2 thoughts on “Why It Seems Nobody Can “Fix” Health Care in the US”

  1. Good points, and I certainly think *something* should be done…but when applied to something like medical care, ‘one size fits all’ plans tend to leave everyone with an ill fitting garment, and I have concerns with Medicare in and of itself, much less expanding it so everyone relies on it. I’d much rather go with an option that leaves the marketplace as an option (which could be done with Advantage and/or supplement plans).

    As I see it, the problem of a 20% deductible, Lifetime Reserve Days, and the unsustainably low rates of reimbursal for providers* would leave a whole lot of people in the cold and wishing they had their private insurance back. Maybe the aforementioned Advantage and supplement plans could make up for the issues I have with it, but I’d want *something* in place that let me have more than just a single choice. You can’t fire CMS if they’re doing a bad job, and while you can fire the politicians, the people at the agency that is failing to provide proper service will remain.

    *CMS tacitly admits its payment rates are too low by providing additional funds to hospitals that have a greater than normal percentage of Medicare and Medicaid patients; they’re called disproportionate share hospitals.


  2. At some point, we need to admit that insurance, meaning a group of people pooling premium to cover extreme risk, with premiums tied to the expected losses for that group, is not the right mechanism to pay for the health care of some portion of the population, those with high certain costs or conditions that greatly increase the chances of large claims. Any “health insurance” for this group is essentially charity or social insurance.

    Given that we generally want this group to get health care and for health professionals to get paid for providing this group with health care, we need to decide how to pay for it. One approach would be social insurance paid out of general revenue, spreading the costs over the entire population. Another approach would be a high risk pool, paid for out of health insurance premium taxes, which would spread the costs over a smaller population. A third option would be to have guaranteed issue individual insurance while maintaining the loss ratio requirement, which would spread the cost of providing this health coverage to a much smaller population, those who purchase individual insurance. That sounds like such a stupid idea that the only conclusion I could draw is that it was chosen to guarantee failure, thus allowing certain political types to declare health insurance a failure, and push for single payer.

    Something that sounds reasonable to me is for us all to decide that individual or group health insurance is the right funding mechanism for health care for X% of the population, say 80%, perhaps with multiple standard plan designs like what currently exists for Medicare Supplement insurance. Go back to underwriting the risk, and have some level of substandard rates. For the 1-X% too sick for health insurance, make Medicare the insurer of last resort, with some premium level higher than individual insurance, but much lower than the actuarial value of insurance (1/0.8 times expected claims if an 80% loss ratio is the standard).


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