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The Implosion Cometh Early

  • brdcstr1 is still upset with me because i suggest that sanchez would have done a better job than JDB in 06 & 07.

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • not bad. but it seems similar to the current system. there is a tax deduction currently although indirectly.

    i guess people with high costs get screwed in your system. but i follow you

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • Actually, it would be nothing like the current system, and those with high costs would not get screwed unless they are long-term high-medical need cases.

    The big difference is that there would be a tremendous increase in market-oriented competition along with dramatic decreases in bureaucratic morasse. When a doctor charges a fee, it gets paid for directly by the patient. No submitting to insurance companies, who then fiddle around with it, eventually dis-allowing various parts, and then re-submitting, etc. No situation where you turn your decisions and payment over to some big bureacracy, with little to keep the patient from over-using the system, or lacking respect for the cost of services by not taking advantage of the things they are paying for, indirectly, and vaguely. The industry would be dramatically more appealing to participate in as a doctor, where your client is your patient, and you have more freedom out from under bureacracies determining what you can and can't do. As a result, I would predict more people going into medicine. I would even be fine with making more alternative medicines approved to use HSA money on, rather than the current limitations by insurance companies. I have said in the past, I would be willing to have some "tax" or fee placed on all of the major medical policies that is intended to help those with long-term needs, which would fit within the context of pooling risk.

  • sounds good greg. you sure seem to know a lot about this issue. tell me, what would the detractors of your system say is the weakness of your system?

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • Long term needs folks, and in particular, those with pre-existing conditions with such long-term needs. No doubt about it. To be honest, I have not thoroughly hammered this element out, but the total number of people impacted is relatively small, and that's why I would be OK with some form of fee tacked on to all major medical policies to help cover such folks. I would still like for them to be covered by a private system, if possible, but it might have to be more of a public system. Like I said, though, the numbers would not be huge, with the biggest problems with our system covered by the HSAs and major medical.

    By the way, the foundation, the first step, for my system is moving the deduction from the employer to the employee. That would immediately create more flexibility. I have no problem with individuals opting for more comprehensive policies if they like, and moving the deductible over to the patient/employee from the employer would provide that flexibility. You could also have pools created by any number of groups (professional, social, clubs, etc.) that might want to still go into bigger group plans, but having them directed and controlled by the patients/users, rather than employees. I just think, on a personal level, that it makes most sense to get people to be paying, out of pocket (or out of HSA) for most of your medical care.

  • Great thread. Thanks swr and Greg.

    signature image

    "Dude looks like a friggin rock star" - TrojanWarrior1 on Dzhokhar Tsarnaev

  • Without employer paid wouldn't there be a lot more people who forgo insurance?

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • Ok. Take me through an example. Low income woman with diabetes. Needs lots of hospital trips for diagnosis, work out which meds won't interfere with other meds etc. Then she gets an ear infection. She could go again to the doctor but her allowance is tapped out. Couldn't that lead to a burst eardrum and higher costs incurred at the catastrophic level? Do you see what I am getting at? Isn't there a possibility that, especially low-income folks, will have to pay higher costs because of the environmental factors that lead to their illness and might be worried about exceeding their ability to afford doctors visits leading to higher, more serious costs due to underaccess at the primary level?

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • Thanks for your kindly words. What are the twenty year numbers? I'd be intrigued to know...

    Some context for the new numbers, good and bad:

    On high-deductible options under ACA:

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • Employer-paid is kind of dumb. The ever-higher costs are reflected in lower wages. There are benefits to bigger firms over smaller ones. And changing jobs or being unemployed is problematic. There is no reason for it other than historical coincidence.

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • Greg's really helped my thinking on this stuff. Much better than the threads with the usual 'all libs blah blah' or 'George Bush hates black people' nonsense!

    This post was edited by swr22 2 years ago

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • I not sure dumb is the right word and I wouldn't call it coincidence. It's based on history and law. I agree it seems quaint. I would guess without it there would be an even bigger (maybe much) problem with uninsured. It's kind of like a minimum wage in that it's artificial. I do like gregs theory of doctors getting paid more directly.

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • "Obamacare", or 2 unfunded wars. We don't have the $ for either.

    You people better stop complaining about the president, lest his A-G come to give you some "due process" way of predator drone.

