What if All Americans Had at Least Catastrophic Health Care Coverage?

Picture 9I really dislike the term healthcare reform. I think our system needs to be changed not reformed. I assume that I am not the only person who suspects that the recent health care reform act is not going to be the final solution for America’shealth care problems. The cost of healthcare is not really addressed at all, and even if it works better than expected some Americans will not have even catastrophic health carecoverage.

This post is really just my first shot at suggesting a way I think makes sense to address the problem of the large number of uninsured people in America, while at the same time leaving lots of choice and personal responsibility that seems to be needed and a part of the American culture. I am certain that I have not thought through all of the gritty details, and really don’t profess to have the talent or knowledge to write legislation, but I think this basic tenant might be a starting point.First my assumptions:

  1. The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.
  2. Americans want personal choice in choosing a medical plan and providers.
  3. American corporations are at a global disadvantage in having to pay for expensive health insurance plans that put their cost of producing goods and services higher than in countries with governmental healthinsurance.
  4. If American’s were more responsible for their health care costs, it is likely that they would take a greater responsibility for how their dollars are spent on healthcare than if they are spending other people’s money.

Next the basic elements of a solution:

  1. The federal government provides every American with a catastrophiccoverage medical plan. This would be a very high deductible plan to cover expenses over a chosen amount, say $5000./ family per year. (This number could be different, depending on actuarial and legislative input.) This would be paid for by a national tax of some sort, maybe a combination of a corporate payroll tax and health coverage value added tax, or other individual tax.
  2. Individuals and employers could choose to purchase supplementalcoverage for themselves or their employers beyond this catastrophiccoverage. Most Americans would want to at least purchase access to a PPO type of network to access discounted fees negotiated between providers of services and insurance plans, much like PPO fees now. They could also choose to contribute to a HSA account to save/pay towards the deductible or to a supplemental plan to cover some or most of the deductible expenses. There would be no mandated services to be covered in these supplemental plans. Individuals could choose what services they want to have insured. This would allow insurance companies to offer plans tailored to the desires and needs of individuals, not the current every willing provider, cover everything for everyone that the many current mandates dictate. If we are ready for really big change, this could be for all Americans, and our less affluent elderly and our poor could have some sort of assistance in purchasing supplemental insurance to replace Medicare and Medicaid.

That’s pretty much it. Everyone would have catastrophic national healthcoverage to prevent most Americans from facing the risk of financial ruin from an accident, injury, or illness. We could all choose to purchase whatever other coverage meets our needs on a open market, without regulated mandatory coverage of any services we might choose not to purchase.

I’m hoping to have this topic be an ongoing forum for discussion. Comments, better ideas, suggestions for major problems I’ve neglected to address, and the expected outrage that this idea is a step toward socialism, fascism, or some other ism is welcome. Make comments and join the dialogue.

Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primarycare physician’s perspective at his blog, DrPullen.com.

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31 replies »

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  4. 50% of health care costs in this country are borne by the federal and state governments. When you add-in the 25% borne by corporations, people are only paying 25% of the actual health care costs. The hidden health care costs are bubbling up and will eventually be so bloated our government will collapse when this bubble bursts.
    Every problem and I mean every problem in health care has one simple cause rooted in the payment system. Every health care provider has two motives, which drive their business: the financial motive and the caring motive. These two motives are in conflict when a health care provider gets paid for providing goods and services. The financial motive is to deliver more care. The caring motive is to deliver better care. More care is not better care, usually it is the opposite. We want to be healthy i.e, spend less time and money on health care simply because we need less of it. Insurance companies, hospitals, pharmaceutical companies, doctors and other service providers all deliver more, not better CARE.
    Conceptually there is a simple fix, revise the payment system so the caring motive and the profit motive are always in sync. Providers get more money when they provide better care. It is nearly impossible to drive this sort of change from the top-down. It gets enormously complicated and almost always is enforced by placing a cap on earnings for health care providers. In a capitalistic society this is unacceptable. Health care vendors (so-called insurance companies) receive payments periodically so that a patient can ACCESS the health care system, i.e, vendors get paid fee-for-access.
    Pay health care providers fee-for-access instead of fee-for-service, i.e., periodic payments instead of service payments. This simple change aligns the caring motive and the financial motive every-time, all-the-time. There is no cap on profitability. The better a health care provider is at providing care the more money that provider makes.
    Driving this change one-doctor, one-patient at a time from the bottom-up is the only way to implement this. There is too much vested in the status quo. The push-back for such payment system changes is enormous and will forever prevent this kind of change from happening. But, making the change one-doctor, one-patient at a time can gather enough momentum that the invisible hand of capitalism will gradually drive the current system out of existence. The current vendors and providers who resist this change will disappear, driven out-of-business by capitalism.

