Is there a type of universal health care that would actually work?

[Mormon Red Death]

As a rule I am against anything that assumes your basic rights are more than what the founding fathers said (Life, liberty and the pursuit of happiness).

That being said the democratic candidates will have NHI (National Health Insurance) on their platforms and at least one of repubs (Mitt) have mentioned universal health care.

How would you design a NHI?

[Archaea]

How could one design a system that does not exist inside an already complex and reasonably successful system?

Nobody is considering existing system disruption by a major cataclysmic modification.

We can debate the necessity of extending coverage until the cows come home, but each side can exaggerate the significance of the numbers.

My premise is a system of universal coverage and access in the US is neither reasonably achievable nor desirable other than for political effect.

I'm somewhat familiar with the system finances in place and it's terrible complex and not comprehended by anybody but those involved in system and systemic analysis. Almost everybody discussing it has an agenda.

I predict we will try it, and fail, and undermine the good parts of our existing system, realizing it only too late, but the implementing politicians will take credit for some glorious benefit. Screw them and fight this tendency until it's inevitable.

[il Padrino Ute]

I could never design a NHI that would work because I think universal health care is a farce and would be economically disastrous.

Health care is not a basic right; but we do have the right to pay a doctor of choice to provide that health care.

[Indy Coug]

There are two very basic things the government can do to get most, if not all, Americans health insurance:

1. Create insurance pools where uninsureds (usually self-employed or in very small businesses) can find coverage at more affordable rates. The law of large numbers is a very important principle in insurance where the larger the insurance pool is, the more stable the expected claims are. That stability allows insurance companies to charge less per person because they don't have to build in as much "risk premium" to offset unexpectedly bad claims experience.

It's the same basic reason why the average person can get better group term life insurance rates at work than from purchasing it for themselves on the open individual market.

Individual or small business insurance rates are very expensive for that reason: they are not able to avail themselves of the law of large numbers.

State governments can mandate any insurance company that is licensed to sell insurance in their state has to participate in these "uninsured pools" in order to continue to do business in their state.


2. Just as states mandate licensed drives carry auto insurance, they can mandate that people have medical insurance. Not all uninsureds are that way because they can't afford or don't have access to medical insurance; they simply choose to 'self-insure'.

The benefits of these two proposals is that neither represents an overhaul of the current way health services are provided, nor do they result in the government managing the day to day details of our health care. With a higher percentage of insureds, the costs will decrease, or at least the rate of increase will decrease, for those that have been insured all along because they are no longer subsidizing the costs from the uninsured.

Mock my proposals, if you must.

[Archaea]

These are reforms which I could support because they are market related and work within the existing system.

[San Juan Sun]

Originally Posted by Indy Coug

There are two very basic things the government can do to get most, if not all, Americans health insurance:

1. Create insurance pools where uninsureds (usually self-employed or in very small businesses) can find coverage at more affordable rates. The law of large numbers is a very important principle in insurance where the larger the insurance pool is, the more stable the expected claims are. That stability allows insurance companies to charge less per person because they don't have to build in as much "risk premium" to offset unexpectedly bad claims experience.

It's the same basic reason why the average person can get better group term life insurance rates at work than from purchasing it for themselves on the open individual market.

Individual or small business insurance rates are very expensive for that reason: they are not able to avail themselves of the law of large numbers.

State governments can mandate any insurance company that is licensed to sell insurance in their state has to participate in these "uninsured pools" in order to continue to do business in their state.


2. Just as states mandate licensed drives carry auto insurance, they can mandate that people have medical insurance. Not all uninsureds are that way because they can't afford or don't have access to medical insurance; they simply choose to 'self-insure'.

The benefits of these two proposals is that neither represents an overhaul of the current way health services are provided, nor do they result in the government managing the day to day details of our health care. With a higher percentage of insureds, the costs will decrease, or at least the rate of increase will decrease, for those that have been insured all along because they are no longer subsidizing the costs from the uninsured.

Mock my proposals, if you must.

Good ideas. I'd add one: eliminate state barrier restrictions that make it difficult for insurance to open up a national free(r) market.

[Indy Coug]

Originally Posted by San Juan Sun

Good ideas. I'd add one: eliminate state barrier restrictions that make it difficult for insurance to open up a national free(r) market.

I agree with that too. Some states are such huge pains in the butt to deal with, it's amazing they have any insurance companies doing business there.

[ChinoCoug]

Originally Posted by Archaea

These are reforms which I could support because they are market related and work within the existing system.

I'm not sure how market-related it is to require all to have insurance, but I think it's reasonable.

We can give health care to everybody yet at the same time, allow people to pay for better coverage if they pay for it. The two aren't contradictory.

Another reason why health care costs are so high is because the IT revolution hasn't taken hold in health. Medical records are not standardized. Every time you see the Dr. you fill out your health history on a clipboard. You change to a new doctor, you repeat.

Physicians have no incentives to share medical records with their competitors. I think the government can do something about that.

[Archaea]

Originally Posted by ChinoCoug

I'm not sure how market-related it is to require all to have insurance, but I think it's reasonable.

We can give health care to everybody yet at the same time, allow people to pay for better coverage if they pay for it. The two aren't contradictory.

Another reason why health care costs are so high is because the IT revolution hasn't taken hold in health. Medical records are not standardized. Every time you see the Dr. you fill out your health history on a clipboard. You change to a new doctor, you repeat.

Physicians have no incentives to share medical records with their competitors. I think the government can do something about that.

Markets always have regulations, some are lightly regulated and some are heavily regulated. I'm in favor of usual light regulation except to the point where antitrust common sense does not apply. Unfortunately, antitrust rules have been removed in insurance under the McCarran Ferguson act, IIRC.

We can reasonably increase coverage without requiring government to become the single payer of health care.