I suppose, if insurance companies are limited in what they charge by vouchers, they may press the medical industry harder into being more selective with care.

This is the key. This is the heart of the entire health care reform problem. Now how do we do it? (I remember reading your thoughts but I don't remember which thread it was)

 

Health care reform needs to happen because of rising Medicare and Medicaid costs, private insurance costs being driven up by the uninsured using the waiting room for everything, and over-prescribing and over-testing from doctors. Government will have to step in. We should try to limit the government's involvement to as little and as low-cost as possible, so IMO healthcare reform should be coupled with a drastic reduction in Medicare and Medicaid spending AND tort reform. Is this a fair compromise?

Health care reform needs to happen because of rising Medicare and Medicaid costs, private insurance costs being driven up by the uninsured using the waiting room for everything, and over-prescribing and over-testing from doctors. Government will have to step in. We should try to limit the government's involvement to as little and as low-cost as possible, so IMO healthcare reform should be coupled with a drastic reduction in Medicare and Medicaid spending AND tort reform. Is this a fair compromise?

 

Seniors, the most reliable voters, don't want the government out of their healthcare, assuming they know Medicare is a government program, Democrats won't go for tort reform, and Republicans won't go for anything that would negatively impact the bottom line of insurance companies. In other words, we're doomed. Actually, I do think major healthcare reform will pass overwhelmingly at some point in the future when the untenable mess that is our current system finally reaches critical mass and our economy quits functioning. I just don't know when that will be and find that to be a stupid way of doing things.

A couple of thoughts:

 

Why should ER's be forced to provide medical care to people without insurance or unable to pay for the services rendered?

 

While tort reform would cut down some "unnecessary" tests that are performed by doctors in a defensive manner, many tests are ordered by doctors because the doctors have a financial stake in equipment or facilities used to perform the tests. Stark II was/is designed to limit that "self-referrals" but doesn't do a very good job in my opinion. With the govt limiting the fees paid to doctors under the existing govt reimbursement programs and with the private insurers doing the same, doctors frankly do what they can to maximize their income. Such results in additional tests and visits to the office for which the doctors get paid additional fees.

 

The reduction in reimbursement rates by the govt and private insurers also has an effect on the number of malpractice claims. Doctors stack their patients in the waiting areas so as to make sure the doctors can see as many patients as possible in the course of a day. The thinking being: "you (the govt and the private insurers) want to limit the amount I'm paid per patient service, then I'm going to maximize the number of patients I see each day to earn the income I want to earn per year". Such quantity of patients almost inevitably has an adverse impact on the quality of care provided, and hence more malpractice claims, which leads to more defensive tests, which increases the cost of health care, which leads the payers of health care services to try and further decrease reimbursement rates to save money, and the cycle continues.

 

I think I may have posted this link in the past, but it's an excellent article worth reading: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=1

Seniors, the most reliable voters, don't want the government out of their healthcare, assuming they know Medicare is a government program, Democrats won't go for tort reform, and Republicans won't go for anything that would negatively impact the bottom line of insurance companies. In other words, we're doomed. Actually, I do think major healthcare reform will pass overwhelmingly at some point in the future when the untenable mess that is our current system finally reaches critical mass and our economy quits functioning. I just don't know when that will be and find that to be a stupid way of doing things.

 

It's how we do things. Look at the attempts to reform a doomed social security system over the years. Add that cost to the cost of health care reform and it you have a real doomsday scenario.

FWIW, for those concerned with the spending associated with a healthcare voucher plan...the 2010 Budget proposed by our President has $743 billion proposed for Medicare and Medicaid...this is around $2475 per person (assuming as 300 million person population). That spending would be eradicated.

I am personally FOR anything that provides health insurance options to the greatest number of people.

 

From an idealistic perspective, I think universal healthcare is THE thing. From a pragmatic point of view, it's wholly impossible to provide universal healthcare and not sacrifice a lot in more ways than I have the time, knowledge or experience to list.

 

That said, I personally feel the problems with our current system are "fixable". But no one has the hutzpah to take on the inusrance companies, who I feel are the crux of the problem. Insurance companies are for profit. That's fine, but the problem is that the "profit" often comes at the expense of the people who are contributing to their profits, which is an ethical dilemma....at the very least.

 

Many reasonably healty people pay premiums for years, often with a greater share of their premiums paid by their employer. Yet, often the "coverage" doesn't actually cover a procedure or test a patient may need, although it is written that the plan would cover it. That's because of the "fine print". The fine print is that claims are reviewed, and then paid or rejected. Even if a doctor checks with an insurance company to see if something is covered, it can be rejected later. Then, the onus is on the patient to try and figure out why. The insurance company will give you the reason. But then you have to go back to the doctor to try and get it fixed. This puts the patient in a peculiar position of being an arbitrator between the insurance company and the doctor. Hardly fair, when they and their doctor followed the required steps to ensure the treatment was covered.

 

Additionally, the reasons insurance rates go up for a group have to do with the health of each person individually. So, if one person has a terminal illness requiring a ton of treatment, the premiums for the group go up for that part of the plan. Where I work, we've had a ton of pregnancies over the last year. Guess what? Maternity premiums went way up! Thankfully, that didn't affect me.

 

Other factors are people who use emergency rooms like walk-in clinics. Our co-payment and premiums went WAY up on ER visits.

 

There are so many things that affect the costs of health care. I really do feel there are ways to fix the problems, but that most has to come with somehow not penalizing the healthy for those who abuse their coverage, or are not healthy. How many of you work with people who go to the doctor for any little thing?

 

And I've never understood the theory that universal healthcare would mean the healthy would be paying for the unhealthy. Isn't that what we already do?

 

So many questions, so many different ideas for solutions....