from "the people" to begin with anyway). Are government dollars worth more than my dollars?
    Because people that are knowledgable about health care financing are convinced that tort reform will have a negligible effect on cost savings. In places where it's been implemented, it hasn't even decreased the cost of malpractice insurance required by providers, much less altered their test ordering habits. In other words, not surprisingly, the insurance companies are given more protection, but still don't decrease their rates. Even the cost of losing malpractice suits is miniscule. But the main argument, that releasing hospitals and MDs from the risk of suits will decrease their spending, has never been shown anywhere and is unlikely to occur. Even very conservative groups like the Center for a Just Society are opposed to tort reform:

    In 2007, the Congressional Budget Office estimated that costs associated with medical malpractice claims only amounted to 2% of overall health care spending. Furthermore, multiple studies suggest that the high cost of medical insurance has virtually no correlation with the frequency or amount of malpractice payouts but is actually a result of insurance companies playing the market and—in some cases—intentionally misrepresenting the influence of malpractice payouts in order to keep premiums high. Doctors are not fleeing the medical profession from fear of lawsuits, and those who are sued for medical malpractice are often permitted to continue working with little to no professional censure for the harm they inflicted.

    The truth is that corporate moguls push for tort reform because they have little use for a civil justice system that puts the little guy on the same plane as the rich and powerful. These so-called fiscal conservatives don't like equal justice. They want preferential treatment—something they are accustomed to getting from politicians because of their hefty campaign contributions.

    Conservatives need to educate themselves about the importance of a civil justice system that protects everyone and treats all litigants—rich and poor alike—as equals before the law. Furthermore, true conservatives ought to resist attempts to federalize tort law and impose one-size-fits-all solutions to "problems" that are, in large part, the fictional creations of special interest lobbyists seeking to enrich the coffers of their wealthy clients. Any change in medical malpractice laws should occur at the state level and be tailored to meet conditions in the individual states. The people in Topeka may approach the same problem differently from the folks in Tallahassee. They may be experiencing different problems, or perhaps, none at all. In any event, the residents of Attapulgus, Georgia don't want Chuck Schumer and Olympia Snow dictating the remedy they can pursue when a doctor leaves a pair of scissors in the site of their incision or causes avoidable brain damage to their newborn.
    Remedy or Red Herring? Tort Reform

    Oh....and yes, government dollars are worth more than your dollars....especially when a third of your dollars disappear into the yawning maw of insurance companies.
  5.    #165  
    Quote Originally Posted by sblanter View Post
    And there will allways be a profit motive. Government can't pay for anything, without taking it from individuals first (and nothing comes from corporations/companies/other entities either unless it comes from individuals first), and they have to at a _minimum_ recover their overhead.
    Government also makes a profit...it is just skimmed off the top as corruption...remember the $600.00 toilet seats, etc.
  6. KAM1138
    KAM1138's Avatar
    #166  
    Quote Originally Posted by Kenanator View Post
    Like I have said, I am not anti-capitalism. I just don't think your health is a material item that should have a price tag and be profitable for someone else.

    The only ones who profit from roads are those who build them. I feel that the only ones who should profit from health are the ones who save lives, not some unnecessary middle man (ins. companies)
    And I'm not accusing you of being anti-capitalist.

    As far as health being a material item...well, it isn't. Providing the service of healthcare however carries costs--both in time and material. I'm not sure how we can eliminate a price tag for those things.

    I'd disagree about roads--I think they are very valuable, and while they don't directly provide profit, they provide a means of making profit (helping to conduct commerce) to many.

    In regards to your opinion about insurance companies not making a profit--ok. First, I'd ask why that is, but I suspect that your answer will be that it is wasteful--in that it is essentially adding to the overhead of providing medical care. If that is the case, I'd say that is true. That's why I prefer elimination (to the maximum extent possible) all indirect payer systems--totally take ALL middle men out of the picture. I don't want to trade one middle man for another. In addition to being more efficient, it removes anyone's ability to tell me what care I can get based on their decision to pay.

    I don't want insurance companies telling me what care I can get, and I sure don't want government doing it either. With indirect payer systems, where money doesn't grow on trees (and obviously it doesn't) this WILL (and does) happen.

