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How Health Insurance Ruins Everything

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How Health Insurance Ruins Everything

How Health Insurance Ruins Everything
May 09
14:32 2018

Over the years, I have befriended an eclectic variety of people who fall all over the political and social spectrum. In doing so, I have learned there are a few certainties in life: We all pretty much want the same things, and we all disagree wholeheartedly on how to achieve these goals. In other words, we can’t seem to agree on what means justify the end.

I find this is particularly true regarding health care. According to Newsweek, an in-depth analysis of the health care system by the Commonwealth Fund found that, of the 11 developed countries in the world, America came in last. The study used 72 markers to help them determine the results, including access, efficiency, and cost.

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But how could this be? For what has long been hailed as the greatest country in the world, you would think our health care would be one to admire, not exonerate. But the reality is we are a sick country crippled by medical debt. And, while many factors have gotten us to this terrible state of affairs, there is a prime culprit for our current healthcare travesty.

Insurance companies.

It is hard to imagine, but for centuries before the birth of healthcare insurance, people rarely went to hospitals. Hospitals were viewed as institutions you went either to give birth or to die – neither of which is great P.R.

Ailments like “the cold” were usually treated at home. Someone would hail a doctor (presumably by frantically riding into the night on a horse, as is depicted in almost any old-timey movie), and the doctor would make a house visit. These visits were billed pretty reasonably. If a doctor’s prices were deemed too steep, a family would find another doctor whose prices were more reasonable. Or, if the cheaper doctor provided less quality service, a family might choose to stick with the better doctor because his price range reflected his services. (Ahhhhhh, the free market. Don’t you just LOVE it?)

Before the 1920’s, hospitals were barely making ends meet. People were heavily utilizing at-home practitioner services. With advances in medicine and education, hospitals had a huge overhead and an inability to pay the bills. They were understaffed and underfunded. Enter Justin Ford Kimball, creator of what we now know as Blue Cross Insurance. Kimball realized that if a small, monthly payment plan was implemented, the average person could afford to go to a hospital. For the low price of 50 cents a month, people were afforded a variety of medical services. Hospitals loved it. Citizens loved it. It was a win-win!

But, over time, the implementation of health insurance proved to be an absolute nightmare. Why? Because their interventions destroyed the natural ebbs-and-flows of a free marketplace. Supply and demand were no longer a direct cause and effect, and anybody that understands economics knows that a marketplace cannot be corrected if there isn’t a linear and direct line between supply and demand.

As Jacques Vorhees describes in his analysis Shooting Old Yeller: Why It’s Time To End Health Insurance, “Price is critical in a functioning marketplace because it constantly sends signals (messages) to consumers and producers. It’s what keeps supply and demand balanced. And most importantly, it’s what enables competition, which keeps prices low. If price is removed from the marketplace, all hell breaks loose.”

What insurance companies did was create a middle-man to intercept negotiations and prices. Disguised as a way to help keep costs low (which, in all fairness, was probably what Kimball intended when he came up with the brainchild), the implementation instead allowed doctors and hospitals to increase their prices by exorbitant amounts.

Think about it: if you owned a clothing store and sold a pair of shorts directly to a customer, you probably would decide on a price range that factored in wholesale cost, rent for retail space, employment overhead, and competitors. However, the key deciding factor of price point would be largely determined by what the customer could afford. If the customer could go down the street to another clothing store and find similar shorts for the same price, you probably wouldn’t make a sale. Thus, you have to maintain a competitive price point. Otherwise, your store won’t stay in business.

But what if you didn’t have to bill the customer directly? What if there was a third party that had nauseating amounts of disposable income? You could bill the third party and charge whatever you wanted because you knew they would pay it.

The same concept is what has created such a problem with American healthcare. In the old days, the doctor would come to your house and charge a fee. If the fee was too high, you would find another provider, which incentivized doctors to charge fair and realistic prices. Such is the natural cause-and-effect of capitalism that doesn’t have a third party to mess with the mechanism.

Once the market switched to one in which people felt pressure to buy insurance, doctors, health practitioners, and hospitals were suddenly able to charge whatever they wanted. This, in turn, created stricter prerequisites for insurance companies to agree to pay (i.e., not covering pre-existing health conditions). While morally reprehensible, it makes perfect sense from a business stance.