    This post was edited by oldtrojan 93 2 years ago

  • It is dumb, hardly "quaint". It was the result of people logically trying to circumvent government intrusion, admittedly during a time of war, in the private sector, rather than any logical, efficient way to pay for health care. ANY reasoning in favor of the stupid system ended at the end of the war. Why in the world do we want others to take our money and pay for things, limited by the logistics of buying for full companies and without our own values and motivations, rather than just letting us do it ourselves? It would be impossible for an employer or an insurer to have the ability or interest in giving us the flexibility we would like, or actually shop around on a case-by-case basis, like the individual consumer could/would do. It takes away the patron/client relationship, which ensures the customer is treated well. The pooling makes sense for major medical needs, but it leads to excessive spending on non-major medical use such as trivial office visits, non-essential medicines, etc.

    I'm really glad you are open to listening to this stuff, it sets you apart from so many that seem to really believe there is such a thing as a free lunch, or that government management of our lives is the best way. I can tell you are someone who is willing to work hard, has pride in your own production, and responsible for himself. I believe we, as a society, have gone too far in taking care of those not willing to work hard or be responsible for themselves, often enabling such behavior. Sometimes, the best thing we can do is challenge people to do better, and the result is a more productive, happy person. The challenge is, finding that balance between helping those truly in need, without enabling/encouraging others to fall into "need", and over-burdening the productive and pulling us all down.

  • Absolutely. I have never claimed to have it all figured out. There are elements/considerations that still need work. But I believe these are absolutely exceptions to the norm. And while they are exceptions, we certainly must make an effort to find a solution to them. Part of the solution, as I have said, is to have some form of safety net system, possibly clinics staffed by medical/nursing students and recent grads, as interns, obviously, along with seasoned professionals. The point being have relatively stripped-down clinics, not claiming to the be the best service, but certainly qualified and competent, to handle regular medical care for those not able to cover their own costs. Whether that be someone not at all able to pay for their needs on a long-term basis, or those that find themselves in a situation like you postulate. They may not have as nice of waiting rooms, they may have to wait in the reception room longer, and they may not have as much variety. But they would have service, and those clinics could refer out to private sector care for those services they do not cover.

    The big point that sometimes gets forgotten when we are talking abou this stuff is that more than 80% of us can and would handle the vast majority of our regular care through a system of HSAs and Major medical insurance, and by doing so, I truly believe the vast majority of our medical care costs would drop dramatically (particularly when adding in tort reform). So, those things that we currently see truly outrageous costs would also come down, which would make dealing with these issues even easier than they look right now.

  • Fair enough. Thanks for the answer.

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • Interesting story by Sally Pipes today (


    "Massachusetts Gov. Deval Patrick just exhorted legislators to overhaul the way the state pays for health care. He’s pushing for an end to the traditional arrangement of compensating doctors and hospitals for each service they provide.

    It’s not yet clear what will replace this “fee-for-service” payment system. But there’s growing support for a “global budget” model, under which primary care physicians would receive annual lump sums for each of their patients - regardless of how little or how much care they needed.

    The move toward global budgets highlights the failure of Massachusetts’s 2006 health reform plan to make health care more affordable. Because the Bay State’s plan served as the template for President Obama’s health reform package, the consequences of that failure could soon be felt nationwide.

    A new report from researchers at the University of Minnesota details the magnitude of Massachusetts’ health reform catastrophe. They interviewed more than 3,000 state residents in 2010 and found that “Massachusetts continues to struggle with escalating health care costs, reflecting the decision to defer addressing costs in the 2006 legislation.”

    The study revealed that the share of insurance premiums for family coverage paid by the average worker jumped more than 10 percent since 2006. Half of respondents said that they were spending more on health coverage in 2010 than 2009. And a quarter weren’t confident that they could afford care the following year.

    About 1 in 4 respondents reported delaying treatment because of concerns about cost. That share is up from 2006. And 1 in 5 adults had problems paying medical bills - the same percentage as in 2006. “There was no sustained improvement in problems paying medical bills,” the researchers wrote.

    The Bay State reform effort did expand coverage and improve access to preventative care. But the rapidly rising cost of care has counteracted these benefits. As the researchers politely put it, it’s “likely that the economic downturn and the continuing increase in health care costs … dampened any gains in coverage and affordability that might otherwise have been achieved under health reform in the state.”


    Between 2006 and 2010, average employer premiums increased from $1,011 to $1,200 for single coverage, and from $3,128 to $3,444 for family coverage. If premiums continue to rise at this rate, state residents will see their take-home pay dwindle even more.


    Some policymakers believe that global budgets are the answer to this problem. Because doctors would receive a flat annual fee for each patient, they’d have a direct financial incentive to keep their patients healthy - or more cynically - to limit the care they provide.

