Somehow, virtue in America has become defined as caring. Whole industries
have grown up around caring and compassion. We care for children, the elderly,
victims, criminals, pets, endangered species, the environment, and on and on.
From the time we are born, modern Americans are preached to from the pulpit,
from the school room, from the media, and from our politicians...if you don't
have compassion, you are not a virtuous person. Your duty is to care.
And, truly, having compassion and caring is a virtue. It's just not the only
virtue, or even the main virtue. Other virtues such as fairness, justice, truth,
honesty, open-mindedness, and practicality remain equally or more important,
depending on the specific situation.
Everyone wants to protect their child from making tragic mistakes or falling
into tragic circumstances. That's a worthy goal, but finding the elusive line
between protecting and coddling is much more difficult. Where does
protection interfere with normal, healthy child development?
The truth is, caring, by itself, is not enough. Caring does not relieve you
from the responsibility to make correct decisions. Caring does not make
you more virtuous or intelligent than another person who cares, but who
makes different choices about how to show their compassion.
Caring is easy...choosing correctly is hard. And, good intentions can be
manipulated.
Politicians will use caring to manipulate and control voters for power and
votes. Vote for me! I'm for the poor, the downtrodden, for you...and my
opponent is basically a fascist who doesn't care for anybody.
Educators use compassion as a tool to manipulate minds. Maybe we
can't teach religion in schools, but we can teach the causes that we
believe in...and, if you don't agree, you're probably a fool, anyway.
Religion teaches compassion to manipulate behavior. Nothing wrong
with that, depending on the behavior that's being encouraged. Helping
the poor is good...beheading infidels is not-so-good.
Even the media plays on compassion in it's search for ratings. Am I the only
one that sees a dichotomy between the anchor stating how badly they
feel for the person in the situation, and the field reporter shoving a
microphone in the face of the person stuck under the car and asking them
"How does it feel to have a two-ton car stuck on your chest?".
Even friends and family will attempt to use your compassion as a way to
manipulate you.
So, be as caring and compassionate as you wish. It is a wonderful quality.
But be aware that unscrupulous and crass individuals are out there, who will
try to use your good intentions to their advantage.
Sunday, April 29, 2012
Saturday, April 28, 2012
Why Not Pie-in-the sky?
I know there is a lot to complain about in my pie-in-the-sky plan. Individuals could have
to pay out up to $7,500 dollars a year in medical expenses. Damn, that's a lot!
Of course, most of us will never reach that amount in a year. And the maximum
that almost all of us will have to pay in our lives is only 15% of the cost of our
medical bills...and far lower than that if we ever reach the catastrophic stage where
the state and federal government help kicks in. So, maybe it's not such a bad deal
for the individual.
And doctors and medical services will scream and complain about having to give one
free service for each twenty for-fee services they deliver. Damn, that's positively
un-American!
Of course, they're only giving away less than 5% of their services...and they can
make a lot of money off the twenty for-fee services they deliver. So, maybe
it's not such a bad deal for the doctor and the hospital.
The states will moan that they have to pay hospitals to care for the
uninsured, plus, they have to pay for catastrophic care. My God, how can they
afford it?
Of course, they can collect some of the money back by billing those uninsured
that can afford to pay for some, or all, of their medical bills...and, they will
probably be paying less under this plan than under the existing health services
they are providing. So, who knows, maybe it's not such a bad deal for the
state, either.
The Feds will whine about providing catastrophic coverage, but, hey, whining and
spending money is what the Feds do best.
Besides, if people are signed into such a health insurance program at a very young
age, by the time they reach 65 it might be possible to modify the program to
replace (or supplement) the Medicare program with some coverage from private
insurance companies and states. Maybe there is a financial future for Medicare.
But, there is no free lunch in life. Even though the cost of medical care
is split between the individual, the insurance company, state government, the
Feds, and charities, in the end, the individual is the one who pays the insurance
premiums and taxes that fund the insurance companies and the government.
What all these programs are designed to do is shift the risk of catastrophic medical
care and improve the odds for the individual to survive the cost of unusual
medical emergencies.
Even with this program, there will be situations where the medical co-pay will
place a hardship on an individual. There will be situations where the money for
the catastrophic situation runs out and an individual is left destitute. It is sad,
but it is life.
This program is designed to protect the vast, vast, majority of people from a
medical disaster. It is designed to protect society from contagious diseases borne
by uninsured individuals. It is designed with dollar limits in order to keep the
cost affordable, and is designed to spread the cost between different entities
in order to minimize the risk of financial failure.
