What health plan do you think would work best?

[rangerwickett]

I am not convinced that the primary plan being proposed by Congress is the best one, or even the best one that might get passed. I'm looking for other options, so that when I talk to my congressman I can say what I am [i]for[/i], not just what I am against.

Right now the two possibilities that are most compelling to me are:

1. Interstate

Comments

[arrovian]

A few corrections. The overhead numbers are a bit misleading. Medicare does not count the administrative costs of the ancillary branches of government it requires to function. Treasury/IRS is responsible for collecting the money (not counted). The FBI is responsible for fraud investigation (HMOs have fraud divisions). Per patient costs are nearly triple that of private insurance, and privates, on average, have 13% overhead, not 30%. Medicare also reimburses, on average, less than half what private insurers pay for services rendered, and reimbursement is scheduled to drop another 20% in December. Nor does Medicare have to maintain staff for Federal regulatory compliance matters. HMOs are, after all, a government construct. Right now, a total knee pays the surgeon ~$1200 (Medicare - less than replacing the head gasket on my cavalier), up to $3000 (private insurance). Fair market value based on a survey of patients - $5K (that's what they would pay their surgeon, in retrospect). Overall cost is, of course, higher - anesthesia, hospital stay, implant cost.

Second, it's rather confusing that the current complaints of government created institutions (HMOs) are to be addressed by more government created solutions. We already have de facto socialized medicine. The lack of competition between insurers is a direct result of federal regulation, and there is very little competition in the type of insurance you can carry. Young people would prefer cheap catastrophic insurance, older people would need more coverage. Yes, your health insurance will cost more if you're older, sicker, or have pre-existing conditions. That's what insurance is - risk stratification. If you have COPD and continue to smoke, your insurance should cost more. If you have heart disease and weigh 300 lbs, renal/liver failure and continue to drink, etc - more $$$. Individuals have to make consumer decisions, just like any other product.

It's also rather ridiculous to argue that Medicare for everyone is an answer. Medicare takes money from millions of people who derive no benefit from it whatsoever (workers <65 y/o), and spends it on a minority of the populace, and despite this massive revenue advantage over private insurance is still going bankrupt. Medicare is not accountable to anyone, and it's becoming increasingly difficult to provide treatment to patients.

What we need is a dismantling of the government protected HMO monopolies, gradual elimination of Medicare, and disincentives to defensive medicine. You want to save money in Medicine? Strip down the pencil pushing hospital administrators to a minimum, let patients more directly see the costs of their care (i.e. - pay for it), and functionally eliminate the need for huge billing departments trying to eek out 30-40% of a hospital bill from medicare and insurers. Make it easier to see specialists so that inappropriate tests aren't ordered. And what about those who can't afford it? Docs will see them for free, because their margins will allow for it and that's what we do. We do it now when we can, but it's becoming increasingly difficult in this environment. I simply don't trust the people in congress. This debate is about a massive federal power grab, and has nothing to do with the health of the public, just like the war on terror has nothing to do with keeping us safe.