Why can't we establish a voluntary health care system???

[Selatius]

Let's say we have a country with 10,000,000 people. About 5,100,000 think a socialized health care system is a good idea and would support a federal program to run it. The problem is the rest of the country does not support it; however, traditionally they would have to pay taxes for it anyway like many federal social programs in the US today.

The question I pose to all of you reading is this: What is to prevent those 5,100,000 from establishing a health care system of their own where people can choose to pay into the program and receive benefits instead of doing it the conventional way and having everyone pay regardless if they support it or not? Would this make establishing such a system far easier than if we made it mandatory? Why compel the other 4,900,000 to pay for something they do not want?

Why should we make others bear the cost of something they do not see as worthy? Shouldn't it be our task then? If it's going to be our system, then we should build it with our own resources for the benefit of us. It would truly be a system for us by us.

I have no doubt in my mind that if we banded together to bring this system to reality, then the long-run costs would far offset the short-run costs. If all citizens in the US who supported such a system joined it, we could then speak in one voice together to curb the costs of, say, prescription drugs by negotiating the price and thus save us money. Let people who choose not to join our system pay whatever best price they can get from the pharmaceutical companies on their own.

[Sannum]

1. The Bush Health Care Plan:

Don't get sick.

[SammyWinstonJack]

17. What do we think Health Care is, some sort of Fed program?

With regard to Congress, the pResident and Vice pResident and basically all Fed Employees it is, isn't it?. Why isn't that good enough for the rest of us, who pay their health care premiums? Or am I missing something here? :shrug:

[radwriter0555]

40. Why not? Because it won't be PROFITABLE FOR REPUBLICANS.... why

else?

Think MOTIVATION.

The GOP does NOTHING for the VOTERS, the CONSTITUENTS, the PEOPLE of America. Every action they take is purely designed for their own profit.

[shesemsmom]

2. The only reason we can't have it

is that it would costs the Docs and Hospital and Pharmacy's a lot of moo-la. They would have that.

[Lone_Wolf]

3. It's certainly possible...

Developing an alternate healthcare system can be done. There are those with vested interests (HMOs, insurance companies, and the like) who will tell you that it can't be done. They will also spend their resources to complicate any such cooperative effort.

[sandnsea]

4. They'll use it anyway

Because emergency care is required by law. And if they use it, it won't work.

I don't know why we don't demand the right to buy insurance from the Federal Govt Workers plan. If we all do that, it'll be universal health care in short order.

[Selatius]

6. Can you clarify?

What I propose is a system by us for us. If anyone in our system needs emergency care, they'll get it. We millions who pooled our resources together would cover his or her costs. As for those who are outside the system, they wouldn't get money from our system because they didn't join the program. They'll get emergency care in the hospitals as required by law, but I'll be damned if they charge us for their care when they did not contribute. Let them get their help from traditional HMOs and insurance companies, not us.

[aquart]

8. So who's going to set up this bureaucracy of yours?

Who's going to collect the payments and guarantee care? There are really good reasons why this is done by governments and not private citizens.

[Selatius]

12. I don't see why private citizens cannot do it on their own

If you have a community where several hundred want to join, then what I'd advocate is that they get together and pool their resources as well as form a consensus as a group. (Setting how much money each person would contribute monthly, for instance). It'd be called a citizen's health care committee or collective or whatever other descriptive term.

Once they are together, they can choose a delegate or liason to reach out to nearby committees in other towns (or establish new committees) and form a network. Then you'll have several committees in several communities working together as a bloc. These delegates can then be empowered to set uniform standards and bring all the communities into compatibility with each other, but at the same time, each delegate should be directly answerable to the citizens in their respective communities and can be recalled/replaced at anytime his or her community wishes.

The delegates can either be given the task of taking in money and dispensing funds according to the agreed upon policies of the alliance, or, if the citizen committees want, another set of people could be chosen to handle administrative duties. The point is it should be run directly be the people who are going to benefit from the ground-up, and the process should be open and transparent for all to see.

Doing it through the federal government is another viable option, but at this point I fear this one will leave us more exposed to political shenanigans and corruption. If such a system did exist, I don't want more people like Bush and other corporatists gaining access to the levers of the system and screwing around with it. I'm tired of electing people and hoping to God they do what we want them to do. I believe more direct control is in order.

[Silverhair]

5. You have just described insurance.

What would you do about people who don't join while they are healthy and would be contributing but not using benefits, and then upon getting a health problem then get a change of heart and join so their benefits would be greater than their contributions?

[Selatius]

7. Can you clarify again?

Okay, you're saying a person pays into the system but doesn't join but when he gets sick, he joins to get benefits?

