How would you fix the U.S health care system?

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RCIAGraduate

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Especially to help the uninsured and underinsured like peopel who can’t afford co-pays, dedutibles and premiums?
 
Start by realizing someone must pay. No one will go through medical school and work for peanuts afterwards. Hospitals will not operate at a loss. Drug companies will not spend billions on research and development just to go bankrupt.

Next, adopt the principle that those who can pay, should pay. Those who cannot pay should be helped. Then institute True Medical Savings Accounts. Here’s how it works:
  1. You purchase a cheap, high-deductible catastrophic health insurance policy.
  2. You save an amount equal to the deductible, each year, pre-tax.
  3. The institute with which you save issues you a card.
  4. When you need medical care, you pay with that card. When your True Medical Savings Account is out of money, your high-deductible catastrophic health insurance policy kicks in.
  5. At the end of the year, any unspent money goes into your IRA and you start saving again.
Paperwork makes up 1/3 to 1/2 the cost of healthcare. With this system, almost all the paperwork goes away – there’s almost as little paperwork as there is at Wal Mart.

The Doctor gets paid on the spot – the long time delays that exist in the current system go away, and this is another cost driver for medical care.

You have an incentive not to over-consume – any money you don’t spend, you keep.

You have an incentive to bargain for health care – and more than 90% health care is non-emergency, so you have time to bargain.

You use the same dollars to provide healthcare and to provide for your retirement.

Those who cannot pay apply for help, submitting their tax return (because under this system we take fraud seriously.) They will be given help based on their income – but every dollar they spend on medical care will have some of their OWN money included, so they have the same incentive not to overconsume and to bargain.
 
Invite the smartest people from all of the other countries who have health care in place, use the expertise of lessons learned by others to put best practices in place.
 
We could also throw a dart (got that idea from someone else) on the map (maybe focus on Europe and the richer Asian nations) and adopt whatever system they have, perhaps it’s better? 😝

By the way, heard about your family’s issues, sorry to hear, hope you and your husband are doing well.
 
TheLittleLady said:
Gathering great minds to form a think-tank is the opposite of throwing a dart.
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Maybe or maybe not. When you gather the great minds, you assume a near-socialist system is the answer. Anybody who gets healthcare through the VA can tell you that’s a dangerous assumption. The system I proposed leaves YOU in charge of your health decisions, not some bureaucrat a thousand miles away – who isn’t even a doctor.
 
Do away with the thousand different programs and expand Medicare to all citizens and resident tax payers as a single-payer model. Private insurance can offer additional coverage.
 
vern_humphrey said:
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TheLittleLady:
Gathering great minds to form a think-tank is the opposite of throwing a dart.
Click to expand...
Maybe or maybe not. When you gather the great minds, you assume a near-socialist system is the answer. Anybody who gets healthcare through the VA can tell you that’s a dangerous assumption. The system I proposed leaves YOU in charge of your health decisions, not some bureaucrat a thousand miles away – who isn’t even a doctor.
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Most people are seemingly unaware of the managed care system which has taken over in the last few years, in which every service is pretty much scrutinized by health insurance for medical necessity before they pay, due to the egregious charges hospitals and many providers charge.
 
Wesrock said:
Most people are seemingly unaware of the managed care system which has taken over in the last few years, in which every service is pretty much scrutinized by health insurance for medical necessity before they pay, due to the egregious charges hospitals and many providers charge.
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Note that in the system I described, “Health Insurers” would not make the decisions – the patients would.
 
Market efficiency isn’t always ideal for all services. Efficiency just means supply meets demand, which means some people are simply priced out of care. Market “efficiency” should not be the end goal for services such as education, police, fire, sewage, post, or health care.

Ultimately health care is a very costly risk pool, and costs are most reduced the larger that pool is.
 
vern_humphrey said:
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Wesrock:
Most people are seemingly unaware of the managed care system which has taken over in the last few years, in which every service is pretty much scrutinized by health insurance for medical necessity before they pay, due to the egregious charges hospitals and many providers charge.
Click to expand...
Note that in the system I described, “Health Insurers” would not make the decisions – the patients would.
Click to expand...
With modern medicine, that would be insanely costly to underwrite if insurance just has to pay for everything the doctor and patient orders (even after deductible) , and subject to abusive billing practices.
 
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Wesrock said:
With modern medicine, that would be insanely costly to underwrite if insurance just has to pay for everything the doctor and patient orders, and subject to abusive billing practices.
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Go back and read the proposal again. Under my proposal, YOU make all the decisions and YOU pay the costs. Why would YOU submit to abusive billing practices or unneeded treatments?
 
vern_humphrey said:
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Wesrock:
With modern medicine, that would be insanely costly to underwrite if insurance just has to pay for everything the doctor and patient orders, and subject to abusive billing practices.
Click to expand...
Go back and read the proposal again. Under my proposal, YOU make all the decisions and YOU pay the costs. Why would YOU submit to abusive billing practices or unneeded treatments?
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Yes, because everyday laypeople are well versed enough in medicine to best determine what’s medically necessary and what’s not. And you mentioned insurance pays after the deductible is met. Ultimately this just puts the boot on middle class families who have members (including children) with special needs and the poor with potentially a quarter to a third of their take home income probably going to medical care a year, if they’re lucky, assuming you cap deductibles by government regulation at current catastrophic levels.
 
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I did not go to med school, I am not at all qualified to determine “oh, I think I need a heart ablation, let’s see who has the best price in town!”
 
Thank heavens, we only see doctors inside CHI and they do have access to the same records.
 
#1: Determine the actual cost of standard procedures. No more of this nonsense where different insurance carries get different prices, and those prices are all different from what an uninsured person pays. (Ideally, I would get rid of the need for insurance altogether. While it’s helped some people, for the most part it seems to just cause bloated prices by introducing a middleman to the equation)

#2: Make sure those prices are known and agreed upon upfront. (As yesterday’s Al Cresta guest pointed out on this very topic, this lack of transparency allows them to gouge you after the fact.)

#3: Make it a jailable offense to overcharge for basic services (like bills where they charge a hundred bucks for a box of kleenex)
 
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Wesrock said:
Do away with the thousand different programs and expand Medicare to all citizens and resident tax payers as a single-payer model. Private insurance can offer additional coverage.
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Putting government in charge of healthcare is the worst thing you can do. Just look at the nonsense going on in the UK, with them refusing to even transfer “terminal” patients because they don’t want to have to pay for it or they don’t think it’s worth it.
 
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