Some people seem to feel if we just let the insurance companies and hospitals run themselves everything will be just fine. However, without regulations they will rip you off with whatever scheme they came up with. I found out about one of their interesting new schemes. It seems they want you to spend more billable time in the hospital, but they do not want their pals at the insurance company to have a legal obligation to pay for it. It is so much better to suck you dry. So they hired some legal criminals, aka lawyers, to make a loophole so the insurance company can deny your class despite Obama care regulations. So the doctor recommends to you that you stay in the hospital for observation because of your injury. You think that is reasonable and your deductible is over so why not go on the safe side and stay for some extra time considering how many people have to go back after going home. Well, you would be wrong. You just signed up for the hospital hotel, and you do not get coverage because you were never admitted to the hospital. Yes, if the hospital does not admit you then you are on the hook. Also, they can change your admitting status daily so you better make sure you are admitted every day you spend there. We need to get rid of medical insurance and get something better in place. It should not be too hard if we had decent human beings in charge.
At the present, no one knows but your insurance company what you might have to pay for service. If you have the luxury of time to get it authorized by your health insurance, absolutely: do it. And therein lies the problem with the state of US insurance and healthcare. The consumer cannot make an informed decision for emergency treatment. The market concept doesn't work. Having your employer, and the insurance company they choose, determine your healthcare is obscene. Employers need to be removed from the transaction. Even with this the market will still be ineffective as patients cannot become informed consumers for emergency treatment. The only solution is single payer. Medicare/medicaid expansion to cover everyone, administered by insurance companies (terms determined by the government) is the best solution. Employers can still dangle medigap insurance as a benefit (but not life saving) if they want. Doctors and hospitals won't like this as it gives the government the monopoly on insurance and its terms. Too bad.
We need a much more market-oriented system. Rationed, government-provided health care is for poor people. The system we have now--where most people get their health care through their employers--insulates customers from providers. Employers should be taken out of the equation and employees should buy their own health insurance. Government regulation about what health care systems must provide should be largely removed. We should be able to pick and choose which coverage we want and to pay accordingly. There should be competition for our health care dollars. Also, there needs to be massive lawsuit reform and an intensive review of the cost drivers in current medicine.
How does competition work when you're incapacitated? Consumers won't make informed buying choices on insurance for catastrophic care. They'll go for the cheapest policy that makes them feel good until a visit to the ER and admission to the hospital.
If you're disabled, then you go on the government-run, rationed health care. "These decisions are too important to be left to the people most affected by them!"
Way to obfuscate. Unconscious in the back of a meat wagon is not time to go on government run rationed health care. Nor is it time to decide which hospital or doctor you're going to see or check to see if the cardiologist they called in to stabilize your heart attack is "in network."
Why not? In advocating single payer, that's what you want for everyone all the time. Anyway, if you're in a life-threatening situation, you go to the nearest hospital regardless. Paramedics don't rifle through your wallet looking for an insurance card when they're picking you up off the pavement. Huh? People usually buy insurance before they need it. I don't wait until I have a car accident to get car insurance, or wait until I have a fire to get home insurance. That really doesn't work with life insurance! If you're poor and can't afford health insurance, then you go to the rationed, government system.
^Well, actually they do go through your wallet looking for a health insurance card (and more importantly, allergy information), depending on how time-critical your life-threatening situation is.
In advocating for private insurance, you're requiring people to make healthcare decisions they aren't able to knowledgeably make. Even car and home insurance has requirements placed on the buyer by the lienholder or state. Health insurance is more than accident insurance. Most people want insurance that pays for well patient care and prescription medications and don't worry about catastrophic care. Exactly the opposite of accident insurance. People, as evidenced by the purchase of health insurance both before and during the ACA, go for the policies that are least expensive without considering the costs of catastrophic health care. This results in bankruptcies, poor outcomes and other patients shouldering the costs of their care. Under your scheme, those are the policies that will be sold. Are you going to take the cancer rider? Are you going to opt for the policy that has no yearly or lifetime limits? Will you opt for coverage for out-of-network facilities and doctors? Will you opt for coverage of pre-existing conditions (if you can find it). Healthcare as a free market doesn't work as well as government run single payer systems both in terms of per capita cost and patient outcome. Show me one 1st world country with single payer that has worse patient outcomes than the US.
Steve, what's wrong with limiting the government to a reduced role? Gov-care clinics, on a bronze- or chevy-(e.g. 'Canada') level of care with walk-in and emergency care for those without coverage? Anyway, highest estimates put the US emergency care spending at low single-digits (most at 2 or 3 %). That small amount shouldn't drive such a huge chunk of our economy (over one-sixth).
The reduced role model hasn't worked. What you're suggesting is a high level of government control (gov care clinics etc). I prefer enabling people to choose their healthcare without being hindered by a choice some insurance company made for them in the fine print. Typical single payer systems only pay 80% of the costs. The consumer is responsible for paying the balance whether out of pocket or by purchasing supplemental insurance. The 80% isn't manna from heaven; it's social security taxes. The net result is lower health care costs for everyone, and better care.
So, what about the middle class? Granted, they are more endangered than pandas today, but they've been the people most hurt by the mandate
I see nothing wrong with expecting people to make hard decisions about their insurance coverage and being expected to take it upon themselves to become knowledgeable about insurance. We expect American citizens to become knowledgeable about other matters and make hard informed decisions. Why is health insurance different?
