ponderings: health care
Sep. 9th, 2008 07:01 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
cellioIn 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.)
(no subject)
Date: 2008-09-10 11:27 pm (UTC)Good to know they're out there; that means there might be some data. (They are not common among employer offerings in my experience.) I didn't know about the HSA tie-in.
But, again, you need to have the available income in order to choose this. Some people - often self employed people will - but in our current environment they're not popular.
Yup -- not saying everyone could or would buy such plans. I'm wondering what the effects would be on other plans if these were more commonly available to the people who would buy them. (Or maybe the answer is that people wouldn't and the idea is flawed. I'm open to that; all of this is thought experiment for me.)
On care times: I looked at the chart and the article; thanks for the links. The data is pretty high-level; I wish they'd provided more drill-down. For example, let's take a category I have some affinity for: ophthamology wait times come in at around half a year per that chart. That's quite reasonable for cataract surgery and devastating for repairing a detatched retina. To evaluate most of these categories, we really need subdivisions.
My impression of countries with nationalized health care is that if it's life-threatening it'll be dealt with quickly (e.g. the oncology numbers in that chart), if it's elective you'll wait almost forever (not surprising), and that if it's important but not life-threatening you can be in for a lot of grief. It's this middle category I'm interested in.
One other comment about the chart: this data is hard to get, but the analysis is not complete unless it also factors in time from request for care to initial visit.
But what decisions are being vested in this "single authority"?
What treatment I get, when, and who performs it. (Do government-run systems support the idea of a patient-initiated second opinion, by the way? That can be pretty important if you have something tricky or controversial.) It is possible that some of these concerns would be aleviated in a mixed system (one where you're allowed to buy private insurance or private care), assuming that's affordable with the much smaller risk pools.
There are no easy answers here. Thank you for having the conversation with me.