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Kneecap & Trade

Medical Coverage Exchange
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It seems the solution to the US' medically uninsured & underinsured has been staring us in the face all along!

What we need to establish is a website where one can trade insurance coverage like you would trade carbon. Here's how it would work:

1. Let's say you already have health coverage, and you need to make a bit of money on the side. You post your info, including coverage details, from the golden package to the lowly HMO, your rough geographic location, and relevant physical stats -- no good afterall, to show up for an amputation, and your left leg is already missing! To clarify based on some annotations -- you chose a "covered" indvidual based on your current need, rather than assume their identity forever.

2. The uninsured line up to buy access to your plan, which would cost them a fraction of what it normally would to buy coveage, and receive treatment using your coverage, and you get a cut those fees.

Sure it's grossly illegal, but should the shit hit the fan, you claim identify theft and walk away having made a neat profit.

theircompetitor, Aug 11 2009

A good article on the subject at large... http://www.nytimes....19healthcare-t.html
How we already ration health care... [RayfordSteele, Aug 12 2009]

[link]






       What happens if you need the amputation yourself eventually?
"Mr. Competitor, it seems you've already had your left leg removed."
phoenix, Aug 11 2009
  

       you get more involved with the next election :)
theircompetitor, Aug 11 2009
  

       that, [21], would be why you use a website -- did they do so on the show? -- and why this case is explicitly covered in paragraph 1.   

       You're not stuck with a single covered user, you switch at need.   

       Having said that, I think both you and perhaps phoenix are reading this idea at a different level than it was intended. Which probably means it's my fault. Oh well.
theircompetitor, Aug 11 2009
  

       medical insurance fraud is pretty baked; not sure how your idea of advertising it makes for originality.   

       [marked-for-deletion] blah.
FlyingToaster, Aug 12 2009
  

       I thought you people in the US had finally decided to get rid of the so-called "private" medical system (you know, the grossly unfair one that's 5 times more expensive than public systems that provide superior care - those public systems that don't suffer from the absurdity of charging differently for "preconditions" - e.g. where you (or more likely, your employer) pays low premiums all your life while you are healthy, and then, as soon as you are diagnosed with a disease, your premiums go up so as to reflect your "pre-condition" - where subsequently switching jobs becomes difficult because of the insurance angle, and you eventually become both uninsurable and unemployable as well! )   

       Hopefully, once that's all sorted out, you wont have to worry quite so much about identity theft for medical purposes.
zen_tom, Aug 12 2009
  

       the problem is, [zen_tom], is that I'm not one of them "you people" :) I don't want to debate superior care stats here, and I am certainly no fan of the insurance industry, but sadly what's being rammed through by our leaders will likely not improve things while costing me more, and makes about as much sense to me as other boondogles such as cap & trade, hence the genesis of the title and outlook.
theircompetitor, Aug 12 2009
  

       Sorry [tc] it was a flamy response I was making and I hold my hand up to that with bowed head.   

       Having said that - I've been watching some of the recent "town hall" coverage recently and can't believe the kind of rhetoric being used by some of those opposed to the plan (and, by association - apparently, Obama's birth cirtificate) and let's not miss this opportunity to consider the "death squads" representation of what seems to be not much more than the option to take out a subsidised, regulated form of insurance - is this hysteria widespread, or are the media channels just picking up on the more extreme examples of mindless partisanship?   

       I do accept the "tax hikes during recession = potentially problematic" argument, but counter with "providing government funded jobs while fulfilling a civic need during times of high unemployment = pretty good" style parry.   

       On the idea, to keep costs really low, you could keep a "farm" of people, from birth, who you keep in top physical condition. By insuring just this core of people, and then shipping out their identities en-mass, you would be able to benefit from economies of scale and more effectively bring in profits.
zen_tom, Aug 12 2009
  

       There is a lot of money to be made in hysteria. Maybe it can make up for that giant sucking sound as the health care industry's GDP contribution is slashed.
RayfordSteele, Aug 12 2009
  

       It's getting really ugly and the only ones who are left out are those who truely need to be heard. As usual.
blissmiss, Aug 12 2009
  

       seems a need for a couple different categories of medical care: perhaps "genetic predisposition" should be a given (or not depending on how much you believe in applying Darwin), followed by "environmental" (related to work/home environment dangers) and "accidental".
FlyingToaster, Aug 12 2009
  

       Some of the protesters are over the line. But the key political mistake was made by the Administration and Congress -- this was one area where they knew a lot of people would get upset, and at least some of the rhetoric could have been completely deflated if they made a bigger outreach effort.   

       There are truly winning arguments for changing the status quo: fairness (the precondition issue, and the insurance company getting in the way of care), and cost control.   

       Some of the President's spokespeople have successfully argued the former. But to argue that handing anything over to the government achieves the latter is laughable. Insurance money is already perceived as "other people's money", which is one reason why costs are going up. Government money would be 10 times worse.   

       I cannot come up with a scenario where anyone who has been in the workforce for more than a decade -- people in their 30s and older -- that would not have been better off simply having self- insured -- presuming that the money that they spend on insurance, either directly, or indirectly through employer benefit, could be saved tax free.   

       I do not accept that costs are truly "lower" in the typical comparison cases, btw, even if one includes costs of drugs -- the taxation level simply reallocates from one to the other, but the true costs are not lower.   

