This is already done, albeit in a different way. Any major treatment has to go through a review that assesses its medical necessity.

Outright banning of certain procedures is on shakier ground, because health insurance is a matter of contract, and if someone doesn't like one plan, they can theoretically leave it and choose another plan.

Besides, as a practical matter, not paying for abortions would increase costs dramatically, not reduce them. Some people could not afford to pay out of pocket, and would then need expensive prenatal case, obstetrics, and a lifetime of health care for the child.

This post completely contradicts your first post. You pointed out the adverse selection problem and said that the premiums from the younger, healthier people would pay for others' insurance. By definition, that means that healthy people pay an unfair price. Of course there is always risk, but for your example people can purchase some sort of catastrophic coverage instead of the more standard policy. Moral hazard is a very real problem; people smoke, drink, and eat badly (I know diabetics who refuse to stay on their diet). Healthy people have a legitimate beef with paying for unhealthy people's medical care. Further, once people pay to have insurance, they then feel they should get their money's worth and use it.

As for preventive medicine reducing costs, that notion has been wholly discredited by healthcare economists. It is a myth born out of the rhetoric of political candidates pushing their health plans. If you want to say that preventive medicine should be offered because it's the right thing to do, that's cool. But we won't save money by paying for more preventive treatments.

Anyway, a little off topic. Limiting liability could definitely reduce costs, at least in a free market health system.

I have heard of and know of women getting gastric bypass when they only weight around 225-250 lbs. I also know of some who, when told by their insurance co that they only pay for the surgery for people who are at a certain higher weight, tried to gain enough weight to qualify, so the insurance would pay for it.

Things like this, IMO are criminal. Unless you are over 400 lbs and your health has been DOCUMENTED by physicians as stating that you definitely need gastric bypass for serious health reasons, I don't think insurance should be made to pay for it.

To give a personal example: 7 years ago I weighed around 300 lbs. I'm now around 140, and no, I did not have gastric bypass. I did it the hard way: change of lifestyle (eating properly, and daily exercise.) But now I'm left with lots and lots of loose skin, mostly in the abdominal and upper thigh area. Should my insurance pay to have it removed? I don't think so, but others have told me I should get my doctor to say its becoming a "health hazard" for me, etc. To me, that's like defrauding an auto insurance company with false claims after an accident.

Too many people get gastric bypass done because they just don't have the willpower to stop stuffing their faces. Likewise, I don't think insurance should pay for elective abortions when birth control is readily available. I don't like paying for other people's lack of willpower, whether it be food or sex.

if god wanted your skin tight He'd tighten it. Sugery like that is just playing God.

In any insurance system the people who don't end up using the coverage pay for those who do end up using it. Insurance systems rely on pooled risk to operate. If an insurance pool contains only those people who will use the coverage, there is no pooled risk, and the system will eventually collapse.

Those only become moral hazards if they're the result of having insurance. If people with health insurance are more likely to smoke and eat badly than uninsured people (and because they have have insurance, not because of an independent 3rd factor like socioeconomic status), then that would be moral hazard. There's no research suggesting that that would be the case.

I'm a safe driver, and I have a legitimate beef with paying high insurance premiums that, in your view, pay for the accidents of unsafe drivers. But I want to drive a car, so paying high car insurance is something I just deal with, since it's necessary to have viable insurance in the first place.

That would be a good example of moral hazard, but I wonder how much of an effect it would have. A few years ago, the public health care system of Toronto was considering having co-pays for doctors visits, to reduce moral hazard. In the course of their research, they found that co-pays did not reduce the abuse or overuse of doctors' visits, it just reduced doctors visits across the board for the poorest people.

As a general rule it doesn't reduce costs, but with certain diseases it reduces costs greatly. Unfortunately, one way that preventive medicine can significantly increase costs is by catching diseases early enough to treat; if a person doesn't discover his cancer or heart condition until the advanced stages, he'll probably die, while someone who catches it early will get all sorts of expensive treatment.

So because you know of a person who abused something your are suggesting that someone should have the right to deny it to anyone?

I saw this show on TV (it's edgy you'd like it) where this guy called George Castanza get a cane when he doesn't need one. I think he even got a scooter.

Doesn't mean we want to outlaw canes.

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Peace Out, Philly!

