REAL WORLD EVENT DISCUSSIONS

Requirements for a Health Insurance system

POSTED BY: GEEZER
UPDATED: Friday, May 22, 2009 10:30
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Thursday, May 21, 2009 3:54 AM

GEEZER

Keep the Shiny side up


There's been a good bit of talk in recent threads about problems with the current health insurance. Also a good bit of rancor and name-calling.

I'd like to go at it a different way; by developing the requirements for an improved system. I'm not looking for how to implement such requirements, although I'd like any suggestions to be doable. I'm also not looking for any "Capitalists are just in it to maximize profit", or "Socialists just want to run everything" ideology.

I'd like clear, concise, un-ambiguious statements of single requirements. For example, "Everyone who wishes to be covered by the system shall be.", "Coverage shall provide heated stethoscopes", etc. Reasons supporting the requirement would be allowed.

Although we shouldn't address costs or implementation, obvious non-starters like, "Everyone should have their own personal doctor", might be counterproductive.

So, I'll through out the first pitch.

Requirement - Everyone who wishes to be covered by the system shall be; to a specified minimum standard of care.

Requirement - There should be a minimum standard of care, and options for increased elective care.


"Keep the Shiny side up"

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Thursday, May 21, 2009 5:21 AM

FREMDFIRMA


Subsidize the education costs of participating medical personnel to encourage participation, since that benefits the people as a whole, there's a clear and honest argument for taxpayer funding of that nature.

-F

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Thursday, May 21, 2009 9:36 AM

SIGNYM

I believe in solving problems, not sharing them.


Geezer, since almost all of our healthcare flaws revolve around implementation, cost, and control it's impossible to avoid those topics. Spending 30% on "administrative" costs (and that just on the INSURANCE end! Hospitals, doctors, labs and therapists wrestle with their own contract tracking and billing costs!) is crazy.

So...

Everyone will be covered by a minimum medical plan, unless they specifically opt out.

It will be funded by income taxes (except those who have opted out).

It will be administered by Medicare.

Medicare will be revised to eliminate the "diagnostic groups" approach.

Coverage will not be available to people in this country illegally (but will be available to people on tourist or student visas etc.)

Reimbursement rates will be calculated regionally to reflect regional costs differences in care.

Additional coverage (for co-pays, cosmetic, or experimental procedures) will be allowed through private insurances.

There must be a quality assurance function on the care provided... this is a huge topic and needs more thought.

There will be a stated minimum coverage, and a minimum of care.

All care providers will be required to report rare-disease incidence, treatment and outcome data to NORD or a similar organization.

All care providers will be required to report adverse drug reactions to the FDA.

All care providers will be required to report communicable disease incidence to the CDC.

These de-identified records will be available though PubMed for research purposes.

Patient records shall belong to the patient and will be released WITH the patient when they are released from care. This could be in the form of a thumb drive or medical record card which the patient can bring with them to each doctor visit or hosptialization. (I really hate the concept of centralized record-keeping. Not only is it open to hacking its also extremely vulnerable to disruptions in power or solar flare EMP.)

Hospital and doctor outcomes will be posted online.

There will be special websites set up for patients to exchange information or to complain about care. Each hospital and doctor must have an ombudsman to resolve complaints.

Malpractice lawsuits will be allowed.

----------------------
We should have strapped him into a glider, filled it nose heavy w/ explosives, and dropped his Allah lovin' ass into a large, empty field. After which, release wild boars into the area so they could make good use of his remains. Now THAT's justice.- rappy

Yeah, that's what Sheikh Issa said. Seems you both have a lot in common.- signy

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Thursday, May 21, 2009 9:37 AM

SIGNYM

I believe in solving problems, not sharing them.


More to follow.....

----------------------
We should have strapped him into a glider, filled it nose heavy w/ explosives, and dropped his Allah lovin' ass into a large, empty field. After which, release wild boars into the area so they could make good use of his remains. Now THAT's justice.- rappy

Yeah, that's what Sheikh Issa said. Seems you both have a lot in common.- signy

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Thursday, May 21, 2009 11:26 AM

SERGEANTX


Quote:

Originally posted by SignyM:
Everyone will be covered by a minimum medical plan, unless they specifically opt out.

It will be funded by income taxes (except those who have opted out).



Really!?

Don't get me wrong, I'm entirely in favor of this approach. But it seems to undercut the basic redistributive nature of socialized medicine. It also kind of drives right into the "adverse selection" cul-de-sac.

