# What if NObody had medical insurance? **URL:** \ **Category:** Great Debates\ **Created:** [December 10, 2009, 9:39pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778 "2009-12-10T21:39:26Z")\ **Posts on this page:** 16\ **Page:** 2
**Author:** ![kanicbird](https://avatars.discourse-cdn.com/v4/letter/k/5f8ce5/32.png) [@kanicbird](https://boards.straightdope.com/u/kanicbird)\ **Post date:** [December 11, 2009, 2:14pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/21 "2009-12-11T14:14:53Z")
It would remove having to pay for the insurance staff, the entire insurance company and much of the doctor’s staff and billing office, out of the cost of your doctor’s visit. In general cost will go way down and will become much more personal and less aggravating, and you will just be paying for the medical service, not the entire financial bureaucracy that is now tied to medical service. All MHO ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 11, 2009, 2:53pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/22 "2009-12-11T14:53:40Z")
> [@kanicbird](#): > > It would remove having to pay for the insurance staff, the entire insurance company and much of the doctor’s staff and billing office, out of the cost of your doctor’s visit. In general cost will go way down and will become much more personal and less aggravating, and you will just be paying for the medical service, not the entire financial bureaucracy that is now tied to medical service. > > All MHO Not if you have the government chipping in. Instead of insurance companies, you have government employees drawing salaries (with supervisors and department heads drawing big salaries) and you still have staff at the doctor’s dealing with the government, and they are terribly inefficient. Completely related, yet unrelated anecdotes: Last year my brother-in-law was enrolled in Medicaid after a long period of unemployment. Now he has a good job with benefits available, but why pay for something the government is giving you for free? So, surely the government, with the computer databases, can see that he has this position and should cut off his Medicaid in short order? Nope. He is still collecting it, and just got a renewal notice saying that he continues to qualify and will be reviewed again in January, 2011. #2: Several women that work for the church’s daycare near my home have benefits available through work. Many are also married to husbands that can provide bennies. But why do that when you can get free healthcare? Most have filled out apps with the state saying that they are poor single mothers and have insurance for their kids through CHIP. #3: The county in which I live has a program in that people who are under a certain income level who have not had health insurance for 6 months and who are not offered group coverage at work, can buy into a group policy. My neighbors who have health insurance saw that this plan could save them money. They applied and were approved and promptly canceled their group coverage effective Jan 1. They were also over the income level provided, but they simply left off the wife’s income and claim that she was a stay at home mom. Approved. Those are three examples from my limited exposure to government programs. Fraud is rampant and they choose not to look at it for their continued survival. For example, if the county program didn’t get enough people enrolled, then their funds might get eliminated next year. So there isn’t any incentive for them to be watchdogs of the taxpayers money. A profit motive, like with private insurance, cuts down on those things. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [December 11, 2009, 3:13pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/23 "2009-12-11T15:13:14Z")
> [@adaher](#): > > 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. Actually they just get fancier and more impressive tools when you have a lot of money to go after. In Japan the cost of medicine is not so profitable. They have invented smaller, cheaper and faster MRIs to compete. Competition is what makes innovation, not huge profits. ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [December 11, 2009, 4:19pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/24 "2009-12-11T16:19:08Z")
> [@jtgain](#): > > Those are three examples from my limited exposure to government programs. Fraud is rampant and they choose not to look at it for their continued survival. For example, if the county program didn’t get enough people enrolled, then their funds might get eliminated next year. So there isn’t any incentive for them to be watchdogs of the taxpayers money. A profit motive, like with private insurance, cuts down on those things. Which explains why every other industrialized country in the world has UHC, their costs are lower, and their results are better. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 11, 2009, 4:44pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/25 "2009-12-11T16:44:53Z")
> [@DanBlather](#): > > Which explains why every other industrialized country in the world has UHC, their costs are lower, and their results are better. But a large part of their costs being lower is the fact that they piggyback off of the US. If we couldn’t give a profit to the drug companies, doctors, and surgeons, they just might say fuck all and not come up with innovative solutions.. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 11, 2009, 4:51pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/26 "2009-12-11T16:51:39Z")
