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Aerden [userpic]
Reply to Rich (and anyone else who is interested)

From here:

Hi, Rich! I had to post this in an entry because my reply to you was getting too long for the comment buffer.

I definitely support the concept of increased access to health care for all people. I just don't like the way my current government is trying to bring it about.

From what I can see, they are trying to burden the country with a horrific amount of debt in addition to the debt we already owe. They don't seem to understand that, when it comes to something huge, like health care, all cost-projections are likely to be under-estimated.

I'd rather that, along with insurance, people be able to have individual, after-tax, health care savings instruments, which would be, by law, opened at a child's birth and whose contents would be tax-free and unused (so funds could accumulate) until the child was removed from the parents' insurance coverage. I'd require a set amount for each family to put aside each month for each child in their family (say, $50/month). My reasoning behind this is that it should be fair for children of all standards of living.

What if a family can't afford $50/month for each child? That is where a private charity or, as a last resort, the government, might step in.

I'd tax the interest on these accounts at a low rate (2-5%), and I'd stipulate that their funds be used only to pay for documented, prescribed, medical expenses, as well as for health insurance, itself--so you can't use the money as a tax shelter. Also, you wouldn't have to use this account to pay for every medical expense, though you could. Personally, I would use mine to pay for large expenses, such as surgery, hospital stays, dental work, hearing aids, whatever. Medical bills could be paid in part, in installments, or in full from this account.

I like this concept better than a health care reimbursement account (HCRA) because, while a HCRA is tax-free (It's subtracted from your annual earnings), you lose any money you don't use during each year.

I'd sever health insurance coverage from employment and have people simply buy their own, the way we used to. I would also do away with the concept of pre-existing conditions. Everyone on this planet has a pre-existing condition. If insurance companies need to increase prices because of that, let them do so for people who smoke or engage in other health-threatening behavior. Got a drunk driving conviction? Then your health insurance costs will go up. Go to a gym regularly? That could decrease your insurance costs. In other words, make health insurance premiums dependent on the buyer's behavior and not on the will of God.

If you lose your job, you would not then instantly lose insurance coverage, because you could still pay for it with any unused money in your health care savings account. When you become elderly, or if you become disabled, you would not necessarily have to use a government health insurance plan, because you could still contribute to your own health savings account with your retirement income. If your child is born with a disability, that is what I would want the government to insure, because multiple disabilities can be ruinously expensive for a family, and many children with multiple involvement will never be able to work and need 24/7 care, which most families cannot afford.

I also think we should allow insurance companies to become nationwide instead of limiting them to state borders. Right now, for example, Aetna in Texas isn't necessarily the same as, say, Aetna in Rhode Island, because Rhode Island (our smallest state) has a much smaller risk pool than Texas does. If you have a lot of people bearing the cost burden of those few who have a lot of health care needs, the cost to everyone is diminished.

I would also limit the amount of damages a person can get from malpractice lawsuits. Medical mistakes are devastating. But the insurance against them can be burdensome for doctors. I was appalled by the amounts in my twenties; I can only imagine how much more malpractice insurance must cost, nowadays. If a limit can be put on damages, the malpractice insurance costs can at least be managed. At the very least, I would limit it to verifiable medical and counseling expenses, and legal costs, only.

It's a complex problem, and even though I have opinions, I really can't pretend to have answers, just possible solutions which make sense to me and which I hope would work.



It's terribly obvious you've never tried to get individual insurance. The main reasons it's so much more expensive than the employer-based sort are that a great deal of time and effort is invested in underwriting to rate people individually (and weed out or drastically overcharge those deemed poor risks) and because it's a smaller pool - people who are generally healthy are more likely to take their chances without, leaving a pool that is both smaller and costlier. Employer-based programs work better because all employees are in the pool whether they think they're invincible or not, so the costs average down.

Also, yes, Aetna-TX is different from Aetna-RI, but not just because of the size of the state. Texas is also the most lax of any state insurance regulator in the country, whereas the northeast states tend to be more stringent. (Not that any state regulator puts the insurers on a particularly short leash, but some are longer than others.) The main objection to interstate marketing is the race to the bottom that will inevitably result, where all the insurers rush into the state that will let them get away with the most obscene abuses.

So riddle me this, Batman. Why are we paying thousands more per capita annually than any industrial country in the world, and getting substantially worse outcomes than so many of them? We're #39 in outcomes, with far and away the biggest per capita expense. Every other industrial nation in the world has managed to set up a national delivery system for health care services; what the hell is wrong with us?

(I note, by the way, that apart from med-mal restrictions you say nothing about controlling costs. Texas has had brutal med-mal restrictions for many years. How's that working out for you, hm? Especially in McAllen?)

If insurance companies need to increase prices because of that, let them do so for people who smoke or engage in other health-threatening behavior.

They do this already; because of my weight, even if I could get insurance, it would be ridiculously expensive. Despite everything I've tried for the past twenty-four years (I went on my first diet at eleven,) I'm still fat.

Go to a gym regularly? That could decrease your insurance costs.

I did a triathlon and managed to gain weight during the course of it; I had more muscle and less fat at the end of it. But by the numbers, I was a worse risk.

In other words, make health insurance premiums dependent on the buyer's behavior and not on the will of God.

I grind my teeth. It's not a conscious thing, but it is something I do. I'd hate to lose my coverage because of that. I also chose to do eldercare and work at a stressful job.

I guess it just feels like that's blaming the victim?