I was listening to an interview with a doctor who is part of concierge medical practice. They charge less than $125 a month, with no co-pays, regular office visits, a 24 call in number that hooks them up with one of the doctors, they have deals with the local hospitals for low cost services (including surgery), and even run a pharmacy that has even name brand medicines at about $0.05 per pill. He gave an example of Imitrex migraine pills at $0.03 per pill.

He was saying that if you were to take the other $200 and put it in a medical savings account every month you could have thousands of dollars very quickly and still be better off than under any [un]ACA plan.

I'm not so sure about this professor of finance.

I've said here many times I do want to see health care disconnected from employment for many reasons, if not just because it will be better for the individual as well as better for business.

But I think many of his examples are spurious and show he may be disconnected himself.

I am not a Walmart hater. I shop at Walmart all the time, and use their pharmacy.

But even when I was in business school, we recognized that the Walmart model ruined a lot of profitable, high quality businesses in favor of low quality high volume businesses.

And that was true for pickles http://www.fastcompany.com/47593/wal-mart-you-dont-know and lawnmowers http://www.fastcompany.com/54763/man-who-said-no-wal-mart

and in my own personal experience, shirts that didn't last through a single washing, or recently very inexpensive avocados that just never ripen.

So while I admire Walmart for a variety of things, I am not sure I want a Walmart of health care.

I'm also not sure I want Apple "innovation" involved either, because I was never sure moving from a 3 button mouse to a one button mouse was innovative, or that iTunes worked all that well, or that I could buy an iPhone just so long as it was AT&T the worse carrier of them all, or that my 5" Android Phone is less good than 4" iPhone, or that a mini tablet like a Nexus 7 could not have value until invented by Apple, and now it turns out there are tons of Apple employees in the States that are not so thrilled with their working conditions, not to mention the Foxconn suicides....

I am strongly in favor of Southwest and Costco who manage to make very nice profits, and seem to be loved by customers and employees and stockholders.

Also Amy, I believe your HMO is much closer to the group insurance model which you seem to dislike (people of all ages and health grouped together as in the Obamacare exchanges) than it is to the individual model where you don't have to pay for the crap I bring to the table and vice versa.

Businesses cannot establish or contribute to portable individual policies, or employees would have to pay taxes. So businesses only offer group plans.

In my experience working for large companies, group plans have always offered much better coverage with lower deductibles and at much reduced rates even when I was young and out of college and in great health. It may be the case that businesses cannot contribute to individual policies, but I am not sure that many people in group plans would prefer to negotiate coverage, deductibles, and rates on their own, and believe they may appreciate their employer's group plan that enables discount volume pricing and the much greater leverage in negotiating prices down.

And I suspect that's one huge way your HMO delivers quality care for you at reduced rates.

I think there are many ways to reduce rates including transparency of prices before care and sending itemized bills to patients regardless of who pays them and perhaps including chucking out the insurance companies entirely who have done little for me but prevent care or delay care that I have already paid for.

I'm not sure this finance professor's suggestions are the way to go.

How many times do I have to post the damn solution to this?

My example does all of the things cited. If you focus on PAYING FOR A SERVICE RENDERED, you avoid losing hundreds of millions of dollars in overhead costs and insurance company shell games -games that will go on regardless of the amount of government involvement.

Will someone please explain to me just why you should pay for something you do not get, in a system where someone else always decides what care you get, and therefore how much of your own money you get back?

jerry: "...we recognized that the Walmart model ruined a lot of profitable, high quality businesses in favor of low quality high volume businesses."

Is that because the customers of the profitable, high quality (and probably higher priced) businesses preferred Walmart when they had the choice?

"I shop at Walmart all the time, and use their pharmacy."

Why, when there are other profitable, high quality pharmacies available?

A retailer selling products to a large group of customers can negotiate better prices with its suppliers than a business with a smaller group of customers.

An insurance company selling health care services to a large group of people can negotiate better prices from its suppliers than someone negotiating for a small group or individual (How much would I have to pay for Imitrex or an MRI through Blue Shield compared to Kaiser?)

Seems like more freedom and competition among insurance companies and health care services would be a good thing. As long as people aren't forced to buy their products the competition would lead to better prices and products (better meaning preferred by customers over what the competition is offering).

Would it be better to have the government protect existing profitable, high quality businesses by preventing competitors like Walmart and Costco from offering products and services the existing businesses' customers might prefer?

As far as the Walmart model versus others, within 12 miles from where I live there are multiple Walmarts, Costcos, Home Depots, Macy's, Nordstrom, Sears, Loews Hardware, JC Penney, Safeway, QFC, Albertsons, Amazon, Best Buy, Ross, Starbucks, Target, McDonalds, Outback Steakhouse, Red Robin, and more others than I can think of, along side of literally thousands of independent, profitable, high quality shops and boutiques, specialty stores, home businesses, pot shops, contractors big and small, and whatever you can imagine... with prices and quality ranging from cheap, cheap, cheap to the best money can buy... all implementing their own business models. Some have great success and some not so much, depending on whether free people who are not forced to buy their products will choose to do so.

