[whell]

Originally Posted by bobabode

Where have you articulated an alternative to O Care, Mike? I would love to read it. I would love to see any alternative from a conservative or a Repub.

BTW, nice to know that you are spokesman for the conservative hivemind.

Originally Posted by Ike Bana

I'd sure like to see any GOP politician's alternative or any internet forum right winger's alternative that covers everybody.

It's interesting that the only one I've heard being honest about it is Limbaugh. He's come right out and said that he doesn't care if 30 million Americans have no health insurance. It's just not an issue for him.

Far as I've been able to determine so far, it doesn't appear to be an issue for whell either.

Ike - You have no clue about what is "an issue" for me and what isn't. But you're free to keep making incorrect assumptions. Also, let's be clear: no one has put forward or passed any legislation - neither Dems or Repubs - representing an "alternative that covers everybody." Obamacare was not designed to cover everybody. It may have started out with that objective when it was originally scripted, there were even a fair number of Dems who were unwilling to overhaul the current system to that extent. As it was finally passed, Obamacare's objective was to reduce the number of uninsured. Therefore, any reasonable alternative to Obamacare needs to be viewed through that prism.

Bob - I don't feel like going back and digging it up either. But I'll summarize it below.

The first, best antidote to reducing the number of uninsured it to get the economy moving again. A 1% - 2% annual rate of economic growth just doesn't cut it. It doesn't provide sufficient incentive for individuals/corporations to risk captital. Getting the economy moving again spurs job creation, and job creation creates competition for labor that supports wage growth and, typically, supports employers offering jobs that include benefits.

However, the issue to me is not availability of medical insurance, but the cost of medical insurance and medical care. The two go hand in hand. As the cost of care rises, the cost of insurance rises. The additional issue is that insurance is also the primary culprit in the rising cost of care. Since consumers don't pay the full cost of medical care, they have no incentive to look for ways to save money on care: behave like good consumers usually do.

Recent personal example - I needed an MRI prior to back surgery a couple years ago. The hosptial that I was treating at wanted $5500 for the MRI. Another local hospital - same MRI machine, an MRI tech with the same level of training - wanted $3500. Because I have a larger deductible to pay before my insurance covers anything, I went with the $3500 MRI. I'm confident that most people with more traditional types of insurance plans don't make those same choices. They'd spend days surfing the internet getting information on the purchase of a car, a vacation or the like, but don't do that same when it comes to their medical care. They go to doctors because they're "in the network", but spend less time gettng information about their medical care providers than they do understanding the point spread on an upcoming football game. Their physician tells them they have to undergo 5 tests to support a diagnosis, when 2 test would be sufficent, and they undergo the 5 tests not realizing that the other three are reccommended by the physcian's malpractice liability carrier, but don't contribute much to the medical outcome of the patient. All these items and many, many more contribute to the cost of care, and most patients have far more control than they realize, or currently care to exercise, becuase in most cases they don't pay the full bill.

Increasing access to insurance coverage as Obamacare does is not a solution, becuase the market incentives that support the increasing cost of care are locked in to the system. Yes, Obamacare does create some incentives for health care providers to enter into agreements to be compensated based on health / efficient outcomes. However, it also cements into place the key problem - in my opinion - of rising medical costs which is using an insurance product as the primary method of reimbursing for physician/medical services. Folks completely understand that if they are in a car accident, there's a probabllity that their auto insurance premium rises. However, most folks look forward to being covered under health insurance so that it will reduce their out of pocket costs for even routine medical costs, yet are incensed when the premiums rise year after year. They don't seem to grasp that the same economics that drive the cost of auto insurance - including claims experience / utilization - also drive medical insurance.

My house burning down, or me getting into a car accident is not a likely event from an actuarial perspective. My kid getting strep throat from another kid in school, and taking the kid to the doctor for treatment, is a much more likey event actuarially. The insurnace coverage for the likelyhood of each event is priced accordingly. If you've ever had your car in a repair facility you know that insurance company reimbursment practices will attempt to reduce the cost of repair, sometimes to the policy holders detriment. Yet, when these same practices are applied by insurance carriers to reduce expenses associated with human body repair, folks seem surprised and incensed by this.

Long story short - get rid of insurance as the primary means of covering first - dollar out of pocket costs for medical services.

Get rid of employer - sponsored group health coverage. Give individuals the ability to purchase the coverage of their choice with premiums that are dollar for dollar tax deductable. To make the libs happy, you can even phase out the tax deduction as income rises. The coverage for health insurance is limtied to covering preventive services and major medical services only. Routine medical care is on the patient's dime. The net effect of this will be very similar, and far less expensive, to Obamacare's premium subsidized plans.

Employers provide plans that allow employees to pay for insurance premiums and save for health care expenses on a pre-tax basis. These tax - favored plans are great if you work for someone, but it you're self employed or retired you have no access to such plan. So, I'd expand health savings acccounts to provide incentives to indivduals to save money to cover the cost of routine care.

And, since folks are spending their own money on routine care, they'll finally have some skin in the game and start treating medical care purchases the same as any other product or service they purchase.

Overhaul the FDA and how the FDA regulates the pharma industry, so that new drugs and maintenance medications can get to the consumer faster and at a lower cost. Provide profit tax rebates for pharma industries that have the greatest net positive impact on signficiant heath issues each year. In exchange, reduce the duration of patent protection on new drugs so that the cost of those drugs comes down sooner over time.

Keep safety net programs like medicare and medicaid in place for individuals that don't have other altermnatives, or are incapable of self-care.

Review medical service delivery requirements/laws. For example, do I really need a doctor to dianose my bronchitis, or could a physician's assistant or clinical nurse practitioner do the job just as well and at a lower cost?

There's more, but I think you get the gist. Attack the issue from all sides, but attack those issues that drive up costs while having zero impact on medical / quality outcomes. Meanwhile, put the consumer in the drivers seat, rather than the insurance company or health system, to help reduce costs / utilization of health services.