Health Care is Easy...

King of the Americas

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Seriously, I have figured it out. It took me a year in grad school, but if you want, I'll help you set up a 501(c)(3) that operates as a non-profit health care savings cooperative, for your hospital district.

The model I developed for my district requires enlistees to pay a marketplace average premium price for their particular demographic, for one year. This subscription price is intended to create a fund large enough to sustain catastrophic loss. Private insurance premium prices current include- care or claims, administrative overhead, legal services, taxes, advertising, as well as profit. Government services can do the same more efficiently, because it can eliminate some of these cost drivers.

If your board members are required to volunteer, you can eliminate ALL of those problems...

After paying one year's marketplace premiums, subscribers become full-members, who's monthly premium is based on the actual health care services and medications consumed by the group the previous year.

The present re-imbersement model hospitals deal with from Medicaid, Medicare, and private insurance sources is..."inconsistent"... Hospitals actually have to do a lot of outright guessing when it comes to setting their prices, because they get repaid for the same procedure, at a different rate, depending on who is paying for the services, NOT what care the patient actually receives... As a non-profit, your organization can serve a single hospital, and negotiate/offer to pay 100% of all actual services consumed, at not only their actual price...because the hospital itself can get a tax deduction at the end of the year for donations made to non-profits!

Within your bylaws, you should include another requirements for members like 2 yearly check-ups and annual physical. This is intended to accomplish two things- early detection & create data. The data is really important as a long term cost reducer, as the ability to predict who will arrive at the hospital is the single piece of criteria missing most often.

When government and the marketplace fails, people ban together to form social groups, and the tax code both allows and encourages these actions. If you want to pay the lowest premium cost, while helping your hospital better prepare to serve your needs, create a non-profit health care savings cooperative.

Anyone here a fan of Alexis de Tocqueville?
 
You haven't solved anything anything. There would still be many people that would not be able to afford insurance.

And any kind of health insurance scheme needs large amounts of people to buy insurance without using it much in order to pay for the treatment the sick people need. But those that need insurance the least have the biggest incentive to not buy it. While those that need it have the most incentive.

How would a co-op make sure that enough healthy people buy insurance? They probably couldn't. The members would end up being disproportionately sick, which would force the co-op to increase premiums, which would in turn give healthy people less incentive to buy insurance.

Also, have you never heard of Kaiser Permanente? It is a 501(c)(3) that goes further than what you propose. Not only do they handle the insurance, they own the hospitals and employ the doctors (who are paid a salary). I believe they do a good job, but they still have plenty of competition from regular insurance companies and hospitals.
 
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Tony Stark said:
And any kind of health insurance scheme needs large amounts of people to buy insurance without using it much in order to pay for the treatment the sick people need.
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This seems like such a simple and obvious concept to me, but it's the part that a lot of "fixes" to Obamacare leave out. Not just armchair stuff, either - actual people in charge of policy. How is it that people don't get this part?
 
SOdhner said:
This seems like such a simple and obvious concept to me, but it's the part that a lot of "fixes" to Obamacare leave out. Not just armchair stuff, either - actual people in charge of policy. How is it that people don't get this part?
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They get it, all right, but their goal is not to cover everybody; it's to reduce government spending and lower taxes, which means kicking off as many people as possible who need Medicaid, who have pre-existing conditions etc.
 
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Bob001 said:
They get it, all right, but their goal is not to cover everybody; it's to reduce government spending and lower taxes, which means kicking off as many people as possible who need Medicaid, who have pre-existing conditions etc.
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Sure, but the plans being proposed are going to cause a total disaster due to not understanding this simple concept, and even if that's what the lawmakers want it seems like much of the general public don't get it.

Though maybe I'm mistaken?
 
Tony Stark said:
You haven't solved anything anything. There would still be many people that would not be able to afford insurance.

And any kind of health insurance scheme needs large amounts of people to buy insurance without using it much in order to pay for the treatment the sick people need. But those that need insurance the least have the biggest incentive to not buy it. While those that need it have the most incentive.

How would a co-op make sure that enough healthy people buy insurance? They probably couldn't. The members would end up being disproportionately sick, which would force the co-op to increase premiums, which would in turn give healthy people less incentive to buy insurance.

Also, have you never heard of Kaiser Permanente? It is a 501(c)(3) that goes further than what you propose. Not only do they handle the insurance, they own the hospitals and employ the doctors (who are paid a salary). I believe they do a good job, but they still have plenty of competition from regular insurance companies and hospitals.
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Haha, we can accept tax-free donations, and extend coverage to those who can't qualify otherwise!

Yes, I have heard of that model. Mine is a form of how they began.
 
SOdhner said:
Sure, but the plans being proposed are going to cause a total disaster due to not understanding this simple concept, and even if that's what the lawmakers want it seems like much of the general public don't get it.