> [@jtgain](#): > > But a large part of their costs being lower is the fact that they piggyback off of the US. If we couldn’t give a profit to the drug companies, doctors, and surgeons, they just might say fuck all and not come up with innovative solutions.. What exactly is piggybacked off of us? Can you elaborate on that instead of parroting these talking points? To help you out: exactly what innovative solutions come from your local dermatologist that contributes to the corpus of medical knowledge? Primary medical research in this country is not funded by doctors or insurance companies. The NIH accounts for the plurality of research dollars. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 11, 2009, 4:54pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/27 "2009-12-11T16:54:12Z")
> [@Rumor\_Watkins](#): > > What exactly is piggybacked off of us? Can you elaborate on that instead of parroting these talking points? The drug companies make their profits off of sales to US residents, whether they pay cash, or the insurance companies reimburse them. Then, they can go into other countries and sell the drugs for pennies because the marginal cost of the drug is minuscule. The R&D costs are reimbursed for the $$$ that Americans pay.. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 11, 2009, 4:58pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/28 "2009-12-11T16:58:45Z")
> [@jtgain](#): > > The drug companies make their profits off of sales to US residents, whether they pay cash, or the insurance companies reimburse them. > > Then, they can go into other countries and sell the drugs for pennies because the marginal cost of the drug is minuscule. The R&D costs are reimbursed for the $$$ that Americans pay.. Most of the R&D is shouldered by the NIH, and it’s been demonstrated in many threads here that alot of the cost recovery done by Pharma is marketing/advertising expense. I would also like you to extend your logic to every other facet of modern medicine. ---
**Author:** ![Lemur866](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lemur866/32/434_2.png) [@Lemur866](https://boards.straightdope.com/u/Lemur866)\ **Post date:** [December 11, 2009, 5:01pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/29 "2009-12-11T17:01:09Z")
With UHC, you don’t have to worry about checking eligibility, because everyone is eligible. The problem with the “out of pocket for routine, insurance for catastrophic” model is that basic health care is also a public good–we want people to get their routine checkups, we want people to get their routine vaccinations, we want people to get regularly told by a doctor to quit smoking, lose weight, and exercise. And when you look at private insurance plans, routine checkups are often covered 100% with no co-pay for that very reason. They want Bob to control his weight _before_ he has his first heart attack, not after. And of course, if Bob has that major heart attack and needs quadruple endoscopic whatever, he’s not going to have tens of thousands of dollars sitting around to pay for it, so we need insurance for that, or we go back to the 1950s standard of treatment, which is give Bob an aspirin and wait to see if he lives or dies. ---
**Author:** ![CC](https://avatars.discourse-cdn.com/v4/letter/c/f1d935/32.png) [@CC](https://boards.straightdope.com/u/CC)\ **Post date:** [December 11, 2009, 5:07pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/30 "2009-12-11T17:07:52Z")
> [@jtgain](#): > > …Those are three examples from my limited exposure to government programs. Fraud is rampant and they choose not to look at it for their continued survival. For example, if the county program didn’t get enough people enrolled, then their funds might get eliminated next year. So there isn’t any incentive for them to be watchdogs of the taxpayers money. A profit motive, like with private insurance, cuts down on those things. Underneath **jtgain’s** points lies a fundamental philosophical position: “the peeple” are essentially immoral. If you believe that people, in general, cannot be trusted, you will take the position that everything has to be designed in such a way as to eradicate the likelihood of fraud. And you wind up with the arguments advanced here. Additionally, there’s the assumption that inefficiency is a product of the number of people involved. And while there’s some truth to that, it’s not always the case, and sometimes, more people involved can reduce inefficiency - note what happened when Reagan reduced the number of people involved in the social services because he thought he saw wasteful spending and inefficiency. Fewer people got fewer services, making the money spent on those systems even more of a waste. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 11, 2009, 5:09pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/31 "2009-12-11T17:09:38Z")
And here is an indication of how little prescription drugs account for a public health insurance budget > [@](#): > > Committee chairman Edward Leigh said: "Around a quarter of all expenditure in primary care is on drugs and both the volume of drugs prescribed and their total cost are increasing. [http://news.bbc.co.uk/2/hi/health/7190267.stm](http://news.bbc.co.uk/2/hi/health/7190267.stm) So that means 75% of healthcare spending in the UK is not on prescription drugs. The US spends 10% of its healthcare spending on Drugs: [http://www.kaiseredu.org/topics\_im.asp?imID=1&parentID=61&id=358](http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358) Healthcare spending per capita in 2007: [http://seekingalpha.com/article/146992-comparing-u-s-healthcare-spending-with-other-oecd-countries](http://seekingalpha.com/article/146992-comparing-u-s-healthcare-spending-with-other-oecd-countries) US: 7290 UK: 2992 So the US spends ~$720/person on drugs The UK spends ~$748/person real leeching ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [December 11, 2009, 5:18pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/32 "2009-12-11T17:18:03Z")
