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    Posted by $ AJAshinoff 3 years, 9 months ago
    Easily - remove government from health assurance entirely. Remove the restrictions prohibiting all medical insurance carriers from selling everywhere in the US. If there are monopolies with pharmaceuticals break them up and compel more consumer options the marketplace. Game over.

    The free market will take care of pre-existing conditions, price gouging, and competition will bring down monthly costs for the consumer.

    Government is beyond its Constitutional mandate in this and many other things. This is why its a guzzling pig. This is why we pay 30-50% in wages. This is why US children are born with a staggering bill to pay.
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    • Posted by Suzanne43 3 years, 9 months ago
      Well said! If I were to design a health care system, the only thing that I would have to do is get the federal government out of it. A free market would then follow. And Bob's your uncle.
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    • Posted by Storo 3 years, 9 months ago
      I would do two things:
      1. I would set up a system of free clinics across the country, run by the government, generally for low income people. No insurance required.
      2. I would have insurance companies offer catastrophic coverage policies as stand-alone policies. Since the pool is the entire US population, the risk is widely spread, and the premium costs would be low, allowing almost anyone to be able to afford it. if you don't buy it, you don't have catastrophic events covered.

      I don't see any other way to do it. Trying to fit everyone into a single program, single payer, will just run costs through the roof due to the idea that everyone would get whatever they need for free. Nothing is free.
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      • Posted by $ AJAshinoff 3 years, 9 months ago
        The trouble with what you are suggesting is that you assume government or you have the right to dictate terms regarding health insurance and/or health care. Each doctor, nurse, scrub tech, and every other person practicing a medical profession has a individual right to profit from their own knowledge, right? Value for Value, yes?

        "free clinics" mean subsidized with tax dollars. Why should anyone else pay for my healthcare?

        "would have companies" assumes you or government has the right to dictate to a private business how they should function in order to make money.

        I can't agree with your well meaning points for these two reasons.

        Sink or swim, fair or foul, you have one life and its yours to do with as you wish.
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      • Posted by CircuitGuy 3 years, 9 months ago
        "I would do two things"
        Here are my issues with those.
        1. Why does the gov't set them up instead giving money to the poor? If the gov't is going to provide food poor, for example, it does not need to set up a system of grocery stores.
        2. Would there be underwriting on the catastrophic plans? If not, people might wait until their sick and then buy the catastrophic plan once they realize they have a serious problem, e.g. heart disease or cancer, that will cost a lot over a long period of time.
        How do you handle someone who does not buy the insurance and does not have much wealth if they have an accident requiring expensive emergency surgery?
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  • Posted by $ WilliamShipley 3 years, 9 months ago
    You cannot make health care affordable by playing a shell game with who is going to pay the bill. The problem isn't health care financing -- it's health care costs. No one actually thinks 17% of their earnings should go to health care but it's 17% of of GDP.

    You start by getting the government out of it. Remove the laws that enshrine the AMA as the gatekeepers of care so that we can develop new and innovative ways of caring for people.

    If you can't get rid of the FDA, at least limit them to determining safety. The market can determine effectiveness. As we know more about genomics we find that the effectiveness of drugs is highly variable based on genetics.

