Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

The Lifetime Distribution of Health Care Costs http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

You've got that almost completely backwards, though few people are aware of this (in the United States).

I'm hazy on the details myself, but briefly:

1. Healthcare insurers are covered under ERISA, the Employee Retirement Income Security Act, of 1974. Among the provisions of that act are limitations on the right to sue, under the theory that a retirement fiduciary is an agent of the employees. It's been a long time since I've looked at this, and I don't recall all the specifics, but yes, there are some limitations on suit for lack of coverage.

https://en.m.wikipedia.org/wiki/Employee_Retirement_Income_S...

2. Lawsuits against the government are possible and happen all the time. I'd have to see what specific limitations apply, if any, to Medicare, Medicaid, Disability, and VA care, but you'll find numerous instances of suits:

https://duckduckgo.com/?q=lawsuit+medicare+denial+of+(care%7...

Update, additional info on ERISA and its impact on lawsuits: appeals through the insurer must first be exhausted, but statute of limitations applies whilst lawsuits are blocked: https://www.lawyersandsettlements.com/articles/stock_option/...

And yet, the most dramtic improvements in healthcare outcomes (life expectency, mortality), came in the period before intensive medicine. Robert Gordon's The Rise and Fall of American Growth (2016) describes this in detail. Progress since 1970 has been particularly abysmal and almost totally due to increased access for the most under-served populations.

It turns out that there are very sharply diminishing returns to intensive medical care. And that getting the basics right -- pre-natal care, effective childbirth, well-mother-and-baby care, vaccinations, good nutrition, an environment clear of pollution and contamination (especially lead, mercury, asbestos, smoke, and miscellaneous hazards) has a tremendous effect on improving infant survival and adult capabilities in both physical and mental health.

The same precise services which lack of healthcare limit.

There are also specific interventions which can be hugely impressively. One doctor I know entered the profession after witnessing what a single dose of narcan could do to an ODing heroin junkie. (Mind, you've still got an addict to deal with after ripping them out of Death's Cold Hands, but you've got a live addict, not a dead one.) Wound care, reconstructive surgery, bonesetting, and treatments for at least some diseases and conditions are pretty amazing.

But people still eventually die, and putting of the inevitable is extremely expensive. The share of Medicare (and total) healthcare expenditures invoked in the last 12 months of life are quite high, though I've not the specific figures.

And the US healthcare industry, in cost for outcomes achieved, is horrendously inefficient. It remains unavailable for far, far too many people.

1.) It might be possible, but that would probably take time, a lot of work, and likely intervention with laws and money. I'm not all that hopeful that it could be done. Right now there are a lot of people with inadequate to no health coverage. They have issues and problems that are going to need taken care of, which means that the first 3-5 years are probably going to be more expensive than later on. Some are just things folks have been putting off - surgery for carpal tunnel, for example. A few folks will have much larger problems that they can't do much about without insurance. Maybe they don't take care of their diabetes well enough or should really be taking heart medicine or anti-depressants.

Basically, gotta get everyone caught up to the healthiest they can be, and afterwards there would be a lot better maintenance, which in return would mean that the companies have a chance of not needing to worry about the adverse selection.

It would probably also help to get rid of the networks and simplify the insurance end at the doctors offices to both reduce costs and get rid of some of the redunancies in addition to having some sort of care and coverage standards that spread across insurances, just so that people are able to get the care they need instead of going with not-quite-so-good-for-them alternatives because they happen to have a crappy prescription plan.

Other changes I would make would be to require all insurers to sell directly to consumers and decouple insurance from employment - much like most folks get their car insurance. In addition, I'd require insurers to use the exchanges if they want to be in the business and make it so that insurers have a national license instead of needing certified in each and every state they sell in. This would not only standardize coverage, but reduce overhead.

Unfortunately, this sort of thing requires planning on a rather large scale and fixing a lot of problems such as affordability of care. The current political climate hasn't been so keen on that sort of long-term planning nor cooporation, not to mention that the companies themselves might not be too keen on that last one either.

2.) I tend to think all pre-existing rules are bogus. Though they say they help with their risk, I'm skeptical. Most the plans I saw wanted folks to have continuous health care coverage to go around some of the rules (I've always gotten insurance through and employer when I lived in the US). Yet having coverage doesn't mean you take care of your condition. The opposite is also true. Obviously, some folks don't take care of x,y, or z because of lack of coverage as well. And things such as gall bladder surgery are more one-time events with few lasting needs after the surgery for most folks.

Anecdotally, while Britain's medical system has less wait times, doctors working for the NHS are chronically overworked and underpaid. Many move to Australia or go into private practice after completing their residencies.