By Jane M. Orient, M.D.

Republicans say they are going to “replace” ObamaCare, but they will come up with something very similar and at least as bad if they start with the same misguided objective: “universal coverage.”

There are necessities of life, but insurance is not one of them.

Just what good is that little card in your wallet? Once it has expired, it is good for absolutely nothing, even if you have paid $100,000 or more for it over a period of years.

It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others. It by no means guarantees that the facility will provide you with the care you need or want—or even that you won’t get an outrageous bill, especially before you meet the deductible. It will guarantee that you will be paying for a lot of things you don’t need or want. Some will be other people’s medical care, or anti-tobacco lectures, or alcohol rehab (even if you are a teetotaler). You’ll pay for some things just because they are “quality” metrics—hospice evaluation is a newly proposed one. And you will definitely pay for administrators, managers, monitors, clerks, claims processors and re-processors, etc., all of whom get their paycheck or their pension even if your doctor doesn’t.

Many people choose to be uninsured, even if they are a good risk and can afford insurance, and more end up uninsured because they are a bad risk or can’t afford it, or simply choose to use their money for something else. In 1940, less than 10% of the population had health insurance.

You could go your whole life, and never miss that insurance card.

Most people, of course, do need medical care at some point. If they are uninsured, they can go to the doctor and whip out their checkbook, just like your mother or grandmother did, and just like you probably do at the veterinarian’s, the dentist’s, the massage therapist’s, or the mechanic’s.

The best reason for having insurance of course is the unexpected accident or catastrophic illness. Oh how I miss my AAA catastrophic policy that I had for years. It cost about $250/year and had a $25,000 deductible but promised to pay about $1,000,000 above that. They changed the rules and started requiring a “basic” (or “comprehensive” policy), which would cost about $10,000. So I said no thanks, and increased my automobile policy to the maximum medical coverage.

There’s still the risk of an expensive medical illness. What then?

I have actually bought quite a lot of medical care and paid out of pocket, although I have never filed a medical insurance claim. For one reason or another, insurance probably wouldn’t have paid anyway. And if you ask, the cash price is often quite reasonable, and the service prompt and courteous.

But what about something really expensive, like surgery or cancer therapy? Options include medical “tourism” abroad or in the U.S. Look for a price online, for example on MediBid.com or Surgery Center of Oklahoma (surgerycenterok.com), or ask in advance at facilities of your choice.

One option is to do without. Sound terrible? Well, it would be the patient’s choice, not President Obama’s deciding the patient would be better off with the “pain pill.” Nor would it be the insurer’s decision that the care was “unnecessary,” “inappropriate,” “not prudent,” or “experimental.” And of course if you decided to do without, you’d still have your money, not having paid it to the insurer in advance in exchange for a worthless promise.

There’s the risk of a bona fide emergency, with no time to think about the cost. Fortunately, these days you’ll still get the care in the U.S. If you have assets, you might have to sell them to settle your hospital bill. But consider this: would you rather buy a nice car and risk having to sell it to pay a bill, or pay the insurance company the same amount and never get to drive the car? If you have to borrow money to pay a bill, the interest is likely less than the amount it costs to funnel the money through a third party. And charity or cost-sharing ministries help a lot.

If most bills were paid directly instead of through a third party, medical care would cost far less. Wouldn’t that be better for everybody?

Everybody—except those who profit from gaming the system.

Cancer patients’ stories are featured. But they would probably be worse off with universal third-party payment.

Too much “insurance” (third-party payment) is the problem—not the solution.

The right to be uninsured is a necessary safeguard—not a threat to the system.


https://www.heartland.org/news-opinion/news/the-case-for-being-uninsured

No question, health insurance is a real racket.....

yet so are health care costs...

wanna drop insurance rates...

start limiting how much doctors can be sued for... for some of the stupid stuff people take them to court over...

OTOH, you're always 1 sarcoma away from lifetime financial disaster. My 1st wife had cancer and that little card paid over $100k before she died. Without it, I would have been left with bills I could never hope to pay.
Can you be sure that you will always get home from work without tangling with a truck?

per the article

"It might be a ticket to get you into certain medical facilities, but in these days of narrow networks, it will keep you out of others. It by no means guarantees that the facility will provide you with the care you need or want"


remember, gov't health care is rationed health care

When you are forced to have something, there is no way to regulate what they charge you. Its a blank check.....sold to the system.

