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Mandatory Health Coverage

Celebrity

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Health care costs in the U.S. are staggering, and since many Americans have trouble coming up with $1000 in the event of an emergency, some say that universal healthcare should cover all Americans. Recently, President Obama voiced this opinion and the Affordable Care Act is meant to put that plan into action.

This abstract from four years ago describes two ways consumers can choose their public health insurance http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2125945

Should businesses be required to provide health coverage, or should the state run insurance policies owned by private individuals? Under universal health care, all Americans would be passively insured, although active choice allows for coverage above the minimum under the ACA.

What about just being able to walk into a hospital/doctor's office to receive adequate treatment with no co-pay? Isn't this ideal, since the alternative would leave sick people in the population?
 

KevinKohler

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Or....we could simply address the issues for why it's so expensive in the first place. Everything else is addressing symptoms, not actual problems. Well, populations not have any money set aside is a problem, but there's not much anyone can to help THAT problem.
 

Beaudreaux

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Step one - Have people pay their own bills. Then the cost to the rest of us will go down.

Step two - Impose a "loser pays" rule for lawsuits, even medical lawsuits.

Step three - Tort reform (lawyer reform) - et al.

Step four - Allow the purchase of insurance across state lines.

Step five - Go back to the premise that if you don't have insurance, and you don't preplan for potential health problems, it isn't the government and tax payers that should be on the hook to pay for it.

Step six - Get the government out of private sector health care, not the DoD, or the VA. When the government sets unrealistically low payment schedules for doctors and other medical providers, it's the rest of us that have to pay the difference.

Step seven - Require doctors to publish their fees, and have a publically accessable database for patients to be able to determine which doctor is the best doctor for them. We can shop around for the best price for the best performing cars, why can't we shop around for the best prices from the best performing doctors?

There's more, but that should be enough to begin with.
 
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jaeger19

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Step one - Have people pay their own bills. Then the cost to the rest of us will go down.

Step two - Impose a "loser pays" rule for lawsuits, even medical lawsuits.

Step three - Tort reform (lawyer reform) - et al.

Step four - Allow the purchase of insurance across state lines.

Step five - Go back to the premise that if you don't have insurance, and you don't preplan for potential health problems, it isn't the government and tax payers that should be on the hook to pay for it.

Step six - Get the government out of private sector health care, not the DoD, or the VA. When the government sets unrealistically low payment schedules for doctors and other medical providers, it's the rest of us that have to pay the difference.

Step seven - Require doctors to publish their fees, and have a publically accessable database for patients to be able to determine which doctor is the best doctor for them. We can shop around for the best price for the best performing cars, why can't we shop around for the best prices from the best performing doctors?

There's more, but that should be enough to begin with.

Pretty good.

I'll flesh it out a bit.l

Set up healthcare savings accounts in which employers can pay into for an employee to go purchase their own healthcare insurance. That way employers get the tax advantage of providing money for healthcare and the advantage of healthier employees. While employees get to choose what healthcare insurance they need, and its portable because when they switch jobs, the next employer simply starts paying into the healthcare savings account.. with no break in coverage or switching.

Add to the existing exchanges. The exchanges are a great idea to foster competition.. but are too limited.. let a person go on their state exchange and the federal exchange..

Get rid of referral for profit. or at least limit it. There should be no reward for physicians referring for tests, etc.

Mandate that people have insurance..and mandate that insurance must provide 4- physician visits a year without charge.

Get rid of penalties for having expensive healthcare plans

Get rid of the mandate that employers provide healthcare.
 

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So I take it you guys think we should choose our health coverage, instead of taking what's handed to us?
 

jaeger19

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So I take it you guys think we should choose our health coverage, instead of taking what's handed to us?

that would make sense.

Right now.. an employer is paying extra so that his employees family "can" be placed on the health insurance plan... even when a lot of his employees have spouses that work and will never be on said plan.

Meanwhile, the spouses employer is paying extra so that their employees family can be placed on the health insurance plan.. even when a lot of employees have spouses that will never be on said plan.

Studies show that healthcare insurance policies vary in premium not based on an employers experience.... but will increase if that company does well financially.
 

ashurbanipal

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Beaudreaux said:
Step two - Impose a "loser pays" rule for lawsuits, even medical lawsuits.

Most states have such laws, with some exceptions. Generally speaking, if there was reasonable legal basis for a lawsuit (past precedents unclear, for example), it gets a little more tricky. It'd be nice if things were this simple, but they aren't. Imposing this kind of rule across the board would result in a great deal of injustice.

Beaudreaux said:
Step three - Tort reform (lawyer reform) - et al.

Reform how?

Beaudreaux said:
Step five - Go back to the premise that if you don't have insurance, and you don't preplan for potential health problems, it isn't the government and tax payers that should be on the hook to pay for it.

Seems pretty unethical, especially when a fair proportion of necessary jobs offer so little pay that there isn't a reasonable chance a person working at one of those jobs could afford to purchase their own health coverage.

Beaudreaux said:
Step six - Get the government out of private sector health care, not the DoD, or the VA. When the government sets unrealistically low payment schedules for doctors and other medical providers, it's the rest of us that have to pay the difference.

Seems to me that it was private insurance that got us into the mess we're still trying to get out of in the first place.

Beaudreaux said:
Step seven - Require doctors to publish their fees, and have a publically accessable database for patients to be able to determine which doctor is the best doctor for them. We can shop around for the best price for the best performing cars, why can't we shop around for the best prices from the best performing doctors?

