Orlando theme parks adapt to accommodate overweight guests

Have catastrophic coverage insurance (like folks did when I was a kid) and some type of health savings accounts people can use to pay for the rest.

I have nothing particularly useful to add to the discussion beyond opinion.

Mine is that the system is broken - mostly because of the way we insure. Insurance should not be synonymous with health care. Insurance should be synonymous with emergencies and Unforseen Bad Things™.

Creating a system that forces everyone onto something that's inherently incorrect seem like exactly the wrong direction to move. If you want to fix health care you get everyone away from insurance-based care, not on it.

GoBucks89 said:
Without other incentives to reduce costs (such as those Jeff mentioned in last last post but not the post before it), externalizing the costs to the patients (with no/low deductibles/co-pays) will result in increased costs

Right... that's where I was going. Spreading the risk out is one thing, but getting people to understand the right usage scenarios is part of the problem. Most health care is not consumed on an elective basis like laser eye surgery. You don't get to shop around when you're having a heart attack or they find you have cancer. There's no time.

The problem with insurance companies is that, for decades, they haven't seen the benefit of preventative care, and wouldn't cover it. There's plenty of data suggests that the return on investment is high, but oddly it's the employers buying the health insurance that know this, and they're taking the responsibility. Weird how that works.

And let's not kid ourselves either about being "forced" to participate in "the system." If you're hurt, you're going to receive care whether you can afford it or not. Someone will have to pay for it, whether it's your government subsidized county hospital, or a private hospital that subsidized the expense by charging more to insured "customers." Everyone is participating in that system already, one way or another.

Jeff said:
If you're hurt, you're going to receive care whether you can afford it or not.

Emergency care, sure. Otherwise...ehhhh.

Someone will have to pay for it, whether it's your government subsidized county hospital, or a private hospital that subsidized the expense by charging more to insured "customers." Everyone is participating in that system already, one way or another.

Exactly. The system is the problem.

Whether I smoke or get fat or don't get regular check-ups or whatever shouldn't affect you or anyone else one bit. The fact that it does is a problem.

(Which then creates the secondary problem where we find it acceptable to 'nudge' people into certain choices - which is equally crap)

The problem with insurance companies is that, for decades, they haven't seen the benefit of preventative care, and wouldn't cover it.

No, the problem is that you need insurance to participate in the health care system in the first place.

I make no apologies for buying into the 'every man for himself' mentality.

Health care is not a right and it's not a priviledge, it's a responsibility. I believe in personal responsibility.

Health care is not a right and it's not a priviledge, it's a responsibility.

That's too much of a blanket statement for me to agree with.

I agree 100% with your emergency care comment. I have so many people coming in to apply for Medicaid that aren't eligible, and they've never needed it before, they've taken decent care of themselves and just covered the costs out of pocket, but now they're facing something major, like surgery, and no Dr. will touch them till they either have insurance or can come up with hundreds or thousands of dollars up front.

Sure, they could wait till it is an emergency and then get emergency care, but will that be too late?

I do agree that health care should be our responsibility, I really do. And knowing how the government run health care runs, I disagree with a lot of it, and I disagree with a lot about insurance that is private pay.

And trust me, there are major issues with the new health care reform going into effect. I don't like a lot of it, but some of it I do.

Sadly, and I see this here and elsewhere, a lot of what people say and think are so far from how a good majority of people live. And most of the times, those people aren't choosing to live the way they do, but because the systems are so broken, they have no choice.

Jeff said:

GoBucks89 said:
Without other incentives to reduce costs (such as those Jeff mentioned in last last post but not the post before it), externalizing the costs to the patients (with no/low deductibles/co-pays) will result in increased costs

Right... that's where I was going. Spreading the risk out is one thing, but getting people to understand the right usage scenarios is part of the problem. Most health care is not consumed on an elective basis like laser eye surgery. You don't get to shop around when you're having a heart attack or they find you have cancer. There's no time.

I don't have statistics but my guess is that most of our health care dollars are not spent on emergency type issues. You can't shop when you are having a heart attack. But patients typically do shop around with respect to cancer treatment. Its not for price but for treatment regimen. But catastrophic coverage would cover at least most of those types of big health issue costs.

The problem with insurance companies is that, for decades, they haven't seen the benefit of preventative care, and wouldn't cover it. There's plenty of data suggests that the return on investment is high, but oddly it's the employers buying the health insurance that know this, and they're taking the responsibility. Weird how that works.

I guess that varies from plan to plan. My insurance plans have covered preventative care for ever since I got my first real job 20+ years ago. I think the bigger issue is that in general, Americans don't want to take responsibility for their own health. Obese folks don't need to see a doctor to know that they need to lose weight and to do that they need to eat less and exercise more. They just don't. Same is true for smokers.