  5. Medical care in the U.S. is already rationed by income. Those of us fortunate enough to have medical insurance can see a physician. In a poor neighborhood, you may not even find a doctor; if you are wealthy, you can see a doctor of your choice.
    I agree that catastrophic care for everyone should be covered. Where we disagree is that some payment for care would discourage “frivolous” medical care.
    We all need basic, pre-emptive care that means a pre-diabetic patient learns of his condition and does not become a patient in the emergency room. What about the child with a fever and rash that might be dangerous and contagious? How can a patient make that decision without a medical evaluation?
    It does not serve me (or any patient) to avoid a $20 co-pay (especially if that means no lunches for the family that week), rather than get appropriate medical care at the earliet possible time. Should I avoid a medical visit to check on an itchy mole that might become a costly and dangerous melanoma? Is it “frivolous” to see a doctor for an eye irritation that might blossom into a full-blown, blinding infection?
    We Americans need the same medical care we could find if we were French or Italian or Canadian. To keep us and our neighbors healthy.

  6. The only insurance I have right now is catastrophic and that seems to be the best thing for me, since I rarely need a doctor for medical issues in my life. But it would be nice to have a reasonable medical plan.

  7. The truth is that people don’t have the common sense to understand that we all really have more than we need. This society has lost the reality of what is really valuable. It isn’t “stuff” and should something catastrophic happen and we are forced to barter for water (something we take for granted) it would be a game changer. Once handouts in this country started, it began to erode our society.
    I am always shocked that people think all doctors should give up their services freely when they worked so hard to achieve their stature. I don’t own an ipod or anything more than a simple phone. How many of these people wanting free health care do? How many of them have designer clothes, purses, cell phones, cable tv, go out to eat, drink liquor, smoke? This is the fleecing of America and I do take issue with people wanting things for free. If you don’t make much money you have to understand that you must live within your means. Expecting someone to pay your way used to be UnAmerican. We were too proud! I want that America back.

  8. “The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.”
    False. The biggest issue is of DYING because poor people aren’t a parasitic drag on the population and maybe DO want to pay their bills, but can’t. So they will go without care, because they can’t pay. And all your pretty financial and “healthcare” words won’t change that.
    I render I.T. care to doctors for free, too. I render I.T. care to other people, too. I do it because it needs to be done. Doctors aren’t the only people with a calling to care for others.
    But “healthcare” is the only system that, because of the “fog of war” – that is the fog of medical care – can choose not to pay when you really need it, and choose to kill you thereby.

  9. “The poor–whether on Medicaid or uninsured–receive sub-par care in this country. ”
    Considering the care I’ve rendered personally and that of many physicians in NY City, I’d take issue with that remark. I’m beginning to get the idea that Ms. Mahar has some grudge against doctors.

  10. Ah, Ms Mahar, isn’t reality about choosing what we can afford? Who writes your blank checks, and can I be sent some so I can spend what I can’t afford, but what this other person can?!
    You are out of touch with reality, Ma’am!
    And, by the way, people are afraid of dying or disability, but have you given a thought of those who have to pay the bills for the others they support?
    Again, it is not about Maggie Mahar, it is about the general population that inhabits this country. And, if this monstosity called Health Care Reform survives past 2011, the general population is going to be in a plan that is basically Medicare/Medicaid. You just don’t want them to know this until the consequences are fully in play, eh?!
    Note the insensitive and doltist thinking of the elites that passed this bs legislation!!!
    Finally, people on Medicare and Medicaid do not get subpar care, they get subpar benefits from what little these plans pay for! Bet your private insurance coverage has less a restrictive formulary for precription access than what Medicaid has. Oh, and why should Dr X, who spent $150K on his medical education, be forced to be reimbursed half or even less for the interventions he learned on his dime and time? Doctors do not have choices, only the Maggie Mahars, who do not even spend a second providing care and fool you into thinking she and her ilk should dictate the rules and consequences.
    And then you tell the author of this post what he should be saying.
    America, meet the mindset behind the Health Care Deform Legislation coming to squash your life choices by 2014!