Suddenly, health insurance companies started enforcing higher premiums, deductibles, and copays (along with a long list of restrictions) to justify insuring a huge portion of the American population. As a result, Americans stopped paying for health insurance and, subsequently, going to doctors. This has resulted in a lot more emergency visits and high-risk procedures due to untreated conditions that might have been prevented had people scheduled yearly exams, physicals, and tests. (Really, we’re not much different than a car. When you don’t keep up on maintenance, worse and more expensive problems come up in the long run).

To make up for the rising gap in medical bills that go unpaid by uninsured, poor, and/or illegal patients, health practitioners and institutions continue to raise their prices, and the cycle of chasing money among the three subgroups continues to manifest with no end in sight.

I certainly don’t have a solution. Health care is never easy, and there will always be “winners” and “losers.” What I am fairly certain of is that the extinction of health insurers would certainly create a checks-and-balance system that would force doctors to drop rates to competitive prices because there would be no “financial cushion.” Good doctors offering fair rates would continue to see patients. Bad doctors with unfair prices would meet the fate they deserve under the free market. The American people would stop going broke for basic health care, and you would see a healthier, happier, more productive society. You would also see a boost in the economy because more money would suddenly be available for spending.

And that is why a truly free market almost always benefits all parties involved.

Now, how do we get rid of insurance companies?

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mclain warren

mclain warren

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  1. Hugh
    Hugh May 10, 01:35

    Trying to rein in the largest business in the country, insurance companies, presents a daunting challenge on so many levels. The current system is ridiculously expensive to the average consumer as all of us who pay health insurance premiums know. To satisfy the physicians financial needs the insurance company stockholders needs, the hospitals financial needs adds up to a lot of money. I have worked in healthcare for 48 years and have seen some changes. But one thing that has not changed is the rising cost. Is a one payer ( government backed ) system the answer. Not sure. Do we leave it as is ? Well if no one is happy it must be a good system. It is a cash cow for all of the above. Canada, France, Germany all have good working systems which would work here but too much profit in too many businesses would be lost. I feel it will go broke anyway

    Reply to this comment
    • The Burgie
      The Burgie April 15, 19:42

      Of the 10 countries that have a higher standard of living than the USA, all have that “damn socialist healthcare”! It works for them, why wouldn’t it work here?

      Reply to this comment
  2. FDRII
    FDRII May 10, 12:23

    You’re right about eliminating health insurance companies, but wrong about throwing providers and patients onto the free market. That’s fine for wants like consumer goods, but try hospital shopping when a heart attack strikes at 3 AM. Disease is a danger like fire or crime or foreign invasion. Government protects against those, and should for health as well. With doctors as employees, a government system would have great leverage on pay (and doctors could finally practice healthcare instead of running a business), a single consumer would be able to negotiate with drug and other health goods makers, and just dumping the profit margin would lop 15-18% of costs off the top. Yes, there are the usual worries about government inefficiency, but that’s a management issue, not one of basic concept. Uncle Sam won WW II, didn’t he?

    Reply to this comment
    • czhus
      czhus May 10, 17:50

      Please tell me one thing the government has every taking over that became better and cheaper.

      Reply to this comment
      • FDR II
        FDR II May 11, 12:40

        Sure, Medicare. Overhead is 2%, not 18%. And consumer cost is $100 a month, not $900, with all the really big costs like surgery covered completely.

        Reply to this comment
      • Lance
        Lance June 22, 19:39

        For 75 years, it was said that Roosevelt’s New Deal saved capitalism. By softening the rough edges of the free market capitalism with reforms such as social security and unemployment insurance, FDR may have prevented adoption of much more radical changes.

        75 years from today it is unlikely that anyone will think Obama saved market-priced medical care. Rather, he only prolonged it, and that will not be thought of as a good thing. In the developed world, market-priced medical care still exists only in the USA. It is only a matter of time until market-priced medical care joins communism, slavery, racial segregation and fascism as systems that no longer exist in developed nations.

        The USA is the last holdout with market-priced medical care not only because of any inherent conservative or free market ideology. Rather, as the wealthiest nation that ever existed we are the last ones who can afford it. Switzerland was one of the last advanced economies to abandon market-priced medical care. It is arguably a greater bastion of conservatism than the USA. Switzerland’s women were not granted the right to vote until 1971.