Though maybe I'm mistaken?
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The Repub lawmakers might or might not know, but they clearly don't care. Some part of the public, including in Trump Country, is starting to realize what they could lose, and that's why some congressmen are starting to worry about 2018. But it's a foundational Republican premise that there are "makers" and there are "takers," and the takers shouldn't get a damn thing from the makers.
https://www.washingtonpost.com/news...grams-that-affect-up-to-a-fifth-of-americans/
https://www.washingtonpost.com/graphics/politics/trump-budget-benefits-cuts/?utm_term=.14687c88efe2
https://www.washingtonpost.com/news...ugh-to-be-poor/?tid=hybrid_collaborative_2_na
 
Yeah, its easy, health care is 17% of GDP, so your health care premium should be 17% of your income.

Problem solved
 
King of the Americas said:
Haha, we can accept tax-free donations, and extend coverage to those who can't qualify otherwise!

Yes, I have heard of that model. Mine is a form of how they began.
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So, ...

Your plan to cover poor people is to have rich people donate the money that is needed to pay for the coverage of the poor people.

For some reason, I would not expect such a plan to be successful.
 
So is Middle East peace.

So is Middle East peace according to the orangutan.
 
Tony Stark said:
And any kind of health insurance scheme needs large amounts of people to buy insurance without using it much in order to pay for the treatment the sick people need. But those that need insurance the least have the biggest incentive to not buy it. While those that need it have the most incentive.
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This.

You only can have an affordable health care system if you simply require everyone to buy insurance.

Secondly, on top of that, you need a risk equalization pool. For instance, in the Netherlands, 50% of the funding of healthcare insurance is collected by the Tax Office and distributed among the (private) insurers based on the risk profile of their clients. If you leave out this essential part, insurers will try to game the system and only/mainly attract young, healthy clients in order to make a hefty profit. Or you could just do away with the insurance part and go for an NHS-style system (or "Medicare for all").

ETA: and really, we've discussed all this ad nauseam on this forum when Obamacare was in the works.
 
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Crossbow said:
So, ...

Your plan to cover poor people is to have rich people donate the money that is needed to pay for the coverage of the poor people.

For some reason, I would not expect such a plan to be successful.
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No my plan if for a social group to share coolly the costs of the actual care and services their group receives.

My plan eliminates ALL of the cost drivers not direct associated with health care.
 
King of the Americas said:
No my plan if for a social group to share coolly the costs of the actual care and services their group receives.

My plan eliminates ALL of the cost drivers not direct associated with health care.
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Due to your poor spelling, your incoherent writing and your lack of understanding of the issue that you speak of makes me think that your OP is quite incorrect.
 
King of the Americas said:
No my plan if for a social group to share coolly the costs of the actual care and services their group receives.

My plan eliminates ALL of the cost drivers not direct associated with health care.
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How big is your group? What are you going to do if some members require expensive, long-term care for chronic conditions? State-wide premiums for one company just went up in Iowa partly because one patient was racking up bills of $1 million per month. Can your plan handle that? And how big is your provider network? Will a large number of local doctors and hospitals accept your plan? Or are your members restricted to using one hospital and the docs who practice there?
 
My plan is even easier than all that. You choose any provider you want, go to them for treatment and then pay them. Kind of like how we deal with food distribution and housing. We have a safety net for the poor and everyone else pays for what they use. You can't get simpler than that.
 
xjx388 said:
My plan is even easier than all that. You choose any provider you want, go to them for treatment and then pay them. Kind of like how we deal with food distribution and housing. We have a safety net for the poor and everyone else pays for what they use. You can't get simpler than that.
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Seems something is missing. Perhaps you could give us the conservative solution to that there "safety net" you're speaking of. Or perhaps we're heading for yet another "Who knew how complicated health care is...." moment?
 
xjx388 said:
My plan is even easier than all that. You choose any provider you want, go to them for treatment and then pay them. Kind of like how we deal with food distribution and housing. We have a safety net for the poor and everyone else pays for what they use. You can't get simpler than that.
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The difference -- and don't even pretend you don't understand this -- is that subsistence food and housing can be paid for by someone earning relatively little money. Even a penniless, homeless person can survive in shelters and soup kitchens. But the costs of health care are literally unlimited. Premiums on the Iowa exchange just went up because one patient with a severe chronic illness is costing $1 million a month. And someone who can't afford basic preventive care is likely to put off treatment until he lands in an emergency room, where he gets uncompensated care paid for by everybody else.

What is your objection to the basic premise of insurance? Everyone needs health care, if not this week or even this year, then sooner or later, and if you're unlucky you'll need treatment for cancer or heart disease or getting run over by a bus. Sharing costs across the widest base is the only way to guarantee that everyone will get the care he needs when he needs it. If you want to argue that health care is a luxury good, and someone who can't afford it doesn't deserve it, you won't find much support outside the Freedom Caucus, and even they are starting to smarten up.
 
