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Be careful what you wish for.

Right now I ain't wishing for anything. The next idea I have that will fix our current health care system will be the first idea I have that will fix our current health care system. I think Imp is on the right track however. Any plan has to have a clear accounting of who wins and who loses. In my current situation my health care insurance is pretty darn great. (Though of course that can always change) In any radical shifting I will be considerably worse off. As above, I am fine with that as long as we have a good idea going in who wins and who loses and I know how much my loss is going to be. I just haven't seen a plan that gets me all excited yet.

Wally
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Sure it is. Where do we get the money to expand coverage to those who don't have it?

There are three sources -

1.) Reduce overhead in insurance. This is a fine idea except the high overhead policies are the single policies. Most policies are employer group and have fairly low overhead. There is just not enough overhead savings to expand coverage to everyone.

2.) Pay medicare rates for everyone. If we just payed medicare rates for everything we would have enough money, but I don't think we could get something like that passed through the health care lobby. Also, it is pretty much goring health care providers at the expense of others.

3.) Raise the differential between what we pay now through private insurance and what we are taxed.

1.) doesn't cover everything, 2.) is not politically possible and is kind of jerk move. I'd be O.K. with 3.) if they just came out and said it and gave some reasonable expectation of expense, but I think nationalizing insurance is the wrong way to go to fix healthcare.

Wally
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If we just payed medicare rates for everything we would have enough money, but I don't think we could get something like that passed through the health care lobby.

Take a gander at the income adjustments on medicare rates. Imagine yourself single...
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Take a gander at the income adjustments on medicare rates. Imagine yourself single...

I was talking about the rates that medicare pays providers not the rates paid in.

Wally
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I was talking about the rates that medicare pays providers not the rates paid in.

I had cataract surgery when I was in my early 50s and while it was paid by regular health insurance, I was told for that (and many other procedures), medicare reimbursement rates drove the prices paid providers that were set for all insurance.

Since hitting Medicare a few months ago, the biggest difference for me was the lack of insane($10K) deductible. But I do regular screenings, immunizations and an very occasional visit to a minute clinic at Walgreens for a long lasting cold/sinus infection. I have no drug plan because I take one drug that costs about $120/ year and the income adjustment made drug plans a ridiculous price.

I will say the deductible did keep me from accessing much health care in the past 8 years. I had insurance but I didn't consider it affordable. Even though I am healthy, apparently my supplemental insurance will increase on every birthday.

Be careful what you wish for.
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No. of Recommendations: 1
Be careful what you wish for.

Right now I ain't wishing for anything. The next idea I have that will fix our current health care system will be the first idea I have that will fix our current health care system. I think Imp is on the right track however. Any plan has to have a clear accounting of who wins and who loses. In my current situation my health care insurance is pretty darn great. (Though of course that can always change) In any radical shifting I will be considerably worse off. As above, I am fine with that as long as we have a good idea going in who wins and who loses and I know how much my loss is going to be. I just haven't seen a plan that gets me all excited yet.

Wally
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{{I will say the deductible did keep me from accessing much health care in the past 8 years.}}

That was part of its job. Along with copays, a deductible is supposed to make people weigh whether or not seeking care is needed.


As an anecdote, in grad school, I could access a doctor for free whenever I wanted. I went roughly once a month or so just to check something out. Because when there is no cost, it is always worthwhile to have something checked out just in case it could be something of concern.


It is all about rationing care. No society can afford to not ration care in some manner. If I self ration my own care by deciding not to go, then it goes over much better than an insurance company or government denying me that care.

c
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That was part of its job. Along with copays, a deductible is supposed to make people weigh whether or not seeking care is needed.

I totally understood that. At $10K, even with the ability, it was a formidable barrier. There was at least one "screening" that I did even though I had to pay. Had I known the anesthesia was going to be $800, I may have tried to skip that.

The flip side would be something that would end up costing the insurance company(now Medicare) way more because of a delay.

But the rhetoric about affordable health care...

As an anecdote, in grad school, I could access a doctor for free whenever I wanted. I went roughly once a month or so just to check something out. Because when there is no cost, it is always worthwhile to have something checked out just in case it could be something of concern.

My current doctor has been the minute clinic at Walgreens which will go away at the end of the year. One doctor just quit about a year ago. Another kept changing practices to the point that I was unwilling to follow her.

I have zero desire to hit a doctor pretty much without a real need. Even with better insurance, I didn't go more than a couple of times a year. I am pretty sure I get to pay more when I get a year older each year to subsidize behavior like yours.
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{{I am pretty sure I get to pay more when I get a year older each year to subsidize behavior like yours.}}


This was a university. To get the $0 copay and $0 deductible, we had to use the university clinic. I doubt that it affected your insurance payments at all.

I use that anecdote just as an example of how some people will use health care if there is no copay or deductible.
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It is all about rationing care. No society can afford to not ration care in some manner. If I self ration my own care by deciding not to go, then it goes over much better than an insurance company or government denying me that care.

But if it's a public health system, at least that information about rationing will be publicly available. I'd much rather have a bunch of bureaucrats making decisions that are public knowledge because the needs of the many outweigh the needs of the few or the one than some group of executives deciding behind closed doors to deny coverage so they can get larger bonuses.
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{{But if it's a public health system, at least that information about rationing will be publicly available. I'd much rather have a bunch of bureaucrats making decisions that are public knowledge because the needs of the many outweigh the needs of the few or the one than some group of executives deciding behind closed doors to deny coverage so they can get larger bonuses. }}


1. Having been a government bureaucrat, I do not recommend increasing the power of people like me and people I knew in government. Even in the Obama administration, political appointees and higher ups strongly encouraged phone calls so that no records were generated.


2. At least when healthcare has multiple options in the private sector, I can and I have switched plans in order to obtain a changed coverage that I needed or preferred. If there is only 1 government mandated plan, that is not an option.
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