<p>Musicprnt…</p>
<p>That was a pretty amazing post.</p>
<p>You pointed out many issues with our healthcare system.</p>
<p>You have obviously thought a lot about this issue and took a lot of time to write your post.</p>
<p>Did I mention your post was amazing? :)</p>
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I don’t think it should be an either or thing. Medicaid should exist to protect the most needy and unable to care for themselves. But it does need to be reformed. Accountability has to be brought into the system, among other changes. I also like the idea of vouchers for those who would feel comfortable using them and making their own choices. I think a lot of healthcare should be handled at the local level for efficiency sake, and I think a person should own his or her insurance and be able to take it with her. I’ve read here with great interest various people who swear by Kaiser. The City of New York insures millions of employees and does a pretty good job using a cafeteria menu starting from very basic all the way up to a gold plated plan involving contributions.</p>
<p>I’m not sure that I believe preventative care is the answer. I’ve recently read some interesting things about how across the board, without regard to personal risk factors, testing does nothing so much as drive up costs.</p>
<p>Ok…zoosermom…I like reading what you are thinking.</p>
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There was a capitated system with a now-defunct healthcare carrier here many years ago. Problem is, the capitated systems (flat fee to a provider group for “covered lives”, meaning people) is that there is a disencentive to see them. The caregivers get the same flat monthly rate whether they see 1 person or 1000 people. So while you could say, mini, that the provider is paid even if the paitent doesnt show, thats true. But the provider is paid the same amount if 1000 patients do show up.</p>
<p>Another system that also didnt work, IIRC, is the “case rate” system, because it also was a disincentive system. It might possibly work for an acute illnes or problem (the per diem hospital stays are based on this model) , BUT they were proposed early on for management of patients with chronic illnesses (eg diabetes). They would pay the doctor XXX dollars, but thats all they were paid, and saw the patient as often as the patient needed to be seen for problems related to that illness. If the patient came once, the doctor made money. If the patient came mutliple times, at some point the doctor was basically working for free. Either way it feels yukky.</p>
<p>Another system coming down the pike is the “pay for performance” model, which is supposd to be based on some performance measure or delivery target. But how would that work for something like, say, radiology, which is moreso for diagnostics than treatment outcome. Its a puzzle to me.</p>
<p>jym, the more options I read about, the more I’m convinced that single-payer is the only answer. I don’t see any other way to ensure that every American – young or old, healthy or sick, rich or poor, employed or not – gets decent health care.</p>
<p>I see why single-payer looks good, unfortunately I don’t know if the government is competent enough to run it. I also see why the mandate would be necessary with single payer program. </p>
<p>However, I do not understand why the government should be allowed to require everyone to purchase it. What’s to stop them from requiring every citizen to own a gun (something the city I live in does, it just isn’t strongly enforced), or requiring every citizen to purchase flood insurance, or even a hybrid?</p>
<p>Ah, a resident of Kennesaw!</p>
<p>AHHHHH!!!CREEPY!!! LOL</p>
<p>Yes, I am. You live in the area, I assume?</p>
<p>Well your ID says you live North of Atlanta. Not hard to guess form there.</p>
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<p>I read an article last year (I believe in NYT) about orthopedic surgeons who were talking about how overused MRI was. One of the main reasons I’ve heard from those who work in orthopedics for the overuse of MRI was that it was an insurance requirement for particular injuries. Not that the MRI was going to change the course of action with a particular injury, but that insurance required it before proceeding…</p>
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<p>Hi, FW.</p>
<p>The reason is because of the way insurance works: A whole bunch of people pay into an insurance pool. Most years, most people won’t need much healthcare. But in that year when you or I have a really expensive illness, the money is there to pay for it, from the pool. And the bigger the pool – that is, the more people paying in, especially healthy people – the lower the cost of insurance for everyone.</p>
<p>This only works if very large numbers of people are paying in. It also means that, in any given year, most of those people need to be healthy, so that with all of their premiums, they can support the costs of the few who are very sick that year. </p>
<p>Young people often see no reason to buy health insurance – after all, what are the odds that someone like you is going to have an expensive illness in the next 12 months? That’s the reason for the mandate – so that many healthy people are paying into the pool.</p>
<p>You might wonder why you should have to pay for some old geezer’s health care. But the insurance is for you too; if you get unlucky this year and get very sick, the pool will be there to cover your costs. And (don’t tell anyone) you’ll be a geezer some day too. ;)</p>
<p>Yes, I know all that. I don’t mind paying into it, as that what insurance is. People have to pay into the system to make it work properly.</p>
<p>I just want to know since when can the government decide what we as Americans must buy. (A question that I have never gotten answered by anyone, on cc and in real life, who supports this mandate)</p>
<p>States require that owners of vehicles purchase auto insurance. It is to protect the public.</p>
<p>FW, there’s a a 50-year-old precedent for forcing people to buy insurance: Medicare. </p>
<p>But let’s say that the Supreme Court rules that the rest of us can’t be forced. That leaves the current system, where millions of people receive medical care without paying into the pool. Do you think we should keep that system? Is that fair to those who do have insurance? Or should we adopt a policy, especially at ERs, of “No pay, no care”?</p>
<p>ETA – Being forced to buy guns isn’t comparable. An individual gun works just as well, no matter how many people own guns. But insurance doesn’t work well unless everyone participates. It’s not “freedom” when my insurance premiums skyrocket in order to cover people who won’t buy insurance.</p>
<p>The way I see it is that buying is an action: we are required to use seat belts, turn in taxes, pay bills. There are consequences to not doing these things. We are the government and as a group decide on courses of action to take as a group.</p>
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<p>Not in the Live Free or Die state.</p>
<p>Living and working together allowed those folks to live free and if they didn’t they would have perished. The meaning has shifted over the years.</p>
<p>BCEagle, what happens when a person lacking health insurance is seriously injured because they weren’t wearing a seatbelt? Are the rest of you “free” to refuse to pay their medical bills?</p>
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<p>There are a lot of very small towns in NH. I imagine that there were quite a few self-sufficient households going back through NH history. At any rate, they all eventually perished anyways.</p>
<p>It’s still a state with a lot of freedoms but both parties have been encroaching on those freedoms as of late.</p>