Why are politicians so loathsome?

[Benko]

Mostly no. The main question is money. 

[Pointedstick]

I would mostly expect government to overspend in those cases, except for in a very small number of politically-driven cases where they would deliberately underspend or deny treatment.

[Mdraf]

I'm going to have lunch with a doctor friend. I'll run MediumTexcare by him see what he thinks 

A lot of young people in my system would never need to have an insurance claim processed at all because their annual health care expenses wouldn't exceed $1,000.

In other words, the paperwork associated with a lot of the people in the system would simply consist of collecting a payment at the point of service.  For poor people, this payment could be made by using the health care equivalent of a Food Stamps-type debit card.

Back from lunch. Doc friend approves! But he did bring up the expensive end of life costs mentioned by Benko and the need for "death panels".  I said that the >$50K could simply be handled by Medicare according to their guidelines and reimbursement rates.

MT - how would independent insurance companies track that you've already spent your first $1000 in order for their insurance to kick in?

[MediumTex]

MT - how would independent insurance companies track that you've already spent your first $1000 in order for their insurance to kick in?

The same way that high deductible health plans do right now.

I'm covered under a HDHP, and early in the year I still provide my insurance card, even though I am paying for it all out of pocket.  Providing the insurance card allows the insurance company to determine when I've met my deductible and it tells the provider which contract rates to apply to the care I am receiving.

[MediumTex]

If gov't is paying for this, they will decide who does and who does not get money spent on their care.  `You want gov't deciding this???

Is that what is happening right now with Medicare?

My Dad was covered by Medicare and died of cancer after two years of very expensive care.  I was actually surprised that none of the providers seemed the least bit concerned about the cost of anything they were doing.

Since my plan only takes you through age 64 in any case, most of this end of life stuff would be Medicare-related, not MediumTexcare-related.

The birth expense stuff would certainly be something to think about, but if the government is going to subsidize anything in society, I would think that subsidizing the birth of a human being and providing good prenatal and postnatal care would be something that most people could agree was a useful thing for the government to do (if the government insisted on doing something).

[Mdraf]

MT - how would independent insurance companies track that you've already spent your first $1000 in order for their insurance to kick in?

The same way that high deductible health plans do right now.

I'm covered under a HDHP, and early in the year I still provide my insurance card, even though I am paying for it all out of pocket.  Providing the insurance card allows the insurance company to determine when I've met my deductible and it tells the provider which contract rates to apply to the care I am receiving.

I also have a HRDP.

I thought the first $1000 was with no insurance. So this would mean that there would have to be an individual mandate to purchase medical insurance for up to $50,000 with a deductible of $1000 ?

If (Mdrafcare) the first $1000 would not require insurance we could do away with "negotiated prices" of insurance companies and have consumers negotiate directly with providers for cash.

[MediumTex]

MT - how would independent insurance companies track that you've already spent your first $1000 in order for their insurance to kick in?

The same way that high deductible health plans do right now.

I'm covered under a HDHP, and early in the year I still provide my insurance card, even though I am paying for it all out of pocket.  Providing the insurance card allows the insurance company to determine when I've met my deductible and it tells the provider which contract rates to apply to the care I am receiving.

I also have a HRDP.

I thought the first $1000 was with no insurance. So this would mean that there would have to be an individual mandate to purchase medical insurance for up to $50,000 with a deductible of $1000 ?

You could purchase a policy or you could self-insure, but yes you would need to do one of them.  If you don't, the pool will only be sick people and healthy people will just wait until they get sick and buy insurance then.  This is a legitimate problem.  I'm trying to craft a solution that could actually work in reality.

If (Mdrafcare) the first $1000 would not require insurance we could do away with "negotiated prices" of insurance companies and have consumers negotiate directly with providers for cash.

That's not a big difference, though it would probably be somewhat harder for your insurer to know when your coverage kicked in.  Do you you really think that on health care services totaling under $1,000 total for the entire year that it would be worth your while to negotiate on your own?  You might be able to do better than the insurance company's pricing structure in some cases, but on $1,000 of health care I would rather just take the insurance company's pricing structure and call it good enough.

[Mdraf]

You're right but I was trying to address the problem of those who will blow off the system, not buy anything and end up in the emergency room like what goes on today. Then we're back to "What do we do with the uninsured?" question. Since everybody would be uninsured up to $1000 prices would come down for smaller matters.

[Pointedstick]

You're right but I was trying to address the problem of those who will blow off the system, not buy anything and end up in the emergency room like what goes on today. Then we're back to "What do we do with the uninsured?" question.

...Bill them for the services they use?

Perish the thought, I know.

At its core, this is a problem of high prices resulting from a broken, hyper-regulated market. IMHO what needs to be done is to focus on making the market for non-emergency care more transparent and more subject to actual market forces. Purchasing and consuming non-emergency care isn't fundamentally different from purchasing and consuming anything else. You can do research, compare providers, find patient reviews, etc; all the stuff you do when you're shopping for a new TV. Emergency care is different, but that's what insurance is for.