If we establish a health care system where peopel can opt out and gamble on their health ...?

Question

What happens to the people whjo lose their bet and suffer a catastrophic illness?

And doesn't even private insurance count on subscribing enough healthy people to pay for teh ones who are sick?

Answer 1

You've hit on one of the major flaws with all the proposed systems I've seen. The one plan I've found that makes sense is totally voluntary but it also deals with the massive number of other problems that drive up health care costs. The author's solution should a person end up with catastrophic medical bills is to treat the person as though he had had the plan in place at the time of his need BUT demand three years worth of the insurance premiums be added to his bill (or deducted from the benefits coverage) to reimburse the plan for his bad gamble that he lost. You could look at that as punishment or a fine, or you could be a lot more fair and recognize that a "free ride" is something no one should get--so if he'd been signed up as he should have been with SOME plan he'd have had some coverage. As he chose to pocket the money, he should have to contribute because having a claim after three years would have provided some decent buy-in rights.

Again, you really have to read the entire chapter on health care to get it all, but you can see some highlights here and in the free PDF:

First, deal with the REAL problems of high health care costs, not what the pols misdirect attention to:

government meddling

violation of contract law (refusal to pay legit claims)

violation of antitrust law (control of the market so you can set prices)

lack of price transparency (there are tens of millions of uninsured Americans and we pay far more than the insured do for identical services)

The solution is out there--it's here:

QUALITY, ACCESSIBLE, AFFORDABLE health care for all.

That means preventative care (physical with follow up). Real medication (no Medicare "donut holes" the really ill are ripped off again.) No bogus ridiculously low "caps" on needed medical procedures. No abuse of the ER. No paying for the silly with the sniffles to go to the doc for free. No more bankruptcies over medical bills. I want THIS plan that ends abuse of the taxpayer, takes the burden off employers, provides price transparency, and ends the rip-off of the US taxpayer at the hands of greedy insurance CEOs (which has been repeatedly documented).

http://www.booklocker.com/books/3068.htm...

Read the PDF, not the blurb, for the bulk of the plan. Book is searchable on Amazon.com

Cassandra Nathan's Save America, Save the World

It is similar to what you suggest but has built-in aspects that are superior. First all of the things wrong are corrected (the book's chapter on health care is huge and the basics of the plan are not all in the free PDF). Second, the number of physicians, nurses, and other providers is increased. Third, there is a two-pronged approach to savings.

First, preventative care which is cheaper and morally superior to the alternative is covered--for a reasonable co-pay a person would have an annual physical and follow-up visit--when things are caught early they are cheaper to treat.

Second, after that preventative care, then, as it SHOULD be, the cost of seeking medical care shifts to the person--just as we have to pay for our own housing, utilities, food, etc. When and IF that NECESSARY care becomes an actual BURDEN, then the plan's catastrophic coverage kicks in to prevent bankruptcy--something current insurance plans fail miserably in doing.

Third, there would be prescription med discounts (initially just some discount because of bulk buying power) so that people can afford necessary meds. HOWEVER, if a person has a serious condition, such as cancer or heart disease, those meds will NOT be subject to bogus nonsense like the Medicare "donut hole" that leaves the needy up the creek while ensuring big pharma got another windfall from the taxpayer. The plan will ensure you don't go bankrupt because you have to battle cancer.

The plan's premium will be sliding-fee scale, so when some 75-year-old can't work anymore and is on a fixed income he can afford his premium, his meds (if needed) and get the care he needs knowing he will NOT be bankrupted by medical bills. The catastrophic financial feature will take NEED into consideration--so his threshold of medical debt will be lower than a working 30-year-old who has an accident leading to surgery and expenses--he won't go bankrupt but he's got more income and doesn't need the same level of safety net to prevent bankruptcy.

Funding for the plan is discussed and rolls assorted federal programs in AND resolves a major taxpayer abuse as well to bring in more money to make sure those premiums, co-pays, and deductibles are reasonable for all.

For whatever reason, though this is free market (restrictions that exist and cost us all money are removed), it takes the burden off employers, and is completely VOLUNTARY (no fines or such involved), though I've contacted more than 60 federal level pols, they won't even respond about the plan. I guess as graft, kickbacks, patronage, etc. are blocked by effective communication (price transparency) and enforcement of the laws (contract and antitrust) that there is no way for anyone to unfairly benefit and that's "scary." It would be an honest market, rewarding the efficient and honest and pulling the special interest deals right out of the system.

Read Jamie Court's book on HMOs and about that ERISA shield and other things to make you want to vomit over the special deals the large insurers get to try to bankrupt the country.

IF they paid legit claims and turned a profit, that would be a good thing; BUT that is NOT what they do.

When 75% of the people who declare bankruptcy over medical bills ARE INSURED, then insurance is CLEARLY not the answer.

"Aldrich’s situation is "asinine" but increasingly common, said Dr. Deborah Thorne of Ohio University. Thorne, co-author of a widely quoted 2005 study that found medical bills contributed to nearly half of the 1.5 million personal bankruptcies filed in the U.S. each year, said that ratio has likely worsened since the data was gathered.

...

Like Aldrich, Thorne said, three-quarters of the individuals in the study who declared bankruptcy because of health problems were insured. "

http://www.msnbc.msn.com/id/20201807/

Linda Peeno, MD testified that SHE had often denied treatment JUST to save the insurance company money http://www.thenationalcoalition.org/DrPe...

Furthermore:

"the vast majority of health insurance policies are through for-profit stock companies. They are in the process of “shedding lives” as some term it when “undesirable” customers are lost through various means, including raising premiums and co-pays and decreasing benefits (Britt, “Health insurers getting bigger cut of medical dollars,” 15 October 2004, investors.com). That same Investors Business Daily article from 2004 noted the example of Anthem, another insurance company. They said the top five executives (not just the CEO) received an average of an 817 percent increase in compensation between 2000 and 2003. The CEO, for example, had his compensation go from $2.5 million to $25 million during that time period. About $21 million of that was in stock payouts, the article noted.

A 2006 article, “U.S. Health Insurance: More Market Domination, More CEO Compensation”

(hcrenewal.blogspot.com) notes that in 56 percent of 294 metropolitan areas one insurer “controls more than half the business in health maintenance organization and preferred provider networks underwriting." In addition to having the most enrollees, they also are the biggest purchasers of health care and set the price and coverage terms. “’The results is double-digit premium increases from 2001 and 2004—peaking with a 13.9 percent jump in 2003—soaring well above inflation and wages increases.’" Where is all that money going? The article quotes a Wall Street Journal article looking at the compensation of the CEO of UnitedHealth Group. His salary and bonus is $8 million annually. He has benefits such as the use of a private jet. He has stock-option fortunes worth $1.6 billion."

--Save America, Save the World by Cassandra Nathan pp. 127-128

"Insurance Companies Robbing Patients

Robbing patients to pay CEOs leads to unprecedented medical insurance corporation greed.

Thursday, January 3, 2008 8:52 AM

By: Michael Arnold Glueck & Robert J. Cihak, The Medicine Men"

http://www.newsmax.com/medicine_men/medi...