Designing the perfect health care system
From ColoradoHealthInsuranceWiki
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[edit] Government Participation
| "Government as a funding vehicle for health expenses is a loss leader in many respects.
In order to really tackle the funding issue, we must do two things: 1. Pre-fund for future expenses 2. Have these reserves owned by the participants. Neither of these 2 requirements are met by the federal government. I will be happy to detail why that is so, but let’s not lose sight of a not-for-profit insurer which meets those 2 requirements: A Voluntary Employees’ Beneficiary Association (VEBA)." How may a VEBA be one potential answer? First, it allows for pre-funding on a tax-advantaged basis. Participants own individual savings accounts, similar to HSAs, but without the mandatory insurance policy. Second, the VEBA is a non commercial insurer, so that it also provides a pooled reserve in order to pay claims. I believe there are many ways to advantageously use these 2 funding methods, together. Any one have any suggestions? --Don Levit |
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Jay: Good questions. VEBAs are subject to discrimination requirements of section 505. As a defined contribution arrangement, benefits can vary proportionately with contributions. The difference would be, as in a 401(k) plan, if one withdraws benefits, he has lower benefits than one who does not. I think premiums would be based on affordability subject to a cap, such as $400 a month (split evenly between the contribution for savings and insurance). The lower earners would contribute lower amounts, and have correspondingly lower benefits. They also will typically have lower assets to protect, so less coverage would be needed for that important purpose. Bear in mind, as a non commercial insurer, the VEBA is encouraged to provide plans that are not commercially available. So, the number of plan designs is virtually unlimited. --Don Levit |
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In health care, how does having fewer assets demand less coverage? If a rich person has a $500,000 hospital stay and not enough coverage, they might still be able to pay for it. But if a poor person has a $500,000 hospital bill and not enough coverage, they're going bankrupt. --Grant 00:31, 26 July 2008 (MDT) |
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Grant: I agree that the first order of business would be for people, of all income levels, to have enough insurance to pay all the catastrophic bills. The ideal situation would be for everyone to be made whole, including the hospital and health care providers. One of the other purposes of insurance is to protect one's assets. If a person has a net worth of $500,000, generally, he should insure for at least $500,000. One has to make a reasonable calculation, based partly, on assets to protect, how much to insure for. The balance of the decision, it seems to me, would be based on his concern for any remainder of the bill not being paid. In my opinion, paying off a medical bill for 10 times one's net worth is, primarily, a societal responsibility. If enough of these bills remain unpaid, it is probably a good indication that some of these services charge more than the market will bear, even including insurance. --Don Levit |
[edit] If No Government, For-Profit or Non-Profit?
I don't mind government involvement, but even if there isn't government there should not be any profit motive in the health care system. With both government and non-profit, there is less overhead and less of a reason to try to find more ways for people to use the system (usage). In the profit based private sector system, the more people that use the products and services - the more profit there is to be had. The corporations need to show shareholders growth year after year. Pharmaceutical companies push providers to prescribe more, providers run extra tests and procedures to pad their pockets, the AMA, pharma, and the insurance industry bankroll large amounts of money to lobby lawmakers and fund think tank organizations. Overuse and overhead are the problems. A government (or non-profit) system discourages usage as much as possible and runs lean.
[edit] Should It Be Voluntary?
Voluntary entrance into the pool is a bad combination with no underwriting (as discussed in this article). People would not contribute to the pool until they need benefits and be able to enter into the pool with no problem when they do need benefits. So the pool would essentially be funded only by the people needing benefits.
[edit] Solution to a voluntary and non-underwritten plan
Don said: "contributions be paid for 2 years, in which coverage accumulates, but does not become effective until year 3. It would be similar to a defined contribution plan, which does not vest until year 3."
[edit] Health Care Regulation
Hello! My name is Karen and I have some ideas. I am 34 and have chronic kidney disease. I was first diagnosed with this at age 23. All along I have been told that nothing can be done about my condition, and that all they do is manage my disease into dialysis, potential transplantation, and/or death. WTF??? I am now looking outside the box for treatment, including contemplating stem cell therapy. I can get stem cell treatment with cells from umbilical cord blood in Mexico. Don't know if this will be a "cure" but it sure sounds better than anything else I've been told. Why can't we do this kind of research here in the states? This is umbilical cord blood cells, with no ethical arguments. I think it's because this kind of treatment could eat into the profits of drug and other healthcare companies. After all, a cure would render them unneccessary. btw, I am not on dialysis yet, and I hope to be able to stop that from happening!
