Recently Susan Blount, a Think Daily subscriber commented that we should get rid of health insurance all together. There is no competition and no discretion in health care, (the two elements we need for great service and low prices) we wait for approvals, and the cost of the insurance kills us, (who’s paying for those big office buildings filled with employees of the insurance company’s?).
The providers of health care don’t like it either.
In so many areas, we think that x is broken, and what we need is more x, or tighter regulation on x.
In health care, the Affordable Care Act (remember how things were going to get so much better and cheaper?) said that everyone should have health insurance – it required it. Obviously, that didn’t work at all. But what if we went in the completely opposite direction?
At Think Daily, I want to encourage you to think. But let’s not think in the conventional way, like we have been conditioned to think. Let’s REALLY think. Let’s question conventional wisdom when it needs to be questioned. Let’s look at paradoxes, and the madness of crowds, and social conditioning and all of it. No politics, no prejudices, no holding on to dogma for it’s own sake.
So, let’s carefully consider Susan’s idea. What happens if nobody had health insurance?
Here’s a starter list of what I think would happen –
People would pay by cash, check or credit card.
Providers would not have to wait to be paid.
Providers would not have to play the game of charging the insurance company more than they have to because they know they insurance company will tell them “no, we only pay $x for that”, or “x% of what you charge”.
People would shop around for the cheapest prices OR the provider of the best results like they do in any other industry.
Providers would become more efficient to reduce their prices.
Providers would not need a small army of paper pushers.
The cost of the entire insurance industry would be taken out of the system.
Employers would have far less red tape and expense.
Employers could pass this savings on to employees or lower their prices for their product or service which would reduce the cost of living for the consumers, who also happen to buy healthcare.
Consumers would use discretion – “do I need this” (all these prescriptions).
Some providers would get super-efficient (“drive-thru service”)
The government could still pay for people who can’t afford it as they do now, but their cost would likely be less as providers have learned how to lower cost or be more efficient.
Innovation would happen – in speed, service, etc.
It’s true that people would not be able to afford the “big stuff”, but what if we had insurance to only cover any health care expense in a year of over $20,000, since health care for a family is almost $20,000 a year anyway?
What else do you think would happen?
We need creative thinkers to solve big problems. That’s you, and me.
Let’s hear your comments with the orange button!
A health savings account that you can use or buildup as needed with only major medical for extreme situations. I heard of a medical firm in the west that charges a yearly family fee with very small cost for visits and services. When they discussed it with the radio host, they made a good living and the consumer/patient saved a bundle.
It would drive people to live healthier lifestyle and be more responsible for every day choices in diet and routine. Preventative healthcare will grow and it is the least expensive route to address health issues. I hear people say it all the time, if I invest in my health by buying better produce and exercising regularly why I am paying such a high cost of health insurance? Obviously, people who are born with health problems and children have to be covered 100%. I would just stay away from government funded healthcare for all idea as I lived through it in Ukraine and it is a prototype of DMV and Post Office in USA.
Without health insurance, there are no restrictions on who you chose as your Doc… Total freedom in the market. We have that now… but you pay out-of-pocket for the luxury. No one forces me to choose a particular doctor, but if I want insurance to pay of the visit, I have to use their doc.
We need this thoughtful approach to review a variety of our problems in this country. Strip away all of the narratives and truly look at the facts. Thanks Larry!
This is a great idea. I would also like to add a waiver that patients could sign to release the doctors of any malpractice lawsuits. I believe that alone could cut healthcare costs by a 1/3.
Let’s face it. Doctors, hospitals, and specialist don’t get paid what we see on our bills that insurance supposable paid. They negotiate with terms and rates with all health providers. They do this with meds all the time as well. That’s why if you pay cash for generic drugs. Many times it’s cheaper then what you would pay with insurance. This is also the reason we pay for office visits. So if we paid cash unless it was a large problem. Everything would be cheaper. Because then you setup real competition. Which lowers cost,
Most hospitals are not for profits. But they are buying up all the private practices. They are some of any towns largest land owners. And they are diversifying into therapy, sports injury, whole Hospitial dedicated to births. Women’s only hospitals. Cancer hospitals. Ears, nose, and throat.
And all those have building and the expense in keeping them running and clean.
Think about all that admin cost we pay, And they are protected by tax free status.
So you see Larry is correct. The insurance companies. And the hospitals have to much opportunities to make billions to see us pay cash for our small needs. If Cancer is one of our largest killers. Why couldn’t we have regular mri screenings. But no. We can only have it if there might be an issue.
Cancer is a huge money maker. The money isn’t in the cure. It’s in prolonging the sickness.
