What would you think about universal, high-deductible healthcare?

[Shyatic]

I had posed this idea a long time ago to friends just as a thought, but it's something I had griped about for years because I was one of the few people who didn't have insurance (at a young age). Long story short, my dad lost his job, there was no such thing as COBRA, my mother had a heart attack and we almost went bankrupt. I remember shuffling around clinics for getting my teeth cleaned and if I was sick, I had to suck it up...

Anyway, I like the concept of universal healthcare. As an adult now, my medical coverage is now excellent for myself and my family. I pay towards it, but it's very good.

Anyway, here's the jist of it... everybody pays taxes (in lieu of payroll deductions) to create a universal healthcare plan. However, based on your tax bracket that plan actually doesn't pay ANYTHING until you meet a reasonably high deductible (which is based on your income). So if you make 100k a year, then you have to incur $2000 of healthcare on your own before the plan kicks in at all. The numbers obviously are "for example", I'm sure it could be more considered and thought out if I put the math and time into it.

This benefits us in a few ways. First, everybody pays the SAME PRICES to doctors because the universal healthcare makes it a huge "group" rate to everybody. Insurance companies can still exist AND be choosy about who they allow on. For example, if you're a fatty, or smoke, or have cancer, they can reject you. Their purpose is to make money between the lines of zero and the deductible. And lastly, nobody goes broke due to lack of insurance.

That's it in a nutshell... thoughts?

 

[SammyJr]

This is essentially a variation on Medicare for all. Sounds good to me.

 

[MovingTarget]

/que the Wharrrrgarblsocialism!!! crowd...

Honestly, I think that it is a decent idea. It wouldn't fly in today's political climate though seeing as how the public option was discarded...

 

[fskimospy]

I've always thought that something similar was the best avenue for universal health care.

What I would implement would be nationwide, universal catastrophic coverage. If something cost more than X dollars (forgive me the details), it would be picked up by the government. All expenses below that however would be paid for through health savings accounts or something to that effect. That way we cut down on people getting treatment that they don't need while protecting people from catastrophic illness.

 

[Shyatic]

Well I've grown up in clinics so I know all the in betweens.. some old people go there because they are literally just lonely. Now they would have to pay for that company. But then there are really destitute, sick people there, and they get crap care because they can't afford anything better.

It keeps people running to the doctor for a cold (which nothing can be done about), so we stop raising a nation full of pansies, and still protects people from getting their life fucked if they happen to get sick, as was the case with my parents. I have a shitload of college debt, which I wouldn't have had if my mom didn't get sick and my dad was in between jobs.

 

[Shyatic]

I've always thought that something similar was the best avenue for universal health care.

What I would implement would be nationwide, universal catastrophic coverage. If something cost more than X dollars (forgive me the details), it would be picked up by the government. All expenses below that however would be paid for through health savings accounts or something to that effect. That way we cut down on people getting treatment that they don't need while protecting people from catastrophic illness.

I think this is ill advised, because if you don't factor in regular checkups and things for preventable problems, then you are just going to have a bunch of people with catastrophic problems ONLY, and at earlier ages.

I should mention that the universal healthcare takes care of regular checkups too, mammograms, etc. It's actually a cost fighting step in the long term.

 

[Ausm]

It would never happen because it would destroy the Healthcare for profit margin that the Rightist seem to embrace in here.

 

[Ninjahedge]

Actually, that idea is faulted in only one way.

You do not promote preventative care. You get sick, you tough it out and save $50.

Now if you get sick, then it goes to Bronchitis/pneumonia and you need to go to the hospital, you may be out the $2000, but we are also out the $1000 or so above that and ANY other medical expense you have that year.

You PREVENT what you can from happening (just like painting a bridge to prevent rust before having to do major repair) you save money.

So maybe you have a high deductible on emergency care?

(My plan is to just start out with preventative, and have people pay insurance for the low-risk, but expensive stuff. The NEXT step would be the high-deductible plan like you mentioned...)

 

[fskimospy]

I think this is ill advised, because if you don't factor in regular checkups and things for preventable problems, then you are just going to have a bunch of people with catastrophic problems ONLY, and at earlier ages.

I should mention that the universal healthcare takes care of regular checkups too, mammograms, etc. It's actually a cost fighting step in the long term.

