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02/13/2006

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Richard Mason

Some of