I think there should be 5 options when you go for health care, none of which require you to buy
healthcare, although they do require you to ultimately be responsible for your own care. Those
options are:
I’ve got the money and I’ll pay for it (then show proof).
I’ve got insurance, here’s my card.
I don’t have Insurance now but I can prove I had it X months ago. I will buy insurance, at today’s
monthly cost for the entire interim since I last had it MINUS the proven out-of-pocket expenses for
covered procedures during that time period, so issue me a card. Burden of proof is on the consumer.
“Today’s Monthly Cost” means you pay your current risk level retroactive.
I am flat broke- please help me I’m begging. At this point the government says “yes but”, and
determines your eligibility. If you are not actually broke, you just have too many toys or have spent it on
the proverbial wine, women, and song, and have decided not to buy insurance, they send you back to 1
or 3 or on to 5.
If you refuse the audit, you walk away without treatment. Once you accept the audit, any
garnishment or property confiscation determined appropriate in #4 can only be reversed by a court
appeal where you are also liable for all court costs.
In every case, the government NEVER pays you or the providers, only an insurance premium. MediCaid
goes away completely, as the rules above cover everyone under retirement age. MediCare follows the
same rules, except everyone qualifies for most premium assistance. Congress can debate the out-ofpocket expenses and whether to make that assistance needs based. Even VA becomes just a place to go
for vets, and it should concentrate on service related problems, as virtually every vet has excellent care
available closer to home for the ailments everyone gets.
As far as regulating the plans and insurance companies, every company should be required to offer “the
government plan” at an advertised price, needed so you can see exactly what you are buying. This plan
would basically cover all necessary and catastrophic, but not any elective, and could include co-pays and
a specified out-of-pocket max per person. There would be 3 allowed risk levels for this plan, with
Congress negotiating a rate structure with a rigid ratio on the rates like 2-3-4 or 3-4-5. There would also
be a limit of 33% of customers in either of the top 2 risk levels . This limits risk level bait and switch and
forces all the companies compete like hell to get those low risk customers, as the rigid ratio on the
premiums makes them valuable customers and any increase in network size or reduction in premium to
entice them automatically benefits the 2 higher categories also. It also creates incentive for young, low
risk people to buy insurance now, as waiting could throw you into a higher risk category and cost you
retroactive premiums at a much higher rate. Any plan offered by a health care insurance company or
provider should be available to anyone to buy at the appropriate risk level. Any price negotiated with
any plan buyer for a drug is available to every consumer at the same price. This is all aimed at a simple
goal- a single risk pool with many providers. The single risk pool consisting of everyone in the country
requires every provider to compete for business
The only way to beat this system is to die without using any health care. Lousy way to “win”, and great
for society because even though you paid nothing into health care, you also took nothing out, so we
really don’t care
Government programs do not pay providers or healthcare facilities an amount that even meets costs. They reimburse at less than cost of running the business. Meaning even running the electricity. On top of that they require a large amount of paperwork which requires both specifically worded notes from the providers (which is not based on medical training but on Administrators who determine how to deny claims) and paperwork to file to get reimbursed. In addition, most care must be prequalified requiring employees to do this prequalification. And on and on. This increases the costs to the business which increases costs to the patients. In addition, programs like Medicare under the government use Treasury bonds that government can take to pay down the deficit thus are not used for actual Medicare. Thus when media and the government reports that the highest costs to government are programs like Medicare that’s not actually true. What is true is they took the money from Medicare and used it for a vast range of other things which have nothing to do with healthcare to pay down the debt they ran up elsewhere. Kind of like the buyins of toys. So letting Congress decide anything to do with reimbursement will not work. It is best to give people HSAs and give them the freedom to spend that money on the healthcare of their choice.
Hospitals are already required to help people even if they cannot pay. You do no have to sign a consent to pay. In cases where people do not pay their bill they can already be taken to court or sent to collections. Cash options to pay are also already available for those who can pay cash at the time of service. This usually comes with a discount because they don’t have to spend money on collections or as much money trying to collect.
How is this a health CARE plan? You mean payment plans for through- the- roof medical fees, without addressing those, along with the endless referral fees, duplication of services, repeated initial consultation fees again at the specialists… .
It is how to structure the payment side, creating the ability for all to get care and true market based competition for the consumer. It gives incentive for insurers to keep their costs low. The actual cost of those drugs and services is a completely separate side of the issue, except for the part where I require any price offered to be the price for everyone. No one, not a big corporation or even the givernment can use their power to negotiate a better deal just for them, at the expense of the rest. Everyone gets the same deal.
And none of that changes in my plan. Got cash? Go ahead. No government paperwork because the government doesn’t get involved in actual treatment- simply pays some portion of some people’s premiums. The truly poor, the elderly at retirement age, veterans. But requiring hospitals to care for and then use the courts to try to get paid is hardly cost effective. And literally creates an incentive to not buy insurance and spend every dime so there isnothing to sue for.
Several of the points that were made in my previous comment are only to demonstrate that it is already the current system. For example, people can already pay cash at the time of service and get a discount for doing so which encourages up front payment and reduces costs of collection. Those who cannot afford care can apply for Medicaid. But many providers are not going to take Medicaid because it literally does not pay for the cost of business. There are too many time consuming wasteful hoops to jump through to get reimbursed $12 when that won’t pay for the lights to even be on. Government plans are not sufficient for businesses to survive. What would happen is they just wouldn’t accept those plans. Unless government is going to actually pay for care instead of under cost and stop making providers jump through so many hoops to get paid government plans are insufficient and unrealistic.