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Bob001 said:
How big is your group? What are you going to do if some members require expensive, long-term care for chronic conditions? State-wide premiums for one company just went up in Iowa partly because one patient was racking up bills of $1 million per month. Can your plan handle that? And how big is your provider network? Will a large number of local doctors and hospitals accept your plan? Or are your members restricted to using one hospital and the docs who practice there?
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Seems like you can never find a death panel when you need one.
 
Foolmewunz said:
Seems something is missing. Perhaps you could give us the conservative solution to that there "safety net" you're speaking of. Or perhaps we're heading for yet another "Who knew how complicated health care is...." moment?
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We have had a medical safety net for a long time now. No need to reinvent the wheel, just maybe improve it a bit.
 
xjx388 said:
We have had a medical safety net for a long time now. No need to reinvent the wheel, just maybe improve it a bit.
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The "safety net" is that emergency rooms are required to keep people alive if they can, and some states allow some people to enroll in Medicaid if they can meet tough restrictions. The other alternative is that people get expensive care billed at retail rates, then declare bankruptcy. There is no safety net for the working poor who need treatment for major issues or chronic conditions -- and "working poor" could include pretty much everybody without insurancei if life happens. I repeat, what is your objection to the basic principle of insurance? Or do you think people who can't afford to pay for care out of pocket just shouldn't get it?
 
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Bob001 said:
The difference -- and don't even pretend you don't understand this -- is that subsistence food and housing can be paid for by someone earning relatively little money. Even a penniless, homeless person can survive in shelters and soup kitchens. But the costs of health care are literally unlimited.
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So really, the key is determining what the functional equivalent of "shelters and soup kitchens" is in healthcare.
Premiums on the Iowa exchange just went up because one patient with a severe chronic illness is costing $1 million a month.
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That brings up the next couple of questions: Why does that condition cost so much? Should a healthcare system be expected to meet every need of every citizen regardless of how much it costs?
And someone who can't afford basic preventive care is likely to put off treatment until he lands in an emergency room, where he gets uncompensated care paid for by everybody else.
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If they are poor, I agree that we should reform Medicaid to cover anyone in poverty; Medicaid is too limited right now. If they aren't poor, then what do you mean "can't afford basic preventative care?" If you have no insurance, a yearly preventive visit will run you somewhere around $150. After that, the best prevention is extremely low cost: diet and activity modifications, don't smoke or drink, don't engage in risky behaviors, etc. Do that, and your risks of chronic illness are much lower.
What is your objection to the basic premise of insurance? Everyone needs health care, if not this week or even this year, then sooner or later, and if you're unlucky you'll need treatment for cancer or heart disease or getting run over by a bus. Sharing costs across the widest base is the only way to guarantee that everyone will get the care he needs when he needs it.
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I have no objection to the basic premise of insurance. The key word is "insurance." Insurance plans should insure against catastrophe. We shouldn't demand that it covers routine costs that are more efficiently delivered through a cash based model.
If you want to argue that health care is a luxury good, and someone who can't afford it doesn't deserve it, you won't find much support outside the Freedom Caucus, and even they are starting to smarten up.
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That's not my position at all. Insurance will be affordable when we stop expecting it to cover every possible medical expense we will have. So for most things, you pay healthcare providers directly in cash. The insurance plan will kick in if and when spending exceeds a certain level. Even then, however, it's unrealistic to expect insurance to cover unlimited expenses.
 
xjx388 said:
Should a healthcare system be expected to meet every need of every citizen regardless of how much it costs?
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Of course not - the costs would be prohibitive. Insurance should only cover minor illnesses that are cheap to cure. Expensive treatments with low benefit/cost ratio should be refused.

The insurance plan will kick in if and when spending exceeds a certain level.
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No no no no! You have it backwards. Coverage should be denied when costs will exceed a certain threshold. What benefits the most people - 50000 Viagra prescriptions, or one heart transplant?

The real problem with health insurance is that people expect treatment for major life-threatening conditions. But this is exactly what makes health insurance so expensive! The only way to significantly reduce costs is to just let all the really sick people die. Let's face it - most of them will eventually die anyway, even with treatment.
 
Roger Ramjets said:
Of course not - the costs would be prohibitive. Insurance should only cover minor illnesses that are cheap to cure. Expensive treatments with low benefit/cost ratio should be refused.
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Or, we could have insurance pay only for the really expensive stuff while individuals pay for the cheap to cure stuff. The problem arises when we expect insurance to pay for every little thing even tangentially related to health.

No no no no! You have it backwards. Coverage should be denied when costs will exceed a certain threshold. What benefits the most people - 50000 Viagra prescriptions, or one heart transplant?
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Hows about no Viagra coverage? Eliminate coverage for anything but catastrophic lhealth events.

The real problem with health insurance is that people expect treatment for major life-threatening conditions. But this is exactly what makes health insurance so expensive! The only way to significantly reduce costs is to just let all the really sick people die. Let's face it - most of them will eventually die anyway, even with treatment.
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Yes, exactly! Insurance should only pay for cheap insignificant things that most people can afford! Why should insurance protect people against the stuff they can't afford? So glad we are on the same page here....
 
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