    It's time to get away from the doctor with the black bag as the basis of our healthcare. In the future our primary physicians will be software based and virtually free -- you might have to look at an ad.
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    • Posted by CircuitGuy 3 years, 9 months ago
      "You cannot make health care affordable by playing a shell game with who is going to pay the bill."
      This really summarizes it. It seems like politicians are like a kid trying to arrange a set of coins on a table in a creative way that makes them have more buying power.
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  • Posted by $ rockymountainpirate 3 years, 9 months ago
    Obamacare is not about heath care, it's about insurance. It is not a healthcare system it is a health insurance system. I work for an Optometrist in a state where 50% of the state is on medicaid. I do the insurance and private pay billing so I see it on a daily basis. Many of the people on medicaid are working, not all certainly, but it's because they don't have to not because there aren't jobs unfilled. It really ticks me off when people come in for their 'owed' free medicaid exam and glasses and never pay their $2.00 copay. I also live on a rez, so there is Indian Healthcare, again, paid for by others. The government should get out of the way and let the private sector fill the need. There are co-ops forming continually for those that either don't want to or can't pay the premiums on the obamacare plans. They are stepping in to meet a need.
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    • Posted by CircuitGuy 3 years, 9 months ago
      "It is not a healthcare system it is a health insurance system."
      Moreover it should be a market. A system is something I might design. I need to know all the tolerances on the parts to make a model of what output the system will give given any input. People can't be modeled that way. They're people, with their wants and abilities and lives. Maybe they make eyeglasses, and they want to work less in the summer, but if they get OT they'll work more. And they're people need glasses. They have +1.25 with only 0.25 of astigmatism, so they can just buy cheaper readers online, but if they get a job or hobby that requires finely detailed work or they start to need a +1.00 ADD on top of the +1.25 or if there's a sale or a cool new style at the eyeglasses place, maybe they get them there. It's not a system. It's just groups of people helping one another for money. I can't stand that the gov't has turned it into a system.
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  • Posted by Snoogoo 3 years, 9 months ago
    A few years ago, I was out of insurance for a period of time due to a job change. A local physicians group had a preventive care plan. At $75 a month, you could get regular check ups and minor injury and illness care. They created it as a supplement for people getting pushed into higher and higher deductible plans after Obamacare started. I bought into their plan and also purchased a catastrophic gap coverage type plan so in case I was suddenly diagnosed with cancer or something I would have some coverage on that side as well. I paid $150 a month for both plans which left me some ability to stash away money into my rainy day fund. I never ended up going to the doctor in that 6 month period but I got a hefty fine at the end of the year because what I had didn't count as "insurance" according to Obamacare. I think small co-ops are the way to go and I also agree insurance does not equal healthcare. There should be no government involvement. If costs go down, charitable organizations will have more than enough to help the poor and elderly and we all would have more to give them if we choose to.
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  • Posted by $ blarman 3 years, 9 months ago
    It first and foremost starts with the principle of personal responsibility. I am responsible for me (and my family). That means what I eat, how I exercise, and if I work to cover my bills all pertain to my ongoing health and risk factors.

    Part of being responsible is risk management - dealing with the potential/unexpected. That means private insurance according to one's risk factors and needs. but ONLY private enterprise can sufficiently craft a plan that maximizes my coverage while minimizing my outlays. Note that this does not mean I get to demand a Cadillac plan and pay nothing. For the same reason I purchase automobile insurance and homeowner's insurance, I purchase healthcare insurance.

    Now, I do believe, however, that there should be two kinds of healthcare insurance and that much of the problem with our current system is the failure to recognize these. First, there is what should be called catastrophic insurance. That's what covers you if you find out you have cancer or get in an automobile accident. These are the rare but really expensive cases that really qualify as "insurance".

    The second kind isn't really insurance at all, but health maintenance costs. These are the items people want covered under an insurance plan which aren't either catastrophic or rare: things like routine checkups at the doctor's office, getting an initial diagnosis of the flu, etc. Those shouldn't be termed insurance at all because they are routine. These items should be paid for out-of-pocket so as to reduce their actual consumption and bring it back into the realm where then products and services can be created to assist. This is where your company can purchase group services to specific doctors or groups for a negotiated rate for these basic services. (This was done a century ago.)

    So that's how I'd do it.
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  • Posted by ameyer1970 3 years, 9 months ago
    No, 'society as a whole' is not responsible for those in poverty. There is no entity known as 'society'. Society is just a group of individuals who choose to live in the same geographical area. As an individual if you wish to help someone who is poor out, that is your choice. It is not the governments job to force others to help them out. Healthcare is not a right, it is a service. So yes you should be responsible for covering the costs of the services that you use. Insurance companies should be free to provide you with the coverage you want or need.
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  • Posted by DrZarkov99 3 years, 9 months ago
    Promote the idea of hospitals and other medical centers posting their charges online. Now the difference between what one person is charged vs another can vary by a factor of as much as ten, based on their insurance. Normalizing the charges would create a basis for competition. The Surgery Center in Oklahoma City posts all of its prices online, which has forced what other local medical centers charge down.

    Encourage physicians' cooperatives, with patients paying a subscription fee for all non-surgical treatment. A coop in Tulsa, OK charges its patients $50/month for a family, and sells them prescriptions at their cost. They accept no insurance for their services, but will connect patients with insurers who sell catastrophic coverage to cover surgeries and critical care. The cooperative is financially sound.

    Make the cost of health care 100% tax deductible, including the insurance premiums for those who want insurance. This will help people with serious preexisting conditions.

    Expand the use of HSAs, as noted by handyman.
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  • Posted by Herb7734 3 years, 9 months ago
    The fact is healthcare is not the reponsibility of the state. There is no way that Washington can devise a system of one type fits all and doesn't go bankrupt. There is no way that pre-existing maladies can be covered and the insurance remains viablle. But Washington is stuck. Once something desirable like that is offered, no matter how destructive, taking it away is political suicide.Unlike games, we cannot say "Let's stop and start all over" if you want to be re-elected. The Democrats would be slavering at the mouth were the Republicans try that. You'd get the biggest reversal in history.We are stuck with a fiscal monstrosity for all time.
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  • Posted by $ Temlakos 3 years, 9 months ago
    Abolish all government "health help" programs, and abolish government licensure requirements for doctors. I think it wise for the government to insist on an appropriate show of competency and understanding for hiring a coroner, medical examiner, or police, infantry, flight, ship's, or other surgeon. But I see no reason to pass judgment on who may or may not recommend medical treatment to others.

