From: fyl@fylz.wa.com (Phil Hughes)
Subject: Health Care Insurance Reform
Organization: FYL
Distribution: pnw
Date: Tue, 26 Jan 1993 17:05:16 GMT

I offer this thread as a new beginning to what started out as a
discussion of health care reform and degenerated into a name calling
contest.  I am going to attempt to offer a starting point (but I am
sure people disagree with even that).  What I would like to see happen
is to build something that might actually be a proposed solution.
If we manage to do that I am sure I can get it read by at least one
Senator and one Representative.

The Problem
-----------
Current U.S. health care costs are skyrocketing.  The
currently amount to about 14% of GDP.  Add to this that almost one
fourth of the population is either uninsured or underinsured.

The current patchwork plan has the following functional problems:
  - massive overhead (in the range of 15%-25%) from multiple,
    for-profit insurance providers
  - different "rules" for individuals and enployers with regard
    to health care insurance costs.  In particular, they are
    tax deductable costs for employers, not so for individuals
    creating a subsidy for employers who provide health insurance
    but cost individuals who don't have employer provided plans.
  - qualification requirements such that someone new to a company
    (or plan) is not covered for what may be deemed a pre-existing
    condition.  This also causes employees to be "stuck" with a
    particular employer.
  - overhead costs out of proportion for low-cost procedures because
    paperwork costs are somewhat constant
  - no common negotiation position over doctor's costs
  - malpractice claims add to already high costs

Comments for pervious discussions
---------------------------------
[Note: these don't necessarily reflect my position -- they are just
points that individuals have made.]

General:
- AMA control over the number of doctors is a major cost problem
- Overhead costs are very high for routine procedures  (suggesting
  that a major medical plan would be a better alternative)
- limits on malpractice claims would reduce costs

For single-payer (Canadian-style) plan:
- it works in Canada
- doctor charges for procedures are negotiated on behalf of the
  patients by the plan provider  (This works because the provider has
  nothing to gain by increased costs, unlike the US system)
- only having to bill one company for payments reduces paperwork
  costs for doctors offices significantly
- everyone is covered in a fair manner (on need rather than ability
  to pay).  This siginficantly reduces costs of emergency room
  procedures for what should have been routine care.
- individuals don't have to get involved in the billing cycle reducing
  both costs and the time and energy the receiver of the service must
  invest (Note: Group Health, an HMO works like this and it sure is
  nice.  However, with an HMO you don't get to select any doctor)

Against single-payer plan:
- doctors, rather than patients, determine if and when a procedure
  needs to be performed (In other words, you can't buy your way to
  the front of a queue)
- costs are shared equally rather than on the basis of what sort
  of risk an individual offers
- getting the government involved will always increase costs (note,
  this is just put in here so it doesn't have to get added.  The
  Canadian plan clearly demonstrates that government overhead is
  less than the overhead from competitive private companies.  The
  reduction in cost is not just elimination of competitive insurance
  providers but the reduced costs for doctors and patients of only
  having to deal with one company that "pays the bills".  Even if
  a plan was created where a private company paid the bill there
  would be significant saving over having hundreds of different
  bill payers.)

---------------------------------------------------------------------

I am sure there are more points but I thought this should be a good
start.  Please, add points, address concerns, offer solutions, etc.
I doubt it could happen but I would be real pleased if we could mail a
summary to a few congresscritters to at least show them that we see a
problem.
-- 
Phil Hughes - FYL - 8315 Lk City Wy NE - Suite 207 - Seattle, WA 98115 
Phone: 206-526-2919 x74      Fax: 526-0803
E-mail: fyl@fylz.com or nwnexus!fylz!fyl 
Newsgroups: pnw.general