  11. it would be nice if individual PCPs could capitate their services and sell directly to consumers

  12. Ed,
    Well reasoned analysis and a reasonable proposition.
    I would like to add a few comments:
    1) The fundamental problem with health insurance in the US is that there are third party payers. This distorts the ability of price to automatically match demand and supply. Patient and provider should consider the cost of treatment alternatives – such as $700 for MRI vs. sore knee.
    2) The contributing problem is that health insurance is really no insurance if it compensates for routine medical care. Primary care should be completely free market that is cash based. Imagine how much will auto insurance cost if it paid for tires, oil, etc.
    3) The costs are directly proportional to government involvement – see education costs as an example. The less government involvement will result in lower costs.
    The best solution for healthcare is to let free market do its magic. It works every time.

  13. Nate, your plan in a nutshell is to have people take the risk for the first 10K and insure the rest. What you don’t seem to understand is that 10K is a lot of money for most people and they cannot afford to take such risk. Sure they can gamble on not needing to spend 10K on any given year, but it still qualifies as a gamble.
    I do remember having this conversation before and I do remember that accepting a 10K deductible does not lower your premium by 10K.
    As to the NHS, I like what they are proposing to do, but that is not why I said “local”. My idea of single payer is really more of a single “collector”. There are many European countries using that model: government collects taxes and regulates minimum benefits. People get vouchers or whatever to pick a private insurer. All the government does is pass the funds from people to insurers or sick funds. And this should go for Medicare/caid as well. I never wanted one big government insurer and certainly not a government that owns hospitals and doctors. It would be more uniform if this was done at the federal level, but I can see it done at a state level, thus the “local”.

  14. so paying 20% more to insurer bad, paying 30% more to government great. I’m begining to think you don’t care at all about healthcare just raising revenue for the government to spend as that is the only outcome of your suggestions.
    “That’s where the 10K comes from. “buy that down”, I assume means extra cost.”
    You assume wrong. This is why it is best to learn then discuss. On countless occasions I have explained how I do exactly this on a slightly smaller scale with great success today. I hear some people have chosen to skip over my post, maybe you where in one of those phases and missed it. Allow me to repeat.
    My clients have normal deductible before comming to me. Lets say $500 in this example. Lets saying they are spending $10,000 a month for that plan. When they go with me they instead purchase a $5000 deductible for $5000 per month. With that $60,000 in savings they pay directly for claims back down to the $500 the employee had before. Those total claims for all employees for the year come to $40,000. That means employees had the exact same plan they did before, it just cost $20,000 a year less. There is no extra cost, the only person losing out is the insurance company.
    Now replace $5,000 with $10,000 and you have the same concept. Right now only a very small group of second tier carriers sell a $10,000 deductible.
    So this is what drives me nuts about you liberals. Instead of taking 2 minutes to learn what your talking about you fire off these pointless and inaccurate comments. Maybe your trying to be witty or maybe you think confusing the discussion with strawmen is good for your cause I don’t know. It just confuses me that seemingly inteligent people can say such stupid things when they have no idea what they are talking about. Now me, when I don’t know something that drives me to look it up and learn, for some reason it drives you to post babble?
    What could have been a very interesting discussion on alternatives to achieve what everyone claims is the main goal, I’m teaching you basic math concepts.
    “Here is some more money more than likely going out of pocket.”
    So you never heard of a PPO before today? FYI this has been going on for 20 years. Everything that was old is new again. Say hello to our old friend POS now with a sexier new name slim network. In the 1990s people used POS networks and didn’t go broke with every office visit. I’m pretty sure the universal laws of finance haven’t changed thus they won’t go bankrupt now. Making informed decisions with transparent pricing should actually save people money, I would expect that high cost providers would have problems justifying their additional bill when the patient is the one paying it.
    “This paradigm is only valid if you are not mildly sick.”
    You sure are an expert on paradigms you didn’t even know existed an hour ago. When you pay 20% less for care that savings is actually increased for the sick. More of the 20% means more overall.
    ” Planning for sunny days and blue skies in perpetuity is what gets people in trouble.”
    This you actually got right, you just failed miserably to apply it. Your logic is to pay an insurance company a very high premium so when you get sick they will pay all the bills. Great if your terrible at math. Your actually better off paying the insurance company less, pocket the money, pay your own bills when your sick and still have money left over. As an example, I still see a lot of groups that have zero dollar deductibles. Carriers know suckers, er I mean customers, that buy these policies aren;t cost concisious. If you do the math, these groups could buy a higher deductible and even if every single employee and dependent on the plan got sick and maxed out still save money. Lucky for the insurance companies there are still a lot of peopel that think like you.
    ” That’s why I want to see the system changed. Not to employer self funded schemes, but to tax supported, national or even local, self funded systems, i.e. single payer (not single provider).”
    Curious have you not heard of Medicare? Maybe you think the 40 trillion dollar funding shortage is just a rounding error? Medicaid, you like the quality of care and reimbuirsement levels they provide? What sane logic can yu provide for supporting another tax funded government ran health system? Do you hate your kids so much you want to guarantee a life of indentured servatude? Or do you believe someone will just magically pay off all our debt and unfunded liabilities and everything will just work out? What thinking in a liberal mind allows you to think this time a tax supported public health plan will work?
    PS what do you think of the proposed changes in NHS? Is that what changed your single payor to local single payor?

