The alternative to insurance is that you get the bill flat out from the hospital. Can you afford a $5K bill for an ambulance ride? A $3K bill for ER care, $200 for the lab work? $1500 for the CT-scan? $500 for the ER physician's consult? $5000 for the MRI? $500 for the surgeon's consult?... etc, etc.
Insurance is a necessary evil. It spreads out the financial risk across time and across the population making the service more affordable for everyone. But we have to understand the insurer's perspective. Their entire business is in assuming someone else's risk. The only way to do that is to give them a way to make some money themselves by doing it. If we tell them they can't have a profit, why take on the risk? Leave it to the individual to manage his own risk. So, the question here really is what is a "fair" profit for the service they provide?
And it gets more complicated than that because then we have to deal with the value judgement about what's being purchased. If you walk into a Walmart with a greedy toddler, they'll tell you they "need" every toy in the toy section. Maybe he's got a rich, doting grandparent who he expects to pay for it. Who actually makes the decision about what the kid needs? Not the toddler (our patient). Maybe the parent (our doctor) gets a say, but really the decision is made by the grandparent (the 3rd party payer). We've got a system that separates the people with the biggest stake in the value assessment (ie 'is this worth the price I'm being asked to pay?') from the decision to pay or not. In fact, in our scenario, Walmart figures out the game and takes all the price tags off the products knowing that the rich grandparent is going to pay regardless, then jacks up the prices. That whole scheme has to be changed.
I think we agree fundamentally. In a free market, insurance can be a viable product and a sensible purchase. But it isn'ta free market at all: not for insurance, and not for medical care.
Medical costs are too high, because it hasn't been a free market. In particular the supply of doctors and nurses is limited. Best evidence is that medical schools turn down huge numbers of qualified applicants each year, and the number of graduating doctors each year is fully controlled by a monopoly, the ACGME (Assoc of Collegiate Graduate Medical Education). The costs should be much lower.
Insurance is also not a free market by any stretch, starting with the fact that it's a mandated purchase for most corporations, and for most individuals thanks to Obamacare. It's more like a regulated utility with an insurance component than actual insurance.
Add in the fact that medical bills including hospital bills are only incidentally related to actual cost. There's a huge cost bubble that doesn't reflect true costs at all.
There are ways it can be reformed, if the government approaches it in good faith. But I've lost confidence in gov't's good faith. I'd much rather see a totally unregulated market.
Not to mention that most doctors can't cure anything anyway; they're only trained in symptom suppression, culturing a chronically ill population. But that's a whole 'nother can of worms.
The alternative to insurance is that you get the bill flat out from the hospital. Can you afford a $5K bill for an ambulance ride? A $3K bill for ER care, $200 for the lab work? $1500 for the CT-scan? $500 for the ER physician's consult? $5000 for the MRI? $500 for the surgeon's consult?... etc, etc.
Insurance is a necessary evil. It spreads out the financial risk across time and across the population making the service more affordable for everyone. But we have to understand the insurer's perspective. Their entire business is in assuming someone else's risk. The only way to do that is to give them a way to make some money themselves by doing it. If we tell them they can't have a profit, why take on the risk? Leave it to the individual to manage his own risk. So, the question here really is what is a "fair" profit for the service they provide?
And it gets more complicated than that because then we have to deal with the value judgement about what's being purchased. If you walk into a Walmart with a greedy toddler, they'll tell you they "need" every toy in the toy section. Maybe he's got a rich, doting grandparent who he expects to pay for it. Who actually makes the decision about what the kid needs? Not the toddler (our patient). Maybe the parent (our doctor) gets a say, but really the decision is made by the grandparent (the 3rd party payer). We've got a system that separates the people with the biggest stake in the value assessment (ie 'is this worth the price I'm being asked to pay?') from the decision to pay or not. In fact, in our scenario, Walmart figures out the game and takes all the price tags off the products knowing that the rich grandparent is going to pay regardless, then jacks up the prices. That whole scheme has to be changed.
I think we agree fundamentally. In a free market, insurance can be a viable product and a sensible purchase. But it isn'ta free market at all: not for insurance, and not for medical care.
Medical costs are too high, because it hasn't been a free market. In particular the supply of doctors and nurses is limited. Best evidence is that medical schools turn down huge numbers of qualified applicants each year, and the number of graduating doctors each year is fully controlled by a monopoly, the ACGME (Assoc of Collegiate Graduate Medical Education). The costs should be much lower.
Insurance is also not a free market by any stretch, starting with the fact that it's a mandated purchase for most corporations, and for most individuals thanks to Obamacare. It's more like a regulated utility with an insurance component than actual insurance.
Add in the fact that medical bills including hospital bills are only incidentally related to actual cost. There's a huge cost bubble that doesn't reflect true costs at all.
There are ways it can be reformed, if the government approaches it in good faith. But I've lost confidence in gov't's good faith. I'd much rather see a totally unregulated market.
Not to mention that most doctors can't cure anything anyway; they're only trained in symptom suppression, culturing a chronically ill population. But that's a whole 'nother can of worms.