    Problem is--my dream situation is thwarted by costs that are so high that almost no one can afford them. So, we fall back to these "spread-around-the-costs" schemes, which result in...yes inefficiency and overhead. Its really a catch-22 in some ways. That's why I prefer a middle ground, where we move the bulk volume of medical interactions out of the hands of any middle man entity, and let the open market regulate prices (which has been blocked by indirect payer schemes). Retain an insurance model for major medical. It doesn't eliminate the overhead--it just makes a much smaller system, and hence less waste.

    There are many details that would need to be worked out to set up a system like this, but I believe it is possible. However, no one to my knowledge has even considered it.

    Also--since the poor have no ability to pay for anything, no matter what the cost (they often can't even afford food), they would still require support if they are to have medical care--that doesn't change. Nothing changes this in any of these plans or suggestions. The poor are still poor. Of course, perhaps a more global view of that problem would enable us to find a better long term solution to things like healthcare.

    Anyway--sorry that sort of drifted off a bit from the core point.

    KAM
  7. #167  
    Quote Originally Posted by Woof View Post
    Seriously? You think this? You don't don't accept the notion that any business that transports goods of any kind, benefits (and makes profit) from the roads?

    If the ambulance driving you to the hospital uses the road and gets you there faster than if it has driven through fields and a yard or two, and you live, aren't you profiting from the road?
    I was referring to the BUILDING of roads. Not the use of them.

    Does anyone besides you profit from what you do? OMG how could you let them do that?

    Should the companies that make medical equipment that saves lives in the hands of a doctor make a profit or should they just break even because they aren't really doing the work?
    Gee, a company that makes medical equipment pretty much falls under what I said about those who save lives, don't you think? They earn their money because they actually do something and provide a product. How has an insurance company actually advanced the medical field? They haven't. In many cases, they have done more harm than good, all the while, they make more and more profits and charging us higher premiums but giving us less and less service.

    Do you tie your own shoes?
    Way to show you ability to have an adult conversation and solidify you place as the lowest common denominator...
  8. KAM1138
    KAM1138's Avatar
    #168  
    Quote Originally Posted by kabamm View Post
    I disagree. Using my own personal experience as an example - had it not been for AFDC, food stamps, school lunches and all the other trappings of 'welfare', I very likely would have been quite malnourished and otherwise even more seriously under-privileged as a child, and possibly would not have grown into the healthy, hard-working, college-educated, tax-paying citizen I am today. That early government investment has saved me from a life of misery and need.

    As an adult, I have watched my insurance quality markedly decline while my premiums have skyrocketed over the last 15 years. This is not just anecdotal - costs have risen out of proportion to inflation. The corporate middle-man must be paid - and apparently in a handsome fashion.

    Reliance upon individuals acting in a 'free' market for health-care has failed. The evidence and anecdotes are all around us. Heck, unless I was dying, I'd have to make an appointment about six weeks in advance to see my doctor - and I'm currently paying for premium-level health insurance. Not 'concierge-level' health care, mind you, but good.

    I'm single, and I watch my co-workers with families struggle to pay their share of the so-called employer-provided coverage. I'm aghast at the premiums - two children and two adults - it's about $1,000 per month! On a middle-class ($80k+) salary, with a family, there is no longer any such thing as affordable individual health insurance in the U.S. - except for a subset of the upper-middle class and the wealthy - and this anecdote illustrates that the group policies don't always come cheap either.

    Mandating insurance is not the answer - I myself went without health insurance in my late teens and twenties - I'm now in my late forties - because I simply could not afford it - and also eat, for example, and pay the mandated liability insurance on my old beater car, and tuition at a public college while I worked full-time at various just-above-minimum-wage jobs to scrape enough together to keep it all going.

    I've managed to claw my way out of the lower-class - but not without help. There were no boots to which I could attach the damn bootstraps, but I earn a handsome wage today and firmly believe that a modest increase in my taxes - and especially in the economic rung just above mine - to support a public health care plan for others is a very good idea.

    It is beyond time for our government to get further involved on behalf of individuals - and remove shareholder profit as a primary motivating force behind providing health care - just as most other technologically advanced societies have done.

    The single-payer plan is inevitable, health insurance is an anachronism, and this needs to be done correctly for posterity. It is what the majority in this country voted for as a primary plank in Obama's platform. Blustering and moaning about the awfulness of socialism using Objectivist simplicity is not helpful.

    Filling the emergency rooms with uninsured folks at a very high taxpayer cost isn't working either.