I don't see why less regulation of the massively regulated health care and insurance industry wouldn't result in a similar variety of choices in quality, services and prices to what we have in retail, food service, electronic devices, contractor services, cars, hotels, entertainment and whatever else money can buy.

Still there.

Has anyone else noticed how ludicrous this is:
"You have the right to continue with no unexpected increase in premiums if you get sick."

Newsflash: if you're chronically ill, you should expect costs to go up. Life is not fair, and it is not going to be regardless of who you voted for.

"Why, when there are other profitable, high quality pharmacies available?"

Because they have a $4 per month plan for many generic drugs which are regulated and thus I can be sure of the quality to treat me unlike their clearly horrible avocados and clothes all of which are unregulated, cheap shit, and rely on the invisible hand in the long run to reign Walmart in.

And because there aren't other high quality pharmacies around where I live. There is Walmart and Walgreens. And Walgreens is the worst pharmacy on the planet.

HTH

And because there aren't other high quality pharmacies around where I live. There is Walmart and Walgreens. And Walgreens is the worst pharmacy on the planet. -- jerry at December 26, 2013 4:25 PM

Have you ever told Walgreens they suck? And why?

As it stands Wal-Mart effectively has a monopoly, as you noted above. And why is that?

The U.S. is never going to go back to the small single owner or small chain <provider> from stores, groceries, restaurants or pharmacies. The downtown storefront is effectively dead.

But if I have a choice to shop for food at Wal-Mart or a Kroger store, I will pick the Kroger about 99% of the time. The reason is that the choices and the quality seem better.

But even when I was in business school, we recognized that the Walmart model ruined a lot of profitable, high quality businesses in favor of low quality high volume businesses.

But even if insurance was done in a true free-market that had the insurance company able to dump you, sell a limited product, sell across state lines and many similar items we would still be better off. Right now you are saying the restrictions are better as done by the government.

Just look at the advertisements for auto insurance. You have Progressive that is "just right", you have Safe Auto with the "minimum legal coverage", Allstate with "accident forgiveness", and those are just off the top of my head. (Geico with the lizard but I can't remember the approach.)

There would be the Wal-Mart insurance that would only cover the major stuff. Then the Macy's insurance which would cover you from cradle to grave at more cost.

The government (state and fed) is as much an 1200 pound gorilla as Wal-mart. But restricting solutions by a government fiat is a failure.

A local small city that objected to the creation of a super Wal-mart inside the city limits. A regular Wal-Mart was already in town. Wal-mart said fine and just negotiated with the township that contained the city and literally built the super Wal-Mart on the other side of the road outside the city limits. It was a 1.5 mile difference from the old location. Take a guess where the taxes go now?

The government forces you to do what it wants. Walmart has to persuade you, unless it partners (colludes) with the government

In fixing the Obamacare mess (and healthcare delivery and health insurance in general), don't forget to extend the length of the patent on prescription drugs.

Right now, if a drug company invents a new drug they only have a limited time in which to make the entire research investment back before the companies making generics take over. So, they price the drug high to recoup the investment. Extend that patent time and they can reduce the price and recover their investment over a longer period of time.

High prescription drug costs were cited as one of the justifications for Obamacare.

The U.S. is never going to go back to the small single owner or small chain from stores, groceries, restaurants or pharmacies. The downtown storefront is effectively dead.

People go where they have choices that meet their needs.

Bob's hardware shop in the downtown strip was a great place ... when there was nothing else. However, if Bob didn't want to carry an item (e.g., rat poison) and you had an urgent need for that item, you were in trouble. Now, thanks to a proliferation of stores selling hardware (Home Depot, Lowe's, Ace, Orchard, Tru Value, Sears, Amazon, etc.), you're not limited by Bob's moral choices.

Read The Great A&P for an excellent insight into the demise of family-operated grocery stores. Thumbs on the scale, adulterated bulk items (e.g., sawdust in the flour), lack of selection, frequent out-of-stocks, and other issues with family-operated stores led to the rise of branded and pre-packaged food items and, eventually, to national grocery chains with wide selections of items that were regularly in stock. People voted with their feet and wallets for A&P over the Ike Godseys of the world - and the Godseys brought most of that down on themselves.

In fixing the Obamacare mess (and healthcare delivery and health insurance in general), don't forget to extend the length of the patent on prescription drugs. -- Conan the Grammarian at December 27, 2013 9:46 AM

Or change the patent date to the final approval date by the FDA. And at the same time cleanup the FDA approval process so it isn't a five year to get to the market.