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I think the US needs a medical insurance program structured somewhat like the one used successfully by US Federal employees and retirees. It should be opened up to all and its costs spread throughout the society. I also favor co-pays except for the poorest in our society. I pay $20 per visit and that seems about right to me.

I keep hearing how great the federal employee program is. Have a couple questions. First, does Congress ever worry about how much it costs? They've suddenly become cost conscious when it comes to the rest of us, but what about their own plan? Second, does the program pay whatever is billed or a preset amount for each treatment?

I'm in a Blue Cross PPO. Savings accrue to me in two ways compared with just paying cash out of my pocket when I need care. First, I too have a $20 copay for doctor visits. That's good except a "visit" is defined very narrowly by the doctors. Mostly it's "Hi! How are you!" Then whatever else they do gets billed as an additional procedure. The second savings is much bigger, however. To be part of the PPO, and 95% of the doctors in my state are, the doctors, and hospitals, agree to accept preset reduced fees. That can save 30% or more compared to paying cash out of pocket. And that savings is there even while I'm meeting my deductible.

One of the ugly features of our current health care system is inflated bills delivered to the uninsured. Everyone knows the care providers would accept much less from an insurance company. But they bill the uninsured for the full amount and then send it to collection when they can't pay. Why force someone into bankruptcy for a bill you would never collect if they had insurance? A whole new industry of health care advocates has arisen to negotiate bills down for those who can't pay. Unfortunately the advocates often take a large percentage of the savings.
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