[Silverhair]

10. I was describing the problem of adverse selection.

Adverse selection kills insurance companies.]

1. Joe is healthy. He will draw no benefits from the plan. So to save money, Joe opts out of the plan. Plan gets no money from Joe.

2. Later Joe begins to feel symptoms. Joe joins the plan, pay in, gets treatment. Treatment costs a lot more than Joe's monthy payment.

3. Still later, Joe is recovered now. Joe drops plan. Plan has lost a lot of money on Joe.

One Joe doesn't hurt you very much, but a few thousand Joe's can kill a plan.

[Selatius]

14. Adverse selection

I've heard of that somewhere else, actually. Admittedly, that is a problem, and it's one that isn't easily handled. Perhaps the one way to to discourage people from skipping back and forth on and off the program is to, for example, make them sign a 4 year committment (4 or 5 years maybe)? Or you could provide some other incentive to keep them steady and not jumping in and out.

[Yupster]

27. An example is disability insurance

Group insurance is much cheaper than individual because individuals who go through the trouble of buying do it for a reason. One reason is they are likely to make a disability claim. That's adverse selection.

[yellowdogintexas]

9. what you are describing is similar to a large insurance group.

of the self funded variety since you don'tinclude an underwriting insurance company to help bear the risk.

If all the small businesses, employed persons who don't have the option to get insurance, persons who have no insurance but are too young for Medicare etc. etc. were declared to be a group as defined by insurance companies, then it would be the largest group in the country, after Medicare itself.

The negotiating power would be huge. It would not be mandatory.
Employers could share in cost of premiums if they so desired.
It could even be means tested if necessary.

Can you imagine, a group w/45million participants?


Kerry's health plan was simple: open the Federal Employees plan to include all the uninsured who wish to join it.

Set up a catastrophic plan w/big deductible for those who only need something to cover them if their costs exceed a certain amount per year.
(Lower premiums)

In any case, everybody pays in, and any money not used by paying claims, costs of administration, etc would roll back into the fund, which is increased every year by the additioanl premiums paid by the members.

[Silverhair]

11. "It would not be manadoty" would bankrupt the plan.

Either that or the premiums would be so high that if you could afford the plan, you wouldn't need it. See my above post on adverse selection.

[Blue Wally]

13. I am a gummint retiree

I pay about $360 a month for my wife and myself. The gummint pays about $600 on top of that. Do you want to join a plan for $960 a month unless you are really sick?? If you are young and healthy, you would prefer that money going towards your Ferrari lease.

[Selatius]

15. Well, for one thing

I wouldn't need something as expensive as a ferrari. I'm just a college student with a few ideas. :)

Regardless, if we adopted a voluntary health care system, I don't see how we would not be able to offset costs with collective bargaining power for things such as prescription drugs. Dennis Kucinich argued for single-payer health care because he realized that people operating as one giant bloc would have far more power than if people operated alone.

As yellowdogintexas says, "the negotiating power would be huge," especially if it was only 45,000,000 who joined. I suspect we could increase that many millions more and thus spread out health care costs even further. That would drive down the cost of medicine. In addition, if it is run directly by the people as mentioned in my reply to aquart in an open, accountable manner, I suspect we would be able to cut down on administrative costs and remove the "for-profit" from health care and maybe drop prices down even further.

It's a theory I'm kicking around because I want input. I wanna see what people here think of it.

[Lone_Wolf]

16. You are proposing a co-op.

Co-ops can be a sucessful business model. There are quite a few examples. Credit Unions are member owned. Rural Electric co-ops are another example.

Mondragon is a great example:

http://www.justpeace.org/mondragon.htm

[Selatius]

19. Thank you for the link, really helpful for the discussion

Your example goes along the same idea I was kicking around here. The only difference is that the system I proposed would be limited to health care only whereas Mondragon apparently has several arms in several commercial/industrial sectors, but I don't see any reason why my model can not be expanded, especially if the people running the system choose to do so.

[Lone_Wolf]

22. Anything is possible...

Don't let the nay-sayers tell you it can't be done...

[eridani]

18. For the same reason it isn't 'voluntary' to pay taxes to support --

--the fire department. If you don't have a fire--tough shit. Pay anyway, because it's part of the social infrastructure, as health care should be.

[Selatius]

20. Well, I was talking about health care only

We could argue over whether or not fire fighting infrastructure should be voluntary or not, but I wasn't challenging the existing order in this arena, just the arena of health care. Right now it's all for-profit, and I don't think it is sufficient, especially since we've got 45,000,000 in this country who don't have health care. On the other hand, there will simply be too much resistance in this country to the idea of "universal health care." I say, "if you don't want to join us and work together, then you should do it alone."

