Yup, who's gonna give a loan? To someone living alone because they're destitute? Especially if they have a very severe illness like heart disease or cancer?

The insurers would be out of the loop. Health care providers? Not so much.

The hospitals and doctors (and pharmacies and medical equipment suppliers) would set up the loan paperwork; the USG pays the providers directly but only for what the government panel decides is reasonable.

You want more? Figure out how to pay for it without relying on a government guarantee -- or go without.

Hi Saladin - I didn't think it would be possible to come up with something worse than what we have now, but this idea might do just that, depending on how it was implemented. Alternatively, with different implementation, if might improve things slightly, while failing to address problems of quality of care or reasonable charges at the provider end, as most reform packages propose.

The entire principle of insurance is founded on shared risk - i.e., individuals would pay similar amounts regardless of whether one ended up having far more costs than average and another far less. That principle is far from completely satisfied today, because of insurer "cherry picking" and different rates dependent on risk. As a consequence, the proposed legislation attempts to reduce these inequities by eliminating cherry picking and reducing rate disparities. Asking individuals to borrow money based exclusively on their individual medical costs would reverse this salutary trend. Government subsidies would not offset these inequities, unless they re-established equitability, so that the "loans" weren't really loans after all but just a form of insurance payment with new loan application paperwork done for every illness and every individual. In that case, we would have simply an extremely inefficient and cumbersome form of single payer system. On the other hand, if the subsidies were merely a means of keeping patients who were struggling to pay back loans from sinking to the poverty level, but still left the patients with most of the repayment costs (as seems to be what was suggested), the increase in inequitability would be nightmarish.

but people will avoid preventive care if they have to pay out of pocket for it. Look at what works in the world and copy it! You are really being obtuse!

With your plan people will wait until the last possible moment to get health care. Why? Because they MIGHT save a few bucks that way.

I can't believe you honestly support this. Why get a Pap smear every year? Save a few bucks and you can get one every FIVE years! Ellen, you have really lost it.

It is silly, isn't it, when you think about it. Lying there, maybe dying, asking a surgeon how much is this going to cost while shopping around for a surgeon who will do it for $300 less.

I've gone that route, though I didn't do the shopping myself. Workman's comp did the shopping, and I ended up with busted, infected stitches as a result. But at least they held down the costs. Somebody won, just not the patient.

If he didn't have insurance, he might not have seen a doctor at all till it was too late or late enough to have caused a much more costly life-threatening infection..

Did you even bother to read this article? The whole point of it was that radiation exposure was being needlessly used on certain patients. People presenting in the Emergency Department independently are different than those who present in the office of a doctor they know. When there is a rush to diagnose, and no possibility for follow-up, more extravagant means for diagnosis are called for; when an emergency room physician discharges someone, he cannot say, "Come back tomorrow and let me check you again."

You are way out of your field of expertise here, Ellen. Just being a fingernail going down a blackboard doesn't qualify you to make judgements about health care.