The Universal Cure (NYT)

[Missouri Mule]

Clearly something must be done. Even Rush Limbaugh has said so and that's good enough for me. Our insurance costs us $1,300 a month and we have another $7-8 thousand in out-of-pocket costs per year. What cost me $29 in 1968 cost about $5,500 last year when I had a similar procedure.
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The New York Times

The Universal Cure
By EZEKIEL J. EMANUEL and VICTOR R. FUCHS

Published: November 18, 2003

The public has good reason to be worried about health coverage. After five years of relative stability, insurance premiums, prescription-drug prices and other costs have soared. This year, premiums went up nearly 14 percent, with those paid by employees increasing nearly 50 percent since 2000. The number of Americans without health insurance increased more than 5 percent just in the last year. And strikes by workers in Los Angeles and elsewhere showed that health coverage is the flashpoint of labor discord.

As a solution, many policymakers are advocating small reforms like a Medicare prescription drug benefit and expansion of the Children's Health Insurance Program. Unfortunately, more services for some groups may increase costs and force reductions in coverage for others.

What we need is a fair proposal that is simple, efficient and appealing to disparate constituencies. For more than a decade, as members of the medical and economics communities, we have advocated such an alternative: universal health care vouchers.

In a morally responsible country, everyone should have health insurance. Each family or individual would be given a voucher to purchase a policy that covered basic services, including doctor visits, hospitalization, pharmacy benefits, some mental health and dental care, and catastrophic coverage. People who want more services, like wider choices of specialists, could pay a premium over the basic voucher...

(SNIP)

http://www.nytimes.com/2003/11/18/opinion/18EMAN.html?th

[JD3]

This is a major problem. I get telling folks this. But the rhetoric makes it hard to have a real debate in this country. but it won't get better until we do. And any answer won't make someone happy.

[Missouri Mule]

I would point out that I have a good doctor, a decent hospital and immediate access to medical care but it is so grossly inefficient that it makes me ill. Yesterday I went to the hospital to clear up a measly $75 bill we had received. Well this was the third time I had received the bill. But we didn't owe it. We had insurance; actually two insurance companies involved. My wife had her group insurance at work (primary) and we kept our insurance from our previous employer (State of Missouri) that we pay dearly for. The primary said it wasn't covered because she had already exceeded her limits for this year. Fine, it should have been sent to the secondary insurance company. But it wasn't although I was told it was. Finally I had to go to the actuall billing office where I found it had been sent to the wrong address where it most likely was sitting on some clerk's office wondering what she was to do with it. How much money has been wasted here? Probably more than the bill was for, not counting my time and aggravation. Yesterday got another bill for $83 and I'll have to do the same blankity-blank thing to get it straightened out.

Is this anyway to run a medical care program? All the politicians do is make noise but they never do anything to fix it. And this is where we need campaign reform so we have citizen legislators up in D.C. to actually do the "people's business" for a change.

[Simon666]

Why can't the law determine upper limits of the money to pay by doctors for medical mistakes. Over here we have guidelines way lower than in the US. Doctors could then have to charge lower prices as they have to pay less insurance. And are there quota on the number of students that are allowed to study for doctor? In Belgium we have an excess, keeps the price down. I pay only 40$ a month or something for my medical insurance, I would have to check. We do pay a lot more taxes though.

[Missouri Mule]

Why? We have a free market system at the current time. This would be price controls and they have not worked well in the past. I don't think the answer lies there. But it is a problem that must be confronted by Congress. One thing I have always said would be a good idea is that the prices for medical procedures ought to be posted prominently in the doctor's offices. They should be clear and they should be uniform. A lot of the problems have been wrapped up in the medical malpractice suits. That is a big problem.

Right now I am about to change my cell phone service. It is almost an impssible situation to know the true cost. As a consumer I am going to have to hold their feet to the fire and get them to come clean with me. We should do the same with medical care providers.

[steve_in_mich]

Originally posted by Missouri Mule
One thing I have always said would be a good idea is that the prices for medical procedures ought to be posted prominently in the doctor's offices. They should be clear and they should be uniform. A lot of the problems have been wrapped up in the medical malpractice suits. That is a big problem.


You're on the right track - if we're going to reform health care rather than just find someone else to pay for it we need it to become more consumer driven.

I have no idea how much it cost for both of my children to be born. Why? Because my insurance covered 100% of it and I never saw a bill. Were the charges reasonable? Did they overcharge me for anything? I truly have no idea.

Even if my insurance plan didn't change at all, but I had to pay the initial costs for minor medical and then got reimbursed I think it would help. When people take money out of their own pocket they are much more likely to scrutinize what they are being charged.

Tort reform would have a major impact also.

[JD3]

Originally posted by steve_in_mich
You're on the right track - if we're going to reform health care rather than just find someone else to pay for it we need it to become more consumer driven.

I have no idea how much it cost for both of my children to be born. Why? Because my insurance covered 100% of it and I never saw a bill. Were the charges reasonable? Did they overcharge me for anything? I truly have no idea.

Even if my insurance plan didn't change at all, but I had to pay the initial costs for minor medical and then got reimbursed I think it would help. When people take money out of their own pocket they are much more likely to scrutinize what they are being charged.

Tort reform would have a major impact also.

How much money do you think the average working joe has to pay up front?

This matters. For some, this would be no big deal. For others, this is major. And if people can't afford care or insurence, and I believe that will be the case for a certain number (I am not sure how large that number will be), do we let them go with out?

While I agree to some reasonable tort reform, like getting rid of rediculous lawsuits, you have to have legal recourse for incompetence. And really, the only medical professions really suffering are OBGYN and Peds. People don't like kids dying and they constantly seek legal recourse.

[Missouri Mule]

We're going to need some politicians with some backbone who will stand up to the medical care lobby and pharmaceutical companies. The companies bellyache about how much it costs to develop new products but their sales costs exceed their R&D.

[Simon666]

Originally posted by steve_in_mich
I have no idea how much it cost for both of my children to be born. Why? Because my insurance covered 100% of it and I never saw a bill. Were the charges reasonable? Did they overcharge me for anything? I truly have no idea.
That's insane. No wonder it is going wrong if it is 100% covered. Over here, the state pays a large percentage of the cost, the rest is still for the consumer so he/she will still try to keep the price down.

[Missouri Mule]

I agree with you Simon.