Health savings accounts are tax advantaged, so people have an incentive to use them. The funds in them (to a certain extent) also must be spent within X amount of time, which means you don't get people just sitting on the money either. Things of this nature already exist.

You would of course also continue health programs for the poor, etc, and people who couldn't afford to pay into such accounts.

 

[rudder]

This is essentially a variation on Medicare for all. Sounds good to me.

Sounds good if you are not a whose doctor whose government reimbursements for services rendered keep shrinking.

 

[soulcougher73]

I think the general idea of that is great. It still allows private insurance for people who deem UHC below them or unsatisfactory for whatever reason. But have a deductible based on emergency care on income helps keep cost low vs. having no deductible and people abusing the system for every little splinter or scrape or cold. Keep preventative check ups etc free (well paid with taxes) but nothing out of pocket.

Sure their are many details to fine tune for the whole thing, but the basic idea behind it is very sound in my opinion.

 

[chucky2]

Health savings accounts are tax advantaged, so people have an incentive to use them. The funds in them (to a certain extent) also must be spent within X amount of time, which means you don't get people just sitting on the money either. Things of this nature already exist.

You would of course also continue health programs for the poor, etc, and people who couldn't afford to pay into such accounts.

That's sort of BS isn't it? I mean, if I put in the max into my HSA to cover my medical costs, but am lucky (or I guess one could say normal, since most don't incur significant medical costs too often), shouldn't I be able to just have my HSA money sit there w/o me having to constantly put more in?

If they're not spent within a certain amount of time, where do they go? Back to me? To someone else? If someone else, to who and why?

I'm thinking about an HSA btw but haven't really checked it out...that would suck if I have to keep putting in and the money just goes.....somewhere....

Chuck

 

[woolfe9999]

Health savings accounts are tax advantaged, so people have an incentive to use them. The funds in them (to a certain extent) also must be spent within X amount of time, which means you don't get people just sitting on the money either. Things of this nature already exist.

You would of course also continue health programs for the poor, etc, and people who couldn't afford to pay into such accounts.

Or just make the deductibles low for basic check-ups and preventive care. That would seem to address his concern.

 

[mattpegher]

It would never happen because it would destroy the Healthcare for profit margin that the Rightist seem to embrace in here.

It actually would not affect healthcare cost at all.

If you take a 1000000 people of all ages and habits. The amount that it costs gets averaged out. Medicare already covers the majority of people that would require catastrophic coverage. The number of people that would be caught by this safety net would be rather small.

Now if everyone that paid for medical care got the choice to have a high deductible plan and an HSA and was 100% invested in the cost (ie what they didnt spend they got in pay). Then we would see people being less wasteful of medical services, insurance companies would make less profit and doctors would have time to see people that really need our services.

 

[kami333]

Sounds pretty similar to a two tier universal healthcare system. More specifically, Singapore's Medishield.

 

[fskimospy]

That's sort of BS isn't it? I mean, if I put in the max into my HSA to cover my medical costs, but am lucky (or I guess one could say normal, since most don't incur significant medical costs too often), shouldn't I be able to just have my HSA money sit there w/o me having to constantly put more in?

If they're not spent within a certain amount of time, where do they go? Back to me? To someone else? If someone else, to who and why?

I'm thinking about an HSA btw but haven't really checked it out...that would suck if I have to keep putting in and the money just goes.....somewhere....

Chuck

I was thinking more that there would be some sort of tax penalty, I just phrased it badly. The point is to discourage people from sitting on illnesses until they would be expensive enough to be covered by the socialized catastrophic plan.

Anyways, my point was that you could have a modest tax advantaged system for taking care of the small stuff along with a national catastrophic plan to make sure that no 28 year old is bankrupted by cancer or whatever.

 

[chucky2]

With your plan though, why would anyone sit on an illness? They've already put their own money into an HSA to cover their end, anything that costs over the HSA is going to be picked up by UHC. What idiot would chose to get more sick so as to not touch their HSA, when their HSA is going to be hit anyways when they go in for their much more serious illness (because they waited)?

If I'm forced to be in an HSA, d@mn sure I'm going to use it when I need it.

 

[Ausm]

It actually would not affect healthcare cost at all.

If you take a 1000000 people of all ages and habits. The amount that it costs gets averaged out. Medicare already covers the majority of people that would require catastrophic coverage. The number of people that would be caught by this safety net would be rather small.

