A poorly thought out, but intriguing proposal: NO one has medical insurance. You pay what the doctor charges. The doctor charges what he needs to in order to run his office and make some money. People who can’t pay get taken care of on a sliding scale and the government pays the rest. Would that cost each of us more in the long run than what we have now?
I think there are too many factors involved for this be be easily answered in GQ. Moving to GD.
General Questions Moderator
How is that not a medical insurance, albeit a rather strange one? Also, who if not the government pays the cost of people who “get taken care of on a sliding scale”?
Yes, it’s a government subsidized plan for those who can’t pay for it. But everyone else would pay their bill, just like they do when they call the plumber. No private Plumbing insurance would exist. So everyone’s medical bills would be much lower. (I’m suggesting that one of the reasons for high medical costs is the amount of money that goes to the insurance company when you pay your bill to the doctor - and to the insurance company.) In the long run, would it cost each of us less?
Not so long ago most people got their health care at religious, school or charity hospitals.It was when we decided to make profit off the illnesses of the people that it went to hell.
Health insurance used to only be disability insurance - it was there for emergencies. Anything else, you would pay as you go. You are simply trying to rewind back to the early 1900s.
Employer based insurance didn’t really hit until WWII and was a way around price controls
I grant that such a plan would not be adopted today. I’ve been wondering how much of our costs are DUE to the fact that we have medical insurance.
I suspect that it would cost each of us less, however there would still be a significant number of people who could not afford it. Which I supposed makes us no worse off than we are now.
I think the problem is if you suffer a dibilitating illness that requires relatively rare and expensive treatments. Economies of scale would likely be such that most people could not afford them.
I think at the very least very high deductibles are a good idea. YOU are paying for this stuff one way or another anyway. Once your “free” insurance pays for something the incentive for you to shop around goes away and the incentive for the health industry to control costs goes away IMO. And you end up with customers that have little or no control or influence on things and at least two beaucracies all in a crap spiral.
I’m a little skeptical of these, they sound like a good idea, but it turns out that even with high deductibles, only a few percentage of total healthcare spending is done below the deductible.
So basically, you end up with people shopping around for minor expenses to save a few bucks, but when they actually encounter the types of illnesses that cost money, they’re going to end up spending their entire out of pocket amount anyways, and there isn’t really any incentive to shop around.
I said deductibles. What I meant to say was copays in ADDITION to deductibles. Or in otherwords no matter HOW high the cost, you are paying some decent fraction of that.
As to the OP, I think my previous post is also relevant. The majority of health care spending on this country is done in very expensive procedures and medications on people who are very ill, and 99% of the population would be unable to pay for them out of pocket (especially since being sick makes it a lot harder to earn money). For all its flaws, health insurance of some sort is pretty much necessary in any place with modern medical technology. Your chances of becoming very sick in any given year are small, but your chances of being able to pay for it are close to nil. There isn’t really anyway to manage it then to pool risk and force budgeting somehow, either through private insurance or a gov’t plan.
Counterproductive. The rich would get anything they want and the poor would be toast. Then the poor would have to put off care making their eventual care very expensive.
is this some “well in the wild-wild-west doc would pull out a bullet and sew you up for a swig of moonshine and a nice hot meal” romanticism?
if nobody had medical insurance (of any variety), a lot more people would be unable to afford medical coverage and the rich/wealthy would still line (the few remaining) doctors’ pockets as they would still pay through the nose to attempt to avoid the one thing they can’t avoid. there would be a corresponding decrease in the numbers of medical practitioners as there would be no more feed at the trough for the little piggies.
i would expect licensure requirements for doctors to either be dropped or an underground black-market for “medical services” to rise. medicines now restricted by prescription would become unregulated (or, again, found in a black market a lot more accessible to common folk). same thing for medical diagnostics as they became unregulated.
(p.s. if it’s not obvious, having medical practitioners, drugs, and medical diagnostics go unregulated is not a good thing)
I find your question interesting.
If no one had medical insurance, the liklihood of the middle and working class not getting routine maintenance and preventative care would skyrocket. In the end, we would have what many hospitals are faced with currently: use of emergency facilities as primary care.
Most of the poor who now go to the ER when their kid has a fever, earache or other kid common illness could be treated much more cost effectively in a physician’s office or clinic. A lot of chronic illnesses among the poor (diabetes, high blood pressure, etc) are much better controlled with routine medical treatment, again in a clinic or doctor’s office.
The cost of the kids in the ER or the adults leaving their own health problems go until requiring more expensive care (eg limb amputation, kidney dialysis) gets passed on to the remaining health care consumers when payment isn’t made.
If no one had health insurance, the population using the health care system in this manner would explode, leaving routine care the province of only the very wealthy. As many problems as our current system has, it’s still better than that particular alternative.
It’s like this in parts of Texas.
There’s large numbers of uninsured, and within communities, doctors and clinics offer discount packages for check ups and procedures. The advertise discounts and prices in the paper, and you look for good deals before going for a check up.
Major diseases… it’s not good… cant afford to get sick really.
That sounds like Ireland’s system. People pay out of pocket until a deductible is reached, and the government pays the rest. The poor and elderly are subsidized for the deductibles.
The thing about healthcare is costs are not evenly distributed. About 5% of the country uses 50% of all health spending (the other 95% use the other 50%). The sickest 1% use 22% of spending, and the sickest 20% use 80% of spending.
We spend about 2.5 trillion on health care. Fifteen million use half that money, and the other 285 million use the other half. So the 5% with the most expensive illnesses need 80k a year each in help but the healthiest 80% (who use 1/5 of spending) only need about 2k/yr in medical care. However members of that 80% are going to be in the 5% sooner or later. Someone will get cancer, or have a car wreck, or have a premature baby, etc.
Market factors probably wouldn’t work in that situation. Health care is to a large degree an expense that people can cover out of pocket, or that is so expensive that virtually nobody can cover it out of pocket.
I’d say that rates would come down, the industry would become a lot less profitable, and innovation would come to nearly a halt.
However, medical care would be more widely available and not eat up so much of people’s budgets. Although a lot of drugs and treatments would only be affordable by the rich. But routine stuff would probably come down in price a lot. I’d imagine births would approach the price of abortions. Other medical procedures would probably cost about as much as they cost to have them done to your dog. The difference between human medical costs and pet medical costs is primarily driven by third party payments bidding up the price, and by the extra liability and greater care that comes from working on humans. Still, getting a broken leg fixed on a human as opposed to a dog shouldn’t cost 20x more. The ratio would probably fall to 1.5 or 2.
Keep in mind, I’m just making educated guesses based on very limited knowledge.
As soon as you do this, you skew the market. Doctors can then start charging what the government will pay. That amount will be set by some bureaucrat in Washington instead of the consumer. Then, as the amount increases, less people will be able to afford it and more people will be on the government subsidy.
Overall, I like your idea, but I would say no insurance for routine procedures but we pool our risk for high cost illnesses like cancer or heart disease.
Sick people account for most health care spending? Who would have guessed?