Response To Free Market Health Care.
A fellow reader NTRWriter wrote in my comments board in response to Why We Need More Health Care Reform and I thought he raised a few good points worth addressing. I will slowly be winning him over to the correct view, check out his blog if you get a chance.
NTRWriter
There’s a lot of good research and analysis here, Matt. Well done. But your point about this program keeping down costs is a little weak. There is nothing here that keeps an insurance company from raising premiums, especially when dealing with a chronically ill patient. That $7500 deductible every year will do less for people with cancer who need several hundred thousand dollars worth of treatment annually. Plus, you’d still need to ban lifetime caps on benefits. And for people who are relatively healthy, why would they ever want to stop receiving 10,000+ dollars per year? Does this really encourage them to make more money, get educated or get a different job when they know that check is just going to disappear and they can just save it that way. The same, of course, can be said for people on welfare except welfare doesn’t roll into a savings plan. My point is, it’s still the government giving people money. Why doesn’t the gov’t just write us all a check every year? But if we stop paying taxes, it just ends any safeguards. Not only with the sick not get care, but they’ll be no money to mitigate that.
Health care is not something that can be easily handled by the free market. There are a lot of issues that just don’t work well. Pre-existing conditions, rescission, caps, preventative care. Also, the report you cited was for people on Medicaid WITH disabilities. I think the amount spent is much lower for low income residents who are in decent shape. Now compare receiving $5000 with a $7500 deductible. That’s quite a bit more in cost for the the patient.
Thanks for the read, though. I learn a little bit more everyday.
You bring up some excellent points, and health care is far to complex to solve in one quick post.
I will start with the catastrophic issue. The reason Health Care premiums keep rising so fast is not because everyone is catastrophically ill. That part of health care is far rarer and overall represents a vastly smaller number.
The reason costs are rising so fast is because the lower end expenses. Consider if you have Medicare or Medicaid, you are one phone call away to getting a free 3k dollar power chair. No questions asked and nothing out of pocket. There are many that probably need a power Wheelchair, but I would guess most wouldn’t buy it if it were their own money. A power wheelchair is one thing, a power chair is another. Another example is going to an ER room for a cough rather than waiting to see a doctor. The difference in cost between the two is thousands. This is poor allocation of medical dollars. Creating better decisions on the low end is what we need.
The second point I agree would be controversial, but consider the current incentive to get off medi*. I would argue it is easier to create a lower scalable subsidy that can eventually phase out and get people off government assistance which must be the ultimate goal.
3rd you are correct about $11,000 being at the high end. However it also shows how it costs $3,900 on average per young healthy person. In this case consider my high deductible of a mere $1,500 and it costs me $103 per month. Under my program I may only be given a credit for $3,000. By continuing to be health in this example I would save $1,500 a year by lowering my medical expenses for being healthy.
We can have different tiered vouchers based on deductibles.
How Free Markets Handle – an answer to your questions
Pre-existing- conditions only exists if you jump around from insurance to insurance, this is why having an employer based policy is dumb. You would never have a preexisting plan if you joined for example the Talkofliberty blog reader’s insurance plan as an individual at birth. Free Market delivers however government restricts this from happening.
Rescission- this is a contract issue. Government is supposed to protect the sanctity of a contract; this requires government to do its one job. Not Free Markets fault if the contract states it will be covered and they do not honor a contract.
Caps- Everything must have a cap because there are not unlimited resources. Allocating resources properly is important. Currently plans covering large deductibles let’s say with a 2 million lifetime deductible plans are illegal. The same policy that covers your first hundred dollars expense should not be required to cover you up to ten million dollars in expenses. Free markets would provide such an additional plan where coverage would kick in after you hit hitting a 2 million dollar lifetime deductible, again Free Markets deliver, and government restricts.
Preventive Care – Today if you go to your doctor and suggest you will pay in cash, the cost of a regular doctors visit may only be $30 bucks. Because government forces people pay for expensive premiums which covers these basic visits the cost shoots up to a $400 per month plan which covers preventive visits rather than a $100 dollar a month plan with high deductible. In the Free Market Plan, I could visit my doctor at $100 dollars per visit every single month, and still be cheaper overall and I assume healthier. Free Market Delivers another, government destroys another.
Matt
http://talkofliberty.com
Health Reform A Blessing In Disguise?
