Darik

I have brought this up before. I think that national health care should be an opt-in program according to needs. If there's a coverage or service you don't feel you need you can opt out of it and costs would be adjusted to what you opt in.
Why should anyone decide what's right for you when you know you best of all? Why would a government or a private insurance even question a request of don't cover me for this?

I realize filling out such a form would be a giant pain in the neck, especially for someone filling out forms for themselves and their families, but if you want the same options the following year just check the box that says in essence roll over the same benefits of the previous year.

That way, religious freedom would be truly respected in the realm of healthcare. Are you a Jehovah's Witness? Opt out of blood products and transplant/grafts. Are you a Christian Scientist? Opt out of hospitalization or pharmacy. Are you a Scientologist? Opt out of mental health benefits*. Are you opposed to contraceptives on religious grounds? Opt out.

I have been racking my brain over this and I don't have any answers. Maybe someone else here might. Is the problem the allotment according to need is too difficult to forecast for the year or the paper pushing and processing of each application too high an administrative cost? Is it something else entirely?

*Yes, Kara, I can hear you laughing from here. The irony, I know. I'm just trying to make a point.

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eighthdwarf Checchinato

Wouldn't that be rather an OPT-OUT system? In my understanding, the best healthcare system would be 100% covered by taxes in the first place, equal for everyone no matter their wealth or income or location or citizenship: Nobody would be deprived of any treatment or care or medicamentation, and nobody would have to pay extra fees.
But you still would be free to say, "It's nice you offer […], but no thanks, I don't want that kind of treatment/care/meds for me", and this choice would be respected no questions asked - though you would be told what consequences your opt-out might have (like, opting out of this treatment increases the risk of […], opting out of that medication will cause […]).

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Darik

Yes, you're right - an opt OUT system. Reason for opting out wouldn't even have to be specified, just indicate no.

Chip Midnight

Philosophically I think it would be great, but in reality too many people would opt out and then get sick or have an accident and everyone else would end up picking up the tab anyway. It's less cruel to demand that people pay their fair share all along then to have to deny them care when they really need it. It would just increase the burden on those who don't opt out.

Circle Widdershins

I think in your example - getting sick or having an accident - wouldn't be things that people opt out of. Because ideally the basic, minimal cover would include things like unforseeable illness, accidents and the like.

But sorry yes, now I see your point, that a portion of every person's taxes should go towards this basic health cover. Sometimes it's hard to wrap my head around the fact that it doesn't exist for some countries

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Cristiano We need to make 'endless celestial sex' into a thing.

Eunoli Rain

People who are young and healthy will tend to skip insurance for diseases or problems that are rare or seem to be "older persons" diseases. I wish I could remember who the guest was, but I listened to a program on NPR about just this idea a few weeks ago. Researchers who looked into it found that the young would be underinsured and find themselves struggling when unexpected things came up and that only as people became much older would they tend to be fully insured.

Darik

Catastrophic, illness, and preventative could be basic coverage. But as a female, why would I need coverage for a PSA and prostate exam or any part of men's health? If I had a hysterectomy, why would I need contraceptive, maternity, or fertility treatment coverage? If I don't smoke, why would I need smoking cessation? Large group plans now cover such things at the discretion of the subscribing business and they get to pick and choose what's covered and what isn't through negotiation.

I'm thinking, though, the possibility of a shortage of funding for those who opt in based on low demand.

Ciaran Laval

Bingo! That would be the exact problem.

Darik

I see. So as a consequence funding for research would also be affected.

Jahar Aabye

The problem with opt-in is that the practical result would eventually become indistinguishable from paying out of pocket. Insurance is a risk pool. Inevitably some people will be paying premiums for coverage they will never need, and some people will be receiving benefits far in excess of their premium payments.

You feel that you should be able to opt out of coverage for prostate exams? But then what happens when men opt out of coverage for mammograms, pap smears, and hormonal contraception? For that matter, what happens when the only people who opt-in for hormonal contraception are pre-menopausal women? What happens when the only people who opt-in for mental health coverage are the mentally ill?

