Care Without Insurance
Friday, May 22, 2009Demand for Personal, Cash-Only Physicians Holds UpBy John LaPlanteCategories: Care Without InsuranceElitist or common sense? The New York Times reports on doctors who charge an annual retainer. In other words, patients pay with cash, not insurance. The hook for the story is the idea that in a recession, demand for such an "elitist" service falls. But the reporter finds little evidence of that. Perhaps it's not so elitist after all; the $1,500 to $2,000 that people pay compares favorably with insurance premiums that are five or six times that amount. Granted, you'll still need catastrophic insurance for hospital stays, but at that point, we're getting closer to insurance as insurance and not prepaid care--meaning, it should be cheaper (if your state laws allow you to get a decent price, that is.) I'm amused at the fact that some people are worried about the rise of this kind of medical practice. After all, as a nation we are supposedly underserved by primary care physicians. What better way to have a doctor in your corner than to have him as your client rather than the captive of an insurance company, or worse yet, government employee?
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Friday, May 22, 2009Personal Care of the Pre-HMO Era, OnlineBy John LaPlanteCategories: Care Without InsuranceYou may be used to going online to do your Christmas shopping, buy books, pay bills, read news and keep up with your friends. But if you have a health question, you probably don't go online to ask your doctor, even for items that aren't urgent. Why not? One reason, if you pay for your medical care through insurance, is that your doctor most likely isn't paid for the time he or she spends in online visits--only in-office ones. Dr. Jay Parkinson would like to offer an alternative to that approach. The doctor, based in Brooklyn, offers web-based services at $35 a month, as well as office visits and even house calls. But he doesn't take insurance. In a profile for Parkinson that she wrote for America's Future Foundation, Elizabeth Nolan Brown says "Parkinson hopes to combine the best of 21st century technology with the localism and personalized care of the pre-HMO era." Parkinson's business isn't a replacement for insurance for catastrophic health events, but it is a good example of how much of health care can be made less bureaucratic and more patient-focused.
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Monday, May 4, 2009Four Myths About Universal CoverageBy Paul HsiehCategories: Care Without Insurance, Employment-based insurance, How Many Uninsured?University of Illinois law professor David Hyman has posted a paper entitled, "Employment-Based Health Insurance and Universal Coverage: Four Things People Know That Aren't So."
We do need significant reforms. But his paper explains why government-run "universal health care" will take us in the opposite direction.
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Friday, May 1, 2009If Only It Were Just a Tax Hike...By Merrill Matthews, Jr.Categories: Care Without Insurance, Individual Mandates, Insurance Regulation, Massachusetts, OregonIt may be a surprise that the least controversial aspect of the proposed Oregon health reform plan is an attempt to raise taxes. The newly proposed tax on insurers and medical providers would be used to fund expanded coverage for 80,000 low-income children and 75,000 low-income adults. The program hopes to use the tax to increase revenues from private sources, but also through maximizing federal dollars. What could be more controversial than increasing taxes to pay for someone else's health care? How about HB 2009, the health system reform bill proposed in Oregon. The proposal would reorganize the entire health system -- including providers, insurance and government-provided benefits -- into a single regulatory body with authority over all of the areas. The new health care authority would be charged with a variety of tasks, including creating its own version of a Massachusetts' connector, and providing guidance on the practice of medicine in Oregon, including the most effective treatments. Both controversial proposals may end up passing the legislature in the end, but the state (as well as the nation's) declining economy have made passage of the proposals far less certain. (Via the Council for Affordable Health Insurance's JP Wieske and Kevin Wrege)
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Monday, April 27, 2009Hope in Health IT?By John LaPlanteCategories: Care Without InsuranceGreg Scandlen, a contributor to this site, recommends The Data Model that Nearly Killed Me, a blog testimonial. Scandlen says that it is "the best description I have ever seen of why the concierge, direct practice, medicine movement is so important."
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Thursday, April 9, 2009The Fall and Restoration of Primary CareBy John LaPlanteCategories: Care Without InsuranceOpinion columnist Ellen Goodman laments, as many people do, the decline of the generalist. "A half-century ago, we had an equal number of generalists and specialists. Now there are two specialists for every generalist. In clear view and with all undeliberate speed, we developed a system that rewards procedures over primary care." If that's a problem, isn't one possible solution the rise of concierge medicine, which various bloggers on this site have mentioned, is under assault from overreaching insurance regulators?
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Tuesday, March 31, 2009Progressive ‘Reform’: An Offer You Can't RefuteBy Mark Todd EnglerCategories: Care Without Insurance, Government employees, MassachusettsReason Foundation's blog had a post earlier this month noting that even giddy central-planning fanboys and groupies aren't squealing unrestrained glee for Massachusetts-style universal health coverage. Just after publication of the article, "Massachusetts Faces Costs of Big Health Care Plan," in the March 15 New York Times, the left-wing Institute for America's Future issued a "scathing indictment of the Massachusetts' plan," said Reason.org's Shikha Dalmia. "Among its findings":
Of course, the glaring policy imperfections of Massachusetts' "TonySopranoCare" have hardly dulled fanatical progressive ambitions for universal government-run care. The IAF's prescription for the shortcomings, inefficiencies, failures and injustices symptomatic of the system devised by former Gov. Mitt Romney is to empower really smart federal bureaucratic capos to "ensure equitable distribution of the cost of care among government, individuals and employers, based on ability to pay," according to the Institute report. At the same time, having the U.S. government "jump into the insurance business with both feet and compete directly with private companies by offering its own Medicare-style health plan for Americans," predicts Dalmia, is really just "a quick way of killing the private insurance industry and paving the way for nationalized health care." But then, American progressives always do tend to spell "reform" the same way, concludes Dalmia: "E-U-R-O-P-E."
