My “ideal” health care system

by thoughtfulconservative

Here’s what I would like to see in a health care system (and I’m pretty sure I’m not alone):

  • I want one where I don’t have to worry whether the doctor, hospital or anything else is covered by my insurance.
  • I want one where I don’t have to pay the doctor an extra 25% (or whatever it is) because he might have to pay $100 million for some poor soul’s “mental anguish.”
  • I want one where my doctor and I determine if and when I need a procedure, not some insurance company rules or government panel.
  • I want one where ANY treatment is fairly and accurately tried and tested.
  • I want one where the doctor doesn’t feel as though he needs me to take umpteen tests just so he can cover his backside against me suing him.
  • I want to be sure I can get insurance, even with my diabetes and high blood pressure.

There are probably more but those will do.

Is it too much to ask? Apparently.

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22 Responses to “My “ideal” health care system”

  1. 1. Yes, I’m with you on that. However, there are treatments that haven’t been scientifically proven safe and effective. These things one should have to pay for oneself instead of an insurer, don’t you agree?

    2. If my hospital truly is negligent and harms me, I want to be able to sue. And I want to be able to sue them for an amount that not only compensates me for my losses, but that is also big enough to incentivize them to actually change something. If that means we pay a little extra for insurance, so be it.

    3. I agree, but see item #1 for caveats.

    4. Of course. Why is this a big concern of yours? Do you believe a lot of viable treatments are not being investigated?

    5. True. However, see #2 for caveats.

    6. Agreed.

    Me, here’s what I want.

    1. I want insurance that I can never lose no matter what my employment or health status is.

    2. I want insurance that covers every medically necessary, non-experimental treatment prescribed by my physician.

    3. I want insurance that costs a heck of a lot less than the insurance I have now.

    4. I want to know that every single American also has what I have.

    5. No company on this earth should make a penny of profit off my premium payments unless both 1, 2, 3 and 4 are true.

    This isn’t fantasy. Other countries have such systems. There’s no reason why we can’t.

  2. 1) All insurance policies will have restrictions on how much can be paid out for certain kinds of insured events. Think of fire or car accident insurance and others. Why should health insurance be any different? If there are restrictions on the amount paid, there will necessarily be restrictions on who can be paid, simply by virtue of different fees charged. Past that, though, I agree there should be less restrictions on who specifically is covered.

    2) I agree that there are some ridiculous lawsuits that have gone through the courts, and malpractice is no exception. On the other hand, they have also taken some bad doctors out of the market, which is a good thing. I think this is more an issue about problems with the law and courts than with health care or insurance itself.

    3) Yes. Realize, however, that whoever pays for something necessarily has a say in how that payment is spent. Again, this can be in the form of restrictions in payouts or in direct rules on what is coverable. If you truely want access to any treatment, you’ll have to expect to pay for at least some of it yourself.

    6) Are you wanting insurance for the direct costs of your existing conditions (insulin, needles, blood pressure medication, et al) or for other health problems that may arise?

  3. Is it really true that all insurance companies “have restrictions on how much can be paid out for certain kinds of insured events”? Is that how it is in single payer systems, for example?

  4. @scott

    I was specifically using a comparison to other types of insurance. Consider car accident insurance. If you total your car, insurance won’t pay for you to get any car you want to replace it. Consider house fire insurance. If your house burns to the ground, the insurance will not pay for you to rebuild any size of house on the lot. Consider theft insurance. If your house is broken into, you can’t replace your belongings with whatever you want. There are restrictions on every one of these, at least there are on all of my policies. Why should health insurance be any different?

    What is frequently called “health insurance” is something much more than insurance.

    For reference, however, I live in Canada, where there is a single payer health system. There are indeed restrictions on how much is paid out, both in terms of how much doctors are allowed to bill for procedures and in terms of what procedures are covered. Add to that the delays such that, while a service may be covered, the hidden cost of waiting while dealing with the condition may be more than the cost of the service provided. This cost of waiting is not insured, and it is in effect another way of limiting the amount paid.

    I’d like to say this as my want: I want health care, not health insurance. Universal health insurance is not health care. Health care is both proactive and reactive. Health insurance, universal or otherwise, is necessarily only reactive.

  5. Yes, what we refer to as health insurance is pretty different from other things we refer to as insurance. And I’m fine with that.