    That’s exactly what has happened in Canada, which implemented such budgets in the 1970s. Last year, Canadians were waiting to receive more than 941,000 procedures. The average total wait time between referral from a primary care physician and treatment by a specialist reached 19 weeks in 2011. That’s more than double the wait time in 1993.


    In 2006, then-Gov. Mitt Romney assured his constituents that “the costs of health care will be reduced” if his health reform package passed. President Obama made essentially the same assurances prior to the passage of his reform package, pledging that it would “bring down premiums by $2,500 for the typical family.”


    If anyone didn't already know, Sally Pipes has been a consistent attack dog on the ass of Obamacare. Just saying to be up front about the author.

    On the face of it, without looking up statistics, it appears the rate of increase in premiums in Massachusetts may be lower than that of America, on the whole. While that may or may not reflect any degree of success of RomneyCare (one must also consider other variables, such as demographics), it still shows that the plan is far from supporting the claims of what the plan would do by those crafting the plan, including Romney. I also believe the problem of jobbing is already huge in Mass, but is likely going to keep increasing.

    This whole idea of "global budgets" seem insane to me. Taking even more responsibility away from consumers holding their health care costs down, but now putting doctors in a position where they have little incentive to even see their patients, let alone spend much time on them. Nope, just pack more patients in, and to do so, limit the time you spend on each patient at any time.

  • Each service means over-treatment, each patient means throughput and undertreatment. Put people on a wage!

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • Absolutely.

    swr22 said...
    Put people on a wage!

    How would you structure the wages? Would they all be flat? Adjusted by cost of living in the various markets? Adjusted by education level, or amount of on-going continuing ed? Would the wage go up or down by some measure of successes or patient approval/demand? Anything to encourage the health care providers to provide better service, to be more efficient, or to go the extra-mile for a patient? Impacted by poor record or low approval?

    Also, how would you handle medications and the costs of divices/scans, tests, etc.?

    This post was edited by GauchoGreg 2 years ago

  • the needle in the haystack?

    What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • Three things to remember. First, as indicated, you have to consider other factors, such as demographics. Second, the conditions in Massachusetts (size/scope of the system, demographics, etc.) are MUCH more likely to support a system like Romneycare or Obamacare, than those of the nation as a whole. And, third, everyone admits the existing system sucks, and just because this case MAY currently be working better than the nation on the whole, it hardly means that it is a situation we should adopt for the whole country when there are much better options.

  • I shall have to look into how some hospitals do it at the moment. I do know, however, that the Mayo Clinic which gets high marks for care and patient experience have doctors on a wage.

    “Close tax loopholes that allow some of the truly wealthy to avoid paying their fair share,” Reagan vowed.

  • What is happiness? The feeling that power is growing, that resistance is overcome.--Friedrich Wilhelm Nietzsche

  • This story adds nothing. We all were discussing that the main reason the CBO revised its estimate is that they were simply being more honest in their reporting, using the full cost for a 10-year period, rather than a fraction of that period and claiming it was a 10-year projection. But the funny part of this article is the following:


    I want to be clear about something. The Affordable Care Act has flaws: Among other things, it reaches fewer people and provides less financial protection than I would prefer. The revised CBO report actually suggests this problem will get mildly worse, since it also expects slightly fewer people to end up with insurance. That’s one reason why the law will cost less; it’s helping fewer people. Another reason is that more employers pay penalties for not offering insurance and more people pay penalties pay penalties for not obtaining it. That's obviously not great, either.

    The report also had one finding that give us at least a little pause: CBO now projects the number of people with employer-sponsored insurance will drop by 4 million people, on net. It’s still a small effect, representing less than 2 percent of the total population with employer-sponsored coverage. That’s well within the margin of error of these models. It’s also difficult to tell why CBO thinks this will happen – whether it’s fewer employers offering insurance, fewer employees accepting coverage, or workers moving into firms that are less likely to provide benefits. Any of those would be consistent with lower economic growth, as CBO now expects. Still, the issue merits attention. (If I can get a more detailed explanation of why CBO thinks this will happen, I'll update this item.)"


    Guy is either being dishonest, or is a fool. This goes back to what I keep saying, the CBO is recognizing (with their increase in the estimate of the number of people who will lose coverage), although not NEARLY enough, that employers have more incentive to drop coverage than keep it, as will individuals. Seriously, how hard is it to understand that if it makes more sense to drop coverage than to have it, that eventually everyone will figure it out????? Why the CBO stops at 4 Million more people losing/dropping coverage is the real question.