Health insurance bill passes the house

[Maximus]

Easy.  Let's say I have rheumatoid arthritis and I think it is quite severe, however, my physician thinks it is a mild case and thus will only put me on simple palliative drugs (like anti-inflammatories).  I know that there are big expensive medications out there that I think would completely get rid of my pain but I don't have access to them as I can't afford them on my own and my physician isn't willing to prescribe them.  If I could somehow manage to get myself a lower score (perhaps reassessed by someone else with less scruples), I might get those expensive drugs as the doctor would be motivated to spend what was necessary to get my failing health score up.

Fair enough. I guess I see "getting" a low score as completely different from "giving yourself" a low score. There are dishonest people in any system.

[DGuller]

Unless I do not understand it, DGs plan involves a patient having some kind of health score, and the lower it is, the more care the doctor should lavish on them, and the more care the doctor is "allowed" in some fashion, to give them. This, btw, is absolutely health care rationing.

That means that both the patient and the doctor will be incented to give the patient as low a score as possible, so there will be less difficulty in obtaining care in the future, should it be necessary. And if care is not necessary, great, the doc gets a higher efficiency rating. I can easily imagine a lot of chronic illnesses of the mild sort being diagnosed for example. More generally, the point is that any kind of rating system like this is going to be a mess. There is no way the government is going to come up with any kind of sophisticated system that will not have incredible unintended adverse incentives.

Notice nowhere in there is anyone injecting any cancer, but I am sure that is what I really mean.

Any system is going to be very complicated.  While our political system is retarded, it's not retarded to the point of suppressing some silver bullet that optimally solves all our problems.

One last point is that this system doesn't have to be administered by the government, it can be administered by HMOs.  In fact, what I'm doing is basically describing a variant of an HMO system, with greater emphasis on statistical modeling, and greater discretion provided to the primary care physician.

[garbon]

Fair enough. I guess I see "getting" a low score as completely different from "giving yourself" a low score. There are dishonest people in any system.

Well you can't really just give yourself one...but the point is that you are incentivized to have a low score as you know you'll always get the best treatment that way. If you have to shop around to get that low score, no big deal.

[DGuller]

True enough - no doubt that there are currently plenty of crappy incentives in the current system.

But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.

Not totally removed, but actually even farther than that.  When you get a cut for ordering tests, directly or indirectly, you're worse than totally removed.  You're connected in a perverse way.

[Iormlund]

But much of that is because the person paying for the expensive tests is totally removed from the people actually getting and ordering the tests.

What's the alternative?

[Admiral Yi]

What's the alternative?

Out of pocket/medical savings accounts is an alternative, not necessarily a superior alternative.

[DGuller]

Well you can't really just give yourself one...but the point is that you are incentivized to have a low score as you know you'll always get the best treatment that way. If you have to shop around to get that low score, no big deal.

Not exactly, or at least not directly.  No matter how low your score is, the doctor has incentives to spend his budget as efficiently as possible.

[Iormlund]

What's the alternative?

Out of pocket/medical savings accounts is an alternative, not necessarily a superior alternative.

That means you decide and pay for your tests, right?

[Admiral Yi]

That means you decide and pay for your tests, right?

Yup.

[Iormlund]

Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.

[Maximus]

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.

Seriously, do you listen to yourself?

I'm sorry Berkut. This shit was uncalled for. I read it wrong.

[MadImmortalMan]

Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.

People have a right to be unhealthy if they so choose.

[DGuller]

Wow, what a nightmare of a system. You don't think that is going to be just ridiculously abused and gamed?

Why won't people just try to get as low a score as possible, so they can justify as much healthcare as they can?

People will be transplanting cancer into their bodies just to get all that sweet sweet chemotherapy.

Seriously, do you listen to yourself?

I'm sorry Berkut. This shit was uncalled for. I read it wrong.

I read it the same way, until Berkut clarified himself.

[Admiral Yi]

Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.

If the objective were a healthier population full stop we would spend 100% of income on health care.  The true objective is an optimal allocation of resources to health care.

[Iormlund]

Sounds to me like that would encourage people to forgo necessary treatment. Not really what you'd want if your objective is a healthier population and less ER costs.

People have a right to be unhealthy if they so choose.

You are missing the point. You think they carried me to the OR at the point of a gun? I could have gone for drugs or no treatment at all if I so wished.

The point is, what that system does is to promote unhealthy behaviour, not just allow it. It's completely irresponsible.