    As far as “restrictions,” of course I’m aware that there are limits on what doctors can charge. But it sounded like you were suggesting either that an insured individual necessarily has some annual or lifetime limit on medical expenses. And I don’t think that’s a universal trait of health insurance at all. I don’t care if there are limits to what doctors can charge or limits to what services are covered. I mean, “every medically necessary treatment that is proven effective” is already a “limit” in two ways. But that’s basically a policy that gives you everything you could possibly need without the kind of limits we have in our private insurance system right now.

  6. I’m not so fine with calling health payment “insurance”. If it is insurance, expect it to behave like insurance. If you want it to behave otherwise, don’t call it insurance. Either way, just because it is paying for health services instead of something else, don’t expect it to ignore basic economics.

    I was not meaning to suggest a long-term limit on payouts. Once you get insurance you should expect to keep it so long as you keep up your end of the contract (ie payments). This should be no different from other insurances.

    FWIW I would only call your current system only partially private, and possibly only a very small part at that. While the companies providing either the services or the payment are not directly owned by the government, they are directly and indirectly controlled by it in many ways.

  7. I don’t at all understand your objection to the term insurance. What difference does it make? You think people are being tricked by this word somehow? Who cares what it’s called. I say we agree to acknowledge that it’s different than auto insurance and then continue to use the word that enables everyone to understand what you’re talking about.

    Many private insurers have limits on payouts. As I said, it can be an annual limit or a lifetime one. Can you imagine paying your premiums for thirty years and then become seriously ill and go bankrupt because of the limits on your policy? Happens all the time here.

    Yes, our system is partially private. Half, I would say. Half is private insurance and half is public insurance. Your suggestion that insurers and providers are so highly regulated that they’re semi-public doesn’t ring true to me. Insurers are about to get kicked up a couple of regulatory notches, it’s true. But I bet our private insurance market right now is one of the least regulated in the civilized world.

  8. I guess I should chime in here.

    1. (Scott) Yes, it should apply only to those shown to be safe and effective. See #4.

    2. Of course, they should be penalized for negligence. That should go without saying. And I’m not advocating limiting the amount of the award, either. But mental anguish should not be part of the award.

    4. What I’m thinking about is competing claims, stuff that comes out later (sometimes unavoidable, I know) and tests that don’t appear as though the FDA is using the drug companies test results.

    5. Right on the caveats. So how about this example. Because of my symptoms, in the course of diagnosing my diabetes, the doctors ran tests on my heart. I had the 24 pack, then an ultrasound, then a stress test, maybe another test and because they suspected a blockage a heart catherization. Were are those really needed? I’m not a doctor so I don’t know. They might do it to be thorough, or they might be going from cheaper to more expensive out of sensitivity to my cost.

    Your 1 and 2 are on my list in basically the same idea. Three can’t happen, because the cost of health care is so high and doubtful it will go down. Four won’t happen unless you require it or make it so cheap everyone wants it. Five can’t happen because of 3 and 4.

    Bruce, you allude to a point throughout your first comment that I think eludes most liberal thinkers. The cost of an item and the frequency of use determines my premiums. Just as in other types of insurance. To control insurance costs, you have to control health care costs and cost controls do not work, IMNSHO.

    Smart employers, if they are contributing to insurance, would also encourage their employees to be healthy.

  9. @scott:

    My objection to the term insurance comes from a desire to be very clear about what I discuss. I find that sloppy terminology prevents clear thinking and discussion, particularly when it comes to political and economic issues. In this regard, I am not singling out health insurance, however it is probably the most abused term in this discussion.

    … and yes, I can agree to disagree on the use of the term for the purposes of this discussion.

    Being the least regulated, while good, does not make it truely private. I think it is fair to ask how much government control would you see as a threshold for you consider it to be semi-public. Obviously, if there are no rules (other than those that govern all industries) and no government ownership then it is fully private, and if the government owns it outright then it is fully public, but where is the threshold?

    My contention would be that increases in government regulation, even without any overt government ownership, brings the industry closer towards public operation. Consider that the effect of an agency (either an individual or a group) increasing its ownership of a company also increases the ability of that agency to influence or direct the operations of that company. I don’t see that as significantly different than increasing prescriptive regulations, except that regulations typically affect an entire industry whereas ownership affects a single company.

