I realize what your looking for but I wanted to add something of relevance.
When we figure the cost per capita that isn't the actualized cost per person insured (or their costs in regards to claims.)
When greater then 50% of the population is getting insurance through their employer they have a significantly lower out of pocket cost then the per capita showing, on average.
This point is irrelevant to the actual per capita costs. The actuals includes all costs. Doesn't matter who is paying it in the bottom-line number.
You're wanting only to focus on what is called the TrOOP. This is not a good number to focus on as there are many more factors than TrOOP in healthcare costs.
However, I find your approach to be the most honest. What resonates most with Americans? How much they will actually pay at the end of the day, not how much healthcare costs, total. What they can feel is what matters.
Americans just do not have the OOP money available to pay for the entire 10k in per capita healthcare costs. That's good, means the money they paid in for years to employers and medicare paid for some of that gap. But that's just 65 an holder. If they are still paying close to 3k in retirement, under TrOOP, that's fairly deplorable. We can do better.
Do you have TrOOP figures? I am having a hard time finding them.
I don't have them however when we start to talk about health reform I would prefer to get away from the analytics because to many math heads will sit there for days coming up different solutions or debunking before any real solutions can be weeded out.
I appreciate your math but the reality is to present solutions (the whys even) then work out the hows after we understand whats needed.
The question is do we need reform, yes. What do we need to provide to make that available, then we figure the costs.
I realize this is an analysis of bernie plan but that is an outlier imo.
Last edited by snowdragon on Sep 11th, 2018 at 07:33 PM
I already explained why and in vivid details. I also cited research to prove this point. We already know people between the age of 5-40 hardly use medical care compared to all other age brackets.
Expanding medicare, etc. coverage is not a simple linear cost per person. People use medical care at different costs by age. Who uses medical care is very heavily weighted towards the high-end of age and a slight uptick during the first 5 years.
Think of it like this:
It's $500 per person to cover the current eligible pool under medicare, etc. plans.
If Medicare for All is implemented, the remaining pool of people will cost, on average, $100 per person because research shows that true costs are 1/5 of the existing medicare pool.
This is ONLY an example and not the actual numbers. The 1/5 number is legit, though: it is the younger than 40 vs. older than 40 crowd.
Expanding to a Medicare for All option is not going to linearly increase costs of medicare per person. You'll be expanding medicare coverage to age brackets that use little to no healthcare and these people make up a plurality of the new pool. This is not to say that costs will be perfectly matched to that trough chart in the study (where there are little costs throughout a person's life between 5 years and 40 years) because there are large administrative costs that do not scale linearly. As far as the actuals, I don't see data on it other than my guessing based on research.
As research shows, it doesn't. When more people have access to healthcare, overall healthcare costs go down because people don't wait for a medical issue to become a catastrophic issue which is much more costly to handle than preventative care. There's a huge laundry list of reasons that affordable preventative care access reduces medical costs.
If France (I'm opening the door up so you can use a strawman), who has a system very comparable to the US system that is already in place, can offer far better healthcare than the US but at a much lower cost than the US, so can we.
Using boogeymen to prevent a UHC or Single Payer option doesn't work anymore.
I feel your idea (but it didn't work in the way you were presenting) about copays or coinsurance is how we can get there. Have a larger share of costs for the most commonly used services so we see a larger margin of those services shared between the individuals and the healthcare solution (I'm assuming a medicare for all solution with this suggestion).
That should offset some of the costs. I don't think we should run a program like NHS in the UK where almost no out of pocket costs ever happen for the individual. NHS - while often scored as having the best or in the top 3 for medical care, in the world - has cost issues that have plagued them for ages. They were getting things under control since around 2012, however, but I still don't think our economic model should directly match NHS. It should be something closer to what we have now but expanded to a "Medicare for All" options.
I can't speak for every state but many medicare services still have a nominal OOP fee associated with them.
We could stick to a traditional 80/20 coinsurance plan with a max oop of something like 2k for an individual, 6k for a family and dial out the details when it comes to out patient/in patient services and emergency rooms. With a 10$ doctor office copay and 20 for a specialist and deal with the perscription list because many brands have generic and are covered under most drug distributers.
There should still be the option of private healthcare and we should allow the purchase of insurance across state lines as well as collective purchase arrangements between bussinesses that want to access private insurance.
Yeah and let's get rid of this in network out of network garbage as well.
Last edited by snowdragon on Sep 11th, 2018 at 07:59 PM
I really like this idea. And then offer what is called a Medicare Supplement plan for those that want insurance for that remaining 20%. That's the American way: let Americans buy what they feel is best for their needs.
The government should offer a minimum. An 80/20 split is a good place to start.
France has a similar system. But they use copays. They have a copay schedule. Some of the more common services have a higher marginal copay cost to the total medical service cost like I was talking about, before. That helps keep the cost for France's universal option, down.
Here's what I think we can do: start with your idea. Maintain that for 3 years. And then adjust after collecting good data. But the plan would have to run for 5 years with the last 2 years being time to debate and put in an adjusted plan.
So, start with your idea in...2020? Then run it just like that through 2025. Then use the data from the first 3 years to draft an adjusted plan that goes into law 2025. Make the law finalization in 2024 to give Americans and the market place time to adjust.
At this point, I think talking about options beyond your suggestion is too nebulous and too much guesswork. We need damn good data. America is different than the UK or Germany.
We are similar to France, sure, but they have a "Medicare for All" solution with a dynamic copay schedule...that won't match up with America very well.
And it will take a while for costing regulations to make a true impact on the market (such as expanded durable medical equipment schedules and Usual and Customary fee schedules for common acute healthcare services).
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Sep 11th, 2018 06:49 PM
That's my point.
