[quote=Jazzman]
That is correct, but the term “superuser” has negative connotations. You can be the same risk profile as someone else but through misfortune be a so-called “superuser.” I’m not a scientist, but I believe genome mapping hasn’t quite developed to the stage where the risk of all diseases can be predetermined. And then there’s accidents.
Doctors should be rewarded for preventive practices and results thereof. It has proven effective in other systems.
I think it fair to say that remains to be seen. Presumably, actuarial calculations took that into account.
Bankruptcy insurance seems a fitting description of some insurance policies. Each generation will be dependent on the next generation so everything evens out. Isn’t social security funded similarly?
I don’t agree with the ideological frameworks being used but agree in principle with the costs and incentives argument.
I’m guessing the second option is a rhetorical suggestion.
Drug companies, training, medical equipment companies, bureaucracy, duplication, litigation, and research must also contribute significantly to the cost of insurance. This is not just about insurance. The core of the problem is costs, so why not apply reductionist principles and surgically remove the tumor as opposed to applying palliatives. In other words, treat the disease, not the symptoms.
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You’re right, superuser does have a negative connotation. I used it because I purposely wanted to dehumanize everything and spin this into a pure cost-wise analysis. And to point out what would truly be the best option if our purpose is to save dollars as well as to include as many of our citizenry as possible.
Doctors have been rewarded with preventive care awards. Most plans have a P4P system (pay for performance) system in place. But old habits die hard. And remember, a primary can make far more seeing 40 patients then 20 patients. And when you see 40 patients, it is FAR EASIER to send the twisted knee for the MRI and the ortho consult. Also keep in mind that a lot of PPO plans allow for self referrals. Which means a guy with heart burn may self refer to a cardiologist first, gets the EKG and the treadmill plus a CT coronary. After the “million dollar” workup, then referred to GI who then does a scope and put him on Nexium (the most expensive option but the rep was in with a free lunch earlier in the day.) Bottomline, without a gatekeeper doc who’s given sufficient time and compensation who’s also monitored on his/her prescription patterns and referrals and imagings, the system’s default is to spend as much as possible.
Funny you termed it bankruptcy insurance. I like that. except in a lot of cases as someone becomes a “superuser”, they also end up getting laid off or fired because of the reduced productivity, which means their insurance then disappears. This is why it is SO AWFUL to link health insurance to work. Again, by linking insurance to work, you are selecting for patients that are healthy enough to work. and when someone is no longer healthy enough to do so, there goes the insurance as well.
The completely capitalistic model was somewhat rhetorical, except to point out that we do not have a RIGHT to be treated, even if you are having crushing chest pain in front of the ER doors. We have a guaranteed right to bear arms, but the Founding Fathers did not grant a RIGHT for a pregnant woman to be delivered in a clean hospital bed with trained professionals. So if the population of this country decides they are willing to stomach seeing people turned away at the ER and die on the streets, we CAN do that.
