costs - as opposed to the insurance mechanism - it is just shifting deckchairs on the Titanic.

You have to give the people making the heath care decisions - a.k.a. whether to treat and how to treat - reasons to take the cost into consideration. Right now that just isn't the case.

Whether that is the actual consumer having to bear more of the direct cost of their heath care decisions, the doctor with incentives to select lower costs options or single payer where the government determines what care you get and how much it will pay or something else.

When the person determining what care/treatment will be (now the consumer or their family) isn't the one paying the direct cost of that care (because it is so spread through insurance which does not change whether they have no care or every procedure / treatment available) their only considerations are the likely best possible outcome with the least inconvenience / discomfort. This is even more exacerbated because we allow employers to provide insurance as a pre-tax benefit, so the real cost of the insurance is even more divorced from most consumers.

It would be wonderful if we had unlimited resources but there simply are not enough resources or money to give every single person the best possible most top of the line treatment and care for every condition. We can't give every person two fill time doctors, six nurses and a private hospital suite every time they get the flu. But, if the consumer is selecting care and has does not bear the cost, why are they not going to select that option?

We now have private insurance companies that place limits on care, but we seem to keep pushing more and more for those limits to be removed or pushed higher. We don't want limits or to see any extra costs for some pre-existing condition to be covered or there to be no lifetime maximum in coverage (for example). We essentially want to say that the insurer has to pay directly but they shouldn't be able to really limit the care that the individual consumer might want or charge them substantially more for that care decision.

The problem is made even worse with the private insurers because we have limited their profit/overhead to a percentage of their coverage payouts with the 80/20 rule. This, perversely incentivizes insurance companies to pay out MORE for procedures so they can charge more in premiums and make more, in real dollars for profit. The 20% only grows if the amount you pay out also grows. If you can keep overhead relatively the same and pay out more in coverage, you can make that much more in profit. So they actually want true heath care costs to go up so that they can charge/justify higher premiums and earn more money. They don't have any incentive to keep true care costs down over time

Consumers either need to feel and see the actual direct costs of their health care decisions (by paying more directly and/or paying more and more directly for insurance for the care they want) or we need to take the decision of what care a person receives out of their hands and give it to the person actually paying directly for the care. A single payer system is one option to do that, but most people don't seem to want some agency or government body (any more than an insurance company) deciding what care they get and when it costs to much. Maybe we find some way incentivizes the providers and give them the power to make care determinations. The doc gets $100K to treat this heart attack. Doc gets to keep everything that isn't used on care. If doc goes over $100K, doc bears that costs directly. Make economic decisions doc. I am not sure people would buy into that scheme either.

In short, someone needs to make / keep more money if they chose the less expensive option so there is actually some incentive to chose the less costly option. Doesn't seem like anyone in the entire system has that incentive now and this bill, as far as I can tell, does nothing to actually address that.




[Post edited by RML Hoos at 09/21/2017 11:38AM]