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If you want us to redesign the system you need to sacrifice something else, most likely increased paternalism - is that what you want?
There are no penalties for misusing the system now, inducing penalties for bad behavior is the primary way we correct things and make systems function.
Or do you want Urgent Care to be staffed by ED and FM? That would certainly address the issue but would dramatically increase expense.
Look, all I want is to be able to buy health insurance that covers only catastrophic injuries and the attendant recovery. I want to be able to pay my doctor in cash for any other services, and be able to have medical care for any minor but debilitating injuries readily available on demand. Why is that practically impossible under the current system?
As it stands, with health insurance tied to employment, I can lose access to a doctor if I switch jobs or the my employer switches insurance plans, and I can't actually be sure how much anything costs because there's no price transparency.
So I'm 'forced' into getting health insurance that covers every little thing, which most studies show doesn't actually improve outcomes for people.
I would hesitate to use a study from that far back because the American health landscape is so different now (in terms of population health, costs, and availability of interventions). Diabetes alone could fuck up the results (and almost certainly does).
I mean what you are asking for is available. Catastrophic plans are available on the marketplace and plenty of family practice doctors offer a practice sort of what you are suggesting. It is expensive but that's primarily because this model is a thing of independent practice which is dying outside of high tax brackets. Doctors aren't in charge when they are employed so they have to do what the employer says. Although my PCP is boring and they can do that (minus cash pay).
Ultimately nearly everything most people hate about healthcare is stuff that doctors don't have any control over and also hate, but we get blamed and people want to make our lives more miserable. It is very frustrating.
Do you have a more recent study to cite because every factor that's changed since that one was published would have made the problem worse. Fewer doctors per capita, more regs, Obamacare, and an older, sicker population.
What's the current status of the situation, according to your research?
I mean it's like comparing ships from the age of sail to modern battleships. Do they both suck and are too expensive? Quite possibly.
Are they totally different things? Also true.
The population is completely different in terms of age and health. What we can do for patients is also totally different - more patients are on more medications that are more effective.
If a given type of health plan increases the chance that patients actually take their diabetes medication that alone will have a radical impact on outcomes.
Those things didn't exist 40 years ago. Nor did the diabetes rates...
Apple to oranges, maybe the conclusion is the same, but still apples to oranges.
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This may be nonresponsive and a tangent to your guys' dialogue, which was fun to read, but thought I would add it since I looked some of this stuff up.
Interesting! I was sure this had been banned and it looks like it pretty much was banned. You have to qualify for an exemption to even be eligible (<30 or poor enough to likely qualify for near total subsidy of another plan anyway) and also still covers the minimum requirements under the ACA like some preventative care and pregnancy.
This is a far cry from what "catastrophic" plans were not even 10 years ago. I got a grandfathered catastrophic plan from my health insurer when I graduated school. My max out-of-pocket was $5,000 and I paid $67 a mo and that included a sort of pre-purchase plan for eye and dental for another $20 or so. That plan kept getting enforcement waivers under Obamacare until it was finally banned as a parting gift of the Obama administration to the next one.
My "catastrophic plan" was better than a current bronze plan except the bronze plan covers a bunch of things I'll never need, and the current "catastrophic plan" now also costs over 6X+ ($420 was the quote I just got using the same age I was in the catastrophic plan) what my grandfathered, ACA noncompliant catastrophic plan, and the max out-of-pocket is now >30% higher than the inflation adjusted max-out-of-pocket. The current bronze plan quote is almost 10X what I paid for a catastrophic plan, the deductible is ~30% cheaper than the inflation adjusted max-out-pocket, and the out-of-pocket max is also >30% higher.
Wow! Hard to think this was in the medical wild west of yesteryear, 2016.
Huh, interesting - definitely missed how much things have changed on this front, thank you for the update.
I don't support catastrophic plans anyway so it makes sense, yeah some of it is the healthy need to subsidize the sick, but also people struggle to understand if they are healthy or sick, and how quickly that can change and so on.
The young always think they are invincible and then you get diabetes and sit on it unmanaged for a decade and end up with a heart attack and bilateral knee amputations or no kidneys.
Preventative care saves people and money in the long run and is cheap as hell but people will refuse.
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