This is sort of funny to me. This topic got waaaaaay off topic. I didn't mean this to be about abuse of any system or the pitfalls of our current healthcare system. Cosmetic surgery was not part of my original example. If you want to discuss cosmetic surgery or abortion please start a new thread, I would be happy to give my 2 cents in that regard.


My feeling is that our health insurance is not like any other insurance we purchase. It really shouldnt even be called insurance. You don't use your home owners insurance to pay for a new roof or a new water heater. You don't use your car insurance to pay for an oil change or new brakes. Both of those "Insure" that there is money in a pool in case of a catastrophic event.

What I wanted to run by the folks of Philly blog was the idea of reducing the financial liability of doctors and hospitals and also letting health care act more like any other service people would purchase. If you want someone to work on your car, you look for the best service at the best price. Not so with health care, currently we only look for the best service, the price of health care is never an issue although the price of insurance is. They are not one and the same thing.

This is how health care started and how I purchased it when I was young.

It's called a 'standard indemnity' or something like that.
Basically the first $xxx dollars of health care were on me. After that it was 80/20 with me paying the 20%, up to a maximum of $5,000

This was how health care started. I think this is what you are advocating.

It was the consumers that asked for other stuff that changed it. The health care insurers changed to accommodate the market. Also companies started offering better health care perks to lure talented workers. Later Unions started demanding it.

The biggest change was in the late 70's. Health Maintenance Organizations (HMOs) were touted. It was thought that by using preventative medicine you could lessen the total cost of medical care on an individual.

I'm all for going back to the standard plan. The worst thing in medical was the Zero Deductible plan. People use that when they need cold pills and don't want to pay $15 for NyQuil and some aspirin. Or when they feel like time off at work. Heck some people even go see the doc when they want someone to talk to.

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Peace Out, Philly!

You're quite right.

Our health insurance is really two things in one: It's partially insurance, to cover medical emergencies and to insure against having an expensive chronic disease in the future, like MS. It's also a prepayment plan for standard medical care. There have been proposals to explicitly separate these two, to allow market forces to work. For example, Singapore's national health insurance has two components: 1) Universal mandatory catastrophic health insurance, and 2) Health savings accounts, with mandatory deposits automatically deducted from your paycheck, and subsidised deposits for low-income families. Since all medical care is provided by the free market, and people actually pay the bills, albeit out of their health savings accounts, there are real incentives for health care providers to reduce costs. Singapore's system was controvercial, and economists are mixed about whether it's any more sustainable than the U.S.'s system, but it's an interesting experiment.

Plus, with health insurance now typically being bundled with employments (for various historical reasons), most people don't even have a real choice over what insurer to choose.

With 47 million who are uninsured in this country...and 80% of those are from working households and 20% are children... a Viable option is in dire need.

The AMA has been working in Washington to try and bring reforms to this Crisis.

http://www.ama-assn.org/ama1/pub/upl...63/ehi1012.pdf

It's a difficult "perceptional battle" battle... since most folks believe HealthCare should not cost them anything... since Doc's are sworn the "care for the sick" no matter what the income, and the former health care system of the 1950'-70's (Unionized, contractual coverage) was so prevalent. While personal Health Insurance was seen as an Expensive Alternative only for the wealthy... and the Medicare/Medicade was meant to cover those without employment and dire catastrophic illness.

With the advent of "Free-market" HMO's, "a good idea" for lowering cost to business for their workers, went the way of all industry market economy values of the 1980's. The HMO's got bigger and assumed the role of "Arbiter of Managed HealthCare" (Not your Doc, or You) since that was where the money was. Slowly, the Good idea, turned into a morass of rationing, where the first to get paid was the HMO administration... the last the Doc, who cares for you.

To get back to the Uninsured... "Free-Care" (charity care) is absorbed so to speak into the Public System (govt via Taxes)... and the rising rates of the providers (Doc's and Hospitals).

It's a vicious cycle when the ER is used as a Clinic for non-life threatening treatments. (I could go on about the litigation of malpractice that also comes into play... we will save that for another time...)

So to answer your question...

Pay as you go service, so to speak.
Reasonable rates, without the behemoth of (HMO administrative cost).
A signed waver, by the Patient, waving a malpractice suit.

I have seen some media reports of General, family practice/ internal medicine Doc's who are going back to "Old school" or off the Insurance Grid... (But of course i can't find the sites).
Which IMHO, makes sense...