Yeah? Done!

I'm gonna let you in on a little secret. All that 'bargaining power of numbers' isn't getting you much. You are getting a discount from a number no one actually pays. It's all false advertising. People who do as Rad keep insisting and actually pay their own bills at time of service actually pay less.

You need insurance for catastrophe. It is what people traditionally use insurance for. There are good reasons for the government to cover emergency. It is hard to shop around when you are having a heart attack. The other 90% of health care spending shouldn't be insurance related.

1. No reason but history for this linkage, which does not exist in most other countries.
2. My initial reaction to the "pay as you go" option: too many freeloaders and people who don't plan ahead. In the modern world of media exposure and easy litigation, no medical provider is going to turn people away. If the norm is to present your HMO card rather than take out your checkbook (except for the copay), there is more social pressure to get coverage.

Here in Israel you present your HMO card and the copay is added to the HMO's monthly credit card charge. It is cumbersome to pay up-front if you are not a member of an HMO. So you have the salutary effect of the copay with a social norm of paying into an HMO.

"no medical provider is going to turn people away." ~Ben David

Bullshit. I've seen people get turned away. Specifically because they had the wrong insurance. I've even been turned away. Though in that case it was due to an incompetent secretary and almost lead to me suing the doctor. (Accepting payment and then refusing to provide service or trying to change the price after you've been paid is a valid reason to sue.)

If you are talking about an emergency situation that is one thing. But the very vast majority of medical spending in the US is non-emergency. As in 98% of it.

I am surprised to learn that Kaiser Permanente is the largest employer in LA. Sadly, I think they would oppose a shift to the credit model of healthcare I propose, because it requires fewer administrators.

I would like to see truly catastrophic coverage so that it is reasonable. I looked for insurance with a $50,000 deductible because I could pay for less than that and was told that it was illegal. I went for a $5,000 deductible per person per illness because that was what I could afford 20 years ago. Even that was $760 per month.

Even that was deemed unreliable by the hospital. They can’t guarantee that they will get your money. It’s not like they are running a credit check.

I went to the hospital with nebulous symptoms and quickly sent home with no tests or minimal tests. As soon as I had insurance, they rolled out the red carpet and insisted on test after test.

It is amazing how things vary. Before Obamacare made it illegal I had a catastrophic plan with a $3k deductible and covered up to $2M. Cost $125/mo. Now such things are illegal.

A few month back I took my youngest to the doc'n'a'box. He was in pain holding his side. We feared appendicitis. They ran their tests which were inconclusive and sent us to the ER. They ran their tests which were inconclusive and stuck us with a $4k bill. Which of course dribbled in over many many individual bills. Now we've figured out he had bad gas. It was one hell of an expensive fart. My oldest had an issue where his knee swool up and he couldn't walk. We took him to the doc'box and they confirmed it would probably go away in a day or two. Then they tried to trick us into going into the ER and sticking us with another huge bill. I got pissed with that doctor. I already knew what he had and was just being extra careful. There was no need to go to the ER. It was completely irresponsible.

Who knows why Jen's experiences and mine are completely different.

As soon as I had insurance, they rolled out the red carpet and insisted on test after test.

That's defensive medicine. They want to make sure, that after you've gotten much worse or simply died, that they'd better insulated against the coming wrongful death/injury lawsuit.

Insurance isn’t a “health benefit”. It is a means of paying for medical services which is sometimes counter productive to actually getting the services you need.

Especially when it covers things that would be cheaper out of the pocket or over the counter,

It destroys market competition.

Dental insurance is an even bigger scam. You are almost always better off shopping around and paying out of pocket.

Its's well past time shift to a portable insurance model. However, that would require we shift to actual insurance plans and not health care plans.

The cost of our current health care model is high - employers actually pay a huge part of it. Without an employer contribution, the monthly premiums for a family of four would be in the thousands.

The HMO concept was supposed to reduce costs by catching serious illnesses at the start. However, with cheap co-pays and ready access to doctors, patients began going to the doctor for every sniffle, thus driving up costs. Unintended consequences.

Conan:
The HMO concept was supposed to reduce costs by catching serious illnesses at the start. However, with cheap co-pays and ready access to doctors, patients began going to the doctor for every sniffle, thus driving up costs. Unintended consequences.
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Not sure if the details are the same but the "HMO concept" with minimal copays saved Israelis from a crappy socialized medical system. Why not adopt a subscription concept for an important service, which society wants to be reliably available?

Here in Israel the compromise was for the government to subsidize a basic basket of services (still provided through your HMO) while opening the market to additional, innovative medical services.

It's my impression that emergency rooms in the States are full of people with no coverage at all. Or am I mistaken?

That is the impression that the news media try to portray Ben David. It isn't that accurate.

It's my impression that emergency rooms in the States are full of people with no coverage at all. Or am I mistaken? ~ Ben David at December 3, 2019 12:38 PM

It isn't that accurate. ~ Ben at December 3, 2019 12:58 PM

It ain't that inaccurate, however. I remember going to the emergency room nearest my house on a Saturday and being told I was better off going the one across town because I had coverage. This one had a 2-3 hour wait because it was the county ER, where the uninsured got care; often for things for which an insured person made an appointment at a clinic. I went across town to the one associated with my insurance and got in right away.

Ben, our experiences were different because doctors were going with the odds. Appendicitis is common among people between 6 and 40. When they can see a swollen knee and the patient can’t walk, odds of a problem are similarly high.

On the other hand, a stroke at 35 in rare, especially in white women at a healthy weight. The symptoms can be caused by drug use, an atypical migraine, or even a panic attack. Of course, if insurance will cover testing, what do they have to lose?

That is why I put it that way Conan. The situation is very lumpy. Most ERs aren't packed with people without insurance. There are some that specialize in it. They tend to get packed. If you want to cherry pick your data or get a good photo op you can certainly do so. But uninsured people running up huge bills in ERs isn't a significant part of medical spending in the US. It is under 2% of it. (probably under 1%)

The impression given by the media is flatly false. Are there sob stories and terrible events, yes. But the exceptions don't disprove the average.

I know people who had insurance through a non-profit association of artists but obamacare made that illegal. Bring that back.