Election 2010: Teabaggin' the Ds & Rs

[Adder]

Originally Posted by sebastian_dangerfield

The only true reform that would make docs and patients happy would be a direct fee for service system.

The only systems that are at all understandable (in the sense of not making a giant tangle of the incentives) are direct fee for service and single payer.

But I'm not sure how one could get from here to direct fee for service. Pass a law making health insurance illegal? I will leave it to the board's resident constitutional scholars to opine whether that is doable (I guess maybe), but as you say it is politically impossible. And my guess is that it would only lead to new pre-payment schemes and the like that would basically re-create insurance unless they were outlawed too.

[Replaced_Texan]

Originally Posted by Adder

That's a different kind of paying, and not the sort of paying that drives overconsumption in the way Sebby is talking about.

Stated differently (in the normal usuage of that phrase), having your employer pay for your health insurance isn't what causes you to get a CT scan every time you get a sniffle. It's the health insurers willingness (or obligation more likely) to pay for the scans (leaving aside the imperfect feedback mechanism of increasing premiums).

Well, the ACOs (and I don't know anyone in healthcare who's not seriously looking into ACOs right now, there's a funny video on YouTube about it that I'll be happy to show if you're as healthgeeky as I am) are supposed to hold down those CT scans. I really like the proposal in Oregon outlined here that throws massive co-pays on "low value" procedures.

[sebastian_dangerfield]

Originally Posted by Cletus Miller

Works reasonably well in dentistry, but there aren't a whole lot of $500,000+ total-cost dental procedures.

That would be a great template to use for HC generally. Let a catastrophic plan cover the big stuff.

But that would mean the average American would have to take control of his own HC. As Ty has often noted, the market has told us time and time again, people do not want to do this. Similar to their approach to personal finance, they want somebody else to do the heavy lifting. They want to be taken care of, and only get involved when they find they're being fucked.

Hence, the Nanny State nonsense we have.

[sebastian_dangerfield]

Originally Posted by Adder

The only systems that are at all understandable (in the sense of not making a giant tangle of the incentives) are direct fee for service and single payer.

But I'm not sure how one could get from here to direct fee for service. Pass a law making health insurance illegal? I will leave it to the board's resident constitutional scholars to opine whether that is doable (I guess maybe), but as you say it is politically impossible. And my guess is that it would only lead to new pre-payment schemes and the like that would basically re-create insurance unless they were outlawed too.

We're stuck with what we've got. There is no cure.

Perhaps a good plague.

[Adder]

Originally Posted by Replaced_Texan

the ACOs

I am guessing you do not mean these guys.

[Replaced_Texan]

Originally Posted by Greedy,Greedy,Greedy

In Mass the real choices happen in primaries; mostly the Rs put up pederasts and imbeciles (quite literally).

We'll see what happens, but I'm not writing off Scott Brown at this point. I believe he is the only Republican in Washington today with credibility to say that he has sought compromise with the Dems more than they have sought it with him.

Have you seen a run on the docs and other services in Mass since heatlh reform there?

[Cletus Miller]

Originally Posted by sebastian_dangerfield

Let a catastrophic plan cover the big stuff.

Administered how and by whom? Presumably with a mandate, too, no? And who gets a subsidy?

[Replaced_Texan]

Originally Posted by Greedy,Greedy,Greedy

The insurers don't offer some viable options because they'd undercut more profitable ones. Once the answer was tax-exempt charitable entities as insurers, but they've all morphed to look just like the regular insurers.

This is just one study, but it's pretty on point with most of the others: Quality of care tends to decline in for-profit health plans compared to not-for-profit health plans.

[sebastian_dangerfield]

Originally Posted by Cletus Miller

Administered how and by whom? Presumably with a mandate, too, no? And who gets a subsidy?

An insurer. That would be real insurance, as opposed to managed health care. That could be done effectively.

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

Have you seen a run on the docs and other services in Mass since heatlh reform there?

No. It's been remarked on, studied and pondered over, but it didn't happen.

[Adder]

Originally Posted by sebastian_dangerfield

An insurer. That would be real insurance, as opposed to managed health care.

It isn't managed care now, which is a big part of the problem (because no one wants managed care).

What we have now is more like an extended warranty or vehicle maintenance plan. It's either a rip off or something you plan to exploit.

[Penske 2.0]

Originally Posted by Replaced_Texan

Well, the ACOs (and I don't know anyone in healthcare who's not seriously looking into ACOs right now, there's a funny video on YouTube about it that I'll be happy to show if you're as healthgeeky as I am) are supposed to hold down those CT scans. I really like the proposal in Oregon outlined here that throws massive co-pays on "low value" procedures.

I like that video. One question, I am a busy healthcare executive, should my organization seek to partner with (an) ACO(s)?

[Penske 2.0]

Separate HC aside. I, figuratively, am now suing a certain state over its proposed cuts in Medicaid as arguably violating Title XIX. Go figure.

[Cletus Miller]

Originally Posted by sebastian_dangerfield

An insurer. That would be real insurance, as opposed to managed health care. That could be done effectively.

But mandated participation and some level of subsidy for poor/seniors/etc., no? To avoid the pre-existing condition problem, if nothing else.

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

This is just one study, but it's pretty on point with most of the others: Quality of care tends to decline in for-profit health plans compared to not-for-profit health plans.

2003. I'm betting the difference has declined substantially.

Charlie Baker's tenure at Harvard Pilgrim being Exhibit A.