Any ideas?

We really need to break down the costs of providing general health care. In this country we rely on high cost health labor (doctors) for services that in other countries would be provided by someone at the level of a nurse or pharmacist. It is ridiculous what people have to pay as an upfront cost for acquiring a prescription, for example. An expansion of Free Clinics offering a modest array of premium services, if universalized, would be a great addition to our health services. Also, an extension of authority for lower-level healthcare professionals.

Thanks for your reply it is appreciated.

I do wonder about one thing, you say there is no way the smaller carriers can compete, yet they are still in business, seems to me they can compete at least on some level. Also you say that: ” To break up coverage between different carriers by geography simply adds too much to the premium.” That seems to support my position that there would be a cost savings at least for a portion of the competion in allowing for purchasing across state lines.

Going back to healthcare, though, one of the things that I consider vital to a decent health care system is that it include dental, vision and mental health care. This doesn't mean that a system should have to provide Lasik surgery but I would consider glasses reasonable (Think of what it means to your ability to work.) and dental shouldn't have to provide purely cosmetic procedures but anything to do with abscesses, infections, etc. should be as should tooth replacement. People die from poor oral health care. An article in The Nation referred to this as the hidden health care crisis. There are also economic issues. Two different articles I've read have pointed out the obvious, which is that it is just this side of impossible to get a job if oral health problems have cost you some of your teeth.

First, let me apologize to Polimom for those comments I made before questioning her honesty. They were over the top and I shouldn't have written them. Not being perfect, I cannot promise that I won't repeat that stupid error but I will be trying to avoid it. Secondly, I'm pleased that I can say that I agree with pretty much everything she has posted in this thread. I even agree with a post of Leonidas's where he is pointing out how advertising prescription drugs doesn't help our system at all.

This is something I had also been thinking of and trying to figure out how to say it. Polimom has done a wonderful job of it in this thread and the huge contribution by jdledell has made for some great reading on the subject.

I did not mean to deliberately sidestep your question, it's just that there is a lot of material in this thread to absorb. As to your question on big insurance companies vs small here is the best analysis I can give. For large companies – Microsoft, Verizon, GE etc, there is simply no way for smaller carriers to compete – the big 7 are the only answer. To break up coverage between different carriers by geography simply adds too much to the premium. For small employers who are located in one spot with say 50 employees, it's still hard for a small carrier to compete with the big boys. That is due to the large carriers having significantly more volume and thus driving better deals with hospitals and docs. With Insurance so expensive, a lower premium that large carriers can offer is 90% of the buying decision.

Large carriers use their cost advantage to pad profits by using the smaller carriers higher premium as a straw target and just undercutting it rather than pass all the cost savings along. Insurance companies don't make much, if any profit, on large employers. The buyers are too sophisticateed and competition is fierce amoung the large carriers since all of them want the big volume to drive their deals with health providers.

The plans offered by large carriers are usually consistent state to state. Most large employers opt for self insurance with the carrier providing administrative services only (ASO) This makes the palns exempt from state regulation by way of ERISA. There is no way for small entreprenurial companies to compete when premiums are so important. If I can get a computer from Dell for $500 vs having my local computer store build the same one for $1000, which am I going to buy regardless how much I like the guy at my local store? The same is true with large and small insurance carriers.

“I do think that people with good insurance often go to the doctor because they can. At the same time people without good insurance often don't go when they should.”

Ron, thanks for your comment. I wonder at your use of the phrase “good insurance”, though. In context, you seem to be suggesting that it's good because it allows people to use it for care that it not catastrophic.

I think this is focused on whether or not people make rational healthcare decisions if they have to pay out of pocket. The biggest study on this was done quite a while ago, the RAND study done in the 70's I believe. Overall, most people did make good decisions when they had to 'self ration', but there were exceptions, most notably among the poor. Simply put, it seems that if you have almost no disposable income after rent and food costs, you aren't likely to decide to go to the doctor every time you should, but if you have disposable income and are choosing between cutting a few dinners out or getting that yearly checkup, most people are pretty rational.

In my mind, sliding scales could do a lot to rectify that one flaw. Have everyone have to feel the effects of their basic healthcare decisions to some extent, but have that effect be proportional to their incomes.

Let's bring some of this together. I'm going to gratuitously lift a comment by CStanley from another thread, from a post started by elrod.

Americare – a defined basic health insurance package paid for through general taxes, and for those who can afford it and want it, a regulated market that offers supplemental insurance.

That's actually a model I might support, depending on how it's structured.

Like most conservatives, I think that our current system which prevents hospitals from turning away poor/uninsured people is responding to a true public obligation. I don't think that giving everyone a publicly subsidized, gold plated healthcare plan is a good method of reducing costs and in fact will add to it by increasing demand for routine care.

But having everyone covered by a basic, bare bones plan- particularly if it were along the lines of HSA/HDHP structure which encourages people to think about how the dollars are being spent- would allow people to get routine care without going to the ER. If it had that kind of individual accountability built into it, but also allowed for a sliding scale according to people's means- then it might work to reduce costs and keep demand under control. The sliding scale could be implemented in one of two ways- either by having the actual price for the policy adjusted to income, or by giving tax credits for people to purchase the policy and fund their HSA.

There should also be some focus on increasing supply, so that it's not so mismatched to the demand which will still increase somewhat under that scenario.

There could probably also be a gradual dissolution of Medicare and SCHIP, if the new system could accommodate those needs.

Elrod's phrasing is at odds with my post. I don't see the solution as a “basic health insurance package”; rather I think we should be thinking in terms of a “basic health care package”. Since that thread evolved from a different place altogether, I'm going to just invoke semantics, and see if anybody agrees with me that there are possibilities here.

again thank you for your commentary but you did not address most of my questions above.