I don't propose getting rid of Social Security, Medicare, or Medicaid, but I do propose that we should look into setting up a system outside the federal government itself administered and owned by the people themselves (a co-op or collective).

[eridani]

36. Why should we have to be the government--

--when we are already paying a bunch of other people to do that?

Doing it alone is for healthy people. Sick people can't.

[Selatius]

42. What do you propose?

You propose a health care system where everybody is compelled to pay in regardless if they think socialism is a good idea. Is that about right? Don't get me wrong. At the end of the day, I'd support such a system if it came before me for approval, but the point is you'll be dragging a huge chunk of this country along with you kicking and screaming about the evils of authoritarian socialism, about people who don't want it being forced to pay anyway, and I decided to try and think outside the box for a minute to see if there is room for accomodation.

If my idea is workable--and I believe it can be--what would you propose to address the problem of only high risk people wanting to sign up? What is your answer? Waiting periods between the time a person pays in and the time he or she starts getting benefits? Setting up a quota so that high risk folks won't flood in? What?

[eridani]

43. People accept it for fire departments, so why not?

I think that the country will eventually come around when the system breaks down entirely.

The only room for accomodation is this--we keep pouring in huge amounts of public subsidy to pay for the people who actually get expensively sick, and do nothing to plug the hole at the bottom of the barrel that represents insurance company theft. What you propose is a version of that--doable, but not sustainable in the long run.

[Selatius]

44. I don't want the system to fall apart completely

We should not be waiting until the system hits rock bottom taking everyone with it before we start moving. Something's got to be done now, and if we can't even get socialized medicine like our European/Canadian counterparts through our federal government in this day and age, then we must try other ways.

It's either working to form regional health care systems at the state level with several states cooperating together to bring it to its citizens, or we can do it ourselves and form a co-op health care system run from the ground-up. If what you say is true, then I would be glad to abandon my idea in favor of regional health care systems at the state level instead over one at the federal level, but as it stands, I don't believe the problems would be insurmountable if we went the route I proposed.

[eridani]

45. Co-op = social, not individual = public sphere = government

I don't like the idea of doing government on our own time when we are already paying people for that function, however, if it's the only way to get things done---

We may very well have to have state and regional governments push the issue. In Canada, Tommy Douglas (recently voted 'greatest Canadian' by CBC viewers) got single payer going in Saskatchewan. Doctors at first raised holy hell, but got on board quickly when they noticed their incomes went up by a third (a lot of unmet need there for awhile). The system was adopted nationally when everyone else saw how vastly superior it was.

[Raksha]

21. Lone Wolf, thanks...

for the link to the story about the Mondragon co-ops. I've been interested in the co-op concept for a long time, not necessarily limited to (but certainly not excluding) the health care area. However, I don't know nearly enough about them. It's good to learn about successful models, especially those that have been successful over the long term.

Thanks again,
Linda

[Lone_Wolf]

24. No problem...

I've also been very interested in the co-op concept. Such a business model seems to have vast potential. If done right, I see no reason why they can't out compete for-profit type companies.

[Raksha]

34. I thought a co-op WAS supposed to earn a profit...

The difference is that because of the way it's set up with the employees also being the owners that most of said profit goes to the workers (who after all are the true creators of wealth) rather than to the managers and stockholders.

--Linda

[Lone_Wolf]

25. Here's a website about starting one.

http://www.wisc.edu/coops/introduction.html

[newyawker99]

31. Hi Raksha!!

Welcome to DU!! :toast:

[Raksha]

35. Hi newyawker!

Thanks for the welcome. I'm a New Yawker too--at least I was born there, but I've lived in California most of my life. I'm proud to say that I'm also a third-generation Democrat!!!

--Linda

[Cleita]

23. I've been thinking of non-profit corporations like the old

free clinics of the sixties. The Haight Ashbury Clinic in San Francisco is still operating. They get money from various sources including insurance, Medicare, Medical, private HMOs and donations. They don't turn anyone away. They only ask for a donation, anything you can afford whether a dollar or a hundred dollars.

I suppose liberal minded people could start at a community level. I think you could even sell health plans to employers for less than insurers if you remain a non-profit. You would have to determine to keep your administrative costs below three or four percent of premiums collected.

I don't know. I have been mentally kicking it around but have been too busy coping with my husband's medical problems to sit down and do some hard research and write up a workable plan for discussion.

[Royal Observer]

26. People who are healthy won't join the plan,

if it costs money. Sick people will join the plan. Nobody wants to pay for health care when they are healthy.

[Cleita]

28. What a crazy observation!

Many healthy people pay into health care because of their spouses and children.

[Lone_Wolf]

29. I'm healthy and I would join...

Many people join because they realize that the might not always be healthy.

