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You continue to present false choices. The government doesn't decide when your care is cost effective.
that is, in fact, the purpose of the IPAB.
Like your insurance company they decide when effective efforts they will pay for.
except that your insurance agency is beholden to you by contract to provide a set of services or face legal suit. the IPAB isn't beholden to give you anything it decides it does not want to spend the money on, and was deliberately made immune from suit.
Your are not forbidden for paying for more through other means
that is true - you are free to pay out of pocket. which will be easier for some than others, and is why I support means-testing.
And there is no evidence a completely market driven system would lower prices or increase access.
completely? who is talking about completely?
as for introducing market pressure to drive down costs and expenditures?
Indiana offered HSA's, which have patients save money in tax-free accounts (where it grows and remains theirs forever and ever unless theys pend it) matched with high deductible plans to it's employees. Employees began to respond to price signals, and medical costs per patient were reduced by 33% and expenditures to the state were reduced by 11%.
Safeway has instituted a program that gave financial incentives to people who engaged in healthy behavior by allowing price signals in the insurance side of the market to work (Indiana worked on the medical side), and saw it's per-captia health care costs remain flat from 2005-2009; when most companies saw theirs jump by 38%.
Whole Foods instituted HSA's, and let's the employees choose what they want the company to fund. This institutes price pressure on the medical side (WF covers the high-deductible plan 100%), and their CEO points out that as a result Whole Foods' per-capita costs are much lower than typical insurance programs, while maintaining employee satisfaction.
Medicare Part D utilized market pressure on the insurance side, and saw expenditures come in at 40% UNDER expenditures - the only such government program in history to do so.
Wendy's instituted HSA's, and saw the number of their employees who got preventative and annual checkup care climb even as they saw claims decrease by 14% (in one year).
Wal-Mart's low cost clinics and prescriptions save us oodles of cash. Wal-Mart reports that "half of their clinic patients report that they are uninsured" and that "if it were not for [Wal-Marts'] clinics they would haven't gotten care - or they would have gone to an emergency room". Walmart - reducing costs and expenditures.
all of these utilize the markets to lower costs and expenditures; and they are just the begining. Not using insurance to pay for every procedure, checkup, etc. reduces administrative costs, which in turn reduces medical costs - and as HSA's catch on (assuming that Obamacare - which criminalizes them - is repealed) we will see the positive effects of that on costs and expenditures as well.
Dr Robert Berry runs a practice called PATMOS (payment at time of service). he doesn't take insurance at all - but simply posts the prices of his services. By removing the cost of dealing with mutliple insurance agencies, medicare, and medicaid, the prices he is able to list are one half to ONE THIRD of standard. That's huge.
what do all these programs have in common? They use market price pressure. People start to make better informed, and more conscious decisions once they are compensated for doing so.
That is more fanasty than anything else.[/QUOTE]