Care Without Insurance
Wednesday, September 10, 2008Fire the Insurance CompanyBy John LaPlanteCategories: Care Without Insurance, TexasThe Texas Medical Association reports on a small movement among doctors, especially what we now call "primary care physicians," to fire the insurance company. The reasons are several, but one gets to the desire to spend more time with patients and less time with billing clerks. Said one physician, "the insurance system that pays physicians is a volume-driven system that doesn’t allow for the extra time you need to spend with some patients."
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Friday, August 8, 2008Getting to Know the UninsuredBy Grace-Marie TurnerCategories: Care Without Insurance, Insurance RegulationIn Tom Miller's detailed AEI analysis of trends in the number of Americans without health insurance, he says the broader issue of slowly-declining rates of insurance coverage in the United States remains more a chronic condition (needing better diagnosis and more than one kind of treatment) than a crisis (needing emergency surgery). Universal mandates to purchase coverage won't work as long as people can't afford it, taxpayers won't subsidize it any more than they already do, and politicians won't enforce unpopular rules to buy it anyway, writes Miller. Reversing decades of overregulation, mistargeted tax subsidies, and lack of transparency in the health care sector would not solve all problems, but it sure would help.
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Wednesday, July 30, 2008WSJ Hit Right Notes on Bay State Budget Blues PieceBy Paul HsiehCategories: Care Without Insurance, Insurance Regulation, Massachusetts, Nanny StateThe Wall Street Journal's oped this week criticizing the cost overruns of the Massachusetts "universal" health care plan is right on target. It's important to recognize that all the problems outlined in the piece arise from government interference in the free market. Patients, providers, and insurers are not allowed to negotiate voluntarily in the free market for their mutual benefit, but instead must do so under constraints designed to somehow guarantee health care for everyone. Adverse economic results are a consequence of this basic violation of their right to contract.
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Friday, July 4, 2008Charity Care: Why and HowBy John LaPlanteCategories: Care Without Insurance, UtahThere are many possible ways to obtain health care. One that does not receive enough attention is charity care. The Sutherland Institute, a Utah-based state policy organization, offers 10 Principles for Authentic Charity Care (PDF). The institute says that the needy uninsured should receive health care even if they can't afford it -- but without government involvement. It calls for a rethinking of what "charity care" means so that it is non-bureaucratic and freely given, not a new law or government program. The institute emphasizes moral obligations but does not create new rights--and thus draws on the helpful principle that a need can be real without turning into a government program.
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Thursday, June 26, 2008Cash Only, PleaseBy John LaPlanteCategories: Care Without InsuranceIf you're a doctor who running out of patience dealing with private and public bureaucracies, check out the the guide How to Start a Third-Party Free Practice, by the Association of American Physicians and Surgeons.
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Wednesday, June 25, 2008I've Nearly Lost My MindBy John LaPlanteCategories: Care Without InsuranceComment on a recent NYT article about the state of the medical profession, Dr. Helen Thomas says "I handle all of my own paperwork for Medicare, TennCare and other various insurance companies and have nearly lost my mind with the mind-boggling paperwork." To be sure, private sector bureaucracy can be as terrible to deal with as government bureaucracy. One reason is that government has imposed itself so strongly into the private practice of medicine. Another reason, at least in medicine, is that our tax laws and cultural expectations set us up for third-party payment--which means, again, bureaucracy. Taking steps to make insurance more affordable is great. Anything that avoids the need to deal with insurance may be even better.
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Tuesday, June 10, 2008Put Down the ShovelBy John LaPlanteCategories: Care Without InsuranceWhen you're in a hole, stop digging. That cliche has some wisdom when applied to health care policy. Writing for the group Americans for Free Choice in Medicine, Richard E. Ralston says:
Ralston then offers seven principles for reforming health care. My favorite, perhaps: generous tax exemptions to promote charity care.
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Monday, May 26, 2008Beyond Politics, Beyond Policy, Beyond ProfitsA different model of meeting health care needs By John LaPlanteCategories: Care Without InsuranceGetting public policy right is one way of improving human life. Another may be to avoid, as best as one can, policy altogether. You know about the tradition of community barn-raisings that are common among some Amish orders. A barn burns down? Neighbors come from around to rebuilt: No insurance claims, no insurance hassles, and certainly no government programs. Very roughly speaking, that's the model behind the Alliance of Health Care Sharing Ministries, though it's not necessary to "go off the grid" to participate. Here's a description of how it works:
A shared religious faith and identity can serve as a powerful glue to make the whole enterprise work, though people who wish to start such an endeavor on some other basis would be doing a public service as well. Currently, 10 states exempt organizations such as Samaritan's Ministries and Medi-Share from insurance regulations that might trip them up. According to Medi-Share, the State of Missouri offers tax deduction for payments to a "health care sharing ministry as defined in section 376.1750, RSMo." That's going to provide a modest financial benefit, at best. But it recognizes that there's more than one way to address the financing of medical care.
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Thursday, May 22, 2008Charity Care in ActionBy Grace-Marie TurnerCategories: Care Without Insurance, New JerseyThe way to care for the poor is through true charity — not government "charity" devised by politicians, writes Dr. Alieta Eck, a specialist in internal medicine and founder of the Zarephath Health Center. Government should step aside and let the physicians and the communities work together to solve the problem. For example, the Zarephath Health Center, which started in 2003, is open only 10 hours a week and yet currently provides free care to 200 patients per month — completely through the kindness of volunteer doctors and nurses. Expenses last year totaled $44,000, so calculations tell us that the physicians provided care, including free medicines, for an average of $22 per patient visit, writes Dr. Eck. Compare that with the average hospital ER visit of well over $1,000. Patients at Zarephath were grateful as they understood the sacrifice of the unpaid staff, and many transitioned to private physician offices once their financial situations improved, writes Dr. Eck. These patients might not still have New Jersey's overpriced health insurance, but they can pay something toward the real cost of their care, knowing that a backup of a free clinic still exists should they fall into hard times again.
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Tuesday, April 8, 2008Charity Role Puts Strain on HospitalsWhere tax breaks, profit, and the uninsured meet By Paul GessingCategories: Care Without InsuranceI found this article on a situation involving a non-profit hospital's going out of business interesting. The hospital in question is St. Francis Hospital & Health Center in the Chicago suburb of Blue Island. The hospital has recently announced that it will close its doors because providing for the poor is too big a drain on its parent, SSM Health Care, a Catholic-run organization that operates 20 hospitals and makes a profit, partly because it has tax-exempt status. In Illinois, Atty. Gen. Lisa Madigan is pushing for ways to require hospitals to provide a specific percentage of revenue as charity care, or information on the discounts hospitals provide for some patients. Ultimately, however, it seems unlikely that more regulations will really do much to improve access to health care for the poor or anyone else. The real question is, "What obligations do tax exempt hospitals have to serve the community" as opposed to being a viable operation? Even without serving a single poor person, hospitals obviously "provide a community benefit," but is it worth giving non-profit status to certain hospitals and, if so, should they be expected to do more than others? Those are difficult issues for sure, but burdening non-profit hospitals with more regulations is not going to help matters. Answering important questions about how to justify non-profit status might.
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