Health Reform

[Dr T Non-Fan]

Oh, like a deductible policy? That's soooo 1980's.

[FormLetter]

Originally Posted by Dr T Non-Fan

Oh, like a deductible policy? That's soooo 1980's.

More like a coinsurance policy. Deductible met --> floodgates are open.


But, cynically speaking, neither would really work. Drug companies and some other providers today will waive cost-sharing for people seeking their products/services. You have a plan with a $30 brand drug copay? Our drug costs $220, we will waive the copay and be happy with the $190 that the insurance company pays. That happens now.

Fast forward fifteen years to when the injection for Two Elbow Disease costs $300 to produce, and even if you have 20% coinsurance in place, the provider of the injection will waive it and survive on 80% of the allowed charge. As they go about mining data for the diagnoses, they will also try to gauge what % level of insurer-paid coverage is out there, and base their R+D on that.

[Dr T Non-Fan]

With a deductible policy, some people will forego medium-cost b.s. ($1000 stuff, if $3000 deductible), look for cheaper alternatives. Even look for cheaper doctors.

[FormLetter]

True. They may also totally avoid care that keeps them out of the hospital.

A deductible is really just a special case of coinsurance where c = 100%. Hehe.

Mathematical dorkery aside, how about 40% coinsurance starting from the first dollar? I'd like to see some more complicated designs but realize that consumers would be overwhelmed quickly. Part D, for example.

[Dr T Non-Fan]

Insurance is for security against financial catastrophe. Hangnail on a toe is not that. Go to the doctor and get it fixed, but ask first what the cost is. Then limp out if you think it's too expensive.

Preventive argument is b.s.

[jayhawk]

Originally Posted by FormLetter

True. They may also totally avoid care that keeps them out of the hospital.

A deductible is really just a special case of coinsurance where c = 100%. Hehe.

Mathematical dorkery aside, how about 40% coinsurance starting from the first dollar? I'd like to see some more complicated designs but realize that consumers would be overwhelmed quickly. Part D, for example.

How does Part D overwhelm consumers? CMS has made sure consumers can choose the best plan for them.

[OldGuy]

[quote][Mental health issues, are just as real as physical health issues.../QUOTE]

The difference is physical health issues have clinical evidence (x-rays, blood tests, etc.). Mental illness is often self-professed without clinical evidence.

[FormLetter]

Originally Posted by jayhawk

How does Part D overwhelm consumers? CMS has made sure consumers can choose the best plan for them.

Maybe I'm partially having a 2005/2006 flashback.

How does CMS make sure consumers can choose the best plan for them? I get that formulary lookups and some math can be done, but that is about it, and it doesnt' mean the consumer understands how the plan works.

[twig93]

Originally Posted by FormLetter

I didn't mean to imply that the procedure might not be covered. I merely wanted to know it it would be. You answered that. Thanks.

I could see how medical tech developers and drug companies would love to mine data for diagnoses under these diagnosis-made policies, and when they see that "Hey look 10 million people were diagnosed with Two Elbow Disease, let's make a drug for that since we know it will be covered forever!!!!", they target their development based on those diagnoses knowing there are a whole bunch of third-party payers out there that have no way to get away from whatever they want to charge for these new procedures/drugs/treatments.

How is this different from the current system of medical insurance?

[twig93]

Originally Posted by Chuck

Your point is an important reason why healthcare costs increase so much in general. If somebody else pays the entire bill, expensive treatments are encouraged. I think a key to reversing the trend is to design policies that always require SOME out of pocket by the insured.

Agree with this as a means of lowering costs. But up to some [very high] maximum out-of-pocket.