Because medicine isn't mechanics. Two doctors practicing exactly the same first/second line techniques on different patients may have radically different outcomes. Imagine if two cars, put together in exactly the same way, performed very differently--one has a top speed of 15 mph, the other can go 105. One breaks down after 20 miles, the other after 200,000. Any attempt at comparison via measurable variables starts to look downright silly if that were the kind of world we live in. But in medicine, two patients with similar backgrounds and health can have staph infections. Doctors can prescribe the same course of treatment. One will improve quickly, the other will experience complications, possibly even very severe, and without doing a vivisection and complete tissue spectrum, there's no way to know why the outcomes are so very different.

This isn't to say that no measurement is possible. But it means most people would have no idea what to look for. Based on past results, Doctor A may look like quack but in fact be highly skilled, just because she got unlucky with her patients.
 

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Most states have such laws, with some exceptions. Generally speaking, if there was reasonable legal basis for a lawsuit (past precedents unclear, for example), it gets a little more tricky. It'd be nice if things were this simple, but they aren't. Imposing this kind of rule across the board would result in a great deal of injustice.



Reform how?

I have no idea how tort reform should work, so my only suggestion is to remember that malpractice suits are usually civil torts. The plaintiff needs to show a preponderance of the evidence in order to substantiate the claim that wrongdoing has been committed. Institutions, not doctors are held accountable for wrongdoing, so it's not sufficient to say that one doctor did something wrong to call a program into question. A doctor stands to lose her license and her job in malpractice. That won't do the community any good, unless it is truly malpractice. Showing that two doctors have committed wrongdoing would be more significant than one. Should hospitals be required to care for patients for better or for worse? If you have any amount of faith in the medical community, then doctors are already held to a high standard as it is.

This isn't to say that no measurement is possible. But it means most people would have no idea what to look for. Based on past results, Doctor A may look like quack but in fact be highly skilled, just because she got unlucky with her patients.

Adequate treatment from the patient's perspective is a matter of getting better or not. Where doctors are able to treat sickness, disease or symptoms should be reduced and healing should take place, right?

Well, some doctors may just get lucky with an opportunistic, non pervasive disease, a tumor which turns out to be benign, or a wound which is not septic in a patient with a healthy immune system. It's easy to know what to look for if you can indicate one symptom in a patient who is otherwise healthy. The converse of death, is a patient who is not healthy at all. Ideally, doctors should have a way to show that they cannot treat a patient with medicine other than saying "he's as good as dead."

I use of unnecessary procedures is the problem from a financial or malpractice perspective. Someone doesn't have to get physically ill in order to receive a huge bill that's not covered by their insurance. Shopping among doctors might fix that, but negotiation on the government end would certainly change things as well. Otherwise, doctors who work for large hospitals essentially would have a monopoly on health coverage.
 

ashurbanipal

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celebrity said:
I have no idea how tort reform should work, so my only suggestion is to remember that malpractice suits are usually civil torts. The plaintiff needs to show a preponderance of the evidence in order to substantiate the claim that wrongdoing has been committed.

Alright, that's the case presently. The standard is preponderance of evidence in civil torts. I'm not clear whether you're saying that this is the ideal, or merely remarking that this is what actually is, but in either case, what you've said is what is true now.

Institutions, not doctors are held accountable for wrongdoing, so it's not sufficient to say that one doctor did something wrong to call a program into question. A doctor stands to lose her license and her job in malpractice. That won't do the community any good, unless it is truly malpractice. Showing that two doctors have committed wrongdoing would be more significant than one. Should hospitals be required to care for patients for better or for worse? If you have any amount of faith in the medical community, then doctors are already held to a high standard as it is.

celebrity said:
Adequate treatment from the patient's perspective is a matter of getting better or not. Where doctors are able to treat sickness, disease or symptoms should be reduced and healing should take place, right?

No, that doesn't follow. I am able to write articles of fine enough quality that they are published in professional journals (I have several such articles published). That doesn't mean that every article I write is accepted somewhere. I have a few papers that have been rejected. Ability does not imply any particular rate of success. If you go back far enough in history, that was the standard. Doctors were thought, by patients, to be claiming they can cure the disease, and if the patient didn't actually get better, the doctor would be fined, branded, or even executed. This was often the case in Renaissance Naples, for example. What happened was that doctors recognized, before anyone else, that treating disease is always chancy, and the doctors just left those areas or went into other professions.

None of this means that good or bad treatments cannot be identified. They have to be identified over populations, however, and cannot be indexed to a particular patient.

celebrity said:
Well, some doctors may just get lucky with an opportunistic, non pervasive disease, a tumor which turns out to be benign, or a wound which is not septic in a patient with a healthy immune system.

Yes. This further supports my point.

celebrity said:
It's easy to know what to look for if you can indicate one symptom in a patient who is otherwise healthy. The converse of death, is a patient who is not healthy at all. Ideally, doctors should have a way to show that they cannot treat a patient with medicine other than saying "he's as good as dead."

I'm not sure I understand what you're getting at.

celebrity said:
I use of unnecessary procedures is the problem from a financial or malpractice perspective. Someone doesn't have to get physically ill in order to receive a huge bill that's not covered by their insurance. Shopping among doctors might fix that, but negotiation on the government end would certainly change things as well. Otherwise, doctors who work for large hospitals essentially would have a monopoly on health coverage.

I don't think, for reasons stated above, that shopping among doctors will fix things. Ordinary individuals are unable to determine the skill level of a doctor (even medical review boards find it difficult). One thing that will fix at least the cost issue is single payer universal coverage. I'm not sure there is a way to fix the malpractice issue itself. Doctors are human beings, and they screw up sometimes. And sometimes, the way they screw up is they stop caring and become negligent, and in those cases, malpractice suits are warranted.
 
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