What is unique in US compared to every other country in the world.

We have the CRISIS. And we have private health INSURANCE. Simply shut it down.

We consider ourselves as the best democracy in the world. But we have absolutely no information available on healthcare cost and quality. We are under seize. Health insurance industry controls all of us like a ruthless dictator and in the process killing all of us slowly.

I hate the term ‘health-insurance’. They take our money and they control us.

Steve B

Two years ago, my doctor sent me to a hospital for a small procedure, an ultra-sound scan; it involves only a medial technician and no doctors. My insurance company rejected on ‘pre-existing’ grounds. The hospital waited for insurance company action; then it sent me a bill for $1,224. For the same procedure, Medicare pays just $65.

Is it not a FRAUD? I am scared to go to a doctor or hospital. My insurance is a total waste. If I can pay & forget, I will go for it.

I just do not want to receive any bills from doctors/hospitals/insurance carriers. Period.

Liz

Now I have insurance, but scared to go to a doctor for fear of issues like out-of-network, co-pay, co-insurance, deductibles, etc. I don’t have time to deal with all these non-sense.

Whatever be the solution, make it simple.

Brian

Coming to the issue of cost, national per capita healthcare expense is over $7,000 and is projected to reach $13,000 in 2016. If the insurance premium is less, obviously your deductibles, co-pays, etc will be higher. So, why waste time talking about premium, it does not matter even if it is just $1000.

Let us look at affordability. The median household (not individual) income in 2005 was $46,326 (http://www.whitehouse.gov/fsbr/income). It means, 50% of the households make less than $46,326 a year. A household of three will need at least $21,000 for healthcare alone; according to your numbers, they need $12,000 for premium and another $9,000 for deductibles, co-pays, etc. There is no way it is doable.

COST & AFFORDABILITY: These numbers clearly show that the cost and affordability are miles apart. If you analyze and try to cut cost while keeping the current system, probably you can cut a few feet off these miles of gap. It is only a waste of time to discuss about fixing the current system.

What can we do? First, think out of the box. Make health insurance just like auto-insurance. Is auto-insurance system in crisis? Absolutely not. Then, why don’t we follow that.

What does it mean? Auto-insurance provides coverage only for ‘accidents’. The average number of claims may be less than 1 per year per person. That’s why, the premium is affordable and everyone has it. For every single auto-maintenance or repair, we pay directly pay from our pockets, the vendors compete for your business, and pricing is completely transparent; in other words, it is extremely efficient.

PROPOSED SOLUTION:
1) Have health insurance only for catastrophic illness (only for a very few procedures). I am not concerned whether it is single-payer or multi-payer, public or private; it must be efficient.

2) For all other procedures, let us pay directly from our HSAs. Can we afford to pay? Let us look at an example; for a simple doctor’s office visit (new patient), Medicare pays $43.36 in Manhattan, NY or $33 in Kansas. Doctors will be happy to receive the same amount when they get paid directly then and there; they don’t need to file a claim and wait for months to get paid. Even if it is 20-30% more, people will have no problem paying it directly. THIS WILL BE THE MOST EFFICIENT SYSTEM with enormous benefits (as I listed earlier); less law suits, low admin expenses, etc. The cost can be cut in half.

What is the problem in this solution?

PJ

Also, the price controls and other distortions imposed by the Medicare system PJ proposes as the model for what is essentially a single-payer system have done more than anything to undermine any incentives in the current system for providers to be efficient and innovative. So I would not support that idea.

But I agree with PJ that replacement for the current system is needed. I also disagree with my friends at Cato Institute who contend that any government assistance (like Medicaid) is just another form of welfare, subject to the same moral hazard concerns, and so should be minimized if not eliminated.

Here’s where I think that goes off track: While most citizens are perfectly willing to repeal welfare entitlements, that’s not the case with health care. Americans will not step over the bodies of ailing-but-curable indigents saying, “Sorry pal, you made bad choices – must be tough to be you.” We WILL provide medical assistance, so reform proposals contingent on ending health care entitlements become circle-squaring exercises created by this contradiction: We don’t want to create moral hazard, but as a society we refuse to withhold treatment.

I believe that the Murray idea may provide a way to avoid the worst aspects of both socialized single-payer systems and the current U.S. system, while also satisfying the public’s desire for universal access to health care.