My guess is that the obese person who is taking 5 or 6 medications for high blood pressure, diabetes, high cholesteral, etc. would be inclined to lose weight and exercise if he had to pay the entire monthly costs of those medications rather than just a $50-60 co-pay. Having insurance doesn't create the right incentives.

And let's not kid ourselves either about being "forced" to participate in "the system." If you're hurt, you're going to receive care whether you can afford it or not. Someone will have to pay for it, whether it's your government subsidized county hospital, or a private hospital that subsidized the expense by charging more to insured "customers." Everyone is participating in that system already, one way or another.

I agree but I would take a different approach. If folks want to opt out of medical insurance, folks can do that. But they need to agree in advance that hospitals and doctors can turn them away if they do not have cash to pay for needed services. And that would go for emergency or non-emergency services. If they do that, I don't care if they don't have insurance.

I think health care is a right, and necessary for a functional society, particularly since children and the elderly can't generally alter their circumstances. Humans have to take care of each other. It's what separates us from the critters.

That said, we have a far from perfect system, I agree. However, spreading risk isn't inherently bad, we just do it poorly. Canada's system is also imperfect, but their administrative overhead is half of what ours is, in part because Dr. Joe doesn't have to work with countless insurers to get paid.

The US government also spends 20% more per capita on health care than Canada does, yet covers half as much and even has a much larger pool. That's pretty broken.

But none of these issues prove that distributed risk is a bad idea, only that it's implemented poorly.

Big part of the problem that I have with the "healthcare is a right" concept (other than the fact that I disagree with it as a fundamental matter), is there never was a debate/discussion on the issue. Politicians just starting saying it over and over and suddenly it became a right. How is that? Is food a right? Shelter? Safe cars? If none of those are rights, why not if healthcare is?

Distributed risk isn't a bad thing (its what insurance does). But having a system that creates the wrong incentives is.

I don't disagree, I'm just saying that let's change the incentives and not throw out the whole system. That seems to be the political theme lately in the US... if something doesn't work, throw it out completely instead of fixing it.

Jeff said:
I don't disagree, I'm just saying that let's change the incentives and not throw out the whole system.

That works if you believe the incentives are what's broken.

That seems to be the political theme lately in the US... if something doesn't work, throw it out completely instead of fixing it.

What if it can't be fixed? What if the 'something' is inherently uneffective in any form?

I feel like the insurance system in today's world is that 'something' and any of the fixes being thrown around are just giving us a system broken in a different way.

From my experience, bureaucracy doesn't do well with "scrap and redesign from the ground up". Requires more political will and fearlessness in terms of voter backlash than we could possibly expect from those in charge.

Other than that little aside above, Jeff's last couple comments have been pretty spot-on. Health care isn't something we want for MOST of the people. Given the health hazards in front of us, we really need to do better in terms of caring for "everyone". Because it only takes a few people for something like Avian Flu to become a worldwide pandemic. And diseases don't care about your income or what sate/country you live in...

Lord Gonchar said:
What if it can't be fixed? What if the 'something' is inherently uneffective in any form?

That's a straw man with no possible way to make an argument.

Nothing straw man about it.

I say it's the system that's broken, not the details of the system.

I think that's part of the problem: it's really hard to identify any particular problem, and therefore even more difficult to fix.

Throughout the system most, perhaps all, of the elements actually make some kind of sense, and maybe even work pretty well. But when it all comes together, you end up with a system that is horribly broken. How do you fix that?

Yeah, that's an oversimplification; several of us have identified specific things that ought to be fixed, and there are a lot of those. But in the end it sure seems that a lot of the problem is that once you put all the pieces together, you end up with a whole system that is broken.

--Dave Althoff, Jr.

Back in the day like when I was a kid, insurance was only supposed to be used to pay for major procedures, like surgery and serious disease. When you went to the doctor for an ear infection or sore throat, you paid in cash, because it was $10-15, and that included a prescription you left the doctor's office with. Now, every visit is around $85-100, only $25 of which my insurer pays. Prescriptions are through the roof.

Now I'm paying about $400 a month for insurance since my former company dropped medical insurance for all its employees, so I couldn't go on COBRA. So for the $4000+ I've paid out for insurance alone, I've gotten around $200 in benefits including prescriptions. The only incentive I have to keep insurance is the possibility/inevitability of needing it somewhere down the road, because it's surely not working in my favor now. Having a stroke would give me a better ROI, but it would effectively end my coaster riding days.

Lord Gonchar said:
I say it's the system that's broken, not the details of the system.

Maybe you're right. In which case I see no reason not to adopt Canada's system.