I'm not enthused about that scenario. What I want for my low level health care is for it to be priced and sold like McDonald's sells food: prices up front, fee for service, multiple providers competing for my dollar. That doesn't work for every kind of health care but it does work for a lot.

There's nothing stopping them, or any other company, from offering this. Presumably no one has, because the financial risks aren't worth it.

You have to imagine: the demand for a free good is essentially infinite. If medical treatment were free, some (many) people would abuse it. That's the fundamental flaw in any sort of government run scheme as well (aside from the inevitable bureaucracy).

If you want inexpensive medical care, *de*regulate. Let people make their own decisions, with their own money. Get the government out of the way and let the free market work.

Bradley -

That's precisely the problem NOW. People truly think that a doctor visit is twenty bucks, so they go like it's twenty bucks.

If they had to pay the full 65 or 90 or 150 or whatever (even if it was reimbursed by the insurance company) they'd only go if they had a real problem, and not for every little sniffle and sneeze.

I like the idea of percentage of purchases going to fund WalCare. Most of what people go to the doctor for (cold/flu/fever/prescription refill) could be done by a nurse or a nurse practitioner. Some WalMarts offer a clinic at their larger stores and they already have pharmacies, so the bare bones of the infrastructure are there. Combine the clinic with a catastrophic/emergency care policy and it could work.

If they had to pay the full 65 or 90 or 150 or whatever (even if it was reimbursed by the insurance company) they'd only go if they had a real problem, and not for every little sniffle and sneeze.

That was the unintended consequence of the "health maintenance" crowd. The idea was to provide cheap primary care in order to encourage people to go to the doctor and enable the doctor to catch the serious problems before they were serious (and expensive).

But it turns out the actual odds of someone having a serious issue are low. And doctors are expensive. So the insurance companies ended up eating the cost of every visit to the doctor for sniffles and sneezes, every preventative test done to avoid a lawsuit, and the expensive chemo and radiation treatments on the seriously ill.

Brian, the problem as I see it is: sure the doctor's visit is cheap *and* the insurance costs are hidden or not in control of the individual.

As an example: I should be able to choose whether I want insurance that makes doctors' visits cheap - but the insurance is expensive. Or perhaps insurance that only covers catastrophic expenses (making the insurance cheap) - and I pay all the little stuff entirely by myself.

If people could make these decisions for themselves, the market would work a lot better. I expect a lot of people would opt for inexpensive insurance - meaning they pay for normal doctors visits and prescriptions.

When individuals pay for these things themselves, you will get real competition - and a huge reduction in paperwork, since individuals won't demand the kind of ridiculous reporting that many insurance companies do.

and a huge reduction in paperwork, since individuals won't demand the kind of ridiculous reporting that many insurance companies do.

Unfortunately with very high deductable/catastrophic insurance the paperwork still has to be done so the insurance company knows you have spent the money. I have even ran into that on my regular insurance. They had no record of a visit and so the cost was not counted against my deductable.

I'm going to weigh in on this because I was recently (as in up until about 18 months ago) without health insurance. I worked for someone who would pay half of my premium for whatever health insurance I wanted to purchase. For me, it was silly to purchase health insurance because the number of times I actually go to a doctor would never pay off. I found a local clinic where normal visits are $39 bucks and complex visits are $99. Unfortunately, two years ago I was in a car accident. However, I still didn't have health insurance. My real awakening came when the doctor ordered MRIs of my neck and back, both with and without contrast. I negotiated a fair price for the complete series ($1350) and had them done. Less than a week after having the MRIs, I received a bill, for almost $8k and that was after they applied the $1350 I paid. Of course the bill said if I had health insurance, please call immediately and provide that information so they could bill the balance to my health insurance. It really irked me that the insurance price was so much more than the cash price. I'm not naive, I get why providers bill the insurance companies so much. But I think it would be far more equitable for providers and insurance companies if the provider billed a reasonable amount for the service and added an administrative fee for processing the paperwork for the patient.

I eventually had to get a job with a group insurance plan because my injuries required surgery. The first 5 days in the hospital and the costs for the OR, etc., were $129k - my HMO reimbursed under $40k. That's why health care, IMO, is so fucked up and out of control.

This idea dates back to 1952 or so. You're proposing a "spherical trust".

http://en.wikipedia.org/wiki/The_Space_Merchants

I wonder about the accounting associated with this. I suspect that it would have to be regarded as a barter system, and each person would have to treat each part of the transaction and a separate transaction. Meaning that your purchases would be considered separately from the insurance you are provided, and that insurance would end up counting as income. However, Walmart would have to count the income from the trade as well. I don't know how beneficial it would be to all parties.

-Julie

I eventually had to get a job with a group insurance plan because my injuries required surgery. The first 5 days in the hospital and the costs for the OR, etc., were $129k - my HMO reimbursed under $40k. That's why health care, IMO, is so fucked up and out of control.

Another reason it's out of control is that insurance companies are required to accept people with pre-existing conditions like yours. Insurance is supposed to be about protecting yourself against the costs of potential illness. It's not insurance if you can choose to join once you've already become sick.

kishke, you're absolutely right. Fortunately, I was able to change positions to obtain group health insurance. It was either that, or end up not being able to walk for the rest of my life. I had to pick the lessor of two evils.

The point of my post is that IF health insurance worked differently, then people like myself wouldn't be put in the position to make the choice that I ultimately made.

Also, I would like to point out that since my injuries were caused by another party and because I recovered under that person's auto policy - thankfully it was a commercial general policy - I have had to pay some of the costs that my health insurance paid towards my medical care.

The point of my post is that IF health insurance worked differently, then people like myself wouldn't be put in the position to make the choice that I ultimately made.

You weren't put into that position. You put yourself into that position by making a conscious decision to do without insurance. You gamed the system. You knew you'd never really get stuck, b/c you could always join up if you got sick, which is exactly what happened. The forty grand the insurance company paid for your surgery came from the increased premiums wrung from the sweat of people who did the right thing and sacrificed to buy insurance.

Heh, and there you have it. Sara was "put into that position" by making a choice which turned out to be wrong. So we should have the govt take our choices away, and save us from our own stupidity. Or Sara's anyway.