Rather than focusing on the uninsured, McCain rightly tackles health care costs. Key ideas include going back to capitation for physician payments as well as medical malpractice reform.
We’ll see if any of this flies, but I agree with his approach emphasizing cost control over universal coverage.
The analysis itself is a little hard to read (due to the frequent use of bold), but well worth it.
Related posts:
- An open letter to Barack Obama and John McCain
- John McCain so gets it
- John McCain on health
- Analysis of Wyden’s health care plan
- John McCain and his health
- Can the Massachusetts health reform plan be replicated nationally?
- Are Liberal or Conservative ideas right for health care?
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Capitation means primary care doctors get to screw on the old “gatekeeper” hat, rationing out the referrals and consultations. We all know how well that all went over the last time around. So what about capitation makes it a better solution now?
People hate rationing. Explaining that it will be necessary to keep costs in control never convinces, unless the right to “escape” rationing is tied to automatic charges that accrue to the patient on the spot. If, for example, a patient said they wanted a dermatology referral on a visit to the internist, that would automatically trigger a co-pay double the usual for the internist service and double the usual for the dermatologist as well. That way, the internist never has to say “no” and the patient has to accept some liability for electing early referral.
Why not just have the patient pay the internist and the derm guys fee directly. Why go through all that foderol to accomplish what ordinary economics would accomplish if insurance were just real insurance—a back up for the catastrophic unpredictable expenses that can’t be budgeted for.
The only net winner of first dollar coverage is the gnome who gets the joy of controlling and manipulating other peoples lives (with money out of the victims pocket) with policies such as you describe.
I agree that health care costs should be controled–and if the patient is paying them, he will control the ordinary outpatients costs better than anyone else.
Much is made of out high costs–but only about 14% of health care costs in the US are paid out of pocket–far lower than most other nations. In Switzerland it is about 1/3.
You could write a one page bill that would stop the cost spiral:
Limit health insurance to policies that pay only those expenses above 7% of AGI.
The idea of the free market regulating the cost of health is fundamentally flawed, as is your analysis. The cost of healthcare is relevant only to ELECTIVE procedures and consultations and has nothing to do with costs incurred by people who are dying or deathly ill. When is the last time you went to the ICU and heard a family member say “It costs too much to keep Uncle Joe alive, please pull the plug” or “Grandpa had an MI, but we cannot afford a 5 vessel CABG, can you pack him up on a plane to India although he might die en route?”. Just as there are no atheists in foxholes there are no Americans interested in controlling healthcare costs when THEY are the patient who has to do without. There is a free healthcare market in North Korea, if you do not pay as you go, you die. I also cannot believe you think capitation is ethical, what happens when you know your patient needs an operation to live but you have already spent all your “capitation” money for the year? If insurance companies do not know how to accurately predict actuarial risk, what the hell makes you think you know any better? It’s just a way of putting the chances of a monetary loss on the doctor, rather than the insurance company, you’d have to be an idiot to fail to recognize this.
I’ve had rheumatiod arthritis for 29 years now and can’t buy an individual policy from ANY of the standard insurance companies. I tried and was told that I am automatically EXCLUDED. Free market programs won’t make any difference, they still won’t cover me. I worked for over 30 years, raised 2 children as a divorced mom getting a whopping $200.00 per month total in child support without ever taking a dime of government support. I finally caved and had to go on disability. The insurance companies I spoke with referred me to a “risk pool” where I was offered a policy that excluded pre-existing conditions for a year, had a $7500.00 deductable and would cost me over $700.00 per month to get. I get $1,286.00 per month to live on from Social Security. For now, I am continuing to pay $510.00 per month to keep the cobra insurance from my former employer, but my 18 months of cobra eligibility will run out at the end of June 2009. Then what?
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