Because people will choose to have no insurance or be underinsured, and then society has to foot the bill through bankruptcies and shared higher costs. Health insurance is different because the market based model is inefficient both in overall cost and effectiveness when compared to single payer systems.
What reduced role model? The government's role has been increasing since at least the early 70's, and health care was a lot cheaper then.
If "society" pays for their subsidized health insurance, "society" foots the bill either way. I'd rather "society" pay only for emergency care or maybe for some limited, rationed health care rather than confine us all to the same system. We don't have a market-based model; state and federal regulation so thoroughly infuse the system, that market dynamics have little chance to operate. And, again, we need legal reforms to reduce the huge liability costs that are built into the system.
I forgot your are a supposed libertarian. You want regulation that has no effect and is impossible to enforce, but you do want it. I am sure that will work great, now the adults are speaking so go play candy crush or something.
Eh, it's a secondary concern. If you look at a breakdown of aggregate medical costs in the US, while malpractice and malpractice insurance is slightly higher than elsewhere, hospitalization costs make up by far and away the largest chunk of excess costs relative to other countries. Personally, I think this has something to do with the 1500 fewer hospitals and 500,000 fewer hospital beds in the US in 2015 (~5600, ~800,000) than in 1975 (~7100, ~1.3m), but hey, let's completely ignore the primary supply constraint there (Certificates of Need) and worry about insurance premiums instead!
I'd rather not as society will pay more for less effective care. Single payer does not confine you in any way to the same system. You still have the choice of health care providers and for most, more than your current private health insurance allows. If it follows the model of France you will have the choice of private insurance to cover any gaps. Not sure what other countries do. I agree, we don't have a market based system. The market is employer based for the majority of workers. I think we both agree that this market is not to our benefit. Where we disagree is that any private based market can work for a commodity that determines whether you live or die. We also disagree on state and federal regulations. I would not see these repealed. There are a lot of quacks and snake oil salesmen out there as it is. Tort reform is a separate topic. I'm surprised you want to regulate lawsuits but ok...
That's interesting. I wasn't aware of this requirement. 35 states have it. wiki I wasn't aware of a hospital bed shortage. Length of stay has reduced dramatically since the 70s. google google...
Length of stay (better medicine) and outpatient procedures have reduced demand for hospital beds. There is a nursing shortage and some areas have shortages in psychiatric hospital beds. I don't see a hospital bed problem. Maybe you can provide details supporting your claim? Some emergency departments are stressed, but I think the culprit here is lack of insurance resulting in the ED being the first line of medical treatment for many. Here's a 2003 paper on the subject.
When discussing med. mal. it's not just the higher premiums, it's the practice of defensive medicine that most contributes to the (arguably unnecessary) cost increase from the flaws in our tort system. I'd estimate the double-digit growth in health care costs we've seen continue unabated since at least the 80s is roughly attributable 35% each to waste/inefficiencies from government action, and technological development (mainly drugs, procedures, and med devices). The other 30% or so split about half each between theft/fraud and litigation abuse (all that tort, med mal, etc.) that for four decades has treated the 'missing sponge' to be a source of lottery-type windfall rather than a fair compensatory measure (most often judgments of extravagant pain and suffering or punitive damages).
I'd say the double digit growth in health care costs is a broken market. For too long people enjoyed health insurance that typically cost $15 to see their GP and $50 at the time of service to see a specialist. There was no constraint to demand. It sucked though when you got cancer and ran out of benefits. Do you have any basis for your estimate other than what you think? Provide one and I'll try to find a supporting argument for mine.
^After repeal of ACA penalties my interest in the topic was exceeded by my lack of interest in doing research to support some academic point that will have zero impact on policy. : ( How much of cost growth would you estimate was attributable to actual medical improvements (all tech., or if too complicated, say, e.g., just consider the breakthroughs in statins? or stents?)? Nothing? One-third (like I do)? Half? [And it's no big reveal to remind you that health care has *never* been about free-market; it's nothing even resembling a market-based system. Not even close by any measure.]
Some medical improvements reduce costs through reduced stays and outpatient procedures. Some medical improvements increase costs through unnecessary capital purchases to have the latest and greatest equipment on site. Also unnecessary tests where evidence based practice does not show an advantage to outcomes. This would have been due to the broken market where convenience and Dr office bling were the buyers' main concern. Either way artificial market distortions were at play. I don't think I'd blame lawyers more than John Q Public's spending habits in a market where he could have anything up to his yearly/lifetime limit.
And the federal law still exists to enforce them where the state law doesn't. So it effectively exists in all 50 states. And yeah, length of stay has shortened, but it used to be that you stayed at a hospital until you were feeling better. Now you stay at a hospital until the first instant they can possibly kick you out without liability, and improved medical technology has masked the worse outcomes and increased returns to hospital that produces. Convalescent homes have helped, but not to the tune of 500,000 beds. Granted, circumstances have changed a bit, requiring shorter hospital stays because of hospital-borne infections, but that's beside the point.
Please cite a current case of hospital bed shortage. Maybe in rural areas, but overall I don't think this exists today. Nurse shortage, psychiatric hospital bed shortage, ERs stressed, sure. Are you trying to correlate bed shortage with increased costs?
