Originally Posted by BBQMan

IMHO, we have driven the cost of healthcare too high in the United States by:

1. Making it ‘free’ or nearly so, especially for those on Medicare (that includes me).
2. Needlessly increasing the price of drugs by lawsuits for known side effects.
3. Not having a loser pays to discourage frivolous lawsuits.
4. Failure to have interstate competition for health insurers.
5. Requiring Insurance companies to provide ‘all inclusive’ plans rather than plans meeting the individual customer requirements. Failure to have ‘high risk’ pools in all states that can provide coverage to those with previously existing conditions.

Item 1: Anytime anything is free or inexpensive, more of it is used. This applies to medical care as well as everything else. Today, if you are on Medicare and have a supplement going to the doctor, the ER, the hospital, etc. is essentially free. As a result, people seek care (eg. a visit to the Dr. for a cold and wanting to get antibiotics). Having reasonable copay could discourage this. Some ideas, $25 for a primary care Dr. visit; $50 for a visit to a specialist; $50 for a visit to an urgent care facility; $100 for an ambulance; $100 for an ER visit and $200 for a hospital stay. Free is a bit of a misnomer - plans that offer first dollar coverage are rare today, and very, very costly. Catastrophic coverage with high deductibles of say $5,000, are the most affordable plans and make the most sense, in that they require most people to pay for the normal checkups, problems, etc. out-of-pocket, but protect against the huge expense of say an accident or cancer treatment, etc. I too am on medicare now and look at every statement - medicare pay pennies on the dollar for most procedures/treatments, causing many practitioners to declare an unwillingness to accept medicare as payment for services. High deductible plans, including in the medicare side somehow, may be the only solution.

This would be applied to households with an income of $35,000 per year or more thereby charging two-thirds of the population and leaving the lower income households untouched. Similar ideas could be applied to insurance plans for those under sixty-five.

Item 2: Drug lawsuits. Any drug that is capable of healing will also have side effects. When you get a drug, you are warned of the possible side effects. Drugs go through extensive testing to determine both the benefits and possible damages from them and are released to the market only when it is determined that the benefits outweigh the risks. If you take a drug and it helps you, so much the better. If you take a drug and encounter one of the identified side effects, then this is risk that you knowingly took and the Pharmaceutical companies should not be liable for your loss anymore than GM should be responsible for your injuries if you get in an accident. You accepted that risk by driving. I tend to agree that lawsuits have crippled not only the drug industry, but practitioners and insurers as well. When I was with New York Life we settled a class-action suit for 75 million dollars out of court. I was livid, as I thought we were not wrong, but the corporate lawyers advised capitulation was cheaper than a prolonged fight. Of the 75 million, 50 million went to the defendants law firm. The remaining 25 million went to the class, in the form of incentives that few took advantage of. In other words the law firm got weathy, the alleged injured parties got bupkus.

Item 3: Frivolous Lawsuits: Today, lawsuits can be brought for virtually any mishap, perceived or real. This is why you see the many ads for law firms saying call us, no cost to you if we lose. Far too often, it is less expensive for the insurance company being sued to provide an out of court settlement than it is to go to court. One example – I was involved in a low-speed accident a few years ago – the speed was so low speed that there was less than $500 in damages. Everyone went away and three weeks later the driver decided he had ‘whiplash’. Final settlement, $18,000 plus legal expenses. I can provide numerous other examples including one by an attorney you see on television virtually every day, but I believe all of you are familiar with the problem. See the comments above

Item 4: Failure to have interstate competition for insurance plans. Today, insurance providers need to be approved by state regulators who determine which companies can compete and what they may charge. This is a too cozy relationship and invites higher premiums. By opening up to interstate competition, prices will come down. Not sure this is doable, as each state has a beauracracy in place that is seen as that state's watchdog/ombudsman to protect them from the predatory insurance industry and they would be resistant to disbanding.

Item 5: Requiring plans that cover virtually everything – many of those coverages added by special interest groups. Let people choose the coverages they want and are willing to pay for. Some may want Chiropractors, Acupuncture, contraception, fertility treatments, Viagra, zero copays, etc. covered. Others may not. Let those who want these things covered, pay for their plan. Let those who do not, pay for their less expensive plan. Cafeteria type benefits would be a good idea, but very expensive. I would have to do more research to intelligently comment on this, though it sounds appealing.

Item 6: Failure to have ‘high risk’ pools in all states. Everyone should be able to purchase health insurance. By creating high-risk pools, everyone will be able to purchase health insurance. Some low-income people may need to be subsidized, but everyone needs to have some skin in the game. This has been done in the auto insurance industry - don't know why it wouldn't work with health insurance, though would likely create additional beauracracy.

These are just my ideas, anyone wish to comment?