Now if everyone that paid for medical care got the choice to have a high deductible plan and an HSA and was 100% invested in the cost (ie what they didnt spend they got in pay). Then we would see people being less wasteful of medical services, insurance companies would make less profit and doctors would have time to see people that really need our services.

The why did the insurance companies spend millions and MILLIONS of dollars to grease politicians palms to strip out the Public option?

 

[mattpegher]

I'll say it again, I think my employer does it best. I get a stipend of $1250 for being a full time employee.
I opted for a PPO plan that cost 12000/year, it covers
well visits (shots, screenings, etc)
Labs and XRay if done at free standing facility
child birth,
ER visits

I am not sure if it covers routine visits for patients with chronic illness, if not that would be good.

It has a $5000/family, 2500/ind deductible.
I can put that $5000/year away in an HSA that acrues interest, pretax.

Compare this to a PPO plan with $1000 deductible
for $19000/year and no HSA

So my employer pays me $15000/year, I spend 12000 on insurance that covers if I get into a catastrophic event. I save $3000 and put that into the HSA. Since I have had the plan for a few years now I still have over $5000 in the HSA incase of a deductible and I put in a few thousand yearly to cover dental and optometry expenses pretax.

This is what you are looking for but to expect the goverment to spend this amount on everyone is not fiscally sound advice and would likely be double coverage for most of america.

 

[chucky2]

The why did the insurance companies spend millions and MILLIONS of dollars to grease politicians palms to strip out the Public option?

Why wouldn't you spend paltry (to them) millions and millions so as to not lose primary control of a multi-Billion dollar industry?

 

[Genx87]

I am and have been in favor of a catastrophic plan on a national level. Insurance is for disasters, not routine matters. Somehow we turned health insurance into a privately run entitlement program. I also think a high deductible will keep people from abusing the system to an extent and thus lower demand and prices. Right now people go to the doctor\hospital for anything because it costs them 15 bucks. They have no idea what the true costs of healthcare are. They may recieve an EOB. But it doesnt register or worse makes them feel like they gained something when they see their portion of a sizeable bill.

 

[Genx87]

I think this is ill advised, because if you don't factor in regular checkups and things for preventable problems, then you are just going to have a bunch of people with catastrophic problems ONLY, and at earlier ages.

I should mention that the universal healthcare takes care of regular checkups too, mammograms, etc. It's actually a cost fighting step in the long term.

The majority of a persons health care costs are in the last 2 years of their life. A lot of that is terminal issues that wont get curable or caught in a regular checkup anyways.

A regular check up is done once a year. Costs a couple of hundred dollars. If people arent willing to spend 200-300 on their own health. Or if they dont get something checked out because they dont want to spend some of their own money on their health. Or put money into an HSA or FSA. Then, they lay in the bed they have made.

 

[mattpegher]

The why did the insurance companies spend millions and MILLIONS of dollars to grease politicians palms to strip out the Public option?

Correct me if I am wrong, but was the public option a catastrophic plan? I dont remember hearing enough about it.

Ideally if the fed created one or more insurance plans that any american could purchase with a non-profit insurance company then that would really give the insurance companies some major competition. That is what the insurance (financial) industry didnot want. The option to buy a product from a non-profit. Then they would have to try to creat some insurance products that offered more for a little more but at a severe loss of profit.

 

[mattpegher]

I am and have been in favor of a catastrophic plan on a national level. Insurance is for disasters, not routine matters. Somehow we turned health insurance into a privately run entitlement program. I also think a high deductible will keep people from abusing the system to an extent and thus lower demand and prices. Right now people go to the doctor\hospital for anything because it costs them 15 bucks. They have no idea what the true costs of healthcare are. They may recieve an EOB. But it doesnt register or worse makes them feel like they gained something when they see their portion of a sizeable bill.

True
When you isolate the consumer from the cost they are very wastefull.

 

[MomentsofSanity]

One thing I've learned is health care debates on forums are pointless as no one, either side, is capable of having a completely honest discussion on the topic. I know I've engaged them in the past to ensure the facts were what's presented but you just can't possibly cover over the mounds of bullshit that will eventually come out.

Until people are willing to talk about it completely honestly nothing will ever, EVER improve.