![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ponderings: health care
In the comments here we were talking about health care in the US. The current system is broken in many ways, but the "nuke it and start over with some nationalized program" proposals are scary too. What incremental improvements are possible? I have to believe that there are some.
One idea I'm interested in is what would happen if we separated paying for routine care from paying for catastrophic care. What would happen if people could be on their own for the former but could buy a policy to cover hospitalizations, major illnesses, and the like? How effective would that be and what would it tend to cost? What would having that in play do to the over-the-counter (uninsured) price of routine care? (Yes, I know that not everyone can afford to pay for routine care out of pocket. I'm exploring a suite of options, not choosing a single one.)
On the flip side, would medical practices or insurance companies be willing to sell affordable plans that cover all your routine care (only), if they were not on the hook for catastrophic losses? Could that get things down to the point where the average family could afford regular checkups, preventative care, and routine tests (which helps prevent some catastrophic issues)? Such plans exist now in niches (vision and dental, most commonly in my experience), but I haven't heard of one for general medical care. Why not? (Am I totally misunderstanding where the profit centers are in the insurance business?)
Both angles are important. What I'm labelling catastrophic incidents are (as the label implies) financially devastating if you don't have sufficient coverage. Outside of elder-care issues I'm not sure how common they are, but it's the sort of thing I wouldn't want to take a chance on. I insure my car and house, after all -- how much the moreso should I insure my health?
What I suspect has a bigger impact on the poor, though, is the routine care. If you don't have insurance, you're looking at a three-digit number to walk into your doctor's office. Throw in some kids and you're in trouble. (This is why I asked what would happen to those costs if catastrophic care were a separate factor.) Could plans that just cover routine care be made affordable enough for most people? This doesn't solve the other problem, but neither does the current system -- we rely on hospitals' obligations to treat (which is a legitimate public demand while they pay no taxes), or medicaid/medicare/SSI in some cases, to get through those. Remember, incremental improvement.
I'd also like to explore the effects of reducing drug regulation, letting people buy from anywhere that's selling and reducing barriers to getting things onto the market. I know the standard argument against this (those high prices pay for R&D), but I'm not sure how much I believe that. What are the other considerations?
Where else could we look for incremental improvements?
(In case you haven't figured it out, I am not a medical professional, an economist, nor part of the insurance industry.)
One idea I'm interested in is what would happen if we separated paying for routine care from paying for catastrophic care. What would happen if people could be on their own for the former but could buy a policy to cover hospitalizations, major illnesses, and the like? How effective would that be and what would it tend to cost? What would having that in play do to the over-the-counter (uninsured) price of routine care? (Yes, I know that not everyone can afford to pay for routine care out of pocket. I'm exploring a suite of options, not choosing a single one.)
On the flip side, would medical practices or insurance companies be willing to sell affordable plans that cover all your routine care (only), if they were not on the hook for catastrophic losses? Could that get things down to the point where the average family could afford regular checkups, preventative care, and routine tests (which helps prevent some catastrophic issues)? Such plans exist now in niches (vision and dental, most commonly in my experience), but I haven't heard of one for general medical care. Why not? (Am I totally misunderstanding where the profit centers are in the insurance business?)
Both angles are important. What I'm labelling catastrophic incidents are (as the label implies) financially devastating if you don't have sufficient coverage. Outside of elder-care issues I'm not sure how common they are, but it's the sort of thing I wouldn't want to take a chance on. I insure my car and house, after all -- how much the moreso should I insure my health?
What I suspect has a bigger impact on the poor, though, is the routine care. If you don't have insurance, you're looking at a three-digit number to walk into your doctor's office. Throw in some kids and you're in trouble. (This is why I asked what would happen to those costs if catastrophic care were a separate factor.) Could plans that just cover routine care be made affordable enough for most people? This doesn't solve the other problem, but neither does the current system -- we rely on hospitals' obligations to treat (which is a legitimate public demand while they pay no taxes), or medicaid/medicare/SSI in some cases, to get through those. Remember, incremental improvement.
I'd also like to explore the effects of reducing drug regulation, letting people buy from anywhere that's selling and reducing barriers to getting things onto the market. I know the standard argument against this (those high prices pay for R&D), but I'm not sure how much I believe that. What are the other considerations?
Where else could we look for incremental improvements?
(In case you haven't figured it out, I am not a medical professional, an economist, nor part of the insurance industry.)
Routine vs. catastrophic health insurance
(Anonymous) 2008-09-10 05:41 am (UTC)(link)Each category of care besides office visits has a separate deductible. This means that if you are in an accident and are hospitalized, the deductibles (up to several thousand dollars each) inlcude: ER care, OR care, pharmacy, skilled nursing, PT, OT, radiation, home care, multiple categories of diagnostics. I did the math for a sample year in my life (you know, but for the benefit of other readers, I am a YOUNG healthy-appearing person who eats healthy, exercises, does routine check ups, etc, but has several "pre-existing conditions") and it hit six figures. How is that supposed to be a viable option? I don't think it's realistic for a system to *hope* people stay healthy.
Another thought on the routine care issue: I worked in the health center at the mid-sized university I went to. Part way through my schooling, they changed the payment structure for clinic visits from co-pays per visit to charging all students a flat fee--around $100--billed with their tuition (and thus covered by loans and financial aid if needed). In that particular case, the health center decided the math worked better and students got better routine care (because they were more likely to schedule appointments). Maybe something like that would work for routine care on a larger scale? And then a separate funding system for major medical events.
Re: Routine vs. catastrophic health insurance
Re: Routine vs. catastrophic health insurance
Part way through my schooling, they changed the payment structure for clinic visits from co-pays per visit to charging all students a flat fee--around $100--billed with their tuition (and thus covered by loans and financial aid if needed).
That's good news if the math worked at that price! I wonder what the price point would be for the general population as opposed to students.