As I said in the beginning, I'm not sure if I have the correct price points or
not. Maybe the co-pay should be 10% or 20% instead of 15%. Maybe the
feds, or state governments, or the medical establishment should cover more,
or less. I just think that a sweet spot could be found, where all the numbers
work out.
I know it would be tremendously difficult to get coordination between the federal
government, state governments, private insurance companies, doctors, medical
groups, etc, to work this all out. Is it hard? Yes. Is it impossible? I don't think so.
But then, that's the advantage of sitting in the basement in my shorts writing a
blog. I don't have to do it, I can just dream about it. Somehow, somewhere,
someone will have the access and the knowledge to pull it off.
to pay out up to $7,500 dollars a year in medical expenses. Damn, that's a lot!
Of course, most of us will never reach that amount in a year. And the maximum
that almost all of us will have to pay in our lives is only 15% of the cost of our
medical bills...and far lower than that if we ever reach the catastrophic stage where
the state and federal government help kicks in. So, maybe it's not such a bad deal
for the individual.
And doctors and medical services will scream and complain about having to give one
free service for each twenty for-fee services they deliver. Damn, that's positively
un-American!
Of course, they're only giving away less than 5% of their services...and they can
make a lot of money off the twenty for-fee services they deliver. So, maybe
it's not such a bad deal for the doctor and the hospital.
The states will moan that they have to pay hospitals to care for the
uninsured, plus, they have to pay for catastrophic care. My God, how can they
afford it?
Of course, they can collect some of the money back by billing those uninsured
that can afford to pay for some, or all, of their medical bills...and, they will
probably be paying less under this plan than under the existing health services
they are providing. So, who knows, maybe it's not such a bad deal for the
state, either.
The Feds will whine about providing catastrophic coverage, but, hey, whining and
spending money is what the Feds do best.
Besides, if people are signed into such a health insurance program at a very young
age, by the time they reach 65 it might be possible to modify the program to
replace (or supplement) the Medicare program with some coverage from private
insurance companies and states. Maybe there is a financial future for Medicare.
But, there is no free lunch in life. Even though the cost of medical care
is split between the individual, the insurance company, state government, the
Feds, and charities, in the end, the individual is the one who pays the insurance
premiums and taxes that fund the insurance companies and the government.
What all these programs are designed to do is shift the risk of catastrophic medical
care and improve the odds for the individual to survive the cost of unusual
medical emergencies.
Even with this program, there will be situations where the medical co-pay will
place a hardship on an individual. There will be situations where the money for
the catastrophic situation runs out and an individual is left destitute. It is sad,
but it is life.
This program is designed to protect the vast, vast, majority of people from a
medical disaster. It is designed to protect society from contagious diseases borne
by uninsured individuals. It is designed with dollar limits in order to keep the
cost affordable, and is designed to spread the cost between different entities
in order to minimize the risk of financial failure.
As I said in the beginning, I'm not sure if I have the correct price points or
not. Maybe the co-pay should be 10% or 20% instead of 15%. Maybe the
feds, or state governments, or the medical establishment should cover more,
or less. I just think that a sweet spot could be found, where all the numbers
work out.
I know it would be tremendously difficult to get coordination between the federal
government, state governments, private insurance companies, doctors, medical
groups, etc, to work this all out. Is it hard? Yes. Is it impossible? I don't think so.
But then, that's the advantage of sitting in the basement in my shorts writing a
blog. I don't have to do it, I can just dream about it. Somehow, somewhere,
someone will have the access and the knowledge to pull it off.
Friday, April 27, 2012
Pie-in-the-sky Healthcare
Private insurers could offer $50,000 (85% with a 15% co-pay) annual coverage
from age 21 until Medicare takes over at 65. Children under 21 would be covered under
special policies available to their parents, but, upon reaching 21, would need to
purchase their own policies. Their parents (or others) could pay for the
policy, but the newly adult child would own it.
Adult health insurance would be made available only at 5-year increments, at
ages 21, 25, 30, 35, etc., but once purchased, the premium could not be
changed until age 65, unless the premium is not paid or the individual opts
out by written notification.
If the insurance is purchased at age 21, coverage can not be denied for pre-
existing conditions, and the premium rate would be calculated to include all
individuals. If the individual opts out of health insurance and then attempts to
enroll at one of the later enrollment periods, rates could be adjusted for
pre-existing conditions.
So, if an individual buys the insurance policy at age 21, the insurance company
is obligated for up to $42,500 (85% of $50,000) per year until the policy-
holder reaches 65.
I believe that such an insurance policy would be affordable, since most people
never reach that limit in any year prior to age 65.
Now, where does that leave the individual? If they did have a year where they
had $50,000 in medical bills, they are stuck with a bill for a maximum of $7500.