    It's time for that change we requested - too bad about this economic meltdown, eh? Yaay for those de-regulated free markets.
    First--what I was describing was the ability of an individual to provide for themselves individual needs vs public projects essentially, not arguing that people with no money could somehow pay for things without money. Nor was I arguing against people getting help in order to bring them to a state where they no longer need help. If only our welfare system worked for everyone as well as it did for you. Another thing--you know what paid for you to get that help? People earning a profit and giving big chunks of it to the government to give to you.

    Your statement about "deregulated" markets is misleading I think. Those markets were highly regulated. It is a gross oversimplification to state that the problem is a matter of just more or less regulation.

    RealClearPolitics - Articles - The Reregulation Mantra?

    Regulation and the Financial Crisis: Myths and Realities — The American, A Magazine of Ideas

    Again--we do not have a free market system for healthcare, and it isn't the Free market that failed our economy. It is Anti-Free market, non-capitalist manipulation largely pushed by government (and others). Take a look at highly government linked and regulated entities like Fannie Mae and Freddie Mac, and their role in this massive economic problem.

    These hijinks weren't the result of free market principles--they were a trashing of them, filled with manipulation that if left to the free market would result in failure of these entities, but instead--they are propped up and enabled to keep on degrading the free market, and harming everyone.

    Government's job is not to provide specific care to individuals. Not in a free country where people make their own choices. You might want that, but it isn't what our Constitution allows--no matter how much you wish it to be the case. If you wish to give government control over more and more of your life, that's your choice--do not try and force me to do the same.

    I'm not an objectivist, but doing the opposite--following a false utopian promise will fail. That's all that's being offered here with more government promises that never come close to living up to what they claim.

    This is what people wanted when they voted for Obama? I doubt you can prove that. You don't know which of the many possible reasons made people vote for Obama more than any other.

    How about this--leave me out of it. I already pay a very large portion of my earnings to government and some of that goes to support other people, while I use the rest to try to provide for my family. I don't want more government in MY life. I'm not telling anyone how to handle their lives--I'm just saying, I don't want you or government or anyone else increasingly telling me how to handle mine. That's pretty easy to understand isn't it? Stop seeking to do things to me that I don't want. If you want to take part in a big government plan--that's your choice, I won't stop you, but you should respect my choice to not be forced into what you want.

    KAM
  9. KAM1138
    KAM1138's Avatar
    #169  
    Quote Originally Posted by 1thing2add View Post
    Should I laugh out loud like the loyal opposition did last week at this very statement coming from the president's lips?

    In all seriousness, why not run this up the flagpole of your US congressman and senator's offices if you feel so convinced your outline has merit? No one will consider it unless you put it out there for examination. I'm sure they would give you informed feedback.
    Well, comparing the lack of details from the President of the United States and Congress who have massive resources and have been working on this for months to me (an individual with an idea) is really unbalanced.

    As far as my Senators and Congressman--I have not contacted them with details of my ideas, but I have contacted them in general, and the responses have been...let's say less than interactive, so I'm not thinking I'd get any "informed" feedback of any kind. I'm having trouble getting them (one in particular) to respond in a specific way to my very simple statement of opposition or support for one issue or another.

    However, that suggestion theoretically isn't bad, and that is how it SHOULD work, but I don't think it does.

    KAM
  10.    #170  
    Quote Originally Posted by davidra View Post
    Let's see....who pays for your public health units? Who pays for the charity hospitals to be able to provide that $5 care that costs the hospital $150? Do you think that employees of the charity hospitals have families, and like to get raises, or should they work for free? Do you think that private entities like the Ochsner Clinic should be responsible for providing some care to people that don't have coverage? Do you think that city and state support of teaching hospitals for charity care is the most efficient use of your tax money and provides the best care for uninsured? Don't you think it might be a better idea to allow people some choice about where they are seen? You make it sound so easy....hey, all you have to do is walk into a charity ER. It's not that easy, efficient, or effective.
    You are correct, and this is how low income people get their care now. Efficient? No. Choice about where they are seen? No. Easy? No. But, if we go to a Government takeover of healthcare this is what we are all headed toward.
  11. KAM1138
    KAM1138's Avatar
    #171  
    Quote Originally Posted by 1thing2add View Post
    Your unfounded fear continues to cloud your assessment.
    Can you explain why you think those concerns are unfounded?

