Zoti Bemba wrote:However part of the advantage -- and cost savings -- of having everyone insured is supposed to be that it would allow everyone to make use of preventative care and screening services, thereby (it is hoped) cheaply catching and fixing small problems before they become big expensive problems. $20,000 seems like kind of a high deductible if part of your goal is to get people to have a yearly physical and keep up on their flu shots. Unless you envision health maintenance services being provided some other way, one that would not involve an out of pocket expense for patients?
What you are really saying is that it is best to force people to pre-pay for preventative care, because it is in their best interest, and they might not make this wise choice on their own. I kinda agree with you, it is a shortcoming of my plan, but let me give you the bigger picture sales pitch:
We are all paying for our health care, one way or another. If you have an insurance policy, you are paying for the health care, plus you are paying for an additional product - health insurance. Remember, insurance companies are like casinos - they never pay back more money than they take in. It only seems like health care comes cheap to people who get their health insurance as part of compensation for their job.
If preventative care is a good idea, then a smart individual should go ahead and pay for it.
A 20K deductible means an individual is going to pay for all services like flu shots and such out of pocket. But if they bought a health insurance policy instead, on average, they would be paying much more for those services. An insurance money doesn't give anything for free, you pay through your premiums.
The point of the 20K deductble is that you can self-insure. You don't have to worry about huge medical bills, the government will rescue you.
There are no co-pays.
The maximum out of pocket is 20K for one year for a middle class family. Hopefully, their bills will be far below that.
Now, the sliding-scale deductible for a lower income family might be $5000. They will have to set-aside money for medical expenses every year.
A poor person might have a $100 annual deductible. Really just a nominal contribution.
Remember, there is no free lunch!