[leesa]

30. I have to pay for the bombs they buy. Just kidding. It might be a thought

for more rational times. Our government is insane just at the moment.

[Jackpine Radical]

32. The sickest would opt in, the healthiest & wealthiest out.

The result is that you'd be trying to pay for the whole thing based on receipts from a pool of those most in need of health care. It would thus be fare more expensive than any "average" plan.

As it is now, every company tries to "cherry pick" with exclusions like pre-existing confitions, etc. You are setting up a formula for disaster, just like Bush's health savings accounts, and for the same reason.

[Selatius]

33. I respectfully disagree

I believe there are many healthy Americans who would find joining a health care co-op administered by the people themselves attractive, especially those who have children as dependents (as that one previous poster mentioned) and find it hard to keep up with the rising costs of prescription coverage outstripping their income.

[flaminbats]

46. why pay those damned premiums until you have an expensive health problem?

insurance works much like Social Security and Medicare, it depends on the young and healthy to help the sick and elderly..while lowering the burden paid if it was just voluntary.

Actually Kerry did propose a voluntary healthcare plan. Any who are uninsured, including those with pre-existing conditions, would be given the choice of buying into the FEHBP..private insurance options currently available to all Federal employees. Nobody would be forced to except or pay for this coverage, and none would be required to keep it.

This approach is backed by conservative Democrats like John Breaux and Jim Cooper, along with liberals like John Kerry and Howard Dean.

http://www.ndol.org/ndol_ci.cfm?kaid=111&subid=137&contentid=251190

The problem is that health insurance isn't voluntary, but it should be! Employers and insurance company gatekeepers now dictate who gets covered and who ultimately suffers.

[grasswire]

37. I've been thinking about this very thing...

...but on a smaller scale. I was thinking that two hundred families could go together and hire their own primary care physician. They could buy into the group so he/she could get office space and equipment. Office help and the nurse and lab tech might even be people who trade membership for labor. This clinic would be primary care and preventive care -- members would have to cover catastrophic costs some other way. But the benefits of readily available preventive care would prevent much of the trouble that drives up medical costs.

Universities have health clinics that are well-staffed and equipped. Why shouldn't other communities of people?

[Selatius]

38. It seems very possible

You could probably do this in several communities and then network them together to form a federation with a larger pool of resources. You just have to repeat your model in each new community you wish to start one in, and then you can grow outward and move into one community after another. I'm actually tempted to say your model is more workable than trying to form a nationwide collective in one massive go. It'd take a while for the federation to grow to a state, regional, and perhaps nationwide scale, but it'd be worth it, imho.

One issue that does bug me is adverse selection--people more likely to join because they're more prone to sickness or injury than healthy individuals. That'll probably take several measures to keep that in check. For example, should the system be given the power to turn away applicants if the risk is deemed to high? Should a quota be established to keep the system from being flooded by high risk members in any given year? What criteria would be used to determine risk? Should the system be given the power to kick out members who become "too expensive"? These are all questions worth discussion in my mind.

[More Than A Feeling]

39. what insurance companies do now

is establish a waiting period before coverage takes effect, and some things aren't covered at all, if I am not mistaken. It reeally depends on the plan(disclosure: I have never purchased health insurance, but I am currently taking a health economics course)

The reason people join health insurance plans is because they are risk averse. They are willing to pay a certain percentage plus a handling fee in order to avoid bigger losses in the event of an injury or illness. Even healthy people know that there is some chance that they will get sick, some can handle that risk, some cannot.

I know that some doctors have started their own insurance companies as a way to manage malpractice costs (with the aid of an underwriter), so it is not out of the question that ordinary people could start an insurance company.

My main concern would be: how would the physicians and such be reimbursed? That is the main method by which insurance companies control costs. will it be a fee-for-service plan (doctor is reimbursed for everything) or a capitation model (doctor is reimbursed a set amount for each patient each month, incentive to avoid patient getting sick or sending them for lots of tests)? presumably, the point of this exercise would be for patients not to pay anything out pocket, so with that cost controlling tool gone, will this hypothetical plan have to be even more penny pinching than HMOs and other insurance plans are?

Just some things to think about.

[grasswire]

41. good questions

The model I had in mind was for primary and preventive care, realizing that a relatively small group of people could not possibly absorb the costs of catastrophic illness of even one member. The purpose of the small group was to be able to prevent or stop illness early by on-demand access. Some other arrangement would have to be made for surgery or hospitalization or consultation with specialists.

My idea for reimbursement for physician and employees is a salary. The group hires the physician for a salary. His/her remuneration therefore has nothing to do with the level of care he provides any patient. I think care actually would be better than our current system provides.