    For I hold that one can trace a lot of chronic illness to flat-out bad medical advice. People get that advice because the ones giving it have the licenses. But the advice is still bad.

    More broadly: a government exists to manage force. It does not exist to provide goods and service that go beyond being the final arbiter of the use of force.
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  • Posted by term2 3 years, 9 months ago
    Repeal Obamacare. Do not replace it. Endure a period of readjustment whilst the marketplace sorts it out. Healthcare wasn't unbelievably expense in the early 60's. Let's go back to that
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  • Posted by $ Abaco 3 years, 9 months ago
    I agree with AJAshinoff on this.

    Adding my opinion: They took a system that isn't motivated to have healthy citizens (quite the opposite), a system that has the least efficient delivery of services (I pay $2500/month while my pediatrician gets $9/kid), slapped a level of government bureaucracy on top of it, held a gun to our heads and called it a tax. OH YEAH...THAT'S GOING TO WORK OUT WELL!
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  • Posted by handyman 3 years, 9 months ago
    The reality is that governments at all levels are already very much involved in health care. Any system must take that reality into account. Therefore, starting from where we are now, I propose a system that moves everyone closer to being able to “be on their own.” Done carefully, this could eventually move governments at all levels out of the health care picture.

    Legislation would be required to do several things: 1) remove restraint of trade barriers across state lines for insurance, 2) vastly liberalize (if you’ll pardon that term) health savings accounts.

    The first item speaks for itself. The second item requires more explanation in order to see how it could work. Here is a very short version:

    1. Vastly raise the limits on what individuals can contribute to an HSA. All of that limit would be tax deductible. In addition, some of that limit could also be a tax credit.
    2. Allow contributions to HSAs from many sources like employer contributions, and from other individuals or charitable organizations. This would include transfers from one person’s HSA to another’s. For example, if you determined that you had more than you needed in yours, you could transfer some to any other person’s HSA.
    3. HSA balances can roll from year-to-year without penalty, just like an IRA does. This permits a growing HSA account over the years and provides a comfortable health care cushion in retired years.
    4. Withdrawals can be made for any health care related purpose – incidental care, health insurance of any kind, etc.

    A system such as this provides an incentive to make very judicious withdrawals so that the HSA will grow over time.

    The above is enough description for this venue. A more fully developed position paper on the topic was prepared by the Western North Carolina Objectivists some years ago when Obama Care was first being thrashed about in Congress and the media.

    That paper is still on their website here:

    A system such as this produces a number of worthwhile outcomes. One, it provides a mechanism and an incentive by which a person can save for his own health care requirements. Two, it moves health care cost decisions out of the hands of insurance companies or the government into the hands of the individual and his doctor(s). Three, it provides for non-coercive funding (i.e. charity) of less fortunate people’s HSAs.

    Comments and criticisms from fellow Gulchers are welcome.
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  • Posted by $ allosaur 3 years, 9 months ago
    I thought the whole idea was to repeal Obamacare and let a competing free market sort it out.
    It would not be the first time me dino has been wrong about something.
    If I knew better, I still would have voted for Bad Hair Day as the best chance of beating all that the Evil Hag stood for.
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  • Posted by Storo 3 years, 9 months ago
    I don't like government run healthcare of any kind - period. However, we must address those who can't afford insurance or to pay for the medical treatment they need, or the Democrats will come up with another entitlement that the Republicans won't have the guts to stop. Free clinics deal with this issue at much lower cost.
    First, free clinics already exist, but on a small scale. Money, even tax dollars, spent for such clinics and the treatment there would be far less than costs incurred in the ER. While working for a hospital in Florida, I built a free clinic nearby for a group of 7 non-profit groups that operated on donations and grants. The result was a 40% decrease in ER visits, a 75% decrease in ER visits by those without insurance, or the indigent, and a $500,000 per month reduction in ER expenses to the hospital.
    Second, insurance companies already offer catastrophic-only health insurance policies. What I propose would probably expand this, but I am not suggesting a legal requirement for them to do so.
    Nobody should be forced to pay for your health insurance or mine, in a perfect world. But we don't live in a perfect world. I think we will need to accept a certain amount - as small as possible - of government giveaways and tax dollars paying for others.
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  • Posted by Storo 3 years, 9 months ago
    I don't like govt setting up anything. However, since we seem to be heading for single-payer, govt clinics for the poor seem a small price to pay, and will get them out of our ERs for sniffles. Giving people money will just allow them to use it to buy new Jordans and video games.
    2. The catastrophic policies would be sold by insurance companies (I.e. Underwriters). Nobody should be forced to buy these policies, but if you don't and come down with a major health problem, you don't have coverage. If the cost is down even "the poor" should be able to buy a policy. The policy premiums year to year are reset based on the claims history from the prior year. That's how it's done now.
    If an uninsured is in an accident and needs surgery, you treat him, and the cost goes into the cost history and adjusted next year.
    Young, healthy people don't buy insurance because it's expensive. They can use the free clinics for minor medical problems. If they get a major illness requiring extensive treatment, they can still buy the catestrophic policy, but may have to pay out of pocket through a waiting period. The cost they incur is then factored into their premiums for next year.
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  • Posted by $ Thoritsu 3 years, 9 months ago
    Get government out of health care, particularly regulation, eliminate the AMA and open the market. Let nay bright people who can learn basic biology and to pattern match to take care of basic general practitioner work (which a monkey could do).
    Initially get insurance companies out of paying for health care directly, and conspiring with the AMA et al to price fix. Make the payments go through the crucible for individual choice for a bit, even if insurance is paying.
    Offer basic care to people via government service along with elimination of their right to vote and reproduce, until two periods after they receive the handout. (same for welfare).
    Those who can't take care of themselves, can be cared for just like children.
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  • Posted by salta 3 years, 9 months ago
    Simple easy change to the flawed structure most countries have...
    rename it for what it is the "Disease Care System"