    This also only addresses the payment side of things. It is the actual provision of services that is critically more important, and perenially ignored in the discussion of “insurance”.

    @thoughtfulconservative:

    Yes, including “mental anguish” in the awards of lawsuits has opened up a world of bad judgements that shows no sign of abating. Common sense is far from common.

    As far as cost goes, I would argue that health care does not need to cost as much as it does now, certainly not for everybody. Making it cost less (and yes, cost controls do not work) will make the payment side of things less important.

  10. “Being the least regulated, while good”

    You mean “in principle” or “in theory,” perhaps. Because I’m sure you’re not going to tell me that government involvement is directly inversely proportional to the “goodness” of a health care system. Were that true, we’d have the best system on earth and al of Europe would be rioting to copy it.

    You don’t see the difference between ownership and regulation as “significant”? That’s…unique.

    Provision of services? Yes, there’s a lot to be said there. The incentives of doctors to perform more procedures rather than to make you healthier, for starters. Plus, drug companies, hospitals and doctors are often just plain charging too much. I don’t pretend to know how that happened, but I do know that a night in a hospital or a visit to a doctor or a prescription for blood pressure are all far cheaper everywhere. Far cheaper. At some point we are going to have to exert pressure on these groups to stop the growth of their prices so America can catch up to it.

    “cost controls do not work” Really? They seem to be working pretty well just about everywhere. Isn’t that how the prices are so low in Europe and Canada and elsewhere?

  11. By saying cost controls don’t work, I’m just basing my knowledge on the 70’s attempt to harness inflation with price controls by the government. It didn’t appear to work, although there may have been other forces at work. They may work in certain situations for reasons other than controlling cost although at this late hour, I’d be pressed to give you an example.

  12. How about stipulating that no one goes broke from seeking health care?

  13. That would be wonderful. Should we also guarantee no one goes broke from buying a house? Going to college? Starting a business?

    With today’s bankruptcy laws do people really go broke anymore?

  14. Why not Dean? That’s pretty much what happens in other countries. It is damn cruel that in the US people can face the twin anxiety of a health crisis and and a financial disaster so that a health insurance executive can fatten is bank account?

  15. People all over the world are protected from financial disasters due to medical bills. People lose their homes, here, Dean. They lose their life savings, their homes, everything they own. Do you not know this? Or do you believe that everyone who has a couple of heart surgeries just declares bankruptcies and goes on their merry way?

  16. Keith, as an aaging self-employed diabetic with high blood pressure, I am well aware of the possibility of a health crisis and financial disaster than lurks around the corner.

    But both you and Scott are missing my point by thinking I’m your typical conservative commentator. Don’t mistake me for Belling and Sykes and look at my question.

    Are we going to shield everyone from every bad situation that ever happens. You guys are the experts on “the whole world” health care. What are they doing? What is a “health crisis?” How do they determine costs? How do the governments pay for it? Higher taxes, right?

    I know what happens in a third world country because I’ve lived there. My Canadian friends tell me Canada’s system ain’t so hot. I hear it from English and Australian friends, too.

    I’m just outlining what I would like to see. If you think it should be different, show me. Don’t berate me by assuming I don’t care about people. Tragedies happen every day that I can’t do any thing about.

  17. Are we going to shield everyone from every bad situation that ever happens.

    Of course not. It’s not really an all or nothing proposition. Most civilized societies feel, however, that lack of health care is something that people should be shielded from. Why do you disagree?

    How do the governments pay for it? Higher taxes, right?

    Whether you call it taxes or insurance premiums or whatever–the fact is, these other countries pay a lot less than we do. Even though it may be paid in the form of taxes in some of these countries, they pay LESS than we pay. A lot less.

    My Canadian friends tell me Canada’s system ain’t so hot. I hear it from English and Australian friends, too.

    And yet polling in these places show that people are very satisfied with their health care system.

    Tragedies happen every day that I can’t do any thing about.

    And there are also tragedies that we CAN do something about.

  18. @scott

    “I’m sure you’re not going to tell me that government involvement is directly inversely proportional to the “goodness” of a health care system.”

    It might be good to say what constitutes “goodness”. If you mean that a “good” health care system is where everybody can get, on demand, the kind of health care that only the rich can afford, then no, only the government can provide that. I don’t think that is truly “good”.

