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Edawrd Your naivety astounds me First, how will "consumers" now which trips to a doctro to ration - your assumption is that pateint currently go to the doctors when they probably suspect there is no reason to - you ignore there are costs to consultations other than fees. Secondly, you suggest that the elderly can shop around for medicines at prices they can afford. This is simply undesirable. I truly hope that when you are elderly you would not have to be hamstrung with such a task. The presnt system does not rely on the assumption that pateitns are stupid - rather that there is assymetric information between purchasers (patients) and providers (physicians and health plans). Try reading the excellent text by Thomas Rice for an underestanding of the health care market Also when considering the present system - expand yourr thoughts to other countries other than the USA when health care systems are successful with coverage for all citizens . Dogu Doug Coyle Senior Principal Investigator Clinical Epidemiology Unit Loeb Research Institute Ottawa Hospital Ottawa, Ontario Canada K1Y 4E9 Tel: +1 613 798 5555 ext.3548 Fax: +1 613 761 5351 E-mail: [log in to unmask] > -----Original Message----- > From: Edward Day [SMTP:[log in to unmask]] > Sent: Friday, April 07, 2000 12:00 PM > To: MCCARTHY, Roger; health econ discussion list > Subject: RE: MSAs > > But, this is foolish. The usual way that this intoduced is with a > catastrophic insurance clause. That is, one would buy a relatively low > cost, high deductible (perhaps $2500) policy that would insure against > risks that really are terrible when they occur. The day to day, mundane > treatments and other things would be paid out of the MSA of $2500. The > combined costs of funding the MSA and buying the high risk policy should > be > less than the cost of a first dollar risk insurance policy. The best part > of this is that consumers would be encouraged to ration their trips to the > doctor as they would have an incentive to do so, especially if any > residual > in the MSA remains with the consumer. > > The funding of the MSA would not necessarily have to be done directly by > the consumer. In the case of workers, it could be funded by the company > in > the same way that companies presently fund first dollar insurance. It > would certainly be possible for the Medicare program to fund a certain > number of dollars for each of its elderly clients and then insure only > those highest risks. The elderly would be encouraged to shop for the best > medicine at prices they could afford instead of being seen only by those > medical professionals who decide to participate in the Medicare program. > > The same thing could be done for the poor. Medicaid could be treated in > the same way. > > The present system and those who support it assume that not only are > people > old or poor or something else, but that they are also stupid. Some people > are stupid, but there is no way to insure against this risk. > > > *********** REPLY SEPARATOR *********** > > On 4/7/00 at 11:12 AM MCCARTHY, Roger wrote: > > >The major problem with MSA's and any other system of healthcare funded by > >individual payment is that there is generally an inverse relationship > >between the need for medical treatment and the capacity to pay for it - > the > >people with the greatest need for medical treatment (the elderly, the > poor, > >those with long-term disabling conditions) are those with the least money > >while those with lesser needs are the most affluent - with this not being > >unconnected to the fact that illness frequently reduces or eliminates the > >capacity to earn and save. > > > >The second big problem is that even with (in some cases especially with) > the > >internet consumers generally lack the information and training to make > >'cost-efficient' or any other sort of major medical decisions - that's > why > >we need a medical profession and why vast amounts of money are spent > every > >year on quack treatments like homeopathy or on health-threatening > products > >like cigarettes. > > > >OK there is a libertarian argument that people should be allowed to spend > >their money however they like and that if they make bad decisions they > alone > >are responsible for the consequences, but we are here entering the realm > of > >ideology and leaving that of economics. > > > >Of course if we all happened to be perpetually young billionaires with > >medical degrees..... > > > >ROGER > > > >> -----Original Message----- > >> From: BaylorU. Labs [SMTP:[log in to unmask]] > >> Sent: 06 April 2000 05:48 > >> To: [log in to unmask] > >> Subject: MSAs > >> > >> I feel that the concept of medical savings accounts is an interesting > >> alternative to the current health care system. With this system, > people > >> would contribute a portion of their own income into savings accounts, > >> which are in turn used for medical services. I feel that this system > >> will put people in charge of their own health care decisions. > >> Furthermore, if they are spending their own money they will be more > >> likely to make cost-efficient choices. > > > > > > > > > >---------------------------------------------------------------------- > >Internet communications are not secure and therefore BUPA does > >not accept legal responsibility for the contents of this message. Any > >views or opinions presented are solely those of the author and do > >not necessarily represent those of BUPA. > >----------------------------------------------------------------------- > > > A. Edward Day > Department of Economics > University of Central Florida > P. O. Box 161400 > Orlando, FL 32816-1400 > Voice: 407-823-2620 > FAX: 407-823-3269 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%