McAllen, Texas: Free Market Health Care.

No. I don't think so. You still haven't responded to my comments the other day about fixing the problems.

 

Historically inaccurate. Nonprofits, as mentioned, worked just fine. Introduce the profit motive into the healthcare system, and you have the mess that exists today. Blaming it on Evil Gubmint only clouds the issue.

What's the distinction in your mind between a charity and a nonprofit? And what motivation would there be for nonprofits to coexist with for-profit insurers? More to the point, why would consumers put themselves at the mercy of for-profit insurers if they had the option of a nonprofit?

I'm never quite sure who those people are supposed to be, aside from healthy 20-somethings who think they're immortal. What happens if one of them gets hit by a truck and ends up in the ER? You just shovel 'em out onto the tarmac and call the coroner? What if it's a parent who refuses to insure their kids? Let the kids die, not your problem?

 

Interesting that nobody who brings up the "sick children" boogeyman ever gives any consideration to wringing those health care dollars out of the negligent fuckbag parents. Take them into custody and force them to work in a way that returns value comparable to the cost of the kids' health care. Even if they never truly settle up, news of that punishment will become an effective deterrent. The kids can grow up visiting mommy and daddy in a labor camp and vow to never put their own children through that, the bleeding hearts can wail about the injustice of it all. It'll be great.

 

I wonder if McAllen's location (that big blue area south of the city is Mexico) has anything to do with high medical expenses there.

 

No this is an interesting point.

Since I was, at oldest, 19, I have sought out "mutual" insurance companies--companies like State Farm, that are not for-profit insurers.* My current insurer is customer owned and actually pays me a chunk of money annually if the operating picture permits it.

So, from a free market standpoint, logically a mutual insurance company should be the way to go. All other things being equal, not having to earn a profit should allow them to keep premiums below those of for-profit firms. This should, in turn, draw more customers and eventually force for-profits to lower their prices or exit the market.

Since that hasn't happened, one would assume all things must NOT be equal and the for-profits must be doing something to keep them competitive. (Or the non profits must NOT be doing something that keeps them from having an advantage.)

Thoughts?




*I'm talking auto, not health, but the comparison should be valid nonetheless.

 

Nobody said anything about "Evil Gubmit." Drop the bullshit.

On topic, the profit motive has caused no problems. The problems, such as they are, stem from a lack of real, meaningful choice. Individuals are stuck with very limited options, and the entire market isn't served.

The distinction between a non-profit and a charity? While the lines differ depending on who you're talking to, I envision a non-profit as a cooperative, mutual insurance type entity. You need to pay to be a part of the club, and its managed for the benefit of its members. A charity relies on the good-will of others to help those less fortunate at little or no cost. Pretty obvious distinction I'd think....

As for why customers would put themselves at the "mercy" of a for profit? False premise. Customers may choose a for profit for better service, better care, more diverse options, etc. If I can afford the higher preminums, why should I settle for lesser care?

Finally, nice hyperbole on the poor dying kids and the innocent, though misguided 20 somethings. This is where basic common sense and human compassion comes into play. You'd be surprised at how charitable people can be. Kids are always a sticky area, as they can't make informed decisions. Government and society have a roll in protecting children. As for the uninsured 20 something. Patch the dumbass up and send him a bill. If he can't pay, garnish his wages till the end of time. He made a choice and he has to live with the consequences, for good or ill.

 

What if the government sought a profit from healthcare coverage?

I believe that I've already stated that private insurers don't pay providers for preventative care because more than likely, the private insurer will no longer be the insurer of the patient by the time the diseases in question manifest themselves.... Or symptoms may not occur at all due to the effectiveness of preventative care (I know ).

It could be argued that by being aggressive with preventative care, and switching reimbursement from a procedure based incentives to a more outcome focused incentives, that the government could profit by keeping taxpaying citizens healthy longer, so that they will remain taxpaying citizens. I really don't see an incentive to make such a move coming from the private sector.

 

Grand in theory, unsustainable in practice. Until the several states strip their various insurance commissions (and insurance commissioners) from setting minimum premiums in that state, the insurance business will always have government anchors around their necks.

Edit: There was a wee bit of a scandal here a couple years ago over protectionism. ALFA (The Alabama Farmer's Federation and Insurance Company) is the single largest insurance company that operates in the state of Alabama. But, even though they assume much more risk, the Insurance Commission was giving them favorable minimum premiums compared to out of state mutuals like State Farm.

In short, ALFA is the largest insurer in the state because the Insurance Commission was looking the other way with a wink and letting them have the lowest premiums. State Farm, Mutual of Omaha, Met Life, et. al. just couldn't compete with the price. So, rather than the best company prospering, the State's favorite company prospered.

That wouldn't and couldn't possibly happen on a national scale. Right? Right?

 

I've got a request, define your preferred delivery system for your ideal preventative care. Free screenings? Mandatory annual physicals and examinations? How do you motivate Joe Dumbass to go get checked out in time to prevent such ailments? Do you force him?

Cause here's the rub, once you have determined that it is in the state's financial interest to keep me alive, and I have no choice on whether or not I'm in the system, (assuming a single payer system) the state now has a controlling interest in my health, and as such an excuse to regulate all sorts of behavior. Yeah, the argument that healthcare is a backdoor to all sorts of lifestyle regulation is an old one, but it's still pretty damn valid. And not one supporters of it ever seem to answer.