To put it another way, this would essentially be a voluntary insurance plan where you pay according to your income. It's not clear to me why high income people would want to be involved.


SergeantX

"It's cold and it's a broken hallelujah"

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Thursday, May 21, 2009 12:38 PM

SIGNYM

I believe in solving problems, not sharing them.


It would depend on how much they would pay through the system versus how much they might lose through catastrophic health crisis.

----------------------
We should have strapped him into a glider, filled it nose heavy w/ explosives, and dropped his Allah lovin' ass into a large, empty field. After which, release wild boars into the area so they could make good use of his remains. Now THAT's justice.- rappy

Yeah, that's what Sheikh Issa said. Seems you both have a lot in common.- signy

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Thursday, May 21, 2009 1:16 PM

GEEZER

Keep the Shiny side up


Quote:

Originally posted by SignyM:
It will be funded by income taxes (except those who have opted out).



Just to clarify, will the ones who opt out not have to pay taxes to support the system, or do they just opt out of the benefits?

"Keep the Shiny side up"

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Thursday, May 21, 2009 3:06 PM

SIGNYM

I believe in solving problems, not sharing them.


The ones who opt out do not have to pay the taxes. (OTOH it seems to me they cannot opt out for their children.)



----------------------
We should have strapped him into a glider, filled it nose heavy w/ explosives, and dropped his Allah lovin' ass into a large, empty field. After which, release wild boars into the area so they could make good use of his remains. Now THAT's justice.- rappy

Yeah, that's what Sheikh Issa said. Seems you both have a lot in common.- signy

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Thursday, May 21, 2009 4:28 PM

NCBROWNCOAT


Quote:

Originally posted by SignyM:
Geezer, since almost all of our healthcare flaws revolve around implementation, cost, and control it's impossible to avoid those topics. Spending 30% on "administrative" costs (and that just on the INSURANCE end! Hospitals, doctors, labs and therapists wrestle with their own contract tracking and billing costs!) is crazy.

So...

Everyone will be covered by a minimum medical plan, unless they specifically opt out.

It will be funded by income taxes (except those who have opted out).

It will be administered by Medicare.

Medicare will be revised to eliminate the "diagnostic groups" approach.

Coverage will not be available to people in this country illegally (but will be available to people on tourist or student visas etc.)

Reimbursement rates will be calculated regionally to reflect regional costs differences in care.

Additional coverage (for co-pays, cosmetic, or experimental procedures) will be allowed through private insurances.

There must be a quality assurance function on the care provided... this is a huge topic and needs more thought.

There will be a stated minimum coverage, and a minimum of care.

All care providers will be required to report rare-disease incidence, treatment and outcome data to NORD or a similar organization.

All care providers will be required to report adverse drug reactions to the FDA.

All care providers will be required to report communicable disease incidence to the CDC.

These de-identified records will be available though PubMed for research purposes.

Patient records shall belong to the patient and will be released WITH the patient when they are released from care. This could be in the form of a thumb drive or medical record card which the patient can bring with them to each doctor visit or hosptialization. (I really hate the concept of centralized record-keeping. Not only is it open to hacking its also extremely vulnerable to disruptions in power or solar flare EMP.)

Hospital and doctor outcomes will be posted online.

There will be special websites set up for patients to exchange information or to complain about care. Each hospital and doctor must have an ombudsman to resolve complaints.

Malpractice lawsuits will be allowed.

----------------------
We should have strapped him into a glider, filled it nose heavy w/ explosives, and dropped his Allah lovin' ass into a large, empty field. After which, release wild boars into the area so they could make good use of his remains. Now THAT's justice.- rappy

Yeah, that's what Sheikh Issa said. Seems you both have a lot in common.- signy



Sounds good so far. I'd add preventative care services such as eye exams, annual or semi annual physicals with blood work, mamography, colonoscopy (just had a screening one, I had good drugs and I don't remember a thing).


The biggest thing is untie health care and jobs. It kills employers and if you don't have a job that provides health insurance, you're up a creek.

For most people, having your own health care records is OK but some people can't or won't keep up with them and in case of emergency some way to access the records are needed. I'm not sure how, short of implanting microfilm or a flash drive in each person. NOT.


http://fireflyfaninnc.livejournal.com/








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Thursday, May 21, 2009 4:33 PM

SERGEANTX


Quote:

Originally posted by ncbrowncoat:
The biggest thing is untie health care and jobs. It kills employers and if you don't have a job that provides health insurance, you're up a creek.