        During the debate as to whether Switzerland would abandon market-priced medical care there was considerable concern about how it would affect the major Swiss pharmaceutical giants such as Hoffmann-La Roche (RHHBY) and Novartis (NVS) which was Sandoz prior to the merger with Ciba in 1996. However, it was then realized that the Swiss pharmaceutical giants made much of their profits in the American market.

        The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Basic economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.

        Health care is one of the very few things for which the sellers face inelastic demand. The prices of all other goods and services facing inelastic demand in the USA are regulated by government. Retail electricity service providers face inelastic demand. Consequently, their prices are strictly controlled by all governments worldwide, including the USA.

        The inelasticity of retail electricity is obvious. If Consolidated Edison (ED) or any other electric utility were to triple retail service prices, people might be a little more careful about turning off the lights. Turning off their refrigerators? Watching less television? Not likely. Thus, tripling the price would result in only a small reduction in kilowatt-hours sold. Almost all other goods and services are price elastic. That includes non-medically necessary elective cosmetic and lasik surgery whose prices have actually relatively decreased over time. Medical care in the USA is the only instance in any developed country where any product facing inelastic demand is not substantially price regulated.

        Medical prices are controlled in various ways in the rest of the developed world. In Japan, the land of $100 melons and tiny $10,000 per month apartments, all medical care prices are listed in a book, thicker than the Manhattan telephone directory. The prices set in the book are usually less than a third of those in the USA. An MRI that costs $1,200 in the USA costs $88 in Japan. Japanese insurance companies are private as are most doctors. Japan spends less than a third per capita on medical care than America. However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs. They also have better health outcomes as measured by all metrics such as life expectancy. They also wait less for treatment than Americans do as Japanese doctors work much longer hours for their much lower incomes.

        Japan’s explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning “single buyer” is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. More competition among sellers generally leads to lower prices. However, more competition among buyers leads to higher prices. In the health insurance industry the beneficial effects of more insurance companies competing for patients are far outweighed by the adverse effects of insurance companies competing for doctors and hospitals in their HMO plans. This was completely misunderstood during the recent debate on health care reform. With health care, more competition among insurance companies on balance results in higher prices.

        Focusing attention on the insurance companies, which are simply intermediaries between the doctors and the patients, was a tragic error. It would like trying to solve a problem of high energy prices by focusing on gasoline stations. Only if the government sets prices can health care prices be controlled. Controlling prices does not automatically result in longer waiting times. Japan and Switzerland generally have shorter waiting times to see doctors than does the USA. Additionally, if prices were controlled there would be no such thing as “in-network” or “out-of-network” since all doctors would accept all insurance plans…”

        Reply to this comment
      • Theresa Grieshaber
        Theresa Grieshaber April 18, 05:33

        This article waxes nostalgic about the good old days before medical insurance . But the good part about Blue Cross Insurance is that for the first time hospitals and doctors had a steady income. Doctors used to be paid with chickens from the yard, if that’s all the patients had. Many were poorly qualified. There wasn’t enough $ in the system to encourage or enable improvements. A steady income, plus a 3rd party payer with some clout provided what was needed. You see, a doctor only got paid when people got sick, and then a serious illness would limit the patient’s ability to pay, while still demanding more work from the doctor.. We still need medical insurance but other countries have much better systems.

        Reply to this comment
    • thinkr2
      thinkr2 March 19, 14:55

      Actually, if fire protection were provided by the Feds, it would be as bad as the Post Office. Fire protection in small towns with VOLUNTEER fire departments is often quicker to respond than than in larger cities with ‘professional’ fire fighters. Ambulances are similar.
      Crime ‘prevention’ is a joke. When you need a cop NOW, they are only 10-30 minutes away and often when they get there they make so much noise that the criminal slips away. Cops real job is to draw chalk lines around your body and try to find clues so they can later get the drop on the perp and take him with as little risk to themselves as possible.

      Reply to this comment
  3. sidintokyo
    sidintokyo May 10, 12:46

    Universal health coverage with no fee may work for small countries in Europe. The system in Japan provides for insurance companies, but the government is the major competitor. In the US, Medicare could be expanded.

