One of my kids gets most medical treatment at the Minute Clinic…because that is ALL that his insurance will cover.
Sorry…but I don’t think that’s a good medical model either.
It does not have to be an MD. My (not so annual) physicals are done by a NP. If she sees something that is outside of her jurisdiction, she refers me to the doc.
It’s going to be very hard to change the ACA, because any possible change will produce winners and losers, and the losers will scream loudly.
But I think one change that might go through is getting rid of the individual mandate, but keeping the pre-existing condition exclusion provided the person had continuous coverage from <some specified="" date,="" probably="" the="" day="" legislation="" takes="" effect="">. That is, everyone of the same age who wants an insurance policy can buy it, at the same price, no matter how sick they are, provided they have kept continuous coverage.
This change doesn’t have obvious losers. The people who want to gamble and not buy insurance don’t lose out-- they can still gamble and not buy insurance. But then they can’t swan in and get it cheaply when they get sick. The people who have insurance gain because some healthy people are going to decide they don’t want to roll the dice.
I guess all we can do is wait to see if things will be better in the next 2, 3, 5, 7, 10,… years.
“But I think one change that might go through is getting rid of the individual mandate, but keeping the pre-existing condition exclusion provided the person had continuous coverage from <some specified=”" date,="" probably="" the="" day="" legislation="" takes="" effect="">. That is, everyone of the same age who wants an insurance policy can buy it, at the same price, no matter how sick they are, provided they have kept continuous coverage."
Would the plan the way you envision it, @“Cardinal Fang” , allow for those with preexisting conditions to switch to reasonably priced plans from year to year as long as they don’t have a lapse or have a max rate? Because otherwise, they could find themselves in a situation where even thought they might have access to a plan, the rates become so astronomically high that it is truly unaffordable. Are you basically envisioning ACA absent the mandate?
Why not use that concept to expand Medicare. And simply add in a schedule for rates by age below 65.
I’ve actually never looked into the literature on how costly (or not) the annual physical is. IIRC, several european countries reward the GPs for getting their patients in yearly so now I’m curious as to 1- whether or not I remember that correctly and 2- why they chose to do that. (This is not, of course, saying that if they do that it’s based on any sort of evidence.)
The problem with both the current individual mandate and a possible “pre-existing coverage permitted only for those who bought in by X date” is that both scenarios mean nothing to people who just can’t afford the premiums. There is a sizeable population who aren’t buying insurance for the sole reason that they just don’t have the money.
This includes a lot of young, healthy people just starting out.
It also includes young families making a sub-60k salary in a small or solo business.
It also includes people below the poverty line who can’t be incentivized by tax credits or deductions because their income is too low to be taxed.
I envision that someone who had continuous coverage could buy any insurance plan, whether they were sick or healthy, just like now. Everyone of the same age would be offered the same price, just like now. But, if someone who hadn’t had insurance swanned up and tried to buy it, insurers would be allowed to make them go through underwriting, and would be allowed to charge them a higher price or deny them.
Not so simple, though. The under-65 Medicare rates would have to vary, and vary a lot, by region. And the government would have to get doctors to agree to accept Medicare rates for the under-65s. Essentially, this is the public option idea. Many people support it.
The sad fact is that people over about 55 would pay more to buy into Medicare at cost than they pay for private insurance right now. Previously, I didn’t understand why people would want to do it, since it would cost more. But if insurers are allowed to charge older subscribers 5 times as much as the youngest subscribers, suddenly buying into Medicare at cost looks a lot more attractive.
I don’t see expanding Medicare as a likely outcome in the near future.
CF how would that work for new immigrants, or citizens that were overseas and came back. Or new members of the workforce. Or people who aged out off their parents policy. Someone who was disabled and on Medicaid but then improved and returned to the workforce and need regular insurance. Or any of the other numerous wrinkles I didn’t think of off the top of my head…
In expansion states, those people get Medicaid.
Last year, my DD got a gift card from Anthem if she had her physical by a certain date. She did so…and used it to buy Christmas presents. To me…that was unnecessary overhead for Anthem…but they did it.
“In expansion states, those people get Medicaid”
Yes, but only in expansion states, and I’ve seen nothing in the ACA repeal threats about continuing to fund Medicaid expansion. So, I assume that’s one of the first things to go …?
This was discussed in post #82. About 60 percent more people state that they have been hurt by ACA than state that have been helped.
http://talk.collegeconfidential.com/discussion/comment/20048335/#Comment_20048335
That’s self-reported, not real data, and it’s based on feelings–or comparisons with the reality of the ACA and the expectations, rather than the far more salient comparison between the reality of the ACA and the reality without it. That’s not sufficient evidence at all.
I’m curious, marvin… what country do you live in? Where there’s “excellent national healthcare for all”, both for citizens and non-citizens alike? Can doctors in your country be sued for malpractice exactly as they can be here in the US?
On one hand, that is totally irrelevant if we are trying to reduce costs, by eliminating unnecessary services. OTOH, its a sad indictment of the ‘free-care’ policy, is it not?
“Can doctors in your country be sued for malpractice exactly as they can be here in the US?”
Does ANY country face the general litigation risk faced in this country?
@bluebayou My point with that statement (now not know) is that I wonder how much the annual physicals really add to the cost of healthcare. The reimbursement rate isn’t high. And I know not all go annually. I don’t see it as an indictment? How so? People don’t do a lot of things that are in their best interest for a lot of reasons.
If nothing else gets you, prostrate cancer will. And if does, you’ve lived to an age past griping about your healthcare… at least, on a percentage basis.
bluebayou: would you make an educated guess as to the sum total of dollars spent on useless tests/screening? Or as a percentage of overall spending?