Call me cruel, but I do NOT believe that supplemental insurance should be
available to help pay this obligation.
One of the best ways to avoid unnecessary medical procedures and keep
medical costs down is see that the person using the procedure is aware of the
cost, and has to deal with the pain of paying at least part of the cost.
To HELP the individual deal with the pain, state government should offer
low-cost loans to help those who need assistance to pay for the co-pay
portion of the medical costs, based on the need of the individual. This
program could be self-supporting, and should aggressively attempt to
collect all loans.
Catastrophic coverage (over $50,000/year) could be covered as follows:
First Then and then
donated Medical
State Govt Fed Govt & Private Charities
Year 1 $200,000 $100,000 above $350,000
Year 2 $100,000 $50,000 above $200,000
Over 2 years -0- -0- above $50,000
Over 2 years could also be covered by catastrophic private insurance.
Catastrophic coverage would be based per incident, not per lifetime. Sales
and/or payroll taxes could be used to fund the state and federal programs, but
the money should be treated and regulated as an insurance program, not
as a honey-pot for general fund spending. If these taxes were combined with
a maximum income tax rate of 10%, as discussed earlier, there
would not be much impact on an individual's take-home pay.
Finally, what happens to those who either choose not to purchase health insurance, or
those unfortunate enough not to be able to afford it? First off, they would go to
the emergency room, just as they do now. Life threatening emergencies would be
treated, just as now. For those who chose not to purchase health insurance, the
state would attempt to collect for the cost of the service. The state would pay
for those who could not afford to pay back.
For non-life threatening conditions, hospitals should be legislatively allowed to staff
low cost medical clinics near their emergency rooms. The non-insured would be
sent to this clinic, staffed as much as possible with physician's assistants, medical
and nursing trainees, and non-union maintenance worker trainees. Generic drugs
would be required in all instances where they are effective.
Doctors could perform their required free service (1 out of 20) for patients for the
low-cost clinic, helping keep expenses down. The state could still bill uninsured
patients for services rendered, if they could afford to pay. They could even be
billed at a lower-than-market rate for donated medical services.
The low-cost medical clinic would in effect create a two-tiered health care system,
as a strong incentive to get individuals to buy health insurance for better care. The
uninsured would still receive medical care, albeit more of a generic nature and they
may have to wait longer for non-emergency operations. If they are financially
able to, the state would require them to pay for all, or part, of the medical services
they use.
I know, it sounds impossible...but think about it until the next post.
from age 21 until Medicare takes over at 65. Children under 21 would be covered under
special policies available to their parents, but, upon reaching 21, would need to
purchase their own policies. Their parents (or others) could pay for the
policy, but the newly adult child would own it.
Adult health insurance would be made available only at 5-year increments, at
ages 21, 25, 30, 35, etc., but once purchased, the premium could not be
changed until age 65, unless the premium is not paid or the individual opts
out by written notification.
If the insurance is purchased at age 21, coverage can not be denied for pre-
existing conditions, and the premium rate would be calculated to include all
individuals. If the individual opts out of health insurance and then attempts to
enroll at one of the later enrollment periods, rates could be adjusted for
pre-existing conditions.
So, if an individual buys the insurance policy at age 21, the insurance company
is obligated for up to $42,500 (85% of $50,000) per year until the policy-
holder reaches 65.
I believe that such an insurance policy would be affordable, since most people
never reach that limit in any year prior to age 65.
Now, where does that leave the individual? If they did have a year where they
had $50,000 in medical bills, they are stuck with a bill for a maximum of $7500.
Call me cruel, but I do NOT believe that supplemental insurance should be
available to help pay this obligation.
One of the best ways to avoid unnecessary medical procedures and keep
medical costs down is see that the person using the procedure is aware of the
cost, and has to deal with the pain of paying at least part of the cost.
To HELP the individual deal with the pain, state government should offer
low-cost loans to help those who need assistance to pay for the co-pay
portion of the medical costs, based on the need of the individual. This
program could be self-supporting, and should aggressively attempt to
collect all loans.
Catastrophic coverage (over $50,000/year) could be covered as follows:
First Then and then
donated Medical
State Govt Fed Govt & Private Charities
Year 1 $200,000 $100,000 above $350,000
Year 2 $100,000 $50,000 above $200,000
Over 2 years -0- -0- above $50,000
Over 2 years could also be covered by catastrophic private insurance.
Catastrophic coverage would be based per incident, not per lifetime. Sales
and/or payroll taxes could be used to fund the state and federal programs, but
the money should be treated and regulated as an insurance program, not
as a honey-pot for general fund spending. If these taxes were combined with
a maximum income tax rate of 10%, as discussed earlier, there
would not be much impact on an individual's take-home pay.
