Health insurance premiums

[Shafpocalypse Now]

Kill the war on drugs.
Kill foreign aid.
Kill the war on terror.

Give people health care.

Watch the US sink into depression and who knows what other impacts that would have on our way of life.

[Turdacious]

SRS question: what's your proposal for a practical healthcare solution in this country?

From a practical (something that could actually pass) perspective-- keep insurance segregated by state rather than allowing interstate health insurance sales (state insurance commissions are the only competent regulatory body); simplify Medicare reimbursement rates (rates determined by procedure and local rent only with a 10-15% pay bump for rural providers); replace the health care portion of Indian Health Service and Medicaid with the individual market with guaranteed access provisions (minimum # providers per # insured); increase roles of LPNs and retail clinics for insured receiving subsidies; set insurance subsidies at a rate that maximizes participation and hospital profitability; and import the primary care shortage.

Bottom line-- subsidized care should give you everything you need but not everything you want. Only people who pay for insurance out of pocket or through an employer should get certain things like short lines for non emergency procedures, individual rooms at hospitals, direct access to specialists, etc... That allows the free market to determine prices for things that improve quality of life but not necessarily life expectancy.

Realistically we'd have to do something about the real cost drivers in American medicine too-- morbid obesity, hypertension, and diabetes. Limiting what people can buy on food stamps and taxing sugar are probably necessary. All of that is probably the easy part-- getting the federal health care bureaucracies to function effectively is probably the biggest challenge. Getting to the point where we can measure the effectiveness of what we're doing and what we're paying for requires a big investment in primary care that the AMA will resist every step of the way.

Your version is more way more expensive.

Either everybody pays for single payer via taxes, or
Everybody pays via mandated insurance coverage, or
Healthy people opt out, driving insurance costs up for errybody else (and bankrupting themselves when they get sick or have to go to ER).

There is no way around it.

One thing I agree with you on is that we can't ignore the right to care in proposing health policy solutions-- either expand care in a way that protects payers and providers, or limit the right to care. And any Republican that doesn't talk about EMTALA isn't worth reading.

Mandated insurance coverage benefits both the individual and the provider (because if you can't pay if you go the ER, hospitals end up bearing that cost and passing it on; there's a reason that medical debt is discounted so heavily). The mandate isn't going to work without a far more generous subsidy because the tax is ridiculously regressive.

A lot of what I'm suggesting is what a better single payer plan does-- focus on primary care while restricting access to specialty care, slightly subsidizing rural providers, paying providers enough so they provide services, and focusing on major cost drivers. These things are the preconditions for effective cost control. Single payer plans aren't inherently bad, as long as you recognize the weaknesses of them-- they require a capable bureaucracy, and they use a logic that doesn't provide for things middle class people value are willing to pay extra for. Going single payer effectively would require people who pay taxes to give up things they value (not realistic), and would require us to develop a bureaucracy we don't have. There's a reason most European countries have gone away from single payer-- they couldn't pull it off. If you run our major public health care programs (Medicare, Medicaid, VA, and IHS) against their EU country equivalents, I'm guessing we come up dead last in every category.

The closest thing I've seen to what I'm suggesting, FWIW, is here: https://freopp.org/transcending-obamaca ... .h331qfsk2
There's also a less technical readers digest version: https://freopp.org/understanding-freopp ... .a79xn5etm

[bennyonesix]

Kill the war on drugs.
Kill foreign aid.
Kill the war on terror.

Give people health care.

Watch the US sink into depression and who knows what other impacts that would have on our way of life.

Brilliantly said if that last bit is as sarcastic as it looks to be.