    To draw a comparison, food and shelter are two far more basic needs than health care. If you were to suggest that we should be providing professional chefs and mansions to the hungry and homeless, that would be quite ridiculous. But yet switch the topic to health care and the idea of different levels health care, at least in Canada, is quite abhorrent.

    Consider the opposite as well — if less regulation leads to a less good system, surely more regulation would produce a better system. However, the examples of Cuba and USSR would hardly hold that up as likely.

    I also am pretty confident that the health system in the USA is not the least regulated in the world. My wife just recently had a friend (a health care professional and now analyst) discuss her knowledge of Brazil’s system. I have no doubt it has significant regulations, but it seems to be less regulated than what I’ve heard of the USA. And that’s just one.

    “You don’t see the difference between ownership and regulation as “significant”?”

    I did not say the difference was insignificant. I was stating that both are mechanisms for exerting control over a company or industry, and as such an industry that is half controlled by the government is already half public. If the government prescribes how a company must operate, how is that different from taking ownership in the end effect it produces?

    Here’s how: Businesses, all the way from the single man in a market stall to the largest of corporations, exist to make a profit for their owners. They do so by offering products or services that people want. The owners of a business have a vested interest in making the business profit more by offering the product better for the people that want it. That can mean cheaper, higher quality, more quantity, or all of the above. Government has no such compulsion to better the product.

    Really, as much as many like to paint corporations as evil, they live and die by two things: how well they produce a product that people want, and how effectively they can lobby the government. How can giving the government more control produce a better product?

    “Plus, drug companies, hospitals and doctors are often just plain charging too much.”

    How much is too much? The best report I’ve seen for the USA indicate that hospitals in total had an 8% profit margin in 2008, with roughly 20% of hospitals having negative total margins. In 2007, the total profit margin was under 1%. That’s hardly “plain charging too much”.

    “I don’t pretend to know how that happened,”

    Let me help educate you. About 100 years ago, the working poor could get health care from fraternal societies for the cost of about a day’s wages per year. This was seen as a crisis at the time, of the opposite sort — doctors were being paid too little. So, medical societies like the AMA imposed sanctions on doctors that were part of these lodge practices, and since the AMA controlled who could practice medicine (a privilege granted by the government), the lodge practice shriveled up. The societies also restricted who could practice medicine, resulting in fewer more expensive doctors. Crisis solved.

    “People lose their homes, here, Dean. They lose their life savings, their homes, everything they own.”

    Yeah. Nobody loses anything here… except maybe a life or two because they had to sit in an ER waiting room for too many hours, or … Other than that, it’s perfect.

    Really TANSTAAFL. It is true that the US currently pays about a little less than twice what Canada does for health care. However, it is getting harder and harder to find enough additional staff to provide the services here to shorten the massive waiting lists. The most realistic way to change that is to pay more, which is going to narrow that gap a lot.

    @Keith

    “… so that a health insurance executive can fatten is bank account?”

    I don’t know about the executives, but similar to the above about hospitals, the best number I can find is that health insurance companies make a profit of about 6%. That’s not particularly fat. Apparently beer makers have a profit margin of about 25%. That’s fat.

  19. So much to respond to Bruce. I you are a Canadian who hates his system you are very much in the minority, as well as people who have said the same to our host.

    To be short, the Canadian system does it better and cheaper than we do. Where it doesn’t work well, Ottawa is working on it. You know that.

    Yeah companies exist to make a profit. But it is incredibly naive to think they do it by doing thins better. Some do it by cutting employees. Health insurance companies do it by denying claims.

    Yeah health insurance companies make like a 6% profit. That’s because they care dishing out billions in salaries and bonuses to their executives.

    What is so exasperating is that the health care crisis in this country is real and will break us if we don’t do something about it. And let me tell you, if you think tort reform is the only answer you cannot be taken seriously.

    This is a problem that cries for a solution. If you are not looking for one then get out of the way. We should have taken that attitude in the first place with the GOP in Congress because they are not serious about solving our health care mess.

  20. Heya great blog! Does running a blog similar to this require a massive amount work?
    I have virtually no expertise in computer programming but
    I was hoping to start my own blog in the near future.
    Anyways, if you have any ideas or tips for new blog owners please share.
    I understand this is off topic but I simply needed to ask.
    Cheers!

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