If someone who thinks they are making 40 k (and their employer is making some nebulous contribution to their insurance) found out they were making 50k and 10k a year was going to healthcare, I would expect they really would get excited about that really fast. Do YOU know exactly how much your employer contributed to the healthcare of you and your family last year? I sure don't and it sure as heck wasn't on my W2 or income tax forms.
I couldn't tell you how much, Ian. I also couldn't tell you my GPA at any one point of any part of my academic life. However I knew whether or not I was doing well enough to get on to whatever next level I needed. That's plenty.
I'm all for educating people about their benefits, Ian. I've seen it done. However I'm not convinced it will help any more than putting health care kiosks at work will make people take better care of themselves I'm the science guy on all this, and I want to see proof that it helps. Otherwise you get the big shrug from me.
For what it's worth... I measure outcomes from such interventions for a living, and they let me hold back a control group for comparison. We're always throwing pasta up at the ceiling in our population to see if it sticks. Mostly when it does, it's marginal at best. We like the expression "herding cats." Behavior modification in health care inspires it.
Do you know what does work? High deductibles. The higher the deductible, the fewer the episodes of care that are initiated (by the patient). Furthermore, the effect has persistence through the rest of the year when the deductible runs out.
Medical Savings Accounts combined with super-high deductible health plans (as a fall back when the bottom drops out) is the most recent idea du jour.
We know that when people are confronted with the true costs of TV sets paid slowly and with huge interest, or pay day loans with huge interest, they make better decisions, even though a Bill Glasheen would be smart enough not to fall into those traps without needing the warning, because he could do math. People are not all Bill Glasheens out there. Maybe you're so smart you're missing this point? This isn't just about pre or post tax income; it's about hiding a huge chunk of our income as an employer paid benefit we fail to appreciate as income. Get it now?
I see it over and over and over again in data, Ian. Pareto's distribution holds. The reason why we have disparities in income and wealth has to do with basic laws of Nature that we can understand on an empirical level far before we ever get it at a first principles mathematical level. Pareto observed it centuries ago in Italy, and it still holds today.
The statistical distribution also occur in other parts of the data such as the number of hospital days per person per year, the amount spent per person per year, etc., etc.
Maybe if we taught kids about the time value of money in algebra class when logarithmic and exponential functions were discussed, then they'd get it. But I doubt it. Twenty percent of the class would get it at an intuitive level, and the other eighty percent will be more worried about getting laid or drunk (or both) that weekend.
Maybe if we taught kids about the dangers of drugs and alcohol and STDs and pregnancy, then they'd "Just say no." Some will... And others will become alcoholic, smoke, get pregnant, and suffer from cervical cancer years down the road.
It doesn't mean we don't try, Ian. But I'm always depressed when I see the magnitude of the effect of any intervention. We can beat on our chests at political conventions and talk about how our way is the better way. Maybe if we say it loud enough and long enough, we'll start to believe our own propaganda. But at the end of the day, it's just politics.
So then it just comes down to philosophy and execution. Everything else is just the numbers. I know how I want to live, and I find a way to make things work in my world.
I'm the guy who wants to slash social security benefits, raise the retirement age, and ration healthcare--just another typical fuzzy headed warm hearted liberal
If you wish...
We have no choice but to raise the retirement age, and we're already rationing health care. On the latter front, the "r" word is just semantics.
It ain't the what; it's the how. I want the money up front, and I want to ration my own health care. One thing I learned in my research is that people want what they want - even if they don't get the best outcome. This one very elaborate 3-year study comparing two benefits of the two largest employers in Virginia taught me this. At the end of the day, there was no "winner." Satisfaction with what you had was just as valid a measure of "quality" as health status or cost, and there was no product where all three metrics peaked. Who are you or The Guru to say what we can and cannot have? What mattered most to people was choice.
You like your Prius; I want to drive fast. We're happy with our individual choices. We'll go ballistic if someone chooses for us - particularly if it's "the wrong choice."
THAT is unclear...
What is "economy" in health care when someone doesn't want to get out of bed and play? What is economy in health care when Maria wants to swim the Rio Grande and have her baby in a San Diego hospital?
It has to do mainly with public health, or what will serve us all. Even altruism is a selfish trait, albeit a wonderful one. Deliver Maria's baby, and send them back south of the border. Buh bye!!! Diagnose and treat hepatitis and tuberculosis, and do what you can to contain it in the population. If it serves the individual but not so much the public good, then go home and work for it, baby. Buh bye!!!
Most people need to go hungry before they'll get out of bed and get a job. Tough love isn't just something your parents do for you. It's a part of teaching people about dignity and self worth. It generates pain and income disparity, but it also inspires the best among us to be the best. And at some point, the passion reaches critical mass. Achievement then become a contagious disease.