Obamanuts: Are you happy about the Obamacare delay?

[Flopper]

I agree with a lot of the points made over the past couple of pages, including but not limited to:

1. Health insurance becoming actual insurance again can have a place in a new landscape of health care. That's what catastrophic coverage is, actual insurance. What we have now is a co-op. Instead of high deductible plans, however, I suggest limited coverage plans. So you can't use the insurance for routine stuff, but if it's something that pertains to something that the policy covers, you should be able to use it with little or even no deductible. Why?

2. Because high deductible plans will discourage people from seeking care and small problems won't be caught while they're small. They'll end up becoming big and expensive before they're dealt with. Not a cost saver.

There are a few points that have been made that I would comment on further:

1. The health of the nation continues to decline and a few comments have been made as to how to deal with it. A couple of people have discussed education. Education is of no value whatsoever. I dare say you couldn't find an adult in America who doesn't already know that they should be eating more fruits and vegetables and less processed food and exercising on a regular basis. Knowing more about why you should won't make people do it.

Food companies know exactly how much sugar, salt, and fat to put into your food to make your brain crave it. This is a fact. They go so far as to conduct brain scans while people eat (an interesting bit of trivia: they look for what they call a "bliss point," which is the exact amount of sugar they can put into a product that makes the same part of your brain light up in a brain scan as if you had done a line of cocaine).

In order to get anywhere with this problem we're going to have to treat Nabisco and Kraft's products the same way we treat R. J. Reynold's products, and deservedly so. Both produce habit-forming products that destroy your health. The FDA is going to have to be cleaned up and grow a pair and start doing their job. Yes, i realize that means a lot of government involvement, but A LOT more people are dying from the effects of this stuff than they are the effects of cocaine or even heroin, which we see fit to criminalize to protect our citizens from.

2. There has been at least one post who referred to "my idea," by which I am assuming he meant my statement that we could have both public and private health care systems just like we have both public and private schools in our education system. Anyway, the criticism was that it still means that people who take care of themselves still have to subsidize those who don't. My response is that the only system in which that is not true is a completely cash system. Even catastrophic insurance is going to respond to the entire pool of people paying in and an increasing number of sicker people is going to jack rates up.

3. The idea that routine services can be paid for with cash is fine, as long as you're o.k. seeing a mid-level practitioner (nurse practitioner, PA) instead of a doctor, because that's what you're going to get with that model. It costs many times more to get through medical school than NP or PA school, and the cost of school isn't going to go down just because the economics of the market outside school changes. When your routine exam goes from $85 to $45, who do you think is going to be giving it, an employee who costs the company $38 per hour or an employee who costs the company $125 an hour?

More to type, but no more time to type...

Interesting post.

The only problem I see with the patient paying for all routine care, is routine care is very difficult to define. Someone with any of the chronic diseases from heart disease to asthma to diabetes to cancer is likely to have many routine visits to the doctor with accompanying tests and treatments that could easily run into many thousands of dollars a year. Chronic diseases are responsible for most of the hospitalizations as well as most routine doctor visits and treatments. In fact chronic diseases are responsible for about 70% of the nations healthcare bill.

I think high insurance deductions and/or co-insurance up to the yearly maximum are the only practical way of putting more financial responsibility on the patient. The inescapable consequence is people with limited finances will not seek medical care for potentially serious health problems.

The old traditional zero deductible insurance is rapidly disappearing. If you check individual insurance plans, you will find very few policies with less than a $500/ person deductible. Those that do, usually have very high co-insurance. My son works for a large corporation with a choice of 6 different group insurance plans. The lowest deductible plan is $500/person or $1,000 for the family. Considering his ability to manage money, I'm sure he would consider paying any higher deductible to be catastrophic.

Americans have a love affair with high fat, high sugar, and high salt food. Ask anyone in the restaurant business and they will tell you lots of sugar, lots of butter, and salt is the mainstay of their favorite dishes.

 

[thewanderer]

The only problem I see with the patient paying for all routine care, is routine care is very difficult to define.

Not as much as you think. It would simply be defined primarily by diagnosis rather than procedure.

In fact chronic diseases are responsible for about 70% of the nations healthcare bill.

Precisely. Which is why unless we solve that problem none of the rest of these details will matter much.

I think high insurance deductions and/or co-insurance up to the yearly maximum are the only practical way of putting more financial responsibility on the patient. The inescapable consequence is people with limited finances will not seek medical care for potentially serious health problems.

Oh, it would put more financial responsibility on the patient, no doubt about it. But it would end up costing more money in the long run because it wouldn't just be the poor who didn't go to the doctor and catch things early. More of them would do so than middle or upper class, yes, but people do not like to spend money on health care and avoid it across all income levels, especially when they are paying insurance premiums...they resent paying stiff insurance premiums and having to pay out of pocket for health care.

I personally think that we are at a point at which things are going to start shifting with businesses and health care, which is why I'm getting into wellness consulting. And I'm telling our clients the same thing I'm telling you, which is that you can shift more of a financial burden onto your employees with regard to insurance premiums and de-incentivize them seeking medical care by providing huge deductible/co-pay plans, and you can save some money on insurance premiums by doing so. HOWEVER, unless you provide some other way for employees to be regularly screened for and treated for small problems while they are relatively cheap to treat, such as on-site direct primary care, you are going to spend WAY more later than you ever saved on premiums and claims in the short-term in large claims for serious problems (that never got caught), acute injuries that became chronic, disability, worker's comp, absenteeism, and presenteeism (coming to work sick or hurt and being under-productive as a result) in the medium/long term. Think about it; the whole point of raising the deductible and co-pay is to discourage medical claims...to discourage people from seeking care. Well, it will work (I tell them), but you won't like the medium to long range consequences of that strategy.

I think we're at a turning point right now. It makes financial sense for companies to go to pretty extensive lengths to improve the health of their employees, not just provide a high deductible "insurance" plan.