Thanks for your comment. It’s this kind of thinking and discussion that needs to be pushed to the fore.

What you describe is what my family has. The only problem is the cost for catastrophic is so high because we’ve been denied insurance. But for almost all of our health care costs, we pay out of pocket. It’s not as much as I had thought it would be. Worse are the monthly premiums.

Medical Savings Accounts (MSAs) or Health Savings Accounts (HSAs) are emerging, but I agree that they aren’t common or the incentives to participate are low.

The biggest problem I see is that the insurance company has inserted itself between the doctor and patient, subverting what should be a very intimate relationship. It really doesn’t matter to me at this point how the insurance company put itself there. All parties involved are complicit in this. The end result has been a complete destruction of expectations. When you go to see your doctor for an office visit, you pay a $15 or $20 copay, which under fee for service would probably run $80 to $100 bucks. The doctor may try to charge this amount minus the copay you’ve paid to the insurance company, but he won’t get that because of the Usual and Customary Fee schedule set up by your insurance company. He might get 80% of what he billed.

Further, if you get really sick and require a lot of tests and ongoing treatment, the insurance company will put a cap on the amount it will pay out or just flat out refuse to pay. Thus, you don’t get the treatment you need.

Universal healthcare will NOT fix those and all of the other problems discussed here. All that will do is move healthcare from a privately rationed system to a publicly rationed system and make a system that is out of whack totally disfunctional.

What I’d like to see is a removal of the insurance company from the doctor-patient relationship, where you pay fee for service for routine office visits and minor health issues and you have catastrophic health insurance for anything major like cancer treatment or major surgery. Further, this insurance would NOT be provided by employers as a benefit, you would get it, or not, on your own for as long as you wanted to pay for it, regardless of how many jobs you have.

I’d like to see tax-free MSAs exppanded to allow people to sock away money for their out of pocket health expenses not covered by catastrophic health insurance. They exist now in some form, but the restrictions that exist now such as ‘use it or lose it’ from year to year need to be removed in favor of some sort of cap on how much can be in an MSA, say 10K or 20K.

In this way, you have an incentive to see your doctor only when you really need to see him, when you’re sick or when it’s time for the yearly physical and you can expense the cost via your MSA.

Your statement about admin costs being high matches the McKinsey findings (which I agree with also).

The McKinsey report also had some interesting findings regarding physician motivations and new technology adoption.

I agree with most of what you have written. When I talk about reform, I’m really thinking along the lines of a complete system overhaul, which changes the motivations of all parties. ER care isn’t optimal for those who can’t afford a primary physician. Nor are employer subsidized plans.

At some point, employers are going to bail on employees. And that is when the real shit is going to hit the fan.

Do I want to pay for someone who isn’t paying premiums, or isn’t paying a proper amount? No, I don’t, really. I’ll do it for someone who _cannot_ pay for themselves, but I certainly don’t want to do it for someone who could afford the premium.

The big trouble with our current system is that it is so convoluted and full of bad incentives that price signals can’t get through and admin costs are enormous. Take that stuff out, expose the real costs, give people real flexibility to seek out the coverage they want, and we’ll find that the vast majority of people can take care of themselves just fine. Then we can work out the rest.

Unfortunately, most of the calls for “reform” are really calls for income transfers. Yeah, I’m against that.

http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp

Which brings me to his “people are dying” statement. All health care systems have issues that cause unnecessary pain and (occasionally) death, including the vaunted Canadian system.

So, Noah’s insinuation that such issues are unique to our system is either ignorant or irresponsible, probably both.

The reality you seem to ignore is that millions of people don’t have health insurance, don’t know their options and are terrified to discuss other options than for profit insurance that is dwindling in its coverage.

While it’s noble that hospitals don’t turn people away, it’s not a solution to the bigger problems facing healthcare in the U.S. and the world.

Would you disagree with Noah’s notion that people are dying because of systemic problems from within the current U.S. healthcare system?

This notion that hospitals turn away patients because they can’t pay is a myth. The reality is that the average hospital in this country writes off between 5% and 10% of gross revenues to indigent, charity, and other uninsured care.

You’ve obviously always been covered under an employer’s health care policy or you would have a better understanding of how hard it is to get health insurance on your own.

My husband and I have a small farm business and we have only major medical coverage with a very large deductible– the kind where you have to have something catastrophic happen before insurance pays for even part of it. It’s all we can afford, and every year the premiums go up. I don’t know how much longer we can afford to pay a monthly premium that’s as high as if we were purchasing a Lamborghini.

The war in Iraq and health care are the two issues that I will use to decide who to vote for in 2008.