Finally, what happens to those who either choose not to purchase health insurance, or
those unfortunate enough not to be able to afford it? First off, they would go to
the emergency room, just as they do now. Life threatening emergencies would be
treated, just as now. For those who chose not to purchase health insurance, the
state would attempt to collect for the cost of the service. The state would pay
for those who could not afford to pay back.
For non-life threatening conditions, hospitals should be legislatively allowed to staff
low cost medical clinics near their emergency rooms. The non-insured would be
sent to this clinic, staffed as much as possible with physician's assistants, medical
and nursing trainees, and non-union maintenance worker trainees. Generic drugs
would be required in all instances where they are effective.
Doctors could perform their required free service (1 out of 20) for patients for the
low-cost clinic, helping keep expenses down. The state could still bill uninsured
patients for services rendered, if they could afford to pay. They could even be
billed at a lower-than-market rate for donated medical services.
The low-cost medical clinic would in effect create a two-tiered health care system,
as a strong incentive to get individuals to buy health insurance for better care. The
uninsured would still receive medical care, albeit more of a generic nature and they
may have to wait longer for non-emergency operations. If they are financially
able to, the state would require them to pay for all, or part, of the medical services
they use.
I know, it sounds impossible...but think about it until the next post.
Thursday, April 26, 2012
On Health Insurance and Medical Coverage
The following thoughts are not based on health insurance underwriting statistics. I have no idea where the exact percentages and dollar amounts make sense...I have no access to the medical and insurance facts that would lead to a logical, mathematical solution to the problem.
However, medical and governmental organizations that do have access to appropriate statistics could use the following guidelines to help set dollar amounts and create effective programs. Where I am using dollars and percentages, I am only guessing. Hopefully, it's a pretty good guess.
I am trying to set up a situation where the cost of health coverage could be shared between individuals, private insurance companies, medical organizations, state government, federal government, and private charities.
Since Medicare is already set up as a federal program, I will assume it continues to exist
as is, even though I will mention a potential change in a future post. Right now, the
program I suggest would only cover an individual until age 65, when Medicare takes over.
The basic ideas of the program are...
Everyone should have help available through affordable health insurance.
Everyone should have "skin in the game" for medical expenses, in order to help keep
the cost of the insurance down.
No-one is entitled to an unlimited amount of other people's money to protect them
from all risks in life.
No-one should be forced to purchase health insurance, but the incentive to purchase
it should be extremely persuasive.
Each adult individual owns (and pays for) their health insurance plan, and takes it
with them from job to job, similar to the way an employee takes a 401k plan
from employer to employer. Employers could offer employees an additional
benefit above the normal pay, to help fund health insurance, but the plan
would belong to the employee.
Private charities could be organized to help pay for medical services for those without
To receive their licenses, doctors and medical organizations could be required
to provide one free service for every twenty for-fee services they provide.
So, what would health insurance and coverage look like under these conditions? The following post will give an idea of what might be possible.
However, medical and governmental organizations that do have access to appropriate statistics could use the following guidelines to help set dollar amounts and create effective programs. Where I am using dollars and percentages, I am only guessing. Hopefully, it's a pretty good guess.
I am trying to set up a situation where the cost of health coverage could be shared between individuals, private insurance companies, medical organizations, state government, federal government, and private charities.
Since Medicare is already set up as a federal program, I will assume it continues to exist
as is, even though I will mention a potential change in a future post. Right now, the
program I suggest would only cover an individual until age 65, when Medicare takes over.
The basic ideas of the program are...
Everyone should have help available through affordable health insurance.
Everyone should have "skin in the game" for medical expenses, in order to help keep
the cost of the insurance down.
No-one is entitled to an unlimited amount of other people's money to protect them
from all risks in life.
No-one should be forced to purchase health insurance, but the incentive to purchase
it should be extremely persuasive.
Each adult individual owns (and pays for) their health insurance plan, and takes it
with them from job to job, similar to the way an employee takes a 401k plan
from employer to employer. Employers could offer employees an additional
benefit above the normal pay, to help fund health insurance, but the plan
would belong to the employee.
Private charities could be organized to help pay for medical services for those without
health insurance or those who have exhausted all private, state, and federal
benefits.
Hospitals should offer less expensive clinics to care for those without health
insurance, who don't have life threatening emergencies. Life threatening
emergencies would still be taken care of in emergency rooms.
To receive their licenses, doctors and medical organizations could be required
to provide one free service for every twenty for-fee services they provide.
So, what would health insurance and coverage look like under these conditions? The following post will give an idea of what might be possible.
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