    Reply to this comment
  4. Shana
    Shana May 10, 14:07

    Really,; we already have “gov’t run health care “. It is called the V A. Yep well run!,,or the British system where you belong to the state or the Canadian system that’s broke along with all their MRI’s. & a waiting time of 6 months to see a specialist!,,,,Nahhh

    Reply to this comment
    • FDR II
      FDR II May 11, 12:44

      My sister lives in the UK and she raves about National Health. Long waits are a fiction in almost all cases and they cover everything. She just had a pair of special shoes made under NH. Cost here: $1000. There: 0. In fact, they made her two pairs.

      Reply to this comment
      • Jas
        Jas December 17, 05:15

        Jim Carrey ,the comedian, does an online interview about the healthcare in Canada and he says most of the negatives about the HealthCarein Canadais unture !

        Reply to this comment
      • thinkr2
        thinkr2 April 17, 17:56

        Cost to her was Zero. Someone paid for them. The government robbed them for her.

        That’s the thing about government redistribution. When the gov robs Peter to pay Paula, they can always count on Paula to vote for them.

        Reply to this comment
    • thinkr2
      thinkr2 March 19, 14:47

      My niece lives in Canada. When she had a problem with a pregnancy, the waiting time for an UltraSound was SIX MONTHS.

      An UltraSound just before delivery was going to be no use. She had to come to the US to find out what the situation was.

      Reply to this comment
  5. Oscar
    Oscar May 10, 15:33

    Back then there were not nearly as many people as there are now. To attempt to make house calls in 2018 would be almost impossible. Plus the cost for a doctor to attend medical school has grown to be a very expensive undertaking. The equipment needed to give proper care is itself expensive. Knowledge of the human body and it’s ailments have also contributed to the madness. The list goes on!

    Reply to this comment
  6. JudyB
    JudyB May 11, 13:47

    What about dental costs? Wonder how many people are suffering with poor dental health (which impacts overall health) because of exorbitant dentists’ fees. And dental insurance is no bargain, only covers a small portion of costs and isn’t cheap!

    Reply to this comment
    • FDR II
      FDR II July 20, 22:44

      Dental absolutely! The costs for even simple procedures is ridiculous. And dental health is often the gateway to other disease, so widening coverage will save the cost of treating bodily illness. Another massive cost item… hearing aids. I was quoted $5000 with another $3000 needed every three years.

      Reply to this comment
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  12. wibdharp
    wibdharp August 21, 18:08

    Is it a surprise that insurance companies may have an adverse influence in our healthcare, as well as medical foundations? Why are we paying for huge, ornate hospitals with expensive furniture? I don’t have an answer.

    Reply to this comment
  13. Bubba Dunn
    Bubba Dunn August 28, 17:54

    Not enough people working and paying taxes. Not enough people paying into health care. Not enough babies being born to people that work. It is like a Ponzi scheme gone bad. Even SS is in trouble because there are not enough young people paying in to take care of retirees. There is no real solution to he health care problem because the revenues are not there anymore, and the average person is taxed to the point of extinction. Insurance sounded good, but as stated in the article, it caused as many problems as it fixed. Imagine how much money that should be going into health care is being paid to
    administration in these mega companies.

    Reply to this comment
  14. Ginger
    Ginger August 31, 01:38

    The real problem is that insurance companies have share holders and over priced CEO and executives who all want to be paid, so the price of insurance goes up to cover all of the “administrative fees”. Most other countries don’t have the ridiculously high administrative fees that we do in America. Get rid of Obamacare and go back to a free market system where insurance companies have to compete for patients. Also, I agree that many providers would love to not have to deal with insurance at all, and some have started not accepting insurance. So, if more people push for more change to healthcare, maybe change will finally occur.

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  18. MVP
    MVP November 14, 22:14

    “What I am fairly certain of is that the extinction of health insurers would certainly create a checks-and-balance system that would force doctors to drop rates to competitive prices because there would be no “financial cushion.””

    Replace the word “doctors” with “health care corporations” and you might be on to something. With all this runaway cost, the doctors in general have NOT reaped the money; these runaway costs are exactly why the corporations are taking over the entire healthcare industry…they WANT the fees to be exorbitant. And it all goes to the suits in the corner offices, who earn many times what the doctors do. There are few and far between docs who practice without a corporate entity behind them. The corporate takeover of health care (which includes the insurance industry as he points out above) and their PAC money to our corrupt politicians (BOTH parties) are the reason for the current cost structure. But who cares if you get sick and can’t be helped, as long as the big shots can suck the money from the system and become filthy rich?

