Reply #19: You hit this one out of the park

[Bozvotros]

I worked as a Case Management Director for a for-profit Rehab hospital in the early 90's. And what I saw is what you describe here. Capitation was the ugliest element and I think it failed to catch on because so many doctors realized it necessitated violating their Hippocratic Oath, making them choose between their profit and their patient's health. So instead insurance companies pushed Health Savings Accounts with gradually increasing out of pocket costs. This made the patient have to decide what services they absolutely needed and which to forego. This is just patient directed capitation. People with HSAs are reluctant to pay for such things as MRIs, CAT scans and expensive lab workups. Healthy family members will decline services to make sure a sick member has the services they need. When people have to pay 5 or 6 thousand bucks out of pocket before their insurance kicks in, it makes them choose between their health and some other necessity. These plans are cheaper because they don't kick in till you have spent 4 or 5 hundred bucks a month, but the plans can still cost an enrollee as much as two or three hundred dollars a month.

As a Case Manager I saw some horrendous plans which people picked up from their employer because they were cheap and then discovered that it didn't cover critical elements of rehab care. Some covered only outpatient services, some limited the number of visits from a physical, occupational or speech therapist. Many had virtually no mental health services. There were huge deductibles and large out of pockets. People were told they could only get their rehab in a nursing home unless the hospital was willing to provide services at nursing home rates. Many times people inpatient benefits were terminated when progress was viewed to be insufficient for inpatient care. Among the worst was Golden Rule Insurance, a "Christian" company that was good at weeding out benefits and services, weaseling out of paying and selling catastrophic coverage plans in place of regular insurance. They were of course, big contributors to Republicans and one of the earliest companies to promote the racket of Health Savings Accounts.

I am sure, no matter who our nominee is, we will have to fight like rabid wolverines to make it truly universal health care on a par with what Congress now enjoys.