John Lounsbury

Healthcare 'Debate' Dominated by Shouting and Lobbies

Jay - - -

Very clever connecting Grassely, corn and death panels.

Healthcare 'Debate' Dominated by Shouting and Lobbies

I just listened to President Obama's on line healthcare "forum". I heard a couple of interesting things.

1. Questions and discussion on the role of diet in health care costs. Several commenters here have mentioned the importance of this in trying to control health care costs.

2. I heard Obama say that everyone should be required to have a basic catastrophic health care policy. He said that should be the minimum coverage (mandatory, like auto liabilty insurance) and more comprehensive coverage would be optional. I do not recall hearing this before (except in my articles).

I think the comment stream has addressed some of the objections we will hear to these two items. I think these are credible ideas and, to those who object to them based on their freedom being curtailed, I say: I will give you no freedom that takes money out of my pocket to benefit your bad behavior.

Healthcare 'Debate' Dominated by Shouting and Lobbies

jay brebner - - -

You suggested that there are some who do not want to be interfered with. You wrote: "I think that is part of the backlash that is out there - nobody wants to be told what to do - we want to be free to kill ourselves as we see fit."

See my previous comment. My answer is that anyone who wants the freedom to abuse themselves is welcome to do just that - but not on my dime.

Healthcare 'Debate' Dominated by Shouting and Lobbies

mikebrah - - -

Unfortunately you are right. I have suggested that the catastrophic health insurance premiums could be discounted for those who met specific healthy lifestyle parameters OR were making documented progress in changing. Ultimately, I believe the best health care system for cost efficiency and health outcomes will be one that has the patient invested both from the perspective of personal health and personal finances.

I know someone will protest discrimination because they can't get a discount if they are obese, or if they smoke, abuse drugs or alcohol. My answer is that not to make them recognize the extra cost risk they present for their health care will make me pay for it and that is discrimination against me.

Discrimination against someone because of their behavior is called underwriting. Discrimination against someone because of someone else's behavior is called turpitude.

Healthcare 'Debate' Dominated by Shouting and Lobbies

Tiny Tim - - -

I read the New Yorker article. The primary cost driver described in McAllen is called physician self-referral. I mentioned it in my article, but didn't explain it. The author of the New Yorker article dismisses the value of patient "audit" in controlling costs. He gives an example of a multiple bypass surgery. Is such a patient in a position to bargain for the best deal? I agree. But for the small things that can add up to several thousand dollars some years, I think the patient is in a good position to "get a good deal" and avoid fraud and unnecessary drugs, tests and treatments. The multiple by-pass would be covered by the catastrophic insurance, and the insurance company (or Medicare, or Medicaid) would have a cost control responsibility there.

Healthcare 'Debate' Dominated by Shouting and Lobbies

Jay - - -

I tried to keep the article tightly focussed. There were some new points developed here that were not well covered in the article on TheStreet.com and some things that were discussed in that earlier article were not included here.

Among the things not included here was the idea of premium discounts (for catastrophic coverage) for those who (1) have a healthy lifestyle or (2) make progress toward lifestyle improvement under a doctor's supervision. For those in the lower 50% of the income distribution, the government could provide partial payment for the preventive program, with those near or below the poverty line getting full payment.

I have outlined what I think would be a full discussion of all the ideas I have been mulling over. I think it would be between 6,000 and 8,000 words, too long for Seeking Alpha or TheStreet.com formats. Maybe I can do it for a print magazine or a dedicated website.


On Aug 19 04:24 PM jay brebner wrote:

> john -
>
> How does catastrophic care address the need for prevention?
>
> I am assuming that you see individuals taking care of themselves
> because they will be disciplined by out of pocket expenses. I'm not
> sure that would be the case and that it might actually become a barrier
> to good care.
>
> While the debate going on now is centered on the economics of HC,
> it should not be forgotten that HC reform is also a public health
> issue. Getting people into and keeping them in contact with a system
> of care is the best way to do prevention, from flu shots to cancer
> screenings, etc.
>
> I have not been swayed from my single-payer/HMO plan, as I see it
> as the best way to align interests, but the meaningful dialogue is
> again appreciated.