- posted 10 years ago
I'll weigh in (a little lengthy)
Re Public Option/ Insurance pools/Assigned Risk plans
My alternative would be to allow individuals or employers join the largest pool of insured Americans - the people who work for the Federal government. Federal employees have the choice of a number of plans each with slightly different coverage, premiums, deductibles and copays. After an open enrollment period of 6 months or so outsiders would have to sign up within say 60 days of losing or quitting their existing health insurance plans or pay a penalty. Premiums would be the governments cost plus say a 2% (from COBRA) fee for admin costs. (probably about $400/mo for the 60-65 crowd) Who would lose - insurance agents who get commissions from selling health insurance.
They could sign up with Medicare. Persons without a work history (e.g elderly immigrants) can buy Medicare Part A (Hospitalization) for $460 /mo and can buy Part B (physicians and outpatient) for $96.40 (for the lowest income tier). Since S96.40 only covers about 25% of Part B costs a full share of cost would be overt $800/mo (pricey isn't it).
Assigned risk plans are fairly pricey - California's plan (MRMIP) has monthly premiums of over $800/mo for a high deductible 70/30 PPO plan for people aged 60-65
Re: Co-ordination of care etc
If co-ordination of care etc was that effective in reducing costs then Kaiser (a non profit HMO) would have significantly lower premiums than conventional HMOs or PPOs. Guess what - there isn't much difference.
No one really knows how much care is "defensive" care against malpractice lawsuits and how much is just racking up the meter. When I had really good insurance from work I always wondered whether that second doctor's visit to see if the meds worked wasn't just racking up the meter. After my employer switched to an HMO I wondered if I was missing something by not going back. I think we need some defined "standard of care" and if the doctor thought that more care was needed he would have to justify it.
When we reduce fees to the provider, the provider has to hustle more patients through the office and we will get less face time with the provider and more with physician's assistant. We will find "clerical types" in white coats taking our blood pressure etc. Lower payments far enough and we will have Russian style medicine
We need to think more about "end of life care". We might be better off in a hospice with palliative care than undergoing another round of complex surgery so that we can squeeze another couple of weeks of life hooked up to machines. I hope that when my time comes to go into a nursing home I have the strength to reach down and unplug the machines.
How much of one's income should one have to pay for health insurance. Should you be forced to give up cable TV or pricey cell phones?
Should you be able to buy a lower level of care with the understanding that you are on your own and would be forced into MediAid if you can pay