The Audacity of Shamelessness

[marm]

I've been watching the health care reform debate with keen interest. It is one of those situations where I think there's a public policy problem, but the solution is very difficult to tease out. None of the proposals I've heard thus far have truly addressed the problem in an honest way, proposed a solution that would actually address the stated

Comments

[marm]

I think that, somehow, we need to get health insurance detached from employment. That wouldn't solve your problem, but it would change the market by getting individuals closer to the actual cost of their care (as opposed to not seeing what the coverage actually costs, and therefor, not making any effort to shop around). This has worked in vision care, and it's starting to work in dental. I think that in the long term, detaching health insurance from employment would lower costs for everyone (including individuals in your situation), and squelch some of the anxiety that people have because losing your job wouldn't mean that you lost coverage

[marm]

My mother still wonders how she is going to pay for her drugs on Medicare, when she hits the "donut hole".

This is one of the issues that puzzles me, because it's widely acknowledged to be a big issue for folks in Medicare, yet a great number of reformers are pushing their plan as "Medicare-for-all". Mmmm, okay. But Medicare has ginormous problems! It doesn't necessarily provide great care, expenses vary from region to region with no explanation, government has not been able to implement cost controls, and there are notable gaps in coverage. Which is why I've been on board with the "Reform-Medicare-First" crowd--I'll believe there are substantial savings in evidence based medicine that don't negatively affect health outcomes or spark intolerable public outrage once I see it implemented in Medicare (big shock, I'm skeptical that the public will accept the type of rationing that cost control will require; it's what sunk the HMOs and ClintonCare).

[marm]

I don't know what the solution is, but I am HIGHLY skeptical of any plan that says that making people pay for the services out of pocket will bring down costs. Neither my mother nor my father could afford the costs. At some point, people just do without and suffer for it.I think shopping around for routine/preventative care/optional stuff, if everyone did it, would force prices lower. As of right now, most people are utterly divorced from what their care costs, so if a doctor suggests a screening or treatment, no matter how remote or unproven it is, people tend to take it. For maintainence type stuff, which really are predictable and therefor not really "insurance" events, and where the equities are more balanced (ie, not emergency room/life-threatening things), I think HSAs are reasonable