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Monday, March 30, 2009Bureaucrats vs. the UninsuredBy Brian SchwartzCategories: Care Without Insurance, New YorkThe case of Dr. John Muney shows the outright injustice and immoral nature of government regulations that rob us of our individual rights to associate with one another in a peaceful manner. Next time you talk about mandated benefits on insurance, here’s a concrete example of how they violate rights. (Whether Dr. Muney is technically providing “insurance” is irrelevant.)
Just who do these government bureaucrats think they are? Here we have a physician who wants to offer his services for a price, and patients who think it’s a good deal. But apparently this is not allowed, because government authorities forbid it. What of individual rights? Here’s an other section of the article:
Here’s another angle to explain this: insurance companies are “regulated” by government and it’d be just terrible if this up-start doctor could do this without also having to obey the authorities. And needless to say, the authorities want all the power they can get. I mean, how embarrasing would it be for them if people got the medical care they needed without the government having a hand in it to “protect consumers”? (via Coyote Blog via the David All Group)
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Friday, March 13, 2009Crisis of the Overinsured: They Pay Up to Twice as Much for Hospital ServicesUninsured and Self-Insured Benefit from Medical Tourism At Home By John R. GrahamCategories: Care Without Insurance, Hospitals, Medical TourismIn Michael E. Porter & Elizabeth Olmstead Teisberg's Redefining Health Care, they note that major health plans succeed by exploiting a competely artificial economy of scale. Because of the tax-code, American workers are compelled to accept health "benefits" from their employers instead of taking their health-care dollars to buy health insurance that serves their families' needs. (I'm using more libertarian language than Porter & Teisberg do.) This artificial, perverse, government-created, economy of scale leads health plans to structure their products for groups whose members are unrelated except for the fact that they work for the same employer. Successful health plans exploit the lower distribution costs of selling to groups. Unfortunately, this has absolutely no relationship with providing good health care. For example, if I have an inguinal hernia that requires surgery to repair it, the fact that I work for a small-group employer in California is irrelevent to the surgery I need. If I worked for a jumbo, ERISA-regulated employer like, e.g., Cisco Systems, my medical need would not differ, but I might have access to a completely different network of providers from which to choose a surgeon and hospital. Furthermore, because a third-party payer has inserted itself in the provider-payment relationship, costs go up. Worse, patients do not know how much their procedures cost because they are merely line-items in monstrous contracts negotiated by providers and health plans. When doctors or hospitals claim that they cannot tell how much a procedure costs, they are telling the truth. This is because neither the plan nor the provider really care about your specific procedure. They care about payment for the entire portfolio of procedures done over a month, quarter, or year. The provider tries to be as creative with the "coding" of his claims as possible, in order to meet or beat a revenue target from each payer. The payer, in turn, looks for variance in the claims submitted that can justify a query and re-pricing the claims downward. This is changing with the rise of medical tourism within the U.S. Brokers are arranging fixed-price surgeries for self-insured and uninsured parties. At least one health insurer, Wellpoint, has gotten on board. Why would it take such a step, which appears to challenge a key element of its competitive advantage? With bundled prices agreed (and paid) before the surgery, costs are 30% to 50% less than under contracted-network pricing. One of the major, unfounded, criticisms of consumer-driven health care is that it cannot drive down costs because only 10% of the population accounts for 70% of health costs. Once patients have met their deductible, they no longer care what procedures cost. (See, e.g. Timothy Stoltzfus Jost, pp. xi, 136.) Innovations like "domestic medical tourism" debunk that charge utterly.
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Thursday, March 5, 2009Let's Get Moving Beyond the Medicaid GhettoBy Grace-Marie TurnerCategories: Care Without Insurance, Employment-based insurance, Insurance Regulation, MedicaidIn his article, "Empowering Individuals in the Health Care System,"(pdf) which appears in the Winter 2009 edition of the Stanford University journal Pathways, Heritage Foundation health-policy studies director Bob Moffit investigates how the health care system may be improved in ways that will ameliorate racial and ethnic disparities. Portability of health insurance policies -- enabling individuals to keep their coverage when they change jobs or maintain coverage through life changes -- is key to stabilizing health insurance markets and dramatically reducing the numbers of the uninsured, especially among blacks and Hispanics, writes Moffit. He concludes: "If policymakers want to reduce ethnic and racial disparities in health care, they should get serious about empowering ethnic and racial minorities to secure superior private health insurance coverage and care and enabling them to escape the Medicaid ghetto. But it will take political imagination and a passion for serious innovation rather than merely filling ‘gaps' in conventional policies and old programs."
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