Well, Marshall, I think you've done a good job of framing most of the issues. But I think there's a couple of opportunities for improvement here. Much of what you have said is of a hard headed pragmatic bent. I have now officially put my idealist hat on. Much of what you spoke of has nothing, actually, to do with health care; it has to do with health insurance. Talking about insurance is important. Health insurance is an oxymoron and not at all like your car insurance. Insurance is a bet probably better handled by bookies. I've had insurance with USAA for neigh on 50 years. I've had a few accidents and other mishaps over the years that they've handled for me but I've gone years on end with my only communication with my insurer being my premium payment. My health insurance, on the other hand, has rarely gone without being tapped. Not a lot of expense but I was using the insurance. This should really tell you that insurance isn't the right model for this business. That is the strength of Britain's NHS. They are focused on health care, not health insurance.
Besides that, your all payer fails to fulfill the basic function that needs to be provided. The basic function? Yeah. The ability to afford medical care (not insurance). The fact that the price tag is the same doesn't help me if I can't afford it. Most people make it through major segments of their lives without disastrous medical adventures. For example, I made it from November (probably 7th) 1949 when my parents brought me home until August 14th 2014 without spending a single night in a hospital. Then I had a heart attack. There are two ways to look at this. One, I'd been paying (or had paid on my behalf) medical insurance for roughly 44 years. You'd think this would do me a lot of good. Nah. I didn't have the same insurance. I'd retired at ~59 1/2 because I could and because Boeing had pissed me off. That's when I got an edjumaction in health "insurance". So between 59 1/2 and almost 65, I had private health insurance. My 44 years of virtually nonexistent medical claims did me absolutely no good. So I wound up paying a fortune for health insurance that paid for two office visits/yr and had a $10K deductible. I said there's two ways of looking at this. One is that you are funding your own medical care - as it turns out, what insurance paid out for my heart attack was pretty much equal to what they had collected from me in the 5 years I had it. Except, of course, for the $10K deductible....
The alternative is that you're not paying for your health care per se. You're paying to support a medical community. When you're not using them, someone else is. Then when you are, someone else isn't. This is actually the concept behind health insurance with a large insurance pool. I suspect that what's lacking is the leader to enunciate the concepts and possesses the leadership to move the country.
Well, Marshall, I think you've done a good job of framing most of the issues. But I think there's a couple of opportunities for improvement here. Much of what you have said is of a hard headed pragmatic bent. I have now officially put my idealist hat on. Much of what you spoke of has nothing, actually, to do with health care; it has to do with health insurance. Talking about insurance is important. Health insurance is an oxymoron and not at all like your car insurance. Insurance is a bet probably better handled by bookies. I've had insurance with USAA for neigh on 50 years. I've had a few accidents and other mishaps over the years that they've handled for me but I've gone years on end with my only communication with my insurer being my premium payment. My health insurance, on the other hand, has rarely gone without being tapped. Not a lot of expense but I was using the insurance. This should really tell you that insurance isn't the right model for this business. That is the strength of Britain's NHS. They are focused on health care, not health insurance.
Besides that, your all payer fails to fulfill the basic function that needs to be provided. The basic function? Yeah. The ability to afford medical care (not insurance). The fact that the price tag is the same doesn't help me if I can't afford it. Most people make it through major segments of their lives without disastrous medical adventures. For example, I made it from November (probably 7th) 1949 when my parents brought me home until August 14th 2014 without spending a single night in a hospital. Then I had a heart attack. There are two ways to look at this. One, I'd been paying (or had paid on my behalf) medical insurance for roughly 44 years. You'd think this would do me a lot of good. Nah. I didn't have the same insurance. I'd retired at ~59 1/2 because I could and because Boeing had pissed me off. That's when I got an edjumaction in health "insurance". So between 59 1/2 and almost 65, I had private health insurance. My 44 years of virtually nonexistent medical claims did me absolutely no good. So I wound up paying a fortune for health insurance that paid for two office visits/yr and had a $10K deductible. I said there's two ways of looking at this. One is that you are funding your own medical care - as it turns out, what insurance paid out for my heart attack was pretty much equal to what they had collected from me in the 5 years I had it. Except, of course, for the $10K deductible....
The alternative is that you're not paying for your health care per se. You're paying to support a medical community. When you're not using them, someone else is. Then when you are, someone else isn't. This is actually the concept behind health insurance with a large insurance pool. I suspect that what's lacking is the leader to enunciate the concepts and possesses the leadership to move the country.