The fundamental problem with healthcare in the United States is three-fold. First, medical insurance is not a true insurance system – it is an entitlement system which guarantees a higher payout (in benefits) than costs paid. That is clearly unsustainable, because it rewards overuse. What will really fix the system is to de-couple health insurance from employment and then it should be made to become a true insurance system, whereby people pay out of pocket for primary care and then seek insurance benefit only for what today would be called “catastrophic” illnesses/injuries (the premium for which should be, in turn, quite inexpensive).
That sounds a lot like auto insurance. If companies provided auto insurance and in turn auto insurance covered oil changes and tire rotations, it’d be a lot more expensive, too.
What about the relatively novel subscription model? It has exploded from nothing to hundreds of primary care facilities in the span of a few years. Clients pay a physician something like $80 a month for all the visits, virtual consultations, common prescriptions, and basic operations the clients need. They get a subscription and barring something catastrophic occurring, they’re set. Some facilities accept insurance but many, maybe most, do not. With the ACA non-compliance penalty at zero, it’s a sensible approach for a lot of healthy people.
Twinkie continuing on costly CYA:
The second necessary fix is tort reform. As it stands now, any negative outcome for patients (whether caused by healthcare providers or not) is a lottery jackpot for them (and far more of a boon for medical malpractice lawyers). And these days there is A LOT of negative outcomes due to the poor health of the general public (which in turn is largely due to poor diet and sedentary lifestyle). Not only does this increase medical liability costs for the providers, it dramatically increases the costs of healthcare provision by forcing the providers to practice “defensive medicine,” which reportedly eats up a third of the total healthcare costs in the U.S.
Twinkie’s third prong deals with bureaucratic overregulation:
The third fix is deregulation of medicine. People often complain that doctors get paid too much, but physician salaries are not what drive the increase in healthcare costs. Physician services account for roughly 20% of the total healthcare spending. Of that amount, about half is the cost of practicing medicine. In other words, actual physician income is 10% of the healthcare costs. Even if, say, you make physicians take a massive pay cut of 20%, it’s only going to reduce healthcare expenditure by 2%. What’s driving up the cost of medicine – as in the education industry – is the massive rise in “administration” (and compliance). For every doctor there is at a hospital, there is now an army of clerks and desk-bound staff who do byzantine regulatory-compliance and other paperwork. Practice of medicine today is extremely bureaucratic – even though it is notionally not government-run, it is largely dictated by government regulations and is run like a government-provided service. Until that is fixed, just as with education costs, healthcare costs will continue to balloon.
Medicare-for-all or the car insurance approach both strike this blogger as better than the current system. Politically, we demand both the best, most cutting edge care in the world and affordable coverage for all Americans. There is an inherent, unresolvable tension between these two demands.
MattinLA isn’t much encouraged by the integrity collapse of the major media over the last few decades. To the assertion that the neo-liberal establishment couldn’t get away with Iraq Attaq today, Matt wonders where I’ve been over the last year:
The insane lies they’ve gotten away with about this phony “plague” are a million times worse than those uttered during the Iraq war. And the damage incalculably worse. We are on the verge of full scale communism. If media skepticism was some sort of game changer, we wouldn’t be in this situation. I think we are past the stage where wry comments and dry irony can save us.
I’d call it totalitarian corporatism rather than communism. Fed money creation, strangulation of small retail operators, and severe disruption in the rental market–the eviction moratorium is still in place–have been great for large corporations. And now forever Covid vaccines promise new perpetual income streams for the pharmaceutical companies that own big shares of both major political parties.
If two years ago you’d been told that seeing a parent, going to church, or going to work would require explicit government approval, you’d have scoffed at the absurdity and yet here we are. Allowing for Matt presumably being in Los Angeles, which has been more restricted than just about anywhere else in the world over the last year, his is a tough point to argue against.
Obama’s and Hillary’s pointless and gratuitous war against Libya in order to show that lefties could make war too not only destroyed the cooperative government of a strategic country, it also served notice to every second- and third-tier power that the only sure way to prevent an arbitrary attack by the US is to make sure you have WMDs. None will be foolish enough to give up their WMD programs anymore.
Sounds pretty bad, and he didn’t even mention it opening up the migration floodgates from Africa into Europe.
Reacting to the revelation that close to half of African women bleach their skin, Paperback Writer offers the very sensible insight that people should accept themselves for who they are. After all, it’s hard to celebrate diversity if you won’t admit it exists:
There are good looking and bad looking people of all races. People really should accept their racial characteristics.
He can write that, can’t he? Is a white man criticizing black women for making their skin whiter cultural imperialism or fighting against cultural imperialism? Beats me.