    KAM
  12. #172  
    Quote Originally Posted by Technologic 2 View Post
    You are correct, and this is how low income people get their care now. Efficient? No. Choice about where they are seen? No. Easy? No. But, if we go to a Government takeover of healthcare this is what we are all headed toward.
    You sound very sure about that. In fact, that's not true at all of Medicare, is it? You know, that Government takeover that provides care to every person over 65? Please don't generalize from a state and city-run program in a state with minimal resources to a federal program, especially when there exists a very good one like Medicare....and the one that Congress uses. In fact, none of the "government" plans, Medicare, the VA, Medicaid....none of them....tell you where you can or can't be seen. In that way they are much less restrictive, for example, than any HMO that requires you be seen in network. It's nice to be confident....but that doesn't make you right, now, does it?
  13. KAM1138
    KAM1138's Avatar
    #173  
    Quote Originally Posted by davidra View Post
    You sound very sure about that. In fact, that's not true at all of Medicare, is it? You know, that Government takeover that provides care to every person over 65? Please don't generalize from a state and city-run program in a state with minimal resources to a federal program, especially when there exists a very good one like Medicare....and the one that Congress uses. In fact, none of the "government" plans, Medicare, the VA, Medicaid....none of them....tell you where you can or can't be seen. In that way they are much less restrictive, for example, than any HMO that requires you be seen in network. It's nice to be confident....but that doesn't make you right, now, does it?
    Well, but each of those plans that you mention are paid for by a larger pool of people--the taxpayers in general. Correct me if I'm wrong, but a significantly larger group of payers are supporting a smaller group of beneficiaries.

    Does this type of system hold up when the number of beneficiaries significantly increases, while the number of payers does not?

    KAM
  14. #174  
    Quote Originally Posted by Kenanator View Post
    I was referring to the BUILDING of roads. Not the use of them.
    Sorry not what you said.
    The only ones who profit from roads are those who build them.
    Being the lowest common denominator I don't read minds.
    Gee, a company that makes medical equipment pretty much falls under what I said about those who save lives, don't you think? They earn their money because they actually do something and provide a product. How has an insurance company actually advanced the medical field? They haven't. In many cases, they have done more harm than good, all the while, they make more and more profits and charging us higher premiums but giving us less and less service.
    I work for a cell phone company and many doctors use our product. They may even use them in the saving of lives. Would it be ok with you if we make a profit too.

    Do you understand the basic premise of insurance? a group pays small payments into a common pool to cover the risk of what might happen. The pool is then used to pay for the high costs that the individual may not be able to afford. Without insurance who will pay the high bills if the patient cant afford to? The govt. Where do they get the money? Hmm from tax payers all paying small amounts into a common pool. Sounds familiar, no? You just think the govt is more trustworthy in managing that money right? Have you heard of Social Security? Aware that every year there is a scare about it going bankrupt?

    What do you do for a living? Regardless of what it is why should we trust you to do it? Shouldnt your job be relegated to the govt too? I mean youre making a profit arent you? Why? is that fair? Arent you taking advantage? Is your service or product fairly priced and accessible to all?

    And please spare me the "My product isnt healthcare. Healthcare is a right" bs.

    Way to show you ability to have an adult conversation and solidify you place as the lowest common denominator...
    Dude it was just a question. An informal poll if you will. No need to get all high and mighty.
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
    — Ed Howdershelt
    "A government big enough to give you everything you want, is big enough to take away everything you have."- Thomas Jefferson
  15. #175  
    Quote Originally Posted by KAM1138 View Post
    Well, but each of those plans that you mention are paid for by a larger pool of people--the taxpayers in general. Correct me if I'm wrong, but a significantly larger group of payers are supporting a smaller group of beneficiaries.

    Does this type of system hold up when the number of beneficiaries significantly increases, while the number of payers does not?

    KAM
    That is the key question, isn't it? And nobody knows the answer, but as I've said before, at least we understand how these work. We're aware of the limitations, we can address waste and fraud, and possibly provide quality care while still allowing choices and avoiding people dying for lack of access. No other plan has that simplicity. The loopholes and potholes are all visible. IMO, of course.
  16.    #176  
    Quote Originally Posted by 1thing2add View Post
    Was your mother low-income or just overcome by the reality of what healthcare costs?
    No, she had great insurance. She had about $2,000.00 out of pocket. But, her case was extreme, and thankfully we didn't have to come up with the cost that went over $2Million. But, this was covered by a PRIVATE foundation, not a Government Plan.

