Sunday - Aug 20, 2017

The case for being medically uninsured


obamacare_column

by Jane M. Orient, M.D.

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, 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/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—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.

(Jane M. Orient, M.D. has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fourth editions of Sapira’s Art and Science of Bedside Diagnosis).