I could go on about this subject for a long time. But I will leave it here. More and more nurse practitioners are become our primary care givers. And more and more docs can’t afford the school to become a General Practitioner. So our Docs who have to refer us if there is a problem might have a 4 year degree. Instead of the 8 year and 2 internship like they used to. And can you blame them. Health care at its best.
One fee for a year and not per visit won’t work, its a HMO insurance when doctors agree to see certain amount of patients for a flat fee. Doctors gamble and hope patients won’t come, that is the only way they make money. If patients do show up doctors are on the minus after staff pay and supply used alone. I managed in medical field for over 10 years and dealt with insurances. From my experience the best customers/patients were the ones who paid cash. If we could do pre tax saving account that can be used on health care only and rolled into retirement after 65 when Medicare kicks in people will have a choice to keep their money and be responsible or not. Still, insurance for hospital stay, major procedures, emergencies have to be in place but as those occurrences are rare the cost of it would be manageable.
Interesting. I was playing golf with some doctors a while ago and they were telling me they don’t like the insurance system and dependency it’s created in patients. They also said that doctors were proponents of hmo’s and ppo’s initially because they saw the plans as a way to improve their collections and delinquencies. I like the high deductible plan idea with hsa option continuing. Also, I would initially think that all individuals have access to medicare fee schedule before relying on the market alone to bring efficiencies necessary for competitive pricing for services.
There has to be a better way.
Love it! I don’t like my employer being an intermediary between me and my doctor. 20 yrs ago I knew a businessman who said, “I will NOT offer a 401(k) retirement plan” for similar reasons. Made sense to me–let me choose my own car-house-education-healthcare-retirement. Much like I have collision insurance on my car, I could purchase a major-issue health coverage plan. Doug Dean’s estimate of 1/3 may be low on the impact of legal costs and malpractice insurance in healthcare.
I served in Insurance Business. Health and Life. I have preached this for years. She right on the button this. Insurance people are the lazy drag that makes there living on projecting fear. Get rid of all the none producers . Its no different then a rob peter to pay Paul. Shameful.
How about making a doctor an employee, on staff, and possibly cost share with another local business in your area for the doctor. This way employees can basically take out insurance for the big things and doctor visits are covered. All employees HSAs have an employer contribution piece and the rest is funded by employer. This money is then used for other necessary tests and prescriptions. We can get creative with our health care and get the care we need. Yes Larry you are correct, no matter how you cut it, health care costs are around $20k for a family if no one in the family is sick. And this amount is even more if you do not have a commercial health insurance plan. Some analysis can be done to bring down these costs.
Hi,
A challenge to finding truth is biased, unexamined bias. We all want to think we are right, and in the quest for truth mist be willing, more than just academically to reduce our egos demand that we be right. For example”obviously the Affordable Care Act didn’t work, it required everyone have it”. Neither of those false statements withstand logical analysis. People don’t want hot water and refrigeration, they want warm showers and cold beer. It’s about acknowledgement of the importance of every American, we need to begin w health, because an unhealthy society will struggle w every other facet of development. Universal access to health care, if deyoked from employment can be part of a liberation that unlocks the potential of tens of millions of Americans. There is one party that is truly working to provide Universal access to health care and one that is tearing it down and trying to stamp out hope to maintain the power dynamic and status quo. One that is dividing w fear and one that is leveraging hope. If you don’t make at least $10 M/ year, you may have the wool pulled over your eyes if you find yourself in the fear mongering camp. Data science and privacy make hyper personal ads “normal” our basic psycholocial triggers are known and played to in order to manipulate perception. A wide variety of sources of information is important. We should teach more about critical thinking, common sense, what really is happening in other developed countries how to actively listen and why inclision and not exclusion is the way towards greater security and prosperity. The medical insurance industry is one the largest global industries, they lobby every member of Congress heavily. There’s a significant amount of good hardworking people who make a living in this industry. Its the reason medical malpractice insurance is so expensive in US, and the cost of service goes up also. We have the highest health care cost in the world, by a large margin, and yes it’s good for acute situations but if you think it is an equal value for the service, learn more and perhaps talk w other people from other countries or travel. The US insurance industry is a malignant appendage that needs to be removed or reimagined for universal health care. There is not the political will to do that now. So one party is trying move toward expansion of health services and the other is not. Choose wisely.
Larry Janesky for President!!! 🙂
Yea but….but….How are the politicians going to get paid????
Larry, I love thinking outside of the box, however, today you’re grateful for your health. Today I’m grateful for a drug that allows me to be human. The downside is that the cost is over $50,000 per year. How many insurance companies would write a policy for me, unless they had to.
You’re right, for healthy People they don’t need health insurance, but that can change in an eye blink.
Great thinking. We don’t need a violent revolution, just an evolution.
