Mecical Insurance

[MaryAnn]

Medical "insurance" is completely out of hand.

Rather than list all the problems, of which I'm sure all of you are aware, I will post my own idea of a solution that could be worked out after some thought.

Except the one major problem, which is that medical care is a for-profit enterprise, with stock holders owning hospitals and drug companies and HMOs.

I'd like to see medical insurance structured the same way as credit unions are structured. Members of a Medical Credit Union (MCU) would agree, collectively, on what kinds of treatments would be covered (i.e., AMA only, include chiropractic, include acupuncture, include NMD, include Chinese herbs, etc). The MCU membership would decide whom to include in its physician roster, and how to pay them, which of course would affect who wanted to be included.


The main kicker: instead of monetary profits going to out-of-network stockholders, all profits would go back into the network and reduce costs to the members. Medical care is one of the few areas where I really hate to see capitalism at work, because I don't believe it is ethical to profit off anyone's illness.

How much money do drug companies spend on advertising every year? How may ads on TV are drug ads? What do you think this is doing to the price of the pharmaceuticals you have to buy?

Who owns the HMO you belong to? Where is all the money going that you pay into the HMO?

How come when someone without health "insurance" has to go to the emergency room, the bill they are sent is five times as high as the bill sent to someone who can afford insurance?

I don't see any reason why such a system could not get started right now, except that the existing systems would fight tooth-and-nail to keep it from being legal.


MA

[Joe Baker]

MA, I disagree with you on several points, although by no means all of them.

As to profiting off of someone's illness, don't grocery stores profit from our hunger? Don't home-builders profit from our need for shelter? Doctors go to school for a LONG time, followed by internship and residence -- then have to be available basically 24 hours a day. In my book, they deserve to be well compensated.

If an insurance company is contracted to provide that compensation for a fixed price to the consumer, there is always the chance that some outbreak of illness might cause expenses to exceed revenues. They can handle that because there is a large pool of assets reserved for such occurances. Don't the people who place their wealth in the pool deserve to take a slice of the profits? If they didn't invest in the insurance companies, there wouldn't be any insurance. So again, I say they deserve their slice. Besides, any of US can invest in insurance companies if they are such sure-fire wealth producers!

That pool of assets that insurance companies have to have is the reason someone can't just put together their own little insurance co-op. If the premiums all get spent, who will pay when a member gets sick? There has to be a pool of assets.

Also, "alternative medicine" is a tricky thing. I'm not about to try to make a case that it's all phony mumbo-jumbo -- but I think you would probably agree that some of it is. Snake oil sales has always been a favorite among scoundrels. So who would make the decision which treatments are snake-oil and which are legitimate therapy? How would one go about appealing those decisions? Ultimately, you'd wind up with a situation just like the one we have now, but with the line drawn in a different place -- and far more arbitrarily (though not necessarily less appropriately).

I'll bet that some mainstream insurance company would love to be able to offer a policy that covers alternative medicine, IF you can solve the dilemma of separating legitimate therapy from snake oil.
__________________________
Joe Baker, who has never found alternative treatments effective, but knows that others' experiences differ.

[MaryAnn]

As to profiting off of someone's illness, don't grocery stores profit from our hunger? Don't home-builders profit from our need for shelter? Doctors go to school for a LONG time, followed by internship and residence -- then have to be available basically 24 hours a day. In my book, they deserve to be well compensated.

Hmm. I belong to a food co-op. I had to put $120 into the general fund to join. I was able to do this in $15 increments every three months.
AZ has a really neat group that builds straw-bale houses; they all go to the site as a group and raise the house.
I have no problem with doctors' being compensated. (I don't think the focus of my post was doctors' salaries.) In a MCU, the membership would decide based on whom they could get and what salaries could be negotiated, what/who the salaries and docs there would be.

That pool of assets that insurance companies have to have is the reason someone can't just put together their own little insurance co-op. If the premiums all get spent, who will pay when a member gets sick? There has to be a pool of assets..

MCU's would have to have a large number of particpants in order to be viable. I "presume" that enough people could join one so that the pool of wealth would be sufficient. I wasn't thinking of 20-person co-ops. I was thinking of profits being put back in to minimize costs. I would want to be a member of the chiropractic co-op, the nutriceutical co-op, and the emergency co-op.

Also, "alternative medicine" is a tricky thing. I'm not about to try to make a case that it's all phony mumbo-jumbo -- but I think you would probably agree that some of it is. Snake oil sales has always been a favorite among scoundrels. So who would make the decision which treatments are snake-oil and which are legitimate therapy?