  15. “The deductible should start no lower then 10K, below that your covering to much discretionary care. Employers and individuals can buy that down if they want.”
    That’s where the 10K comes from. “buy that down”, I assume means extra cost. I don’t know what “discretionary care” means but that is probably another cost.
    “If you want to see a provider who charges more you pay the difference.”
    Here is some more money more than likely going out of pocket.
    “Further you don’t seem to grasp the paradign of paying more in direct healthcare cost but paying less overall.”
    This paradigm is only valid if you are not mildly sick. Planning for sunny days and blue skies in perpetuity is what gets people in trouble.
    As to the paying more than it really costs so insurers can profit, I agree. That’s why I want to see the system changed. Not to employer self funded schemes, but to tax supported, national or even local, self funded systems, i.e. single payer (not single provider).

  16. Wow Margalit how Peter of you. Maybe if you put just a touch less thought into your posting you could save us the post all together.
    Since I never said this would cost individuals a penny more then they already pay your doing nothing but beating up strawmen, feel tough now do ya?
    Employers already down below 10K, if we made existing coverage cheaper there is no reason to think they would all raise their deductible to 10K, not sure where you got the idea.
    Further you don’t seem to grasp the paradign of paying more in direct healthcare cost but paying less overall. If paying $80 out of pocket for an exam saved you $100 in premium myself and educated people would call that savings. You somehow look at this, take notice of the $80 payment, ignore the premium savings and shreek about how cruel I am. Find Margalit, we will have a special policy just for you and those that think like you. When you receive any care you will pay 120% of the bill, the provider will keep 80% and I’ll get 20%, hhappy now everything is just like it was before.

  17. Nate, since all your solutions wind up requiring that, when in doubt, patients pay more, I just wanted to point out that after your 10K deductible and catastrophic premiums and uncovered expenses, your lucky renters now have less than $1800 a month in disposable income. Maybe you should give them a break on that rent, so they can afford Goodwill shoes for the kiddies….

  18. When the Liberals running this country are talking like this;

    “This is a rich country. We have plenty of money, and if you don’t believe me, ask Haliburton,” Jones told a group of progressive bloggers and activists at the Netroots Nation convention Friday. “There’s plenty of money out there; don’t fall into the trap of this whole deficit argument.”
    “The only question is how to spend it,” he added.
    American corporations currently face the second-highest corporate tax rate in the world, according to the Tax Foundation.”
    Can anyone really argue honestly that healthcare is what puts our businesses at a disadvantage? How does another failed public program that will only add to our taxes help solve this problem?