The result would be that the premiums of those opting in to a specific set of coverage is going to then have to cover those who need that coverage. This becomes the exact opposite of the entire point of having health insurance: to spread the costs among a larger risk pool.

And the worst-case scenario is when you start allowing religious exemptions beyond actual churches. Birth control is the least of the concerns: mental health care and transplants are two fairly expensive areas of coverage (although I would point out that in both cases the benefits outweigh the costs). If you start allowing any business to opt-out based on religious beliefs, you would find a lot of business executives suddenly deciding that theirs is a Scientologist or Jehovah's Witness business, and using that as a means of denying converage.

I know, that sounds far-fetched, but businesses will go to great lengths to save on healthcare costs if they have the option.

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He pulled a Captain Ahab and Jaharpwn'ed her. - Trout

Maggiedoll Alter

I'm fairly certain that being female would automatically opt you out of men's health issues.

If it isn't applicable, it isn't applicable, what's the point of opting out? And if you have a universal healthcare system, why not cover everybody for all of the same treatments? If they don't want them, they don't have to get them.
The problem with your opt-out thing is that it sounds like you're proposing a reduced cost.. which would end up having people opting out of coverage for things they MIGHT need because right now, they need the money more. If everybody is covered, it's not an issue.

And even if you object to birth control on religious grounds, that doesn't mean you won't develop some kind of hormonal issue that you'd need the same medication for.

Being covered just means you have access to it if you need and want it. If you're talking about a universal healthcare system, the "opt out" part is irrelevant. You "opt out" by deciding you don't want any given treatment and saying "no, I don't think that's what I want to do."

The whole point of insurance is for the costs to be spread around so that it's there in case you need it. Like public schools. Everybody pays for them, whether they have kids or not. It (theoretically) creates an educated public and an education for their kids or grand-kids if they have them. You don't not pay school taxes just because you don't have kids. Public access to education is something everybody needs, whether they need it directly or not. Same for healthcare.

Ann Otoole

7 weeks till my health care kicks in. Hopefully I won't die of whatever this chronic bronchitis is (related to fungus found in the A/C so could be Legionnaire's) before then.

I.e.; Yes we need socialism for health care. Everyone should be able to walk into any medical facility and get treatment no questions asked. We'll also have to nationalize the pharmaceutical industry as well. What good is a Rx script if you can't buy the meds?

Darik

Even with universal funding schools don't meet every need all the time. Additional funding is always needed for things from AP courses to special ed to structure maintenance. These funds are subject to cuts and allotments based on popular agenda. So if you want the standard No Child Left Behind program, you will get that but if your child has special needs, good luck in your fight in getting those needs met. As it is right now, the healthcare industry works the same way based on averages and biases and not meeting the needs of the exceptions. How can that be fixed?

Darik

Tell that to the insurance my husband and I have. I shouldn't have to forego physical therapy because I can't afford the co-pay, but that's exactly what happened.

Eris

Religious freedom in health care kills people. Often in quite horrific ways.

If they get upset because they're paying into a system that provides life saving treatments for people who don't share their superstitions, they can just go fuck themselves.

Jahar Aabye

The way to fix it is precisely the opposite of opt-in. You need universal or near-universal coverage so as to spread the risk out over the largest pool possible. Essentially you need to have the healthy paying into the pool to cover the sick. All that opt-in does is start to create smaller coverage pools for individual conditions or sets of conditions.

Ultimately, not wanting to have to pay for coverage for certain conditions or treatments, whether for religious reasons, philosphical objections, medieval prejudices, etc defeats the entire purpose. Whatever the reason, the outcome is that it restricts the funding available.

At the individual level, it might not be as obvious, but when you "zoom out" and look at the larger picture, it becomes obvious that instead of a large sea, you wind up creating a bunch of little islands of coverage. And that's without even getting into the problems that happen when someone urgently needs care that they chose not to opt-in to cover, because one way or another we all will pay for that care or the lack of care.