The devastating effects of Health Reform are just becoming more and more clear. As companies are able to review how this will impact them, a very common theme is recurring again and again. Basically an Employer who is not offering health insurance to its employee (singular) will be fined $2,000 dollars per employee (singular).
Considering how most families (plural) are on a company’s insurance plan where they work, the likely cost to a company is far greater than $2,000 dollars. Let’s say a family of four gets their full insurance policy from an employer. If the cost of the premium is $3,000 per person, or $12,000 per family, companies will gladly opt out and pay the $2,000 dollar penalty, saving them $10,000.
Even if the cost to the company to insure the person is a mere $3,000 for an entire family it would still be cheaper to drop them and they save $1,000. Even better is that when they drop them, there are no preexisting conditions, and they must be accepted no matter what to an insurance plan. One more piece of evidence this will happen is that a family of four making less than $80,000 will get the insurance subsidized by the government if their employer doesn’t offer insurance.
I will predict that a cascade of employers dropping insurance plans will come. Look for the first few to do it and be crucified in the news, but after the initial stigma wears off, all the other companies will follow suit. It will be a matter of time, before there is no such thing as Employer Based Health Insurance.
The reason I say this may be a mixed blessing is in the worst way, it will make what I have been calling for come true. I didn’t realize it at the time, but it will end the employer based insurance coverage. This part is a good thing, but the way it is set up and the incentives used, is the worst way to get there. I have my own insurance, and plan on paying for it, because I am afraid of a mass exodus to sign up for individual plans. Companies may not be allowed to deny coverage, but as far as I see, the application period to get that coverage will be indefinite.
Why We Need More Health Care Reform
This new health care bill which has passed does not help reform any of the issues regarding cost. Though I am a Libertarian idealist, I can think of ways which provide state support for those who may need financial assistance. I understand in the ideal world, all government programs ultimately hurt individuals and I associate the programs that are intended to help those in need as reason those same people are in need. The reason is the cost. Government is a terrible system of allocating resources. Here is my Libertarian fix to this health care reform I hope those running for election in November will consider and try and implement.
The ultimate goal of any government program should be to lower the amount of individuals using assistance not grow it. With that goal in mind, first we need to look at where we are in order to create a plan of where we are going.
In scouring the internet to figure out the average cost of a Medicaid recipient since this is how the most of those not covered will be covered under this healthcare reform. This report gives us a quick idea of what the average cost per Medicaid recipient is. Keep in mind most doctors are now not even accepting new Medicaid patients even with the average cost being $10,918 per year in Arizona.
Rather than spending $10,918 per person on a plan that then requires the individual to not pay any money out of pocket, we can simply issue a voucher to that individual for that amount, deposited directly into an HSA. The Health Savings Account should be able to be used to pay any medical expenses including premiums as well as deductibles and medications. So now that we are depositing this money into a savings account, let’s now look at what a non government option would look like for individuals.
Using www.ehealthinsurance.com I simply did a quick look for insurance plans for someone who I consider expensive. So I could make this very difficult I used a female who is 55 years old living in Arizona. We can find the highest deductable where we can get the most bang for the buck if you will. This would be the United Health One Plan 100 policy. The choosing the highest deductible that this person could use the voucher with this plan makes the deductible $7,500 per year and has a monthly cost of only $156 dollars.. What this means is that after $7,500 is spent, the insurance company will pay for 100% of all medical expenses beyond that amount. This plan also covers prescription drugs in it as well. It would be important, that any money saved and not spent after one year from the HSA would be allowed to be withdrawn by the individual as earned income or rolled into an IRA. This way it is their money if they do not waste it rather than use it or lose it.
Ok so here is how it will work. Individual would be given the voucher for $10,918 instead of being forced to take an expensive government plan. This private insurance plan will only cost $1,872 per year. Subtract that cost from the voucher cost and the difference; $9,046 would be deposited into the individuals HSA.
Over the course of an entire year, under the policy above the most an individual could have to pay if they are sick would be the deductable of $7,500 leaving $1,546 left over to start since this is above what 100% coverage with all co-pays and deductable covered. I just saved America $1,546 per person already.