    How many times can a nationalized plan, such as you suggest, continue to go to benefactors before they are bankrupted?
    That is the big question that no one has answers to. Medicare/Medicaid is close to bankruptcy and so are all other countries Socialized Medical Plans

    Your unfounded fear continues to cloud your assessment.
    And your unfounded trust clouds yours.
  17. KAM1138
    KAM1138's Avatar
    #177  
    Quote Originally Posted by 1thing2add View Post
    Far too easily, as they are self evident. That is, unless one is so narrow-minded to make groundless assumptions where performance is concerned in completely unassociated areas of government. If you knew anything about how NIH operates and benefits not only the US, but the world's health, you would not ignore such broad-brushes of errant judgment.
    Self-evident, which means no. You cannot or will not explain your claims.

    In short--you are simply declaring yourself right.

    So, if the NIH is beneficial and successful (paid for ultimately by taxpayers who make a profit), that means that must also be true of any other taxpayer funded government program that can be imagined? Is that what you are trying to say?

    Further--your claim regarding unassociated areas of government is completely off. We are talking about government entitlement programs--Social security, Medicare, Medicaid, and either an expansion of these same systems (that have major financial problems) or similar programs. These in fact are very similar programs.

    By comparing the NIH to entitlement programs you are making the disconnected comparison. The dreaded Apples to Oranges comparison you accuse others of using.

    KAM
    Last edited by KAM1138; 09/17/2009 at 11:47 AM. Reason: Additional point.
  18. KAM1138
    KAM1138's Avatar
    #178  
    Quote Originally Posted by davidra View Post
    That is the key question, isn't it? And nobody knows the answer, but as I've said before, at least we understand how these work. We're aware of the limitations, we can address waste and fraud, and possibly provide quality care while still allowing choices and avoiding people dying for lack of access. No other plan has that simplicity. The loopholes and potholes are all visible. IMO, of course.
    Well, I do think that is a very important question. The whole concept depends on it being able to be sustained without increasing costs. That's what any plan must do--keep those costs from skyrocketing (which is why I agree we need to stop doing what we are doing).

    Theoretically we can address waste and fraud, but no one has bothered to do it yet. If it is that easy, why are we wasting time not doing that today? I'd love it if that was the case, but I think that remains a big "if."

    As far as simplicity, I actually think that the direct payer system which eliminates ALL middle men is simpler and more efficient, but as I've admitted--as an individual, I don't have the resources to prove that, and of course an idealized system has to be made realistic (which degrades theoretical benefits).

    I tend to disagree that we ever see or are told all the 'potholes and loopholes" in government plans, and of course there are also the possibility of unintended consequences that any plan can fall prey to (even with total honesty going in). At a minimum I think there needs to be a study that says "what if this doesn't work--then what happens?"

    KAM
  19. #179  
    Quote Originally Posted by KAM1138 View Post
    And I'm not accusing you of being anti-capitalist.

    As far as health being a material item...well, it isn't. Providing the service of healthcare however carries costs--both in time and material. I'm not sure how we can eliminate a price tag for those things.

    I'd disagree about roads--I think they are very valuable, and while they don't directly provide profit, they provide a means of making profit (helping to conduct commerce) to many.

    In regards to your opinion about insurance companies not making a profit--ok. First, I'd ask why that is, but I suspect that your answer will be that it is wasteful--in that it is essentially adding to the overhead of providing medical care. If that is the case, I'd say that is true. That's why I prefer elimination (to the maximum extent possible) all indirect payer systems--totally take ALL middle men out of the picture. I don't want to trade one middle man for another. In addition to being more efficient, it removes anyone's ability to tell me what care I can get based on their decision to pay.

    I don't want insurance companies telling me what care I can get, and I sure don't want government doing it either. With indirect payer systems, where money doesn't grow on trees (and obviously it doesn't) this WILL (and does) happen.

    Problem is--my dream situation is thwarted by costs that are so high that almost no one can afford them. So, we fall back to these "spread-around-the-costs" schemes, which result in...yes inefficiency and overhead. Its really a catch-22 in some ways. That's why I prefer a middle ground, where we move the bulk volume of medical interactions out of the hands of any middle man entity, and let the open market regulate prices (which has been blocked by indirect payer schemes). Retain an insurance model for major medical. It doesn't eliminate the overhead--it just makes a much smaller system, and hence less waste.