  19. A new Seattle area company called LyfeBank has found the solution, check it out.

  20. Yana, I’m curious how you define health insurance and rather you think life insurance, auto insurance, and homeowners insurance is also a scam. I’ll guess you don’t differentiate between what health insurance was, is in some cases still today, and what Washington tried to make it. If your goal is to fix the system this disparity makes all the difference in the world. If your goals are purely partisan then go right ahead attacking health insurance and accomplish nothing.
    “The poor–whether on Medicaid or uninsured–receive sub-par care in this country.”
    Subpar to what Maggie? Subpar to private insurance? Yes that is true because healthcare paid by private insurance is the best in the world. Subpar to Africa, South America, or other developing nations, not even close, it is far superior to those. What about other developed nations, Medicaid could be compared to the NHS and its cost is also about equal. Medicaid might actually even be a little cheaper. If you would first define your argument then we would know if it is valid or not. We can’t afford, no nation can, to give everyone the level of care funded by Private Insurance. So the question is what level of care do those without means and those with means receive and are they equal. Should they be equal?
    “If you can, try to imagine raisign a family on that amount–before taxes.”
    I have no idea what point you’re trying to make here, in parts of the country that is a very comfortable living. Why could someone not imagine living on that? I have a coupl;e beautiful homes in OK in one of the best school districts in the State I rent for $1000 a month. After taxes and rent that still leaves my tenants with $2800 a month to live on. What is so hard to imagine living on $2800 of disposable income?
    Dr. Pullen, nice to see someone come to this concept with a free mind. I don’t think your naïve enough to think it would ever pass but at least having these discussions can only help if it only moves the train of public thought in the right direction. As you develop this thinking I would strongly suggest reading a history of Medicare, ideally from the first time national healthcare was proposed in 1908 until it passed, if you have not already. What your discussing is exactly what Democrats sold the public as Medicare being. At one time when we where a nation built on personal responsibility and providing for one’s self, this idea resonated loudly.
    “The gulf between what the public thought and what was actually in the bill was enormous. The most pressing rationale for compulsory health insurance continually put forward by government officials and echoed by the public was the specter that responsible older people could be ruined financially by catastrophic illness. Yet neither the 1963 nor the 1965 proposal provided coverage for catastrophic illness. During the 1965 Senate Finance Committee hearings, Chairman Russell Long (D., La.) asked HEW Secretary Anthony Celebrezze, whose department had written the bill, “Why do you leave out the real catastrophes, the catastrophic illnesses?” (U.S. Senate Hearings 1965: 182). When Celebrezze replied that it was “not intended for those that are going to stay in institutions year-in and year-out,” Senator Long countered: “Well, in arguing for your plan you say let’s not strip poor old grandma of the last dress she has and of her home and what little resources she has and you bring us a plan that does exactly that unless she gets well in 60 days.”
    Some thoughts on your current idea.
    Item number three is liberal propaganda. It can be easily disproven by a simple question; if American business is at a disadvantage paying $3000 per employee for health insurance, an expense it can manage, eliminate if it must, or postpone, how does replacing it with $4000 in new taxes it can neither eliminate, postpone, or manage improve its position? I speak to hundreds of business owners and executives every year and no more then 1-2 want to replace healthcare with a government ran plan funded with taxes, they all know they will end up paying far more in taxes for a poorly ran plan then they pay in premium for a plan they can manage.
    Number 4 is the foundation reform needs built on. In another post I commented how a member wanted a non covered drug filled in the US for $500 a month. We suggested they get it from Canada for $200 but their doctor says you never know what are in drugs Canadians take and they are dangerous. It’s not their money so of course they want insurance to pay more than double for the exact same Rx. For members on an HSA we hardly ever see this mentality. Like welfare reform Liberals will fight this to the death, people can’t possibly be trusted to be responsible for their own health or money.
    Solution item 1, I would ask why you would want the government, who manages the most cost inefficient plan in the world, to provide this catastrophic coverage?
    Are you familiar with self funding and stop-loss? It is the most efficient medical insurance in the county, low margins, simple, and very cost effective. Eliminating this market and replacing it with a tax funded program would only increase cost and open it to the same ills of all other government programs.
    The deductible should start no lower then 10K, below that your covering to much discretionary care. Employers and individuals can buy that down if they want.
    PPOs are a waste of money. Any other business it would be called extortion. Pay me, the PPO, $x thousand dollars, or my buddy, the provider, will financially knee cap ya. Why not take what the PPO charges and split it between the provider and person paying the bill? Providers should charge everyone the same and publish their prices. The reinsurance program would publish their reimbursement list, what they pay up to. If you want to see a provider who charges more you pay the difference.
    I notice you eschew mandates under the deductible but allow them over? This would be a major concern for me, it goes along with jurisdiction. If government bodies are once again free to mandate benefits and coverage they will take us right back to where we are today. Remember it wasn’t until government reform and mandates that insurance became expensive.
    The reason this will never happen? No money for Washington. Catastrophic insurance is low dollar low margin business. Washington can’t collect trillions in premium and misappropriate it on other causes. Without revenue they can’t prop other their prior failed social experiments. Healthcare reform and nothing to do with fixing healthcare, as you pointed out, and everything to do with funding government for the next 20 years.

  21. Anon,
    I agree with your comment that until we get a congress with the courage to legislate with the countries best interest in mind rather than their own reelection we are not likely to see real change.

  22. Unless you’re living in a studio apartment with no cable, A/C, internet, and subsisting on rice any spending on consumption goods other than health insurance is a matter of choice rather than necessity.