What is better about this plan is how it would empower individuals to save. The individual will be rewarded for living a healthy lifestyle. Those who smoke, eat unhealthy foods, and do not work out, are also those who need medical care more often. This means they will use their deductable money for health care. Those who live a healthier lifestyle will be rewarded financially. Consider if a married couple is actually healthy and just need their regular checkups. They may only spend $500 dollars for the year on medical expenses total. This would actually reward them for being healthy with over $15,000 dollars in additional income for the year.
Anyone wanting a free power chair will think twice about the cost since it will come out of their HSA savings and they will receive that much left in income at the end of the year. This plan would also lower lawsuit issues with doctors since individuals will decide for themselves if they should use their savings for medical tests. Doctors and patients will make decisions together rather than insurance companies or bureaucrats. If an individual decides not to get a treatment, they own that decision; therefore they will not likely sue the doctor since they made the decision themselves. This is who should decide if a service should be rendered or not.
In the bigger picture having a voucher will freeze the growth of medical costs. Clearly in this plan there is plenty of money to be saved. Giving the poor and needy vouchers rather than a plan they do not control savings leads to over use. They will think twice before going to an ER rather than waiting until the next morning to see their doctor. This will begin to turn this massive ship around. We need to control health care costs.
As a libertarian, I can support this because I have realized the transition is more important than an all or nothing battle. This model makes it easier to scale back the amount of subsidies i.e. vouchers are given based on need. If someone makes enough money, it would be reasonable to see the voucher amount decreased accordingly. The ultimate goal of this would be to get all individuals to the point of prosperity where they do not need subsidies. Attaching the welfare checks into the subsidies like this would be far more beneficial to society by rewarding healthy behavior.
This is a scalable plan that gets a handle on costs and will help unleash the free markets for health care. This will be good for individuals.
Matt
Health Care Has Passed, Now What?
So health care reform has basically passed through the final turn and is making its way across the finish line. I have seen many sides to the debate and there are a few things I have observed. I watch those on the left asking why anyone could possible be opposed to this legislation? Here are the top 3 reasons this reform is so loved on the left. On the surface they all seem like good ideas, with the swipe of the magic legislative wand, all these issues will be fixed. Not really, here is why.
- No preexisting conditions.
- Coverage until age 26 on parents plan
- Prevents major price increases.
The three different issues that are being addressed are all intertwined. To keep this short and simple explaining number three, preventing major price increases is really just another way of saying price controls. The bottom lines with price controls are they create shortages. If insurance companies do not have any pricing power to bring in more money, they will not be able to pay more for needed services. This means rationing of care. It will happen; anyone can reason that if there isn’t enough money to pay for the expenses, limits on spending must happen. Who decides where money is better spent, that will now be someone in Washington. Good bad or ugly, without being able to raise premiums means there is not an unlimited supply of money for services. Prices will continue to shoot through the roof because of the crown jewel of this reform bill, preexisting conditions.
Our incredible intelligent law makers figured out they simply needed to write a law saying no more preexisting conditions, and that will solve all of our insurance problems as a nation. It all sounds great, why didn’t they do this a long time ago, because it just isn’t that simple. The reason it isn’t simple is because the mish mash of insurance companies and how we get coverage. Our current system is a patchwork of coverage inter tangled through ridiculous regulations.
Consider the first crazy way we get insurance…….. from our employer. It is ridiculous since if you lose or quit your job, you lose your insurance. Why would anyone purchase based on an employer? We do because of taxes and other regulations requiring companies to provide it. Next it is even more complicated with the ridiculous idea that we can’t shop across state lines. This means if your employer is in NY, then your insurance plan has to be purchased by your company in NY. If you live in a different office of the company located in a different state, you still have NY insurance. If you lose your job, by law you must give up your coverage since you are out of state and shopping across state lines is illegal.
The problem with a preexisting condition is when someone with it, has not been paying into an insurance pool. There are many reasons why this happens. Because most insurance policies are attached to the job, as soon as someone gets very sick, they will likely have to resign losing their current insurance policy, now with the new law, they will simply buy in to a new plan. The problem is that the old insurance company got all the profit while the new company will get all the expenses.
A likely outcome of this new law is the disappearance of individual policies. Why would an insurance company cover individuals now since the only people who will be seeking insurance not from an employer will be a sick person? With no fear of losing insurance from your employer, people will become sick and quit their job to take time off to focus on their health and becoming healthier, this sounds good, but will lead them to an individual policy. Again it will be a new policy that must cover them regardless of history or cost.