I constantly hear about our out of control healthcare cost in this country, but premiums and costs just keep escalating. If the problem is costs, seems that we need to focus on the money. Who better to focus on the money than individual consuming the resource. Most of us don’t know a good CT scan from a bad one, but all of us know the difference between paying $900 and $300 for the same procedure. With a high deductible plan and the appropriate pricing information, I believe the 200 million of us that have and pay for health insurance can have a rather dramatic impact on the cost of healthcare in this country. Just show us the price and my fellow Americans will show you how to reduce costs in fashion that the government, insurance companies, and providers can’t seem to accomplish. We do it every day. Show us the price…after all we pay the premium.

Immediately, people talk about mandatory insurance, etc. A full-time minimum wage worker makes $10,712 a year whereas health insurance premium for the employer to cover his/her family of four cost an average of $12,100 in 2007 (http://www.nchc.org/facts/cost.shtml ); add co-pays, deductibles, in/out-of-network issues, uncovered services, etc. Are we all fools to think that it will work?

Wake up America! Simply the current system will not work. Think out of the box. A fundamental shift in healthcare is an absolute necessity.

As I suggested earlier, let us have a system as follows:

1) Only for catastrophic illnesses (like cancer) let us have insurance, preferably managed by the federal govt. This is to cover a very small number of procedures and they must have some co-pays to control over-use.
2) For all other wide range of routine services, let us pay doctors/hospitals directly from our HSAs (tax-advantaged). The benefits are enormous.
a. Patients pay the bills for the service they receive. In our ‘how-much-I-need-to-pay’ culture, people do not care how much any service costs if it is paid by insurance or some one else. Making people pay the bills is the only way we can control costs.
b. Patients and doctors are the only ones involved in medical decisions, they meet in person and they establish a mutual understanding; leads to most efficient treatments and much reduced law-suits.
c. There is no claim form to fill; leads to significantly low administrative costs.
d. The doctors and hospitals will lure the patients as they are the ones who pay the bills. Result: competition among doctors/hospitals, better service, and transparency (now, up front you have no way of knowing how much any hospital charges for a given service).
e. When cheaper alternatives are available, patients will go for it. Example: a pair of eye glasses instead of expensive lasik surgery.
f. The so called ‘defensive medicine’ (where doctors send you for unnecessary tests to avoid potential legal problems) will be much less as doctors deal only with patients and not with health plans, etc.
g. Large numbers of diseases involve ‘family history’ at least partially. When the entire family can have the same doctor (primary care physician), that doctor is better informed and can provide effective treatments early.
h. Today, doctor-to-doctor discussions are mostly around insurance payments and not on medical matters. This kind of wastage of doctors’ time will completely end.
i. Today, besides federal regulations on healthcare, we have millions of state specific, ridiculous and unnecessary laws/regulations making the system just too complex. This status will be gone.
j. After all, every other insurance (auto, home, etc) does not cover routine services and they are meant to cover catastrophic risks only. That’s why they are efficient and cheaper. We do not send claims for car oil-change.

Do we need any more reasons to understand that it will cut healthcare costs drastically? In this proposed model, the healthcare system will be highly efficient and the cost will only be much less than what we spend today

Also, I think we need to make people go for ‘routine exams’ early in life to identify potential problems. Why not we have a system where the federal government sends 1-2 medical vouchers a year to the individuals for such exams and collect the health data from the doctors. This will reduce the healthcare cost significantly in the long run. Besides, we will have accurate and comprehensive data on people’s health nationwide; this will be extremely useful for making policy decisions.

How to fund? Today, employers spend a lot of money on healthcare; let it be diverted partially to fund the individual’s HSAs and the rest to federal catastrophic coverage fund. Individual’s payroll deduction can also go to their HSAs. Here, younger generation also will be happy to participate whereas they do not in any mandatory insurance.

A fundamental change to the current system is a must. Just simplify the system. Let patients pay directly to the doctors/hospitals for most of the routine services from their HSAs; let the catastrophic coverage be provided by Medicare like Govt program. Whatever employers today spend can be used to fund HSAs as well as the catastrophic coverage program.

This system will be much simpler and there is no third party (like health plans) involvement for every single procedure. There will be less law-suits and less admin expenses. Besides, people are involved in the payment process which automatically enforces healthy habits (diet, exercise, etc) among the individuals. More importantly, it will be cheaper.