Of course the insurance companies & lobbyists would fight it tooth & nail so the politicians would suck up. But…some Dr’s have given up on all the insurance company BS and stopped participating with insurance providers and only offer their services on a pay per service..
Have to put a limit on malpractice (lobbyists again).
What happens if a substantial health care system goes on a pay per service?
How does the pooling of resources like some of the religious based plans we hear about work and can parts of that model be applied?
Can we get around HIPA and the other red tape and allow employers to provide an independent plan where they are allowed to pool their normal contributions to insurance coverage and reimburse employees (or provide a private credit card) for medical expenses and also buy that high threshold coverage for the big stuff? That type of action could mirror an HSA where the employee can make contributions pre tax to their medical reserve fund and that money stays with them until used and can also be used as an investment tool (even a money market) after reaching a certain threshold.
I don’t know enough about the cafeteria benefit plans offered by some larger companies to comment on how that may work into the discussion.
Protections have to be built in to avoid unscrupulous employers and individuals. Eliminating the corporate protection and requiring personal liability for funds contributed is always an incentive. Taking that liability up the corporate ladder spreads out the pucker factor.
As you pointed out, unfortunately the Govt has to participate for those less fortunate but they or an insurance provider would also have to be the backup for COVID and other large scale disasters. If employers & employees were to cover a higher threshold and had a spread of something highly contagious that impacted the their staff it would warp the equation and wipe out businesses.
You would hope a pay as you go would provide incentives to maintain a healthier lifestyle.
Canada has already done this, accept the healthcare system is managed by the government (perhaps a worse idea?). We should look closely at their results. There is some downside as many Canadians have to wait long periods of time for a surgery.
I love this idea because it tackles the real problems.
1)a bunch of bureaucrats, often thousands of miles away involved in your personal health issues. They don’t know you or your situation and you are just a number. When you’re sick or have a health concern, you are vulnerable and often emotional. The insurance rat race will kill you before the illness.
2) Doctors are forced to play a silly game. Bad docs get the same compensation as really good ones. Where else does that happen except for elected government officials.
3) Absolutely no transparency. We sign millions of forms for an X-ray and still have no idea what’s going on or any idea what it will cost.
4) The frustration of losing a good, trusted long time Doc because he doesn’t jump through enough hoops for the plan your employer offers is gut wrenching.
5) The dread each year of renewal by the employer. The premiums always go up and no one is ever completely satisfied with the options.
6) It is confusing, on purpose in my opinion. Co pays, ER exclusions, individual limits, family limits, single coverage, family plans, meeting deductibles, out of pocket costs, blah, blah, blah!
7) The pill racket- Who decides the ole blood pressure norm of 120/80 is not low enough anymore? You guessed it, the pill pushers, the pharmaceutical industry, and most Docs comply. Disgusting.
8) Catastrophic insurance is the way to go.
Purchase a blood pressure cuff, weigh yourself, read about natural remedies that can help you, understand nutrition. Pay for something that will kick in when you get cancer or have a serious, I mean serious accident.
But the real problem is the American people. We want somebody to take care of us. We’re overweight and guzzle enough sugar to kill Goliath. Physical exercise for many of us is clicking a mouse or watching Game of Thrones and scooting to the edge of the couch in anticipation. We don’t save, we don’t plan, we don’t take responsibility for our own health which starts with eating right, exercising, proper sleep, good mental health habits, and questioning the system.
Being responsible for health insurance for many years in our company has made me a little cynical. But maybe it’s because I received a bill the other day for $10,000 dollars each for anesthesia for me and my husband for a 45 minute procedure. How many months and how many phone calls and hours of waiting on hold will that take to resolve. I’ve decided they can come and get me!
Larry,
From your Think Daily post today:
The support system that never goes away
When people are propped up financially, emotionally, or otherwise by someone else or something else, they become dependant. When that support goes away, they have problems getting along.
But the support system that never goes away from you is you. Learn how to process thoughts, be productive and valuable, and take care of yourself emotionally and physically.
Learn to take care of you, so you can help others learn the same.
I like the discussion and believe dismantling the healthcare requirement for the healthy people would work (catastrophic/pre-existing condition insurance for the sick remains) IF people would take care of themselves emotionally and physically. For this reason I’ve lost hope that dismantling the health insurance monopoly would ever succeed because I believe the majority of people are dependent on someone/something else. There is little personal responsibility today and by observation it’s easy to see that most would not and do not take care of themselves.
Great thought process Larry.
Here is a question I have on the subject. What if we used health insurance like we use auto or home insurance. We don’t use our auto insurance to pay for an oil change or tire rotation. We don’t use auto insurance to change the wiper blades on our car or take it to the car wash. We don’t use our homeowners insurance to paint the walls, vacuum the floor, mow the yard, or even check the HVAC system twice a year.