Eventually this will break down the system. Any smart insurance company will exit this dangerous pool of customers. That will start forcing over people to the state rolls. This will lead to a complete breakdown of the insurance industry, and eventually everyone will find themselves on a single payer insurance pool. That is the final outcome with regulations that are too onerous. It will distort the insurance market place until it breaks.
The final proof this new plan addresses none of the problems and leads to more of the above, being 26 and still needing to be on your mothers insurance. This is the case again because we have employer driven insurance coverage. If individuals bought their own insurance policy from the start, they would never need to be on moms insurance.
The reason this even needed to be included is because of how foolish our system is. A person has their family’s policy. The new health care reform will now force coverage on moms insurance until the age of 26 instead of just 18. That sounds great, but just pushes back the same problem; they will have to change insurance companies. It doesn’t address the real issue, the fact we change insurance companies way too much for easily fixed reasons.
This is my case for why health care reform will fail. It fails to address the fundamental issues plaguing our health care system. It will continue to raise the costs and will eventually run out of money.
Matt
http:.//talkofliberty.com
Health Care Bill Creates Health Care Dictatorship
Anyone reading this health care bill which was just posted online will quickly see just how scary this bill is. Everything I keep reading keeps deffering all decisions to the Secretary of Health. Every medical decision is going to be decided if it is fair. The Secretary will have the power to literally run the entire Health Insurance industry.
I think it is quite clear we are actually getting a single payer system with this reform. Everything in health insurance will be regulated and you will see co-pays, deductables, coverage all determined by our new health Dictator.
On the practical side, I have a question for the bureaucrats, it sounds great that all insurance will now have to cover everything right? What happens if somone needs a surgery and there are two ways of performing it. Option one is very expensive but uses the latest technology which makes the entire procedure pain free and easy. Option 2 is an old technique that is far cheaper and often has far more complications in outcome.
Now that insurance companies will basically be zombies run by the dictator, there is no longer an incentive to offer the better coverage than other companies. They will look at each case as an expense and opt for less costly. They will opt of the lower quality of care since they have no pricing power and no ability to offer a different insurance product to their customers, and they will be the monopoly in charge due to these regulations, so you will have nowhere to get better care.
This Health Care Reform Bill is scary, just read it and ask yourself the simple question of how will the secretary of health our new dictator, know what is best for the 300 million people. Make no mistake, this is Socialism, it is here, it is scary.
The Hidden Costs Of Health Care Reform 2 Trillion?
The CBO has returned with the estimated cost of the next ten years of health care reform. A mere $940,000,000,000.00 dollars for ten years. This is likely to be completely wrong and end up costing far more for Americans since it will destroy even more levels of competition through oppressive new regulations and mandates.
One overlooked fact regarding this comprehensive reform package is how it will basically cost $1 trillion dollars to cover an extra 31 million people. I question the idea that those 31 million do not have coverage since half of them are young in between jobs youth who probably do not even need coverage. Regardless, the average cost per person will be a staggering 3000 dollars per year for ten years to cover them for ten years, but the reality is it will cover them for 6 years meaning it is closer to $5,000 per person. Keep in mind, half of this pool is a low risk pool with little cost to cover.
The second overlooked cost of HC reform is the fact that the trillion is the cost of 31 million extra to be covered. What about the other 200 million people who already have insurance? Democrats state that this will lower the cost of insurance for employers to pay for or individuals to buy. I ask how? This bill changes nothing regarding competition or reducing regulations which drive up prices. The only thing in this bill is more coverage mandates. This will no doubt cost everyone more in the bigger picture over the next ten years. Let’s be extremely gracious to the democrats plan and only assume this bill adds additional costs of $100 dollars a year to everyone else, it would add an additional 2 trillion dollars in cost. This is an additional 2 trillion dollars that will pay for red tape not creating a job or healthier people.
Because there is nothing in this bill that increases competition and it was written by pharmaceutical executives, that means this bill can only lower costs through price controls which have never succeeded and always lead to rationing with less supply than demand. This bill will most likely suck at least another 3 trillion dollars out of our economy and divert it to unproductive areas, lowering the overall capacity of wealth generation in our economy. Small businesses will likely be crushed initially since it will takes months to find loopholes around regulations rather than pay for them.
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