The insurance industry is not about healthcare. It started as a non profit system and moved to a for profit system. The stakeholders insurance is interested in pleasing are the investors. They are one of the only corporations permitted to take the premiums and invest it in the stock market. Thus it is their objective to reduce risk by not paying for healthcare and keeping that money invested to make more money. The large payouts for lifelong illness, disabilities, or conditions like cancer etc can be very costly. Thus they must not pay out for other things. Insurance is not what people think.
The cash based systems such as when you look at an outpatient cash only based surgical center which must provide pricing up front (it is already a rule for that type of facility) are much cheaper than going to a hospital.
The hospital systems which overcharges patients and does not tell them prices is a different topic than independent owned provider businesses. These really need to be separated out as two different topics because the rules are different for the business models.
The government is not going to be good at getting involved with this matter unless the government changes and they are not permitted to spend that money elsewhere. When you have a government system which uses healthcare related premiums for National Debt completely unrelated to healthcare that demonstrates they are not focused on healthcare.
If you are stating that people should pay cash at all times that they can afford it rather than use insurance that may be more beneficial. I agree that money should not just be going toward toys and should be put toward healthcare. There is too much dependence on letting the for profit insurance industry dictate care based on their investor stakeholders rather than based on actual care. The decisions they make are based on a business model of keeping as much money as possible in order to keep it invested in the stock market. Citizens need to be putting money toward wellness and true prevention not what the AMA calls prevention but true preventative care. This would reduce costs of healthcare also. However, people are trained to rely on insurance and allow them to control and dictate their health because they have placed a false sense of trust in the insurance industry without knowing the underlying way it works.
I don’t think the insurance industry wants people to give up any dependence on insurance because the premiums they get from people that they get to deny care on help to maintain the investments that increase profit and decrease the risks associated with large payouts for conditions such as cancer and debilitating or chronic conditions which have multiple payouts over many years.
I dud not say the government provided healthcare. I said they assisted with premiums if you qualify (destitute, veteran, senior). I put incentives for people to buy insurance and set rules for insurance companies to compete. Nowhere did I say government sets prices of any service, only that whatever service or plan is offered is available to anyone at that price. And I threw out carrots for insurance companies to keep costs down and compete for young healthy buyers, whole protecting less healrhy buyers with the ratio. In my plan, the government doesn’t pay for any drug or service, it merely pays insurance premiums.
How is that different in the end? They would still be paying but in a different manner. The government isn’t going to participate without being able to set the prices because the insurance industry works by cutting prices. The government uses the taxes for Medicare to pay off debt with Treasury bonds. So it is a win for them to provide. I don’t see how paying a premium to a for profit insurance company will benefit the patient or the government. This leaves the pricing to the for profit insurance company which will ultimately decide they do not approve the care or only approve it partially and will cut the bill to the provider. Which causes the providers prices to have to go up to make up for those losses. Insurance is the problem. So giving them more money to control care isn’t going to help. Insurance companies are for profit companies that invest premiums into the stock market for investors. It is their goal to limit/reduce payouts for healthcare so that they can hold on to more money. This is a risk stratification method because they will eventually have to pay out large amounts for things like cancer and long term disabilities or chronic care. It’s is better to give the money to the patient in a product like an HSA so they have the freedom to spend their healthcare money where they need it and choose to spend it. If your plan causes the government to put money into an HSA for the patient which they are required to spend for healthcare that would be better.
If your plan is based on Heatlh Savings Accounts rather than for profit insurance companies that would make more sense. Otherwise it is feeding the giant for profit insurance industry that prevents the actual needed healthcare.
Years ago Doctors could own Diagnostic Imaging Centers. However, there were laws or regulations passed to prevent them from owning such a facility if they also practiced. This came under the Stark Laws. Physician self referral. Insurance did not want to pay for the testing. But even if it was cash people would claim this was taking advantage of the patient. That the patient is dependent on the provider for the expertise and trusted the provider when they were referred. So there is some limitation to referring a patient for diagnostic testing. People often find they don’t want to pay for the testing after they have the testing. I think you would also have to get around these issues. Since diagnostic testing does require a healthcare provider to interpret the results the provider also become liable for every interpretation. So you would also have to address liability concerns. If you have an increase in diagsnotic testing you have an increase in healthcare provider hours reading and interpreting tests. But these tests also have to be correlated with clinical findings which requires an intake involving a history, physical examination etc. The diagsnotic tests alone are not diagnostic on their own in all cases. There are often what are called incidental findings. Sometimes those are very important such as a cancer. But other times there are benign things that show up on diagnostic tests and the person has no signs or symptoms related to that finding and never will be. There have been cases of people being operated on or undergoing cancer treatments when they never had it because tests were also misread. In addition, things do not always show up on diagnostic tests. For example, a person would have to have a finding such as a tendon tear or even cancer that was at least 50 percent there in order for it to show up on an x-ray. So having the x-ray would not definitively rule out that something is not there. This again goes back to correlating what the healthcare provider finds in an intake and exam to know what to do next. What diagnostic test is needed next or does the test need to be enhanced in some way with a dye for example. This all takes a provider to be part of the team.