That's the reason for the health insurance mandate and part of the reason for requiring insurers to cover certain things (although part of that is also simply to ensure that such coverage exists). The more healthy people paying into the pool, the greater the resources to cover the costs. Ultimately the odds are that as you expand coverage, you will wind up bringing in more healthy payers than sick beneficiaries.

Ann Otoole

damn what is your copay for something like that? I don't make much money but will be buying the most expensive insurance package with lowest copays because I expect to max it out every year. It seriously helps I work for a really huge global company with millions of employees and is bigger than Disney. The health care premiums are still low.

Maggiedoll Alter

We could start by recognizing the need and importance of both education and healthcare.

I'm not sure what you're getting at here, because you're coming up with arguments that seem nonsensical.
The fact that a system isn't perfect doesn't reduce the need for said system. Getting needs met is a fight with most (all?) private insurance. Are you saying that we should get rid of all insurance entirely because it can be a fight to get approved for what you need? The implementation isn't perfect, so scrap the entire idea?

Darik

Another question. Part of the healthcare crisis as is, is that people are getting sicker and sicker because they neglect their health because they are afraid to lose their job that provides their health care. Those that are out of work lose their means to pitch into the pool. How do we provide fair coverage for all in such a case?

Darik

I'm saying if the idea is coverage for all then something needs to be done to assure coverage for all that isn't like the current Medicare/Medicaid system which is full of restrictions. If expecting parents today have a 1 in 100 chance that their child will be autistic, that's something that should be automatically covered in both education and health care. But these proverbial parents will have to fight tooth and nail to get their child that care because that's the current system in both areas. The parents of the other 99 will naturally be paying for this -

I see.

Okay, I get it. Insurance should in essence cover what-ifs in the event you get hit with that what-if by misfortune which was always the selling point and reason to have insurance in the first place. If you overpay most of the time you can be assured coverage if the unthinkable happens. My arguments, nonsensical they may be, are questions because I'm not understanding what the reason for the push for denial of coverage for some things by certain interests and why they should have a say in the matter.

Nibb Tardis

Why not opt-out taxes ? I don't use aircrat carriers or fighter jets, so why should I pay for them?

The whole point of a centralized health care system is mutualization. You pay for others and others pay for you. It's a matter of solidarity. You don't let your fellow citizens down. Isn't there enough individualism selfishness already ?

Kaimi Kyomoon

Health care provision should have nothing to do with employment. It should be run by the government and be available to anyone within our borders who needs it. It should be paid for by taxes. Richer people should pay more taxes than poorer people.

Darik

Should there be any limitations?

Cajsa Lilliehook

The best solution is a single payer national health insurance program that everyone pays for through taxes and covers everyone - with doctors and hospitals remaining private businesses. The cafeteria kind of health plan suggested in the OP is the worst solution as it reduces risk-pooling and increases underwriting costs. It will just add to administrative costs, cost-shifting for people who pick and choose poorly and more paperwork and more restrictions on care.

Cajsa Lilliehook

I have to add that I get sick and tired of the selective concern for people's tax dollars spent on things they are morally or religiously opposed to.

The elective war in Iraq was immoral. Do I get to refuse to pay for it and stop paying taxes? No! I think the death penalty is immoral but my tax dollars pay for that as well. There's no concern about offending my moral sensibilities.

I get sick and tired of the one-sided concern for whose moral values are honored. We have to toady to Catholic bishops to the detriment of women's health. Their neurasthenic sensibilities cannot be offended by allowing a tax dollar to pay for reproductive health care they are troubled by - which is damn ironic given that the churches don't pay any taxes in the first place. Meanwhile, these are the same people who protected child molesters and pedophiliac priests.

When those priests who are also required by the Vatican to oppose the war and the death penalty put 1/10th of the energy into those issues that they do into trying to control women's bodies, perhaps they will have something worth listening to, at the moment though, they seem awfully quiet on other moral issues - ones that are certainly more clearly life and death issues.