    There are many details that would need to be worked out to set up a system like this, but I believe it is possible. However, no one to my knowledge has even considered it.

    Also--since the poor have no ability to pay for anything, no matter what the cost (they often can't even afford food), they would still require support if they are to have medical care--that doesn't change. Nothing changes this in any of these plans or suggestions. The poor are still poor. Of course, perhaps a more global view of that problem would enable us to find a better long term solution to things like healthcare.

    Anyway--sorry that sort of drifted off a bit from the core point.

    KAM
    I agree with you. Eliminating the middle men would be ideal, but it could never happen that way as the costs are just too much for the average person to afford. That is why I would prefer if we had a single payer type system that was managed by doctors and not politicians or insurance companies. I don't feel my idea of a system would be perfect, but it could eliminate a large percentage of the overhead in regards to health care.
  20. KAM1138
    KAM1138's Avatar
    #180  
    Quote Originally Posted by Kenanator View Post
    I agree with you. Eliminating the middle men would be ideal, but it could never happen that way as the costs are just too much for the average person to afford. That is why I would prefer if we had a single payer type system that was managed by doctors and not politicians or insurance companies. I don't feel my idea of a system would be perfect, but it could eliminate a large percentage of the overhead in regards to health care.
    Ok, let's use the shared goal of eliminating overhead/middle men as a starting point then.

    I'm skeptical of "single payer" for several reasons. First is that I think we've got systems now that are more similar to single payer than to direct payer. What I mean by that is that we have indirect payer systems--via government payment and insurance, where the patient is removed from the actual cost of the service (to a very high degree at least). This blocks the consumer from the market essentially. Single payer retains the middle man, and all the inefficiency that comes with it.

    What I prefer is Direct payer, but you are correct--the costs of many services are WAY beyond what your average consumer can pay. So, we can't go pure direct payer as things stand. So, my next best idea is to have as much direct payer as possible. My suggestion is to do this with common medical care (colds, flu, minor injuries, and the like). I think this is acceptable for two reasons--I believe this makes up the bulk of the medical service interactions (many more people have colds than heart attacks), and also tends to be the lower cost--meaning it is in the range where it could be paid for directly.

    However, even some of those costs are high--too high in my view, because the indirect payer system does not sufficiently control those costs, and in fact--might help them rise). So, my solution for that is a free market arrangement. Doctors that have to compete with each other for customers (patients) can't boost prices. Open Competition tends to bring prices to where they should be (in this case lower). Also--no middle man taking profit or overhead--that's overall savings.

    This still leaves rarer, but higher cost medical needs. I think that is better handled by a traditional insurance model, and because it is more akin to Homeowners insurance in terms of rarity, the insurance model can work without skyrocketing prices. This also reduces the volume, so that will reduce the overhead associated with administration. It doesn't eliminate it, but it should reduce it significantly.

    This two-tier type of system can be accomplished with high deductible insurance (which I think is less efficient because it still requires paper work) or by doing some advanced work and clearly denoting what is common and what is catastropic and covering high-cost, low chance items under the Catastrophic.

    As an additional boost, I'd suggest making all medical costs tax deductible to everyone.

    The issue of the uninsured remains a problem, because if you can't pay for insurance, you can't pay direct. However, this is a relatively small portion of people 5-15% (depending on how you read things). What is being proposed now is to concentrate on that minority of people and make a system which causes everyone else to change to address this. I'd suggest that is backwards. I'd rather reform the system that is good, but too costly for the other 85-95% of people, and then address the problem of the uninsured within that improved/reformed system.

    Simply--at first, I think we use the money we are already spending (which is very large--300 Billion a year) to just pay for them to get what everyone else will be paying for themselves. The goal of course should always be to move people off of support to a position where they can support themselves. I don't expect any particular savings here, but within a reformed system (for the other ~90%) the costs will be lower for them as well.

    Are there many details that would need to be addressed? Certainly, but I think it is worth considering. It eliminates the middle man as much as possible while retaining a safety net against catastrophic medical costs. Reduction of the middle man provides savings.

    That's from my starting point (working towards our shared ideal). Do you have ideas that maximizes things from your starting point?

    KAM

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