Same with making something "free". If college is made "free" you will need a 4 year degree to flip burgers.

Until health care is made to be less expensive, it wont matter who pays for it.

That's what catestrophic policies were for, and they used to cost a few hundred per year.

It was good the way it was

THAT.


My parents had one of those way, way back.. Then, one day, the insurance company just up and cancelled the policy w/o a word of explanation.. Dad was pizzed.. So he decided to self-insure.. Nobody out-worked my father, and he did quite well over his lifetime..

Yes, it was. Free to pay more for better, less for crappier, or none for nothing. Sad to see poor freeloaders in this country who can buy booze and cigarettes, but not afford any insurance. But stupid has to hurt sometimes.

That was a very logical article that spells out exactly where we are today with "health insurance." Back in the day, (my grand parents and parents) used to die early in life if they had a medical emergency (heart attack, stroke, cancer, etc.) That's just the way it was and society accepted it. I had a heart attack at age 59 and would have died had I not had immediate care. When I saw the medical bill that my military health care paid, it was over $50,000. Since then I have had two other heart issues totaling about $25,000 which my insurance paid. The question we need to ask is how much are we willing to personally pay for life saving health care? This article really makes perfect sense to me. I was in a position to pay those bills if I had to. Many are not.

What I don't understand is how the government MANDATES this "service", but ignores others.

If you want a car with a leather interior, or heated seats, you pay extra. Want a fine restaurant? It's available IF you pay more. First class flight? Sure, just pay more.

Yet everyone, including the urban rats that we promote to breed are ALL supposed to get the same care in the event of a health problem. But of course thugs NEVER take a slug to the chest or fly through a windshield, or suffer due to a drug reaction that they took for recreation, or beat their women to a pulp.

I think the OP is right. Pay for what you get, and all the derelicts offered one band aid and an aspirin and directed back to the streets. Insurance rates would tumble when one were paying for their own care, not the horde of those with their paws out.

"Universal Care" is a vicious spiral of rising costs. When everything from cancer to a hangnail is covered by insurance, hospitals can charge the insurance company anything they want for the care. And the insurance company in turn can charge everybody whatever they want to pay for the inflated care costs, plus their own costs, plus a profit.

That how an aspirin ends up costing $25 in the hospital, and you pay $1000 a month to get it "free."

We constantly equate "medical insurance" with "medical care" and the two are NOT the same.

Lets not forget the not so stupid stuff doctors get sued for because they and/or their staff can screw up horribly.

Been mentioned before but Johns Hopkins Hospital came out with a study earlier this year that corroborates past studies, showing the American medical system directly and indirectly cause the death of over 200,000 Americans every year.

Limiting those law suits most likely would only exacerbate the issue. If hospitals and med centers would start policing their own and kick out the bad apples, fewer people would be dying and suffering from the bad practices and the law suits would drop off. Then get rid of the middle man as mentioned in the article and you have a healthier as well less costly healthcare system all around.

I'd jump all over that $25,000 deductible policy the author used to have. Best of both worlds: you pay out of pocket for most of your medical care and receive the cash discounts that come with that; but you have insurance against financial ruin in the event of a catastrophic accident or illness.

To many, a $5-7K deductible is virtually the same as 'catastrophic' care. And many can barely afford premiums at that level.
From my view as a small business owner[and manager of a group policy] it seems that increased deductibles and higher out-of-pocket expenses at a higher premium is all that we[our group] have gained from Ocare.

Great post.

Yep. If we went back to free market medicine, all costs would go down to where anyone with a job would be able to afford catastrophic insurance. Combine that system with tax free medical savings accounts and competition across state lines and the problem is solved.

I think Trump and the republican congress is high on Health Savings accounts. Everyone pays for the routine smaller ticket items . . . insurance pays for the catastrophic illnesses. It still won't help the sick, lame, and lazy indigents laying sideways in the public trough, but it is a good start at replacing obongo-care.

Here is an idea that I think would help.
Dial back HIPAA just a little bit.
Everyone still needs to have their health information kept private, but we have gone way overboard with this. I've seen the facility I work in pass on ridiculous HIPAA compliance costs to payers.
Instead of the encryption, and multi-layer authentication to treat health data as though it is Top Secret, treat it as Confidential instead. It would still be private without nearly the cost.