    Reply to this comment
  19. CustomDesigned
    CustomDesigned December 02, 00:49

    IMO, the best solution is high deductible insurance. You pay directly for most things, but you are covered for really bad things. The only time our HD insurance kicked in was when our daughter put her hand through a glass window and required micro surgery.

    When pricing a procedure, e.g. MRI, we call around, and when the person on the phone says, “price? Why do you care? Doesn’t insurance pay for it?” – it’s going to be inflated ($1500). When they have a price list handy by the phone, it will be more like $300.

    Reply to this comment
  20. The Burgie
    The Burgie December 05, 21:35

    One of the Major Villains in the US Healthcare mess is the Health Insurance Companies! The pharmaceutical manufacturers try to justify drug markups of 3,000% saying that they have very expensive Research and Development costs. I have never figured out how Canadian Pharmacies (that DAMN Canadian Socialist Medical System) can sell USA manufactured pharmaceuticals for 40% less than USA pharmacies can!

    Reply to this comment
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  22. Ralphie
    Ralphie December 15, 00:42

    I have lived in Germany for a while. They have a single-payer system since the 1890s; for more than 120 years. It works very well. The so-called “long lines” are a boogey man to frighten us off. Here too you can wait for hours for the E.R. to see you.
    I told some politicians about it, recommended that they go visit. No such luck. Afraid that doctors won’t make election contributions any longer?

    Reply to this comment
  23. CustomDesigned
    CustomDesigned January 07, 17:35

    It is not insurance that is the problem – that has been around since the ancient Assyrian empire in the West (and probably in the East as well).

    The problem is what we call the “HMO”. Flat rate, all-you-can-eat health care. It is deceptive to call an HMO “insurance”.

    Actual health care insurance is what we now call “High Deductible” – where you pay directly for services, but are covered for unexpected disasters.

    As an personal example, while shopping for an MRI, most providers did not have the price ready (“Why do you care? Isn’t insurance paying for it?”), and when they got back to me it ranged from $1200 to $1500. The provider catering to non-HMO customers was $300.

    The only time I actually hit the deductible was when my daughter ran into a glass window while horsing around and cut her wrists. The insurance covered the balance of the micro-surgery to reattach nerves and tendons.

    Reply to this comment
  24. CustomDesigned
    CustomDesigned January 11, 21:25

    Low deductible health care plans (HMO) are *not* “insurance”. That right there is what inflates the cost so drastically – what real insurance companies call “moral hazard”.

    Looking past healthcare, when you buy a no questions asked iPhone replacement policy – there is a significant “moral hazard”, with people going so far as to intentionally break their phone to get the latest model. This inflates the cost of the policies. (Limiting coverage period is one way to combat this.)

    If people only had *actual* health care insurance, not some HMO, it would be a huge improvement.

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  27. Go Doors
    Go Doors March 14, 19:35

    Turning our heath care system over to the Government seems like putting the fox in charge of the hen house, as they created this mess. If the government wants to legislate, why not dictate defined tiers of coverage, ie (“Good”, “Better”, “Best”) that all insurance companies must use. So if you call a hospital, they can tell you the price of a procedure because the actual insurer won’t matter, just your coverage. Granted you might not shop if you have a heart attack, but many procedures are not critical. If you can shop, prices will come down.

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  29. LFRD
    LFRD July 12, 22:38

    I’m SO GLAD someone finally GETS IT. I don’t have and never have had insurance, so I observe from my parents (who of course had it), to friends and family. As the wheel of the machine spins, I watch loved ones be wrapped up into a cocoon of doctoring and issues that if left to the patient to address, the solution could more than solved without our doctor/hospital/pharma. Most people do not understand me when I praise the fact That I am glad I don’t have insurance. I couldn’t explain it to them. They are already wrapped up into the machine. Thank you for this perfect article.

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  30. John from the UK
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    Wow what a post and the comment section is on fire here!

    It’s always really interesting see how you folks run things when it comes to health care over the other side of the pond (UK/US).

    Very very interesting read. Keep up the good work 🙂

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