01-17-2017, 07:06 AM
(01-17-2017, 02:51 AM)Warren Dew Wrote:(01-16-2017, 09:50 AM)SomeGuy Wrote:Quote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?
I'd be curious to see what you had in mind. Not that I am necessarily opposed, mind you.
In an ideal world, the government - or the federal government, at least - would just get out of medical care entirely, limiting its role to safety regulations.
The big problem with our present system is the economic distortion introduced when the beneficiary of a product is different from the payer of the product. That's a recipe for overconsumption and overcharging - or at least overpricing - and is what causes health care expenses to keep going up and up. And we have that distortion both with government provided medicare and with employer provided health insurance, which together include the vast majority of the market.
What that means is that we spend too much on medical care, and that takes away from the money we could be spending for things like a higher quality diet that would be a more cost effective path to good health.
Return the money and control to the people, and we'll see a more rational health care system and better health. And yes, people will likely start paying for doctors' visits and drugs out of pocket and medical insurance will likely be limited to relatively inexpensive policies that only cover catastrophic needs.
Realistically, any transition would need to be gradual. Realistically, the best that can likely be done in the near term is to put individually purchased insurance on the same tax footing as employer provided insurance. Then the market will gradually shift from employers paying for health insurance to employers paying that money in wages, and individuals using it for health care as appropriate. Of course we would get rid of the current blatant interventions like Obamacare, and perhaps permit interstate competition and facilitate competition in other ways. I'm open to keeping the "kids on the policy until 26" rule and the requirement to continue covering conditions that develop while covered by insurance, at least in the near term, but those should be viewed as insurance regulation - similar to the regulations that require life insurers to retain the reserves necessary actually to pay out on death - and not as health regulation.
Now, I'm not unsympathetic to David's argument about having paid into the Medicare system for a lifetime and deserving some return on that. If we take literally David's argument that intergenerational transfer is legitimate, of course, then it's legitimate to say, "okay, the GIs got the benefits but didn't pay in, and the boomers are going to pay in but not get the benefit". But from an individual fairness perspective, it's fair to give boomers Medicare coverage commensurate with what they (we) paid into the system, if not the current levels which amount to much more than they (we) paid into the system.
In order to limit costs to a reasonable level, it would probably be best to shift as many Medicare customers as possible over to Medicare Advantage type plans, where the customer gets a voucher to use toward traditional health insurance. These plans could then get less traditional, for example paying for certain beneficial supplements and possibly even for a healthier diet and lifestyle. The key is that the amount paid should be fixed, adjusted for inflation but not for "average" health care costs, and perhaps scaled to years in the system. You paid in a certain amount; you get out a certain amount.
If we wanted to keep a traditional form of Medicare as well, then costs on traditional Medicare would have to be limited to the same as that for the Medicare Advantage type plans. For example, we could seriously enforce the payment limits. Customers would then have to choose between using low end doctors and facilities, or making up the difference themselves.
Am largely in agreement. I am not sure that it is politically feasible, though a "Medicare for all" option would probably look a lot more like Medicare Advantage for all once people actually grasp with the cost. Is largely what I meant earlier.
I mean, there are the equity issues that are politically powerful, and certain issues with health care versus other types of goods/services (that Dave touched on before), but it is still a rival, excludable good/service, and so it should be primarily handled by the private sector.