Agree 100%.

SergeantX

"It's cold and it's a broken hallelujah"

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Thursday, May 21, 2009 6:54 PM

BADKARMA00


Minimum standard of care is okay, so long as it's a doctor, and not a beauracrat who decides what the minimum standard will be.

I agree with Frem's idea about the educational sponorship or loan repayment for participating providers. He and I have talked about that before, and the benefits should be clear for all to see.

I still say that Medicare is the wrong vehicle. If it's used for this, then an entire new system should be devised that will, once operating, place everyone into the same program.

I still think that using the administrative program already used for Federal Employees is the best way to go with this. It's nationwide, and it is, to my knowledge, fairly well run. The size of the program would have to be increased, of course, but it's cheaper to add on to the program, if it's running properly, than to build a new one from the ground up.

And, like I said, once it's running, then I don't see why Medicare patients can't be enrolled in the same plan, and eliminate Medicare altogether, from a strictly administrative view. The less beauracracy we have, the more funding that goes where it's needed, which is health care.

As always, that's just me.

Bad_karma
Great and Exalted Grand Pooba, International Brotherhood of Moonshiners, Rednecks, and Good Old Boys.

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Friday, May 22, 2009 6:09 AM

SERGEANTX


Quote:

Originally posted by SignyM:
The ones who opt out do not have to pay the taxes. (OTOH it seems to me they cannot opt out for their children.)



Shoulda known there'd be a catch.

But even at that, I'm not seeing how that's going to work. It seems obvious that the young and healthy, and the well-off, would have little incentive to sign-up for a plan that charges them more if they earn more. I see such a plan overloaded with the people who can't currently afford insurance and lacking in those who can.

Are you assuming that the government run system would be so much more efficient that the higher rates for the wealthy would still end up lower than market insurance rates?

One thing I would like to see, assuming the government takes over health insurance, is something like the health savings accounts currently gaining momentum. These seems to provide a natural counter-balance to the undesirable incentives of traditional insurance (where the way to "win" is by spending as much as possible with every claim). So the government would essentially provide a high-deductible insurance policy (eg $3000 individual, $6000 family) and set up a dedicated savings account to cover the deductible. If you're hit hard, you're covered outright, but if you can make it through a year without killing your deductible, you keep the remainder.

SergeantX

"It's cold and it's a broken hallelujah"

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Friday, May 22, 2009 9:26 AM

GEEZER

Keep the Shiny side up


Quote:

Originally posted by badkarma00:
I still think that using the administrative program already used for Federal Employees is the best way to go with this. It's nationwide, and it is, to my knowledge, fairly well run. The size of the program would have to be increased, of course, but it's cheaper to add on to the program, if it's running properly, than to build a new one from the ground up.



Once again, there really isn't a Federal Employees insurance system. All federal employees are insured by private insurance companies. The only thing the Federal agencies do is publicize the availability of the plans from these private companies, deduct the employees bi-weekly payment from their salary, and pay 75% of the cost of the policy. Since this gives the insurance companies a savings in overhead needed to handle payments, they reduce their rates a fraction.

"Keep the Shiny side up"

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Friday, May 22, 2009 10:30 AM

BADKARMA00


Quote:

Originally posted by Geezer:
Quote:

Originally posted by badkarma00:
I still think that using the administrative program already used for Federal Employees is the best way to go with this. It's nationwide, and it is, to my knowledge, fairly well run. The size of the program would have to be increased, of course, but it's cheaper to add on to the program, if it's running properly, than to build a new one from the ground up.



Once again, there really isn't a Federal Employees insurance system. All federal employees are insured by private insurance companies. The only thing the Federal agencies do is publicize the availability of the plans from these private companies, deduct the employees bi-weekly payment from their salary, and pay 75% of the cost of the policy. Since this gives the insurance companies a savings in overhead needed to handle payments, they reduce their rates a fraction.

"Keep the Shiny side up"



-------------------

I understand that, I do. But there is a system in place to provide the coverage, in fact, if I have it right you're saying a choice of coverages, and for getting the premiums paid. Since there's a savings to the complany for the Government doing the accounting, and if, as many are supporting, the government is going to subsidize the coverage, then this still seems like the way to make it work.

Bad_karma
Great and Exalted Grand Pooba, International Brotherhood of Moonshiners, Rednecks, and Good Old Boys.

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