Organization: Penn State University
Date: Sun, 13 Sep 1992 17:53:56 EDT
From: <DGS4@psuvm.psu.edu>
Newsgroups: alt.politics.bush
Subject: Re: Bush/Quayle's Health Plan -- vouchers?
 <1992Sep11.233217.2784@CSD-NewsHost.Stanford.EDU>
 <92256.083946DGS4@psuvm.psu.edu>
 <1992Sep13.195519.25265@CSD-NewsHost.Stanford.EDU>

In article <1992Sep13.195519.25265@CSD-NewsHost.Stanford.EDU>,
andy@SAIL.Stanford.EDU (Andy Freeman) says:
>
>In article <92256.083946DGS4@psuvm.psu.edu> <DGS4@psuvm.psu.edu> writes:
>>While I'd prefer a system financed by income taxes, I'd accept one
>>with community rated premiums.
>
>Now we're getting somewhere.  I have very healthy practices.  Why
>should I subsidize people who don't?  After all, they get the benefits
>from smoking, drinking, driving fast, not exercising, and so on; why
>shouldn't they pay the costs?

I would ask you what you think is the most effective and equitable
way of deterring unhealthy behaviors.  One option is to price health
insurance on the basis of risk.  I would argue that this is both
ineffective and inequitable.  It's ineffective because it is all too
easy for people to heavily discount the cost of unhealthy behaviors
which might increase their risks of being sick 20 or 30 years in the
future.  It's inequitable because it requires health care workers to
ignore the needs of those who need their services most, because they
don't have money to pay.

If you want people to stop smoking, to stop drinking, to stop engaging
in unhealthy behavior it is far more efficient to raise the direct
price of the behavior, rather than raising the cost of health care
(through higher ins. prem.) to deter the behavior indirectly.  If you
want to deter smoking, and make people pay the full costs of smoking,
then you tax it like crazy.


>If you make me pay for them, I'm going to insist on control; money
>always has strings.  If you insist on making me pay for the
>consequences of your private decisions, you can be damn sure that I'm
>going to make those private decisions for you.
>
>>>ANY payer has to keep track of what's done, if it pays on that basis.
>>>The Canadian system seems to fit that model; it doesn't pay a fixed
>>>salary, but reimburses MDs on the basis of what they've done.  (I
>>>"remember" that the Canadian system allows private payment too, so it
>>>has to keep private payers from shifting costs to the govt.)
>>
>>No, A Canadian doctor knows that 99% of his business comes from one
>>payer who uses the same forms.  Other private payers represent such
>>a small portion of a physician's business that he/she can determine
>>the payment methods.
>
>So?  The training overhead of dealing with an additional form doesn't depend
>on the frequency of use.

But it does depend on the number of different types of forms you have to
process.  Every physician in the U.S., in effect, has to have the staff
with training to process several thousand different types of forms.  The
number in Canada is much smaller.  Just take a look at the numbers for
number of non-medical staff in a physician office in the U.S and in
Canada.  They are different by an order of magnitude.


>>But, the Canadian form is different from every other insurer's form.  It
>>requires the physician to train personnel, to staff his office with
>>extra clerical hours, to fill otu this form for all ANOHC patients.
>
>Yet, the Canadian system does tolerate multiple forms and payers.  It works
>in Canada, but can't work in the US because we have multiple forms
>and payers.
>
>>>What?  They have controls that work?  Then why won't they work
>>>in the US?  If they won't, then we've found why the Canadian
>>>system won't work in the US.  If they will, then ....
>>
>>Because we have a multiple payer system.  Go to a single payer
>>system and you'll find that it will work in the U.S.
>
>Hold it.  Canada is a multiple payer system, so why does the
>US have to go to a single payer system to get the same benefits?

Canada is a single payer system.  They do have some private insurers but they
are a neglible part of the system.


Dennis G. Shea, Penn State
<<DISCLAIMER>>
Ain't nobody's bizness but my own. I'll be happy to accept all
the credit for anything I've written.  It's funny, however, how
employers only acknowledge the profitable ideas.