the new health care?

[JoeRedskin]

Originally Posted by Daseal

I was uninsured and went through treatment for Lyme disease. Each blood test cost me out of pocket 550 bucks to get the labs necessary to tell if I had Lyme and how to treat it. How much does this exact same test cost for the insurance company? That's right, 225 bucks. That's not how much the insured person pays, it's how much the lab charges. How in the hell is this fair? A service should cost a set amount regardless of if a person is insured or not.

The reason the insurance companies pay less than uninsured patients is that they negotiate bulk rates and ensure payment. The cost to you, an uninsured patient, reflects not just the cost of the service but, also, the expected returns and additional collection costs when extrapolated over a large population of patients. It's just good business.

Individuals w/out coverage get the same service, true. On average, however, the rate of collection for people w/o insurance is significantly lower. From ten insured patients, the hospital will always collect (and collect relatively promptly) $2,250. From ten uninsured paitients, the hospital may collect $5,500 but will likely collect significantly less and will collect it over a longer time (so it is worth less - 1.00 today is worth more than 1.00 tomorrow) and will incur additional costs in trying to collect it.

Universal insurance with good coverage, good care and cost effective solutions is a chimera. The current system is a Gordian's Knot of insurers, self-insurers, lawyers, doctors and multiple regulatory agencies. Health insurers are subject to regulation by each of the 50 states AND the federal govt. Additionally, doctors and insurers are regulated by different agencies. In the case of doctors, much of the regulation is self-regulation i.e. doctors regulating doctors. One of the reasons malpractice insurance and, thus fees, are so high is b/c bad doctors are allowed to continue practicing by other doctors.

Obama's stated desire to build on the current system sounds wonderful except the idea that he will simply create a govt. "insurer of last resort" is extremely expensive. If it can refuse no one, then it will get all those people too expensive to insure through the traditional coverages.

A national health policy will also have a huge impact on the cost existing coverages. Currently, insurance is a giant ponzi scheme (shhhhhhhh!!) with the healthy funding treatment for the unhealthy. One of the effects of a national policy will be to remove the funding mechanism of traditional employer provided coverages because it allows people to "coverage dip" i.e. otherwise healthy people can dip into universal coverage for benefits but not provide the majority of its funding b/c they generally aren't taxed nearly enough to cover the costs. These large group consists, generally, of people who are young, healthy, w/out children or chronic health issues. If the govt. creates a universal catastrophic care system, then all those essentially healthy people will opt out of the already expensive coverages offered through their employers and rely on the universal national coverage. This then reduces the pool of people who pay premiums from the traditional coverages w/out really reducing the cost to provide for the remaining insureds. Guess who makes up the difference.

Ultimately, IMO, any national healthcare policy will end up being the world's biggest HMO with govt. bureaucrats as medical gatekeepers. To ensure the current number of uninsured for even just catastrophic coverage, I am betting that tax for "premium" would be significant and, further, as a side cost, the premiums for traditional insurance would increase for those who don't rely on the "National HMO".

So yes, universal coverage is absolutely possible. For the lower incomes it will provide minimal coverage where no coverage existed. For the vast number of middle incomes it will, IMO and in the long run, reduce coverage and quality of care and increase costs. For those with high incomes, their will be little or no effect other than to decrease their disposable income.