Triple XXX wrote on June 11, 2007 12:28 PM: Noone who currently has private health insurance would be forced to give it up and depend completely on the government for health care.

JVJ wrote on June 11, 2007 12:19 PM: What many Democrats want on health care is "pay or play" where private employers are either required to "pay" a tax to a government-run fund for covering the uninsured, or "play" by providing private insurance to their workers and the workers' families. The notion that Democrats want to turn health care into a total government monopoly is basically propaganda by the Republicans.

James wrote on June 11, 2007 12:05 PM: What many Democrats (and California's Republican governor Arnold Swartzenegger) want on health care is NOT NOT NOT Canada's government monopoly on health care and ban on private health insurance. What they want is a "pay or play" policy where private employers are either required to provide their workers and their families with private insurance or pay a tax into a government fund for covering the uninsured. The notion that Democrats want to turn health care into a total government monopoly and completely eliminate the private sector is just propaganda by the Republican Party.

cas127 wrote on June 11, 2007 08:01 AM: Until America is willing to let an 85 year old die rather than expend a couple hundred grand to extend her life by 45 days, Medicare/Medicaid will always be a huge, economy consuming monster.

Many parties know this fact (that a huge percentage of health care spending occurs only at the end of life and is essentially pointless) but America has lacked the courage or honesty to admit it.

Until we do, no amount of snake-oil politcal "cures" are going to fix things.

Kirk Allison wrote on June 10, 2007 08:47 PM: What we have here is a type of provider-set capitation for primary care (for the unknown fraction of care) and prepaid care for the checkup and wellness plan (the known fraction of care).

The capitation on the unknown fraction of care is $1500 minus the costs checkup and wellness plan. The rest must cover as much or as little primary care as is subsequently rendered.

Do patients with primary care costs (including lab tests) > $1500 have guaranteed renewal rights in subsequent years?

If so, so far, so good, as long as the average patient cost is sufficently less than $1500 to support an acceptable income.

The structure of the problem however exceeds this solution:

What takes place in the case of a specialist referral, given that only 2 physicians are likely to cover few specialties?

What may work with primary care is not very tractable at the level of specialists (given that one cannot always predict what specialist one is likely to need, and thus who should be paid in advance - the orthapedist? the oncologist? the dermatologist? ...).

One could calculate a likelihood for a particular specialist service or type and then pay a fraction - which is to say return to insurance.

If one gathers enough specialists into a group and charges a fixed rate for both primary and specialty care, then one has returned to a closed panel HMO model with an assumed average expense profile less than the yearly rate.

Escaping the medical bureaucracy may be more difficult than the editorial advances.

Patte Purcell wrote on June 10, 2007 12:36 PM: A brilliant solution to a complex problem.

When people take responsibility for their own health as opposed to taking pills to cure problems and expecting someone else (insurance, gov't, other

taxpayers) to pay for the largesse, we will see a big drop in health care costs.

Kudos to these fine American entreprenuers. Shame on the nay sayers

who only want to extort more money

from the public.

Wake up America. National healthcare

would be the biggest mistake this country could ever make.

If you dislike the rules and regulations of insurance, opt out!!!

Tom wrote on June 10, 2007 12:34 PM: I am a doctor having practiced for over thirty years. People do not understand that Medicare and Medicaid are absolutely and rigidly price controlled by the government statute. Large private insurances enforce defacto price fixing by provider contracts that dictate pay rates to doctors with "take it or leave it contracts". Price controls make it impossible for doctors to spend reasonable amounts of time with each patient, makes it impossible to expand doctor's services e.g. afford a larger office with more nurses and secretaries and added doctors to help people. Price controls must end. Doctors must be permitted to balance bill patients beyond what "Medicare allows" in order to survive in practice and to be available to help people. TG, M.D.

Wayne wrote on June 10, 2007 11:40 AM: Well, of course, "...health care management professor" David Barton Smith would be very troubled by this approach to medical health care. It eliminates all the phoney baloney "health care manager" positions. If this became widespread, there would soon be no need for health care management professors to train health care managers. Much of the increased cost of health care has been due to the cost of all these health care managers who do absolutly nothing for anyone's health or well-being. And if the federal government takes direct control of health care (in whatever form) the "need" for health care "managers" will triple, if not quadruple

Owens wrote on June 10, 2007 10:46 AM: My god, who writes your editorials? Please note the following Washington Post article:

http://www.washingtonpost.com/wp-dyn/content/article/2007/06/08/AR2007060802264.html

You may disagree, with good reason, with Democratic party candidate health care proposals. But to call them "single payer" is just sloppy, ignorant reporting.

Most of the candidate proposals are taxpayer-funded universal coverage (or near-universal coverage) schemes that expand on the existing private-insurance, employer-funded system. They will not correct the tremendous inefficiencies of the existing system, nor will they correct the transfer of over 16% (and rising) of GDP to the health care industry.

But they are not "single-payer". And none of the first-tier candidiates propose to "eventually impose" a "single payer" system.

J. Boccuzzi wrote on June 10, 2007 09:21 AM: I never hear the discussion about the "socialized medicine" countries lack of a tort system like the US's. The contingency fee legal system not only has very direct costs but impose costs by "changing the behavior" of the healthcare provider. Lawyers should not be taking a percentage cut of malpractice money. Of course their healthcare costs less than ours but it is not better and not Universal it is a rationed and state controlled system without our "jackpot justice" lawyers.

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