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Finnforest 
Special Collaborator
Honorary Collaborator
Joined: February 03 2007
Location: .
Status: Offline
Points: 16913
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 Posted: September 30 2010 at 20:48 |
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Jay, would excluding that first $5K make the price tag much more possible than the outlays for the coming reform?
Or, would that not really make much difference because the over $5k is really where the vast percentage of the expenditure is?
Any idea?
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Negoba
Prog Reviewer
Joined: July 24 2008
Location: Big Muddy
Status: Offline
Points: 5208
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Posted: September 30 2010 at 21:05 |
It would make a huge difference. The costs you target are definitely part of the problem.
One of my biggest beefs with insurance in general is that the person receiving the service and the one paying are not the same person. Having some choice to say "yeah that service is worth $500 to me personally" would put economic pressure our system needs in all sorts of ways.
Some other care I think the state should pay for because it's cheaper to do it preventatively than deal with the actual diseases: Immunizations, prenatal care, proven cancer screenings like mammograms and pap smears (probably colonoscopies too).
The $5k number would of course be an issue and I would advocate a sliding scale depending on a few different items.
ed. Your plan doesn't address all the problems but it would be a big step forward IMO.
Edited by Negoba - September 30 2010 at 21:06
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You are quite a fine person, and I am very fond of you. But you are only quite a little fellow, in a wide world, after all.
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Finnforest
Special Collaborator
Honorary Collaborator
Joined: February 03 2007
Location: .
Status: Offline
Points: 16913
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Posted: September 30 2010 at 21:14 |
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Sure, you could make the deductible amount slide based on a person's income. But I still think even the poorest should have to start out of pocket, to encourage wellness, and because we all have to be part of the solution. If they can't afford their base deductible, which in my opinion should go no lower than $2500, they would NOT be denied care, but would be expected to make minimal payments going forward to cover their part of the bargain.
I'd love to try something like this, which solves the economic devastation issue but still requires the individual to contribute a reasonable amount for what they use in exchange for the safety net.
Has anyone in Government suggested anything like this, combining single payer with initial patient deductible?
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Negoba
Prog Reviewer
Joined: July 24 2008
Location: Big Muddy
Status: Offline
Points: 5208
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Posted: September 30 2010 at 21:21 |
 Finnforest wrote:
Sure, you could make the deductible amount slide based on a person's income. But I still think even the poorest should have to start out of pocket, to encourage wellness, and because we all have to be part of the solution. If they can't afford their base deductible, which in my opinion should go no lower than $2500, they would NOT be denied care, but would be expected to make minimal payments going forward to cover their part of the bargain.
I'd love to try something like this, which solves the economic devastation issue but still requires the individual to contribute a reasonable amount for what they use in exchange for the safety net.
Has anyone in Government suggested anything like this, combining single payer with initial patient deductible?
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Yes this has been on the table. No one has the stones because of inertia to put it nicely or too many superfluous bureaucrats losing their jobs to be not so nice.
I was just thinking about someone on medicare or even public aid. I would actually advocate increasing their (government provided) income by their deductible, but then they have to pay that first amount (keep it at $2500 or $5k or whatever). But still, they as the direct consumer have to choose "Do I want to go to the ER because I'm too lazy to make a basic appointment or do I want that money in my pocket?"
Even with this, taking claims out of the transaction for all the small stuff would save massive amounts of money in overhead. Simply pay at the time of service and that's it.
Medicine actually used to look alot more like this.
Edited by Negoba - September 30 2010 at 21:23
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You are quite a fine person, and I am very fond of you. But you are only quite a little fellow, in a wide world, after all.
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Finnforest
Special Collaborator
Honorary Collaborator
Joined: February 03 2007
Location: .
Status: Offline
Points: 16913
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Posted: September 30 2010 at 21:29 |
I have the hunch there are a lot of good ideas out there that could be tried. And almost everyone seems to hate the model that we're going to try. I wish this thing could have worked out differently. Thanks Jay for thoughts, I always wondered if this approach could work and its nice to get some feedback from someone in the field. 
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Negoba
Prog Reviewer
Joined: July 24 2008
Location: Big Muddy
Status: Offline
Points: 5208
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Posted: September 30 2010 at 21:32 |
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No problem, it's nice to talk about the actual issues involved (delivering the care that actually needed and how to pay for it) rather than getting sidetracked.
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You are quite a fine person, and I am very fond of you. But you are only quite a little fellow, in a wide world, after all.
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Finnforest
Special Collaborator
Honorary Collaborator
Joined: February 03 2007
Location: .
Status: Offline
Points: 16913
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Posted: September 30 2010 at 21:40 |
Agreed. I'm tired of the noise. And the tv commercials are just brutal right now. Attack ads should be banned. All political ads should be the same. Candidate sitting at a table with one camera on them, and they get to talk about their ideas. That's it. No other effects or dramatic announcers or anything allowed other than the candidate speaking to the camera.  If all they could do is speak, maybe they'd actually say something. 
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Negoba
Prog Reviewer
Joined: July 24 2008
Location: Big Muddy
Status: Offline
Points: 5208
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Posted: September 30 2010 at 21:46 |
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Welcome to the intellectual elite. Or perhaps old fools who think about things like civic virtue.
Totally support low bling political ads where the actual candidates have to speak for themselves.
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You are quite a fine person, and I am very fond of you. But you are only quite a little fellow, in a wide world, after all.
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krishl
Forum Groupie
Joined: May 05 2009
Location: Land of Enchant
Status: Offline
Points: 84
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Posted: December 07 2010 at 16:27 |
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No.
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