As for my personal "solution" to the health care problem in the US, here's a brief outline; for elaboration and my responses to critiques of such a plan, see
this thread, beginning with post #17. But here's the gist of it:
People should still have health insurance, but it will be more akin to catastrophic coverage (which has largely been discontinued for single payers, iirc, due to its lack of profit margin for the insurance co's). I would propose a model whereby people would have to pay for their health services up until a pre-set deductible, which would be based upon their income bracket. After that amount, insurance would take over and (hopefully) cover the rest, or at least a reasonable amount (unlike what occurs presently).
So, for example, take the following income brackets and what I feel a reasonable deductible would be for people in said brackets to pay to their physicians:
$15-20K Income = $150-250 deductible
$55-60K Income = $1000-1800 deductible (it's not proportional to the previous case due to sustenance costs which more greatly affect those in lower income brackets)
$85K Income = $2200-3500 deductible
$120K Income = $6500 deductible
I feel that this would be a fair system for several reasons: first, it would allow primary care physicians to finally have fee-for-service again, benefitting their bottom lines and allowing them to give the sort of care that all patients desire, rather than having to rush through patients assembly-line style in order to keep their practices solvent; secondly, those who are earning $60K per annum can
certainly afford to pay $1800 for their medical costs (realistically, the only time costs would ever get to that point would be the rare procedure or expensive diagnostic test, which would be needed perhaps once or twice per year if that). I say that they can afford it because these largely comfortable middle-class people don't hesitate in the slightest to shell out $400 for a battery of tests for their dog at the vet, or $800 for a new TV set, or $150 on a dinner, or $350 for their plumber, or $1000 when the coils blow on their car. Yet these same people, by and large, want to be able to go to their primary care physician and hand over the insurance card and a $10-15 co-pay. That is injustice right there, I'm sorry; it cannot be philosophically defended. A person's health is presumably more important than entertainment, or cuisine, or even their pet's health, yet they have no qualms in denying a physician, who is among the most skilled and dedicated of professionals, his due compensation. The sense of entitlement in this country is shocking, and that definitely contributes to this sentiment among the populace; also, however, I do not believe that the majority of people understand how primary care (and ER and other) docs are being squeezed at the moment-- if they did, I do believe that many of them would be more amenable to such plans, or at least with throwing some extra cash or a check their doctor's way after a visit.
It would also benefit insurance companies, as their payouts would decrease, if only due to the fact that they would no longer have to reimburse primary care physicians except in the most exceptional of cases where the cost of care ran over the pre-set deductible. Since the incidence of more expensive procedures such as surgery should remain relatively constant, insurance companies will be able to generate larger profit margins if they keep their premiums steady. However, what would most likely have to ensue is 1) sufficient education of the consumer/employee as to the reasons for the new cost structure, and 2) at least a slight reduction in premiums to account for the company's decreased financial liability for all sorts of primary care. I do honestly believe that most people would be accepting of such a system so long as they are comforted by the knowledge that their medical costs will never go beyond their reasonable means. For instances of extended hospitalization etc. (where costs would go quite far beyond the deductible, not merely a couple of thousand dollars), perhaps a system could be worked out where for every $X in costs incurred, the patient has to pay a certain amount. So, say, for every $10K in costs incurred above the deductible (but
only once cost has gone above $10K beyond the deductible), the patient may have to chip in another $1000 or so (this would, ideally, also be tied to income bracket in my opinion, so the less fortunate pay less and the more well-off pay more).
Also, those who legitimately cannot afford to pay even for primary care service-- either because their income falls below the $15K level or they are currently unemployed-- should not be denied care despite their inability to pay. I feel that if all of the above policies (conceived in haste, but that's the general idea) were implemented, most, if not all, physicians would not have any problem with treating the occasional non-paying patient. Hell, in many cases, they do so now, and actually LOSE money on the transaction with the insurance company. The problem with the current system is that, since
everybody is covered by these ludicrous plans, the physicians cannot recoup the costs anywhere else; in the proposed plan, they'd be able to recoup these costs from the people who can actually afford to pay.
I believe education is the key to this plan, and I've begun it in my own way by speaking to my family about the realities of the current system. My family's combined income is around $60-65K before taxes, and my mother is one of the aforementioned folks who will glady (well, not gladly, but she's done it) drop $600-1000 on my dog at the vet when he's sick, but still hands over a $10 co-pay at the doctor's office. Now, it's not because she's greedy, or feels entitled-- it's because she just doesn't know any better; I'd wager most people don't. I've already told my mother and father that it wouldn't kill them to throw another $20-30 (in addition to the $10 co-pay and the pittance the insurance co. reimburses the doctor) to the doctor when they have to see him once every 2-3 months. We're not going to starve. But medical professionals who've worked so hard for so long and are dedicated, caring (for the most part), and knowledgeable (and saddled with debt in many cases) deserve their due. I'm sorry.
Just my two cents.
This is not to say that such a plan is perfect-- no plan is. One legitimate criticism of it would be that people would say "why should I pay twice for my medical care-- once to my insurance co. and once to the physician?" My short answer to that would be: People did that for decades. Catastrophic coverage was the dominant paradigm for health insurance up until the early-mid 90's. What, precisely, about human nature, the concept of service provider/consumer/payment for services rendered, or the expertise of doctors has changed in that time which now entitles you to essentially "free" care on the backs of physicians who are making less and less after having dedicated, in many cases, nearly a decade in post-graduate schooling to their profession? Answer: Nothing has changed except people's biases and expectations, which is why they have to be re-educated on such matters. When the catastrophic coverage model was dominant, self-reported customer satisfaction with the medical system was actually at an all-time high, especially as compared with today. But my above system is by no means perfect; then again, is our current system perfect? Hardly. Can anyone propose a flawless system? Doubtful, but I'd be quite open to hearing it if you can. What I've outlined above is simply the fairest system I can conceive of for all involved parties; I feel it strikes an appropriate balance where there currently is none. Obviously all notions of "fairness" are inherently subjective, and so I clearly leave myself open to charges of bias and/or skewed notions of propriety. But I would argue we all do to one extent or another.
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So that's my idea, for what it's worth (which may not be much).
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