I would suggest we have a coverage problem that gives rise to a cost problem. For example, EMTALA laws state that everyone has access to emergency care, regardless of their ability to pay. Because of this, many poor folk use the ER as their primary source of medical care. And while ERs are great at taking care of crises, they are lousy at managing chronic conditions. That’s not a criticism of ER personnel; rather, ERs are simply not set up to manage DM, HTN, etc. What often ends up happening is folks with chronic conditions don’t seek medical care until they experience a crisis, at which time the cost of their care is vastly greater than it would have been if they had been managed pre-emptively by a primary-care physician.
This is why I favor a ‘govt option’ to provide universal-but-limited (‘Chevy’) healthcare, while simultaneously allowing individuals to purchase supplemental (‘Cadillac’) coverage on the open market, or engage directly with a physician (fee-for-service).
I’ve largely stayed out of the fray here, but this idea of “catastrophic only” coverage has come up a few times and I really have to chime in at some point.
Some things are relatively easy to put into that bucket: car accidents, injuries due to criminal offenses like an assault. Some things are relatively easy to leave out of that pool. But there’s a huge middle zone which will be incredibly murky and problematic.
Consider a classic case that we see basically every day: a patient presents to the emergency department complaining of chest pain and shortness of breath. The guy might be having a heart attack, so this dude needs to get a workup to see what’s going on (otherwise, he might keel over and die a few hours later). He gets an electrocardiogram and the results are inconclusive and his troponin hasn’t spiked, so it’s not a clear-cut heart attack; but his chest pain will not go away, so he is sent for a cardiac catheterization to determine the etiology of his chest pain. During the exam, the physician sees two severly occluded coronary arteries and places a stent in each artery. Upon leaving the cath lab, the patient is sent to the cardiac intensive care unit for the night; he is hemodynamically stable, his symptoms have resolved, and he is discharged from the hospital after one moer day, with instructions to follow-up with a community-based cardiologist in one month and again every six months thereafter.
Which things in that paragraph are covered by “catastrophe only” coverage?
The main difference being that ALL car expenses are optional. Not only does public transportation exist, but the relative skill needed to perform these things yourself is nowhere near the same. You can change your own breaks, you can change your own oil, etc. On the HC side of things, the amount of knowledge/capital needed to do things yourself is immense.
They dont have much incentive. The reason this is tolerated is because it’s BY FAR the lesser of 2 evils.
Water is a utility. Food/shelter can be provided by the consumer if they so choose with a relatively low amount of capital/knowledge (certainly higher than cars, but still much smaller than HC).
Also I 100% agree the MAIN reason for HC being so expensive is oligopolies existing and big business control in DC.
Wouldn’t it be simpler to define a number rather than procedures? Out of pocket maximums already exist right? So just craft a policy on anything over $10k in one year is “catastrophic” and coverage kicks in. Then the premium cost/benefit is much easier to calculate. I’m willing to pay X/month to secure a Y out of pocket maximum.
I never understood why this common sense option is not universally preferred in the US. Here in the Marxist/communist European Socialist Union this is pretty much the standard.
Everyone has universal-but-somewhat-limited healthcare coverage, ensuring that injuries, surgeries, serious illnesses or prolonged hospital stays do not leave patients and their families deep in the red.
If you want extra stuff - regular additional bloodwork, or I dunno, a colonoscopy for no apparent reason because you “just want so see what’s down there” you can always get additional insurance on the market of simply directly pay a private practitioner.
What tax dollars?
I’m talking close off the dumping ground.
Just got a new credit card, even though I have been out of work lately. I maxed it out buying foreign made goods and making payments on existing credit accounts. Sometimes I wonder if I should have kept a couple of those businesses my family used to build up the ole fortune several generations back. Haha… I probably would never have gotten my Business degree, if my professors heard me saying that.
Thankfully, my credit score in the 800s, functions like a country with an overwhelming military and I should be able to secure more credit cards for awhile. Might at well apply for another one and then research those new Samsung robots.
Well, you may call it “tyranny”, I call it “national solidarity”. Did I pay much, much more through my taxes that I received services in return? Fuck yeah.
But I’m glad I did my bit in helping other, much less affluent people get the basic level of healthcare and access to drugs, medical procedures and services they couldn’t afford otherwise - after all, health is the great equalizer. And we’re talking here about basic healthcare, not gastric bypasses for the morbidly obese or cosmetic surgeries.
I once ended up unconscious, seriously injured in the hospital after a takedown gone wrong in a grappling tournament. My wife was unemployed at the time, at home with newborn twins and I was working as an independent contractor and the money was tight.
I was in the hospital for several weeks, had multiple complex surgeries. Correct me if I’m wrong, but in the US I’d be fucked and still paying off my debt, with an finger-wagging admonishment “well, you shouldn’t have engaged in such a high risk activity such as grappling”.
So someone else paid my hospital stay through his taxes and I have no problem doing the same for others. Like I said, it’s a general consensus over here, and we don’t actually think about healthcare much.
There’s a difference between ‘stupid’ and ‘lacking the proper fund of knowledge.’
I’m not going to defend insurance companies; I’m simply saying that the free-market model is not appropriate re the provision of most health care, for the reasons I stated upthread.
Govt-option HC is an affront to liberty how, exactly?
