The concern I have with this article is that it dances around the core problem with US health care, which is that the underlying market for health services is --- in most cases --- coupled directly and inextricably with the health insurance establishment.<p>It's all well and good to tell people to fund HSAs or buy health discount cards or get savvier about spending and buy generic meds. But a trip to the emergency room or a serious illness is simply going to max out your deductable, no matter how cost-conscious you are.<p>The core problem is that medical services are priced by colluding hospital chains and insurance companies, and those prices are both (a) deliberately decoupled from the actual economics of providing health care and (b) a fig leaf covering the way hospitals and insurers actually resolve invoices.<p>Unless/until you can extract the insurers from medical pricing, no amount of free market cheerleading is going to fix the problem. <i>We don't have a free market</i> to fall back on.
The crux of his prescription is to reserve insurance for the catastrophic, low-probability events like getting cancer or hit by a bus, but high-deductible catastrophic plans seem carefully calibrated to make you go bankrupt anyway. Given any other choices at all, I wouldn't trust my heath to one.<p>I reviewed plans with a health insurance broker in Washington state in September, who openly mocked some Regence (Blue Shield) coverage with a fifteen hundred dollar annual limit on "complex imaging", which means MRIs, CAT scans, PET scans, mammography, etc. He said, "Do you have any idea how many scans you'd get if you had cancer?", and that $1500 might cover most of the first one. If you missed that detail and got sick, you might as well not have insurance.
><i>"The second dimension is becoming savvier healthcare consumers."</i><p>Once you conflate patients with consumers, you have fundamentally moved away from a public health model towards a model where costs are based on what the market will bear rather than the costs associated with providing the service.
I can't believe people aren't tearing this asshole to threads. Between all the bullshit in his article, what he's really saying is this: let's pay less for health insurance by transferring more costs to the individual. I suppose you might support this if you're so deluded as to think lots of people are going to the doctors office because they're bored and have nothing better to do than have time consuming, often humiliating, uncomfortable to painful procedures and tests performed on them on a schedule that's extremely inconvenient. OTOH, those of us whose heads aren't firmly buried up our assholes think that people mostly try hard not to go to the doctor or hospital because the experience sucks, and so the way this Dave asshole is trying to save money is by discouraging <i>you</i> from getting health care you need by making it cost more.<p>ps -- people who don't straightforwardly acknowledge that health insurance isn't insurance, it's group cost pooling, are idiots who should be ignored in the health care debate. It's not insurance and shouldn't be because we can tell that in certain cases people will cost a lot of money to treat. Insurance would leave them out in the cold. Societies with integrity or conscience treat people anyway. Compare to insurance -- if you build a house in a flood zone on the florida cost, you should probably be told hell no -- no company will sell you insurance. If all the women in your family get breast cancer, we should still give you health insurance for when you get breast cancer.