  23. Yes – the poor will be much better off with more stringent price-rationing imposed upon an ever escalating price structure.
    If there’s anything that will get the poor better care, it’s increasing demand for care while capping the supply of people willing to provide it via price controls. Particularly when coupled with highly centralized third-party payment mechanisms that incentivize everyone to consume as much health care as possible without regard to need or cost.
    Thank god we’re on a path towards effectively outlawing personal incentives to consume health-care judiciously. That, when coupled with price transparency and competition would actually drive down the price of health care relative to incomes. Then more people could afford it, and folks like Maggie would be in danger of losing what they cherish most – their pretext for nationalizing medicine.

  24. Anon,
    These are not “poor” people as in rabble. This is half the country. They don’t all smoke cigarettes and eat crappy food. They are not lazy bums or drunks or addicts or whatever else comes to some people’s mind when they think “poor”.
    Most are hard working, church going, decent folks and some have college degrees and young families.
    I would also submit that people that make quite a bit more than $60,000 per household still cannot afford decent ongoing health care any longer.
    I know there’s a backlash right now, but this ever increasing “nouveau poor” citizenry, unlike the classic “poor”, does vote.

  25. Ed,
    There is no one in congress who thinks like this. How would your fiscally responsible plan ensure their reelection? Answer, it won’t. So unstead of a highly responsible plan such as yours we will get oodles of commissions, panels, agencies, regulations all paid for by money borrowed from China and Europe – in my opinion a truly unAmerican way to govern. The taxpayers of America worry about deficits. No matter how much Krugman says it’s OK we worry about run away deficits. Until we get some representatives that share this view, we are in for more of the same.

  26. Maggie,
    The poor receive subpar everything in this country. They drive subpar cars if they own a car at all, they get subpar legal representation, they eat subpar food and live in subpar housing. I could spend all day with a single poor patient with the best medical insurance and it probably wouldn’t make any difference because they eat crap, smoke cigarettes (and how do the “poor” people always come up with the money for cigarettes?) usually abuse drugs and alcohol and have an 8th grade education at best. That is why they are poor and that is why they are unhealthy and that is why they get subpar medical care. Giving them first dollar coverage insurance will change nothing.

  27. Ed–
    You write: “The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.”
    No, “The biggest issue facing Americans who are uninsured is the possibility of DEATH or premanent disability as a result of a major medical condition.” They also face the possibility that their children will die, at a young age, from a major medical condtioni.
    The poor–whether on Medicaid or uninsured–receive sub-par care in this country.
    You add: “We could all choose to purchase whatever other coverage meets our needs on a open market . . ”
    No, we wouldn’t be free to choose, we would be forced to choose whatever we could afford.
    Average household income in the country is aroudn $57,000 or $58,0o00. If you can, try to imagine raisign a family on that amount–before taxes. That’s your total income.
    Half of all Americans earn less than that.

  28. “The biggest issue facing Americans who are uninsured is the possibility of personal financial ruin from a major medical condition.” – This issue is independent of having insurance. Insurance companies don’t have to pay claims. They have to profit.
    “If American’s were more responsible for their health care costs, it is likely that they would take a greater responsibility for how their dollars are spent on healthcare than if they are spending other people’s money.” – I like this to an extent. It isn’t “other people’s money” we are talking about, it is our own that we do not want to spend.
    You are on target that health care costs have not been addressed. Many health costs ought to be priced at 10% of what they are now, such as colonoscopies as just one example. But the idea of having everyone pay his own costs is a potential solution, except for one thing – there is no solution without abolishing health insurance. That game needs to be over. It is a highly contributing factor in the reality that the medical system is the biggest scam ever perpetrated on our people.
    The currently proposed reform cannot solve the problem, and I believe that is well-known. However, it begins the process of dismantling this system. It has to be done this way because of people who like to say that they don’t want to pay for the other guy’s care. They are loud and forceful, quite scary, really. We can go one of two ways, but cost control is essential and would happen automatically if there were no health insurance and every household had to pay for its own care. The other option is single-payer, and although I choose that as the number 1 solution, I admit that cost control would take time. Because those in charge don’t comprehend, plan and think – the same ones who got us in the economic situation we are now in.
    Is it peculiar that there is high unemployment, people losing income, prices being reduced, yet the medical system has not followed suit? No, it is not peculiar. The sky is *always* the limit for prices in that system that says, your money or your life, and it is all too godly to join the rest of society in coming down off its high horse.