“And just for discussion I’ll toss up a thought… perhaps some portions of medical services infrastructure (hospitals, some diagnostic centers such as cat-scans, x-rays, etc) might be more properly treated as public infrastructure such as roads and bridges and the like.”

Uh, I thought the whole point of the post, and of this blog for that matter, is to get the “public infrastructure” off of our asses and to carry our own weight.

That said, I recently switched from a $5000/year catastrophic plan to a $1700/year HSA and saved $30/month in premiums. At the rate I’m saving, in three years I’ll have two years worth of deductibles saved up. If I go to a PPO I get a discount of around 35%, However, the full price is applied to the deductible.

Some people look at me like I’m crazy when I tell them I want nothing to do with socialized medical care. Sadly, most of them think it’s a right and that they’re owed it.

Not quite a year ago I, while fully insured with a good, corporate, low deductable plan, I spent 36 hours in an emergency room with associated testing and such. The bill was just short of $18,000 – call if $500/hr. for emergency room care for my particular affliction. The insurance company took the $18,000 and immediately cut that in half, the cost to them was $9,000. I was responsible for $500 of that. (these are all round numbers).

The point of mentioning the above is to note that had I been uninsured the full bill would not have wiped me out (it would have been painful!) but I would not have had the 50% discount that the insurance company receives. I would have been responsible for the full amount.

On to the next point. I now had a “pre-existing condition” which potentially matters when one needs to change insurance. Some months following the above incident I found myself unemployed. Given the pre-existing condition I thought it prudent to maintain COBRA coverage. Covering a family of four with full med, dental, eye, and prescription coverage is around $1200/month. As far as I could determine I could not have secured any insurance that would have covered my “pre-existing” condition. Since I maintained COBRA (i.e, group coverage) I could not be denied access, even for the pre-existing condition, to the new group coverage when I went to another employer.

Which is all to say… I’m not sure what. I am not the least bit opposed to having true insurance rather than “insulation”. I recently took a fall that wound up costing me $300 to get myself adequately diagnosed and sent on the path to repair. That is not a major cost and we all spend that much and more having ordinary maintenance done to our cars.

Just tossing some numbers out. Personally I believe there are 4 major issues that need to be resolved if we are to gain control of medical costs without going the socialized medicine route with all the rationing and inefficiencies that seems to cause.

The first, as noted in this thread is switching from “insulation” to insurance”; high deductable insurance meant more to cover catastrophes and truly expensive events rather than to shield us from spending, for example, $300 to get a wheel diagnosed and repaired.

Next we need to find some way to figure out what the true costs are – are they the $18,000 I was billed or the $9,000 the insurance agreed to pay. Should I have paid the $300 for my repairs or $600? I certainly don’t know but I suppose the answer is somewhere in the middle. I suspect that having real insurance rather than insulation might help the magic of the marketplace move us closer to true cost/pricing.

Next is controlling liability. We need to stop digging into everyone else’s pockets just because something painful and unfortunate happened to us. We get sick, we get injured, accidents happen, diseases and defects and mistakes are part of life. Negligence is another matter, of course.

Lastly we need to accept that if we want the supply of medical services to be larger so that the costs can be smaller then we need to make entry into medical services easier and less expensive for those who would do the job for us. We need to revise how we go about training and credentialing medical services providers.

And just for discussion I’ll toss up a thought… perhaps some portions of medical services infrastructure (hospitals, some diagnostic centers such as cat-scans, x-rays, etc) might be more properly treated as public infrastructure such as roads and bridges and the like.

Our deductible and consumer ownership percentage went up significantly this year, and we adjusted accordingly. Rational economic behavior.

Clueless Democrats have a vested interest in not allowing this kind of financial flexibility, because it gives them job security for damn near eternity, and it’s a real easy sell to the state-school-uneducated masses.

I am such an evangelist among my friends for high deductible plans. Unfortunately it is really hard to convince someone that has what would traditionally be called “good insurance” that they have more than they need, and that it’s wrecking the healthcare system for everyone.