We need to be able to provide “insurance” to folks like Eric above who need to be able to claim a benefit. And yes, many healthy people will pay money for insurance each year that they don’t use. But you only need 1 house fire or 1 auto accident to understand what insurance should be there to do for you.
Free market would absolutely dictate prices for providers and competition would drive consumers to make better decisions. For small businesses and major corporations the amount of money saved in this process could fully fund higher wages, other benefits, and more growth opportunities.
This works really well. There’s a doctor in my town that doesn’t take insurance – cash only – and she provides great service for a fair price and does very well for herself. She has testified before Congress, and online conversations like this may move our society to this (saner) path. Here is the closest thing to a website for her: https://doctor.webmd.com/doctor/juliette-madrigal-dersch-c318e63d-361c-411a-8a64-ebd77564df51-appointments
Keep up the great work, Larry!
Statistics show that between 50% and 67% (depending on the bias of the study) of all bankruptcies are for medical reasons. Those people still had services provided. Who paid for it? You and me through inflated costs. Bankruptcy attorneys can cost $750 per hour… on both the debtor and all the creditors, plus all the court system costs…. unbelievable amounts of money that could be put to productive use in the economy. Many people live on the edge and cannot afford $20K . Most of us in this forum could easily swing this… most others… not so much. Having employers administer health care is inefficient. It’s not our core business. Think of how much more productive we could be without having to manage this. Think about at risk low paid employees… they get sick, cannot work, loose their job, cannot afford cobra, loose their insurance… now what? None of us would treat our employees so callously….. but not all employers are like us.
I had a health emergency last December while staying in Sedona. We had to call an ambulance and go to the ER. In cases like these there is no way to negotiate prices compare serviced ratings etc. Supply and demand don’t function in this environment.
I had a University philosophy professor who had a very similar opinion more than 40 years ago. I always remembered him and this idea throughout the years. It just seems that we keep selling more insurance and no one wants to give it up!
I’m liking this line of thinking!!it just makes too much sense for it to ever be realized through our political system.
The answer to our health insurance system has been around for a long time but just hasn’t gained enough in popularity yet. It’s called “health sharing” instead of health insurance. I just joined https://www.chministries.org/ personally and I love the way they work. There are several others out there as well but I liked this one the best of the ones I looked at. What I really love is that each month they send out a list of the people with expenses above what their service will pay (pre-existing conditions, excessive costs, etc.). We as members are told how much we can pay extra to meet 100% of all of the needs of these excessive cases. This past month that totaled $5.72/member. I sent in extra and feel good that I not only paid for myself but was able to pay for others as well and that it was all my choice how much to pay. This is a responsible health cost sharing system where everyone can work together towards a common good and save money in the process. I would encourage anyone fed up with health insurance to check out one of these systems.
Wow! I like this !
There are folks out there fighting the good fight. Check out: https://healthrosetta.org/
Also, in working with the Health Rosetta people, my company offers this alternative “Health Care” provider (as opposed to a “Health Insurance” provider): https://sedera.com/
Western medicine is based on a disease health care system, rather than a wellness health care system. Money is made when people become sick, not keeping them healthy.
* Health care prior to World War II was a pay as you could afford it. Many people died because they couldn’t afford to see a doctor or go to the hospital. It was during WW II that businesses started offering health care as an incentive to work for them. The way that health care is provided now is that in a large group (say company) the healthy people support the people who have grave health concerns.
* At some recent point, say last 10 years, there were laws put in place that stated that you could not declare bankruptcy for medical expenses like cancer or heart disease, etc. So pay by credit card would only put people in debtor’s prison, so to speak.
* Some time back, Oregon state took a look at the health of their people, organized a group of doctors, hospitals, citizens to make a list of health issues from wellness visits to brains transplant. Of their list of 400 categories, Oregon figured that they could cover the first 300 categories for every man, woman, and child within the state with the money they received from Medicare and Medicaid. The federal government nixed this idea.
* Within the last 15 years, the federal government decided that doctors were charging too much money. In response, the federal government required doctors to fill out extensive paper work. This resulted in doctors having to spend less time with patients, hire additional staff to handle the paper work and the cost to the patient went up.
* Health insurance companies are already trying to be super efficient. Ordering doctors to only spend 15 minutes with each patient. That is not the way to provide health care. Ask what are you trying to achieve. Only cheaper health care or good health care for everyone?
* As you look at new ways to provide health care to rural and urban places, try to think of the unintended consequences of your actions. Getting rid of health care insurance may not be the best idea. The lowest care may do more harm than good.