Assuming that the government is paying for the prevention and the cure, are they justified in regulating everything from vaccinations, seat belts, tobacco, food, etc?

 

Cheeseburger tax, man. Hit 'em with a cheeseburger tax.

 

The masses would rise up and lop off Michelle Obama's head faster than you can say "let them eat cake."

 

I believe that you overstate the situation by claiming the government has a "controlling intrest" in your health. I simply said that the government has a motive to keep you healthy that the private insurers don't.

Preventative care should be determined by your doctor, of course. If your Dad died at age 53 from a massive myocardial infarction and your Grand-pappy at age 51 of the same thing, if for any reason you utilize the healthcare system and a detailed family and social history reveals that and significant risk factors and lifestyle choices that predisposes you to the same fate, then you should be educated to the risk you face and a battery of exams and lifestyle changes should be reccommended. It is ultimately up to you to take the advice as always.

By the way, the government already regulates the things you mentioned anyway.... and as always, any overzealous politician still has to answer to the public on election day. Let's not toss a good idea today for fear of a theoretically bad idea that may or may not exist tommorrow.

 

McAllen,Tx? I used to live there briefly, back in '89. It's not the end of the world, but you can see it from there.

 

Medicare certainly pays for Visting Nurse Services here in New York. That's when a nurse comes to visit you on a periodic basis in order to perform nursing services. I'm not sure if they pay for a Home Health Aide to come out and perform living choirs for you, but somehow I doubt it. I am not aware of any private insurer that considers those sorts of things as "medical benefits" either, but these things vary from locality to locality. If a patient lives alone and is in no condition to cook, clean and and go to the bathroom themselves and has no one who can do these things for them, then they are better off in a SNF until they in a condition to do those things for themselves. I don't know a doctor that would disagree.

Now you've hit my home. I am a chronic wound care/post amputation specialist. Chronic wound care clinics will one day, in the near future, be like ERs. Every hospital will have one. Regarding post amputees, hospitals are paid by something known as diagnosis related group or DRG. Medicare pays a flat fee for a condition so if a patient stays in a hospital 1 day or 100 days, the hospital gets paid the same thing, so it is in the best intrest of the hospital to get the patient well enough to go home or a SNF as soon as possible. I certainly don't think it's appropriate for a patient to remain in a SNF until the amputation site is healed and a prosthesis is fitted, but it certainly depends on the patient's home living conditions. Is there someone there who can help the patient with living duties? Most of the time, they have someone close by who can come by and help and VNS is always an option along with weekly visits to the wound care center.

Yesterday, I typed up a long ass post about fraud being the biggest problem with regards to healthcare costs as opposed to government beauracrcy. Before I could hit the "Submit" button, my power cord fell out the back of my computer and I lost it. Medicare has been going after fraud for a long time... certainly longer than I've been in healthcare. While i wouldn't describe the fraud as "rampant," it exist and has probably costed taxpayers billions. The vast majority of doctors are on the straight and narrow.

By incentivizing for outcomes instead of for the number of procedures performed, you automatically do away with the fraud, but what I predict would happen from there would be that doctors might begin playing "hot potato" with the sickest patients with poor prognosis unless some countermeasures are taken. I don't know what an outcome based reimbursement structure would look like, but I think it is the right approach. I hope that smarter people than me are looking into it and seeking a way to draw the best and the brightest physicians to provide the best care possible.

 

My mom did some eye-opening work on that when she was working on her thesis. Most Doctors merely stopped taking "problem patients" every. time. it. was. tested.

We're not talking about evil government or evil insurance companies. Doctors did it.

 

Yeah, I kind of figured that would be the case. See my last post.

Problem patient as in "poor prognosis" or problem patient as in "non-compliant?"

 

Both. If it hit the bottom line, the patient hit the bricks.

My mom was very much a fan of outcome based reimbursement until she actually crunched the numbers and did the research for her thesis.

 

Hmmmm....

You know, Medicare is on this big thing now where they refuse to reimburse for the care of nosocomial conditions.... or "hospital acquired" illness. If you come in with a broken leg and get an infection from cross contamination or something, the hospital has to furnish the antibiotics without being reimbursed for it. Come in with a fever and develop a bed ulcer? no reimbursement for the wound care.

Hospitals have responded by training the admitting team to give the patiet a good once over in order to catch all "pre-existing conditions" even if it is not the chief complaint and thoroughly document it. There is more specifically relating to me, a Braden scale that determines the risk that someone has to developing a pressure ulcer so that these patients are identified and put on a bed turning schedule.

Given the current state of science, some conditions for some patients are just unavoidable... and as always, patient non-compliance should only harm the patient. Perhaps an outcome based approach could be caveated to have a group of "outliers." Patients who are just chronically ill and have poor prognosis are set in an intensive care group and are outside of consideration of the incentive schedule.... unless you can pull them back to health.

I don't know, but there has to be a way.

 

But they already are happening. Smoking bans, even in private homes, banning of certain foods and ingredients, proposed taxes on soda, San Francicso's mayor is even into regulating food based on arbitrary criteria.

May or may not? Brother, it's coming, and fast.