> [@Rumor\_Watkins](#): > > So the US spends ~$720/person on drugs > The UK spends ~$748/person > > real leeching But that’s apples and oranges. In the UK, everyone who needs them gets drugs. 🙂 ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 11, 2009, 5:34pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/33 "2009-12-11T17:34:06Z")
> [@CC](#): > > Underneath **jtgain’s** points lies a fundamental philosophical position: “the peeple” are essentially immoral. If you believe that people, in general, cannot be trusted, you will take the position that everything has to be designed in such a way as to eradicate the likelihood of fraud. And you wind up with the arguments advanced here. Additionally, there’s the assumption that inefficiency is a product of the number of people involved. And while there’s some truth to that, it’s not always the case, and sometimes, more people involved can reduce inefficiency - note what happened when Reagan reduced the number of people involved in the social services because he thought he saw wasteful spending and inefficiency. Fewer people got fewer services, making the money spent on those systems even more of a waste. No. A significant percentage of people are immoral. Enough to make the costs of government health care run higher. You dispute that a significant part of the population is immoral? ETA: and it’s not about immorality…it’s about the poor job that the government does of checking the databases that are available to curtail the fraud.. ---
**Author:** ![Rumor\_Watkins](https://avatars.discourse-cdn.com/v4/letter/r/d9b06d/32.png) [@Rumor\_Watkins](https://boards.straightdope.com/u/Rumor_Watkins)\ **Post date:** [December 11, 2009, 5:43pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/34 "2009-12-11T17:43:18Z")
> [@jtgain](#): > > No. A significant percentage of people are immoral. Enough to make the costs of government health care run higher. You dispute that a significant part of the population is immoral? > > ETA: and it’s not about immorality…it’s about the poor job that the government does of checking the databases that are available to curtail the fraud.. These “immoral” people (and _definitely_ not the immoral doctors who perpetrate actual medical billing fraud) you speak of cost the system far more today, anyways what’s better, some immoral person (with nothing better to do with themselves, who pride themselves on wasting healthcare resoucres! because going to the doctor is such a fun way to spend your day) going to see a primary care physician when they aren’t sick, or some immoral person going to the ER when they aren’t sick or have the sniffles? ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [December 11, 2009, 5:55pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/35 "2009-12-11T17:55:57Z")
> [@kanicbird](#): > > It would remove having to pay for the insurance staff, the entire insurance company and much of the doctor’s staff and billing office, out of the cost of your doctor’s visit. In general cost will go way down and will become much more personal and less aggravating, and you will just be paying for the medical service, not the entire financial bureaucracy that is now tied to medical service. > > All MHO I heard (sorry no cites) that concierge docs are an exploding business model right now, especially among the self employed. Docs are popping up charging $300 or so a month for a family, doing some of their own basic labs for minimal fees, and doing almost everything in home based offices or at the patients location. 100 families x $300/mo = plenty for a working business model. Many of the regular services a doc would provide end up falling under that monthly fee. Plenty of GP types are more than capable of performing basic services normally referred to a specialty and just getting a consult on more advanced issues. Since you have a smaller client base and less volume motive (money coming in appts or not) there is more room for study/research WRT specific patient issues ---
**Author:** ![CC](https://avatars.discourse-cdn.com/v4/letter/c/f1d935/32.png) [@CC](https://boards.straightdope.com/u/CC)\ **Post date:** [December 11, 2009, 6:11pm UTC](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778/36 "2009-12-11T18:11:51Z")
> [@jtgain](#): > > …You dispute that a significant part of the population is immoral? > > ETA: and it’s not about immorality…it’s about the poor job that the government does of checking the databases that are available to curtail the fraud.. a) Of course, we will not agree on what constitutes a “significant part of the population,” but, yes, I dispute that. But I also think leadership has a role to play in re-educating the people on the nature of a morality-based system of governance (see, e.g. the preamble of the Constitution) b) Agreed - inefficiency is a problem in just about every system. Unavoidable? Maybe. Reducable? Yep. And an inefficient system doesn’t always mean that the system is inherently wrong. [Previous page](https://boards.straightdope.com/t/what-if-nobody-had-medical-insurance/520778.md?page=1)