Exclusive: Jane M. Orient, M.D., asks, 'Just what good is that
little card in your wallet?' By
Jane Orient MD, 12/2/16
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 percent 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 office, 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 a 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, that is, 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.
Comments
I totally
agree with this article. If we don’t go to a Patient-Pays system, costs will
just continue to rise. The only
deterrent to high medical costs is a consumer who refuses to pay a high
price. Prices are currently well beyond
the Price/Demand curve. We need a free market system that makes prices go down
when demand goes down.
Norb
Leahy, Dunwoody GA Tea Party Leader
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