In essence then, health care provision should not be by an insurance mechanism. A better scheme needs to be developed that encourages people to take care of themselves, but provides for catastrophic support. The real problem is that we’ve evolved a sysetm that devotes the bulk of the services to either the worst actors or individuals near the end of their lives (long after they’ve ceased to be productive).

Capitalist healthcare. Rofl!!!
Free market is rockin’ for the nation now isnt it!!!

You cant expect the average population to study into the menutia of each healthcare treatment they recieve, often in emergent situations. It takes years for Dr.s & Nurses to understand what is and is not important to their acute treatment. For patients to get a menu of treatment options and choose what they want or dont want, or what they can or cant afford is Rabid!

The OP has made an astute observation, but unlike the legislators he/she belittles, theres no proposal there; no implementable solution.
Just a lot o’ hot air.

All other developed countries do not have a single payer system, most have a multi-payer, multi-provider system – almost all (including the French and the Germans) have some amount of co-payment on everyday expenses. (None are comprehensive, all have cost problems and care issues. The Netherlands has an interesting looking new system.)

The UK is (almost) alone in having a single payer, single provider system – and it is without doubt terrible. Thousands of people die unnecesarily because of socialised medicine in the UK, the costs are inceasing, and the standards of care are poor (for instance cancer survival rates are half those in America).

The USA has by any measure the best quality healthcare in the world, with the best doctors, best hospitals, best quality and range of treatments. And boy does it pay for it! Where the USA falls down is both in universality of coverage, and in unnecesary complexity that Coyote does a very good job in exploring! The USA performs poorly in the recent well publicised WHO international health comparison, where three of the five judging criteria are related to equality and access, rather than quality of care, where it is ranked first (the final criteria is cost).

The OECD give the following figures for Health Expenditure (2006) as a % of GDP, (the amount of that spending which is public rather than private I put in brackets)

USA 15.3% (45.8%)
UK 8.4% (87.3%)
Netherlands 9.5% (62.5%) (2002/4 data)
France 11% (79.7%)
Germany 10.6% (76.9%)

http://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls

What IS shocking is that US PUBLIC healthcare expenditure is equal to that of the UK, yet leaves many with no coverage. Yes American healthcare is a mess, by all means reform it, but do not think that Government is any more than a small part of the (and by no means the whole) solution – as a facilitator, not a provider. And don’t throw the baby out with the bathwater!

Those are real numbers. Their system is inarguably more efficient at spending money. Most of the dire predictions of 60 trillion dollars of unfunded government liabilities over the next 75 years are based on projecting out the excess money wasted on our medical care system. Adopt the other system and we save about 1 Trillion dollars a year (the 5% of GDP difference between theirs and ours) and those future disaster scenarios mostly dissolve.
Another interesting idea where government intervention could help comes from Dean Baker. He suggests taking clinical trials away from drug companies and fund them publicly. Once completed, the drugs would be released as generics without the monopoly patents to any drug maker. Cost of the trials would be about 30 billion dollars. Savings on drugs cost would be about 10 times that. Sounds like a deal to me!

1. We live in Massachusetts and have a high-deductible policy — your last paragraph may need fact checking.

2. My experience, like yours, suggests people with high-deductible policies will price-shop healthcare and manage interventions UNTIL they reach the “maximum out-of-pocket” specified in their policy. My experience suggests that once you cross that magic line, you revert to the “normal” purchasing behavior when someone else is paying the bill — you don’t care what it costs and want only the best of everything on offer. In fact, you accelerate the consumption of services at year end before the deductible resets.

3. Recognizing that I was in a good position to help my insurance company manage costs (and perhaps lower future premiums), I once tried to help them by pointing out what I believed was either a mistake in the hospital’s billing or gross over-charging for what I knew was a very simple procedure — specifically, a charge of $1100 for six squirts of liquid nitrogen to freeze common skin lesions with no more than a minute of billable physician time consumed. (Note: this was in addition to the $975 charge for a 20 minute skin exam). The insurance company wasn’t interested in investigating it, so I asked the hospital billing office. They said it was the “normal and customary charge”. On my next visit I took it up with the dermatologist. She was ignorant of the charges for her services. The experience left me wondering what a concerned health care consumer is to do?

Ignorance and peverse incentives are at the core of the problem.

1. Pediatrician does an x-ray. It’s broken, go the ER to get it set.
2. ER does an x-ray. Yes, it IS broken. They splint it and recommend a hand specialist.
3. Hand dr. does an x-ray, recommends surgery, and on and on.

So 3 different places did their own x-rays within the span of about 24 hours. I understand the need to see a specialist sometimes, but it’s nuts that they each repeat work that could easily be passed along from one dr/facility to the next, such as an x-ray image.

First, with prescription medicine for example there is an awful lot of smoke an mirrors. Say a drug company charges $100 for a month supply of drug A which costs $10 to make. The employer pays a “discounted” $60 and the recipient a $20 copay. The insurance/PBM provides a kickback of $40 to the drug company who then writes off a $20 loss instead of a $90 profit.Who the heck knows what goes on in this industry. The employer gets a tax credit for provding insurance,the employee may pay for his plan pretax or itemize expenses.

What is the true cost of the medicine?

If the alternative to the $100 a month pill is a hospital stay and surgery at $40,000, what is the opportunity cost/savings here? Who can tell anyway cause alot of these charges never get paid and are total write offs. This is the next shoe to drop in the economic meltdown.

Everyone from doctor’s to hospitals, to drug companies, to insuracne companies is booking sales and profits and carrying the debt from the sale of services and product at made up prices and a huge percentage will never be paid thus distorting any attempt to come to a true price of anything.

Your proposal is good, but it would need to address the case of the uninsurable. If you’re going to be taking drugs that cost $200 a month for the rest of your life, you’re not going to find insurance for $100 a month. With some chronic conditions, you could still be unable to pay for your medical care even with a six figure salary.

The traditional setup to deal with the uninsurable involves a risk pool, to which all insurers contribute. You could have Medicaid pay the difference for those people who honestly can’t afford medical care. It’s a philosophical argument: what is the maximum we should require someone to pay?

Chronic conditions, even those that don’t make a person uninsurable, should be treated with a plan of care, with incentives for taking actions that help ameliorate the disease (a Type 2 diabetic losing weight, for example). However, currently, these provisions run afoul of some states’ anti-rebating laws.

1. Require everyone to buy catastrophic health insurance from private health insurance companies. (Exception: People can opt out if they can prove they have sufficient assets to cover a major hospitalization.) Bonus: All state regulations of health insurers are dropped in favor of a single national standard. (I’m a libertarian and a federalist, but this is one area where the Commerce Clause should come into play.)

2. Eliminate employer-provided health insurance. (It’s not the task of employers to provide health insurance, and the current system locks sick people into their jobs because they fear losing coverage.)

3. Allow health insurance companies to offer more complete coverage than catastrophic insurance, but do not force insurers to have uniform pricing or to offer coverage to everyone. This means that fat, diabetic smokers will pay much more for a low-deductible policy than a slim, healthy, nonsmoker.

4. Persons too poor to buy health insurance can participate in government-approved plans at reduced premiums (based on income), with Medicaid paying the rest of the premiums. (Note that Medicaid would exist only to verify income and family status and to send payments to approved insurers.)

This plan would give the government only a small role in health care. People with just catastrophic coverage will shop around and negotiate prices, which will drive down the costs of health care. Those who don’t want to do this can pay extra for HMO or PPO coverage. There is no downside to this plan, which certainly beats what we have now and what the federal goverment might think up.