This should be the first thing addressed after they repeal Obama care.

With premiums what they are today, you could pay off that medical bill in under 10 years instead of paying the premium.

I would have no problem paying a reasonable premium for catastrophic coverage, and pay out of pocket for dr's visits, prescriptions etc.

The problem is two fold. People who go to the dr. for every sniffle, and people who are on expensive medications for a variety of things that are based on their own bad decisions.

Boner medicines, birth control pills, fat pills (cholesterol, high blood pressure, etc., et al) and so on should be 100% covered by those who choose the medicine.

But there is a whole lot of personal responsibility that would be required to drop medical costs, and I don't see that happening with most people in our society.

One of the things the Doctor who wrote what the OP posted says "Most people, of course, do need medical care at some point. If they are uninsured, they can go to the doctor and whip out their checkbook, just like your mother or grandmother did, and just like you probably do at the veterinarian’s, the dentist’s, the massage therapist’s, or the mechanic’s". Really? The biggest Vet bill I ever had was $2500.00. Dentist? $5,000.00 Therapists I don't use. Mechanics? Maybe $4500 for an engine. On the other hand I had a heart attack that cost $60,000.00 My wife had cancer treatments that cost over $100,000.00. My mother and grandmother never had to write a check for as much as 10% of those amounts and they couldn't have if they wanted to. Her point is taken but needs a dose of reality. Most people cannot deal with a major medical disaster cost. It would wipe them out.

In the area of the country that I live, at the present time, there are very few independent doctors in private practice. Most are contracted with large health care provider groups that own the hospitals, diagnostics, treatment, and special facilities. They buy up most of the surgical centers and specialist groups. There is no market competition whatsoever. I am not too sure those folks are going to reduce their rates even if we take the government out of the rules and regulations column.

I had the catastrophic insurance plan for years. I paid between $5000 and $10,000 a year of costs and it would pay the rest. It was nice and it was cheap. It is gone now and it's resurrection isn't very likely in my opinion.

The reason for the huge charges is because they bill the insurance company, which pays it because they charge so much to the insured in premiums that they can afford to. Change all that around, and all prices would dramatically go down. That's the nature of a free market.

As for catastrophic coming back, the only thing preventing it is government regulation essentially outlawing it. Remove that, and demand for it will bring it right back at a competitive price.

Yep.

I think that part of the reason the charges are high is because there are so many people who have no insurance that they don't get paid and pass the cost on to us who do pay. It is cheaper for these people to pay the penalty than to buy insurance.

An example: I was charged $750 for a nurse anesthetist by a surgery center. The insurance company paid them $180.00 which the provider accepted. I might have been able to negotiate a cheaper amount on my own but probably would not have gotten down to $180.00. I can go through bill after bill where the insurance company paid from 15% to 75% of the providers charge. While I am sure your example is right in some cases, companies like BCBS don't pay what is billed. They pay what they think the UCR is and they are the ones who set the UCR.

The reason I don't see catastrophic coming back at reasonable rates is because there are fewer people who can afford the deductibles today than there were eight years ago. (At least that is what I read)

I think we can all agree, that a free market healtcare, is the cheapest and most efficient one.

However, when looking at US healthcare compared to the rest of the industrialised world, the US pays almost 2x more then any other country on healthcare.. and recive worse treatment. ( very specialized healthcare, for a few rare diseases are better in the US ).

20-30.000 used to die in the US, each year because of lack of healtcare.


Follow the money.. who makes money on the system beeing partly privatized / socialised. The insurance and drug companies!

They want to keep everything as complicated as possible.

If you want the US to be the special snowflake in the world that keeps wanting to privatize the healthcare system, expect to pay a premium. The incentives for the insurance and drug companies is to gouge the american people.. and they keep paying politicians to do so!

Idunno....my insurance cost for me is about 2400 a year (group policy). My catastrophic hand injury early this year would have been over 50k out of my pocket without it. (Recovering fairly well, BTW) That's just one event, and paying it off at the rate of 2400 a year would have taken over 20 years (not even taking interest into account). I'm against forced coverage or universal coverage, and medical costs should be closely managed - but I don't think it's a bad idea to be insured.

"Snowflake" must be your new favorite word. How cute...

Now, as to the bits in bold, how about some proof?