Well, no matter what kind of system we have there will be lots of death. Humans have a 100% mortality rate and all the insurance in the world won't change that.scriptbunny wrote:@IlliniDave: Thank you for clarifying. I had thought you meant lifetime limits (where insurance company payments truly are capped) rather than higher deductible insurance. I think by and large we agree on most points. I would still say that universal high-deductible catastrophic insurance ends up costing similar to and therefore either gradually (leading to lots of death) or quickly becoming more comprehensive single-payer due the reasons brute has outlined.
I guess I don't see the inevitability , maybe you could explain? I don't see a system that pigeon-holes based on BRUTEs dissection of maladies, rather one that just works on dollars without passing judgement on people or categorizing illnesses, e.g., some hypothetical program that won't cover type II diabetes or allow people who consume alcohol to enroll or whatever.
Much of my family is old enough I an getting a good look at Medicare. Medicare is more than catastrophic coverage, so we're talking about a scaled back version of Medicare for people age 0-64. I don't have numbers, but most individuals incur most of their lifetime medical costs in their last couple years of life, and that mostly happens to people on Medicare. So we've already got a system place where a single payer (the taxpayers) picks up the lion's share of the expenses and people participating have the option of buying supplemental coverage to fill in the gap. And it's not that bad, although it projects to need more funding in the future. The "universal catastrophic" I'm talking about, based on dollars not illness type, should cost a fraction per benefit-receiving participant annually of what Medicare does simply because the insured are younger as a group.
In the end the total cost is always going to wind up being similar irrespective of insurance mechanism because the cost is pretty much the cost. It's only a matter of pooling and smoothing it out over people's lifetimes. However, having a system where providers are always paid promptly and don't have to pass on the written-off costs of people that don't pay (and the cost of delayed payment and failed collections) to future customers that do pay should help a little in lowering the price of medical services. I've seen direct evidence where providers bill 4X-5X the actual cost they can perform services at with a reasonable profit.
From there the next job is looking at how to lower per service costs across the whole industry. For the gov't (both federal and state) it would require massive unwinding and retooling of regulations to further lower costs and allow things like cooperatives a fair chance to get a foothold in the marketplace. Cooperatives are interesting because they essentially combine insurance, group discounting, and the more routine end of healthcare service spectrum. You pay a monthly membership fee which covers doctor visits within the coop (24-7 availability), including tests and lab work, get discounted prescriptions directly from them and such. Something like that pairs very well with a catastrophic/high deductible insurance plan. Problem is there are so many regulations put in place assuming the current commercial insurance model that coops can't optimally exit in many states. I think all of that stuff was supposed to be part of second and third phases Trump alluded to, but the phase 1 was so bad the discussion hasn't moved on to that.