    Taking that a step further. The main source of "health" are our food choices,
    perhaps the agric dept should be renamed "Health Care System" then
    we might remove current subsidies for junk food.
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  • Posted by Rocky012 3 years, 9 months ago
    AJAshinoff you have been tricked into believing the corporate government we have has constitution restraints. It doesn't. Our government services are supplied by the UNITED STATES corporation based in the District of Columbia. It is operating in a Democracy and United States citizens have no rights or protection under the constitution. Check out republicfortheunitedstates,org.
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    • Posted by $ AJAshinoff 3 years, 9 months ago
      I am not tricked nor am I gullible. I understand the ship has steadily moved away from the pier. The Constitution provides for the course correction. All that needed is the will of the people of the United States to make it so. The Convention of States movement is a good first step. I hope its momentum continues.

      btw, the US Corp can declare bankruptcy debt restricting protection and the world economy will plunge.
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  • Posted by rbunce 3 years, 9 months ago
    Not a government healthcare (mostly finance and regulation) system. Ultimately we have the responsibility for ourselves. We each can decide how much charity we want to provide others.

    Getting agencies like the FDA and State licensure boards out of the way will significantly increase the supply of providers and treatments. That will reduce costs. That could also include patent protections. Not sure where to draw that line.

    While our genetics play a roll in our health as well as luck but so does out behavior. Take care of yourself, avoid risky behaviors or accept the risk yourself. Using the coercive power of government to confiscate the wealth/income of your neighbor is neither charity or charitable. Something most would not do on their own but are more than happy to have the government do it for them. Few want to talk about what the people who are taxed to pay for it would have done with those dollars, they might have had a use for them that is more important than paying for incompetent and overpaid government bureaucrats to decide what to do with them.
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    • Posted by 3 years, 9 months ago
      California has a mandatory laws requiring motor cycle an bicycle riders to wear helmets, always wear seat belts in auto mmobiles (but buses and trucks are excepted), using car seats of various sizea for infants and children by weight and size, having a cell phone in your hand while driving, etc. allof which a responsible person would do anyway. But their argument for laws is that some people are not doing so and if those people are injured or killed, "the rest of society has to bear the cost." I say that its impossible to legislate against stupidity and we all loose our freedoms because of a few idiots,
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      • Posted by rbunce 3 years, 9 months ago
        That raises the issue of government coerced care... Current Federal law is a hospital with an emergency department and is voluntarily a Medicare participant then they must provide "emergency care" until "stabilized". Now the discussion is how voluntary is it if it is a requirement for participation in the Medicare program? Also it appears over time that what is counted as "emergency care" and "stabilized" has increased. Finally IF the government requires care to be offered without concern for payment by Medicare participating hospitals shouldn't it compensate the provider directly for that care if the patient does not pay directly or indirectly? Of course that would require the government payer to be diligent in what payments it makes to prevent mission creep and we know that government is not good at that at all.
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  • Posted by CircuitGuy 3 years, 9 months ago
    The first thing I would do for healthcare is make contracts for medical services not enforceable unless they provide a price of some sort. A "blank check" promise to pay any and all costs at whatever price the provider charges would not be enforceable.
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