       I estimate that in my working life, myself and the companies I've worked for have paid $500K to $600K to insurance companies for healthcare coverage. I don't think that I would be better off having paid that entire amount to the government in taxes. I'm pretty confident I would be better off having saved that amount to use on my health care as needed. And have the government pay for those that get hit with a crisis early in life -- I'm fine with that.   

       And we haven't even talked about malpractice lawsuits yet :)   

       But that is what I would envision -- a government mandated deduction, similar to the one used for Social Security, but one that goes to an individually managed health savings account out of which I control spending, and government backup beyond the donut hole in that account.
theircompetitor, Aug 12 2009
  

       It's too bad that there hadn't been some sort of election where people could choose a leader who advocated a solution to health care issues.
tatterdemalion, Aug 12 2009
  

       Elections matter to be sure. That's why in 2005, we had not a single post attacking W or his policies :)
theircompetitor, Aug 12 2009
  

       //...in 2005, we had not a single post attacking W or his policies //

<snigger>
DrBob, Aug 14 2009
  

       //Government money would be 10 times worse.//   

       Possibly not. As RayfordSteeles article mentions, the British government has to draw the line on cost effectiveness somewhere. Many drugs are cheaper in Britain than in the USA because if they are not cheap enough, the British Government will not pay for them. Whereas if they are expensive in the USA, there will still be people who will pay for them.   

       I can't find the english manifesto but I seem to remember the Pirate Party having a great idea on this issue. Have the Government cut an 'all you can eat' deal with the drug companies for each useful patented drug, allowing anyone to manufacture them as if they were generic. That way, no-one gets denied treatment because of patent fees on drugs.
Bad Jim, Aug 14 2009
  

       Count me skeptical. I agree that drug prices are cheaper due to regulation in many countries, but as I mentioned earlier, taxes are higher, in some cases significantly, so in reality, everyone pays more. Plus, the US effectively subsidizes it by paying more.   

       Governments always have a tough time controlling costs, Medicare, which is the best example of a US run medical program, is massively over cost projections -- such that if the new program matches it in spend projections, it will cost roughly 10 x what Congress says it will -- so not a trillion over 10 years, but 10 trillion over 10 years, an insane number.   

       Costs will be best controlled when those that are spending the money feel that it's their money, and those that are making the money compete for customers.   

       Costs that are controlled by government lead to black markets and artificial scarcity.   

       I would propose:   

       1. No insurance for routine care. Pay the doctor out of pocket. Spending should be deductible. Most of the insured population is not spending nearly the 20K or more a year that is being spent by them or their employers on their behalf. And prices will start drifting lower if there's competition.   

       2. Deductible health care savings accounts. Why not do this instead of taking the money out of taxes?   

       3. Catastrophic health insurance where you can buy up to several million worth of insurance like you buy term-life insurance. I would be ok if that was deducted out of pay, and even mandatory.   

       4. Government picks up whatever the first 3 don't cover.   

       5. Limit malpractice awards.
theircompetitor, Aug 14 2009
  

       //No insurance for routine care. Pay the doctor out of pocket//   

       My car insurance has a thing called the "excess". Basically I pay the first £200 of any claim. This would be so useful at keeping costs down I'm surprised that USA medical insurers aren't doing it already. Making people pay their own bills wherever the bills are reasonable would be a good idea.   

       // Deductible health care savings accounts. Why not do this instead of taking the money out of taxes?//   

       It has the advantage of making people think about the cost before getting treatment. But it has the disadvantage that it is not a form of insurance. If I cannot accept a 0.1% chance of requiring $2,000,000 treatment, I can pay a little over $2,000 to an insurance company and I'm covered. A government funded health service would also probably pay. Most savings accounts will not have $2,000,000.
Bad Jim, Aug 14 2009
  

       [Bad] it's called a co-pay here and it does exist. It's usually low for routine care, in the $10-20 range. It can be significantly higher for major care, up to $500-1000 at times. Higher co-pays equal lower rates, but almost no US plan has a significant percentage of routine care paid by the user.

Part of the theoretical problem in changing this is that it discourages the use of routine preventative care, increasing the probable need for emergency/major care.
MechE, Aug 14 2009
  

       As far as excessive drug costs, the problem is that if no one pays them, the drugs don't get developed. I'm actually about to start work for a medical company, and while it isn't pharma, the venture capital that is funding it normally is. The millions that are required to fund this companies development are pocket change compared to the billions the VC firms are used to handing out to develop and get new drugs approved.

I don't argue that costs need to be lowered, but if the cost of drugs is lowered by regulation, expect government to have to hand out much more research funding in order to bring new drugs to market. On the other hand, voiding the patents if the company is making excessive profits doesn't hurt, just be careful that you define everything in determining what is "excessive".
MechE, Aug 14 2009
  

       // voiding the patents if the company is making excessive profits doesn't hurt//   

       Yes it does. Any reduction of profits for any reason will reduce investment.   

       If the patents are making huge profits it is because the patented thing is hugely valuable to society. The patent might be voided due to prior art or concerns over obviousness (if only) but simply making a lot of money is not a reason to void the patent.
Bad Jim, Aug 14 2009
  
      
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