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02/19/2007

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Jack

Jack
Catastrophic health care claims belong in the biggest pool available, something similar to what Kerry proposed during one of the most mis-managed campaigns ever. But The problem is how to define "very costly." To use Kerry's example, let's say claims of over $50,000 shift to the government. That creates great incentives for every incident costing upwards of $30,000 to be made more expensive so that the government, rather than individuals or private insurers pay. [I won't even try to define "incident."] That's what drives me even more towards universal coverage.

....... Right On!! Finance writer Andrew Tobias wrote and lobbied for a "pay at the pump" means of paying for auto insurance. The plan has a host of advantages, including NO uninsured motorists, that you'd have a choice of having any number of vehicles and pay insurance only when you gas up and hit the road. You can see advantages that because the variable cost of driving would rise while the fixed cost would drop of driving the most efficient car of your fleet, and extra incentives to leave it home. Naturally this would require a "no-fault" approach which in itself saves money. But, as you mention, so far no state has a true no-fault with MI having the closest, but it's no-fault up to $4,000 or so which gives exactly the incentive you mention to push up the amount of the claim. (It takes a small book to consider the whole scheme but it would be VERY beneficial to nearly all Americans other than those selling insurance on commission and the Bar Assn.)

Because there seems no way around the adverse selection problem I conclude the pool must be universal. Once that bridge has been crossed, the next may be that of the contractual agreement and there's bound to be a tug of war of some sort.

But I keep bringing up that single payer systems have many pitfalls [what's the average wait for an MRI in Canada?] and someone smarter than I should figure out how to avoid them.

......... There I think we can learn from them and do something uniquely American. What occurs to me is "single payer --- multi-supplier"....... with a number of HMO's PPO's or other groups vying for customers by competing on service and providing more than what might be specified in a basic coverage contract. (There's a flaw in my approach as there will be in any approach, in that the amount the single payer voucher would have to be set by a political process...... but I think the savings of NOT paying insurance cos, lawyers and all the related drags on our existing mess would mean we could cover all of our people for less than the current 16-18% of GDP (plus court costs??) and approach the 8-10% of GDP spent by nations with universal care.... in short there's plenty of money to fix people up bet we're wasting 50% arguing about who pays.


Also, I do favor a cost v. benefit analysis. Remember that every resource spent on someone's health could be used for someone else's health.

......... yes... and a sticky problem it is too. We know that in some venues they do a LOT of invasive and very costly heart surgeries while others do many less and appear to have similar outcomes. (Tough to measure though, eh? as one might live as long without open heart surgery, but have to live with angina? and fear to go five miles from the hospital?)

If we want to extend and improve lives, shouldn't we improve as many as we can for the same price?

......... Yup! And I think the VA may save money on caring for their patients by insisting on regular check-ups and freely encouraging those "at risk" to take flu shots etc. With computers I think we could find out even more than we do, for example a mammogram might have no copay at all or even, if one woman will coax her friend to go too perhaps they'd both get a coupon for lunch or some such small incentive.

Also, the tying of employment to insurance and the problems with that have been amply documented. I'm with you there, especially on the mobility effects.

......... Yes! and all the "futurists" predict a speeding up of job changes during one's career. It just ain't WWII anymore!

........ as I consider a voucher system, in essence creating something of a fixed price competition by the various providers (though in a more detailed look, the voucher for a 25 year old would be less than that of a 50 year old) I'm reminded of the pre-dereg competition among airlines. While it (apparently) didn't do all that well at driving down costs they did compete on service. In fact, I guess there are other similarities, as even in today's cut throat airline competition they aren't allowed to "compete" down to the point of not maintaining safety standards (I hope!) and still make quite an attempt to maintain their on-time record. Then while its most profitable for them to fly full, they have to weigh giving up market share by being too booked up.

Anyway, from what we agree upon, if we COULD tie our insurance hors to the mast and apply several layers of duct tape to mouths of our barristers I think we could design a system FAR better than the mess we've inherited and most likely better than that of the 30 other countries offering universal health care and where "medical bankruptcy" is not often heard.

Haris

Other than the stab at lawyers, I think we got something here.

Haris

Jack
You'll notice you listed industries that are characterized by extensive government intervention. Licensing requirements, patents, and the nature of resource exploitation etc all open up opportunities for cartels, which lead to the ills of monopoly/oligopoly. I'm still not sure why people are allowed to trade price for quality in everything, except god forbid they chose to go to a nurse rather than a full-fledge doctor, or a paralegal rather than a member of the bar. Loosening the barriers to entry would probably go a long way to breaking up the government-enabled cartels.

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