The MCU members would make the decision.

__________________________
Joe Baker, who has never found alternative treatments effective, but knows that others' experiences differ.

I would be in a pretty big mess without chiropractic on occasion. The combination of having played violin for a bunch of years and staring at a computer all day now, with a lower back that decides to take a vacation now and then, would have me hobbled.
I have found much more effective treatments for a plethora of problems through metabolic/nutritional treatment than through pharmaceutical-palliative AMA treatments. I'd be non-functional intellectually if not for that.
(www.johndommissemd.com)
MA

[Joe Baker]

So who would make the decision which treatments are snake-oil and which are legitimate therapy?

The MCU members would make the decision....

I have found much more effective treatments for a plethora of problems through metabolic/nutritional treatment than through pharmaceutical-palliative AMA treatments. I'd be non-functional intellectually if not for that.

You've given me a perfect example for illustration. Suppose the MCU members voted that metabolic/nutritional treatment was non-covered. If they decided that AFTER the fact, you're out of luck; if they decide these things BEFORE the fact, then each person looks to see if their thing is covered, and they pass if it's not. Insurance will only work if all the policies cover pretty much the same stuff. Otherwise, everyone will just shop for coverage that covers EXACTLY their needs and NOTHING else. At that point, each person is just paying for their own coverage, and the insurance serves no purpose.

I rather look at ongoing expenses like you're talking about as just a part of the cost of staying healthy. I buy more expensive lean cuts of meat because they're healthier. I spend money every month on allergy pills because they keep me breathing right. I used to spend money every month on an alarm system because it helped keep me safer. These costs are budgetable, non-crisis expenses. Certainly they're more expensive for some than for others; the only alternative I can imagine to that is socialism, which is unworkable as long as people are greedy and selfish. In any case, these expenses are not what insurance is for. It's to cover our butts when the unexpected happens -- a heart attack, or cancer, or a car accident. True, these policies have been expanded to somewhat socialize health-care costs. I think that's the downfall of health insurance. It's made it so expensive that cost-cutting measures like HMOs and capitation have damaged the quality and cost-effectiveness of health care -- and led to an entitlement mentality on the part of most people.
___________________________
Joe Baker, who has been inspired by this thread to start another one on "Health Savings Accounts".

[ThomasDodd]

I'm with Joe here. what is call health insurance today isn't insurance, but th name is slowly changing to match the product. It's now health care group payment, and is basicall what MA wants, just with differeing rules about the setup. You pay a set amount to be a member. The company negotiates rates with select doctor, and make the payments. Current;y the companies only deal with large companies that have lot's of potential members.

The government involvement has had much to do with the current cost.

Still, very few people actuall pay out of pocket. If they did, most costs would not be so high. Lawyers have had a serious impact as well. Between higher malpractice insurance rate, due to the large payout made, and the frivolous suits filed, and won, it's a loosing battle. Doctors perform unneeded tests, a a matter of course. It a CYA thing. If they don't run some test, and latter is claimed that that test might have detected the problem, and prevented something bad, then the doctor looses. Same with medicine. If the new, super expensive, wonder drug of the day isn't prescribed , the doctor could get sued.

It goes on and on. The insurance companies have to allow the new treatments and test, because they would be sued for not allowing them. So we all pay.

Medical care is one of the few places where capitalism is not allowed to operate.

MSA + high detuctable polices are about as close as you can get. Wouldn't it be nice If medical care followed normal insurance policies. Routine care (maintainance) is paid out of pocket, Insurnce is used for expensive, unexpected problems.

This only falls down for prescription drugs. But even then, if most people paid full price, that price would drop to a level people could afford. Or you'd buy the best thing you could afford. Like a 10+ day antibiotic, instead of the new 3-4 day versions. or OTC instead of Rx. Notice how much price drop when it goes OTC? Look at ibuprofen,
Current , prescription strength:
400mg $0.92 per pill
600mg same
800mg $0.97 ea.
For generics.

What's the cost for OTC brands or store brands? less that $0.10 each for 200m in quantity. I checked Walgreens, and 1000 pils for $0.02 each!

If you look at others, like Naproxen Sodium, or Loratadine(Claritin or Alavert), you'll see the same. So these things can be sold for less. If few could afford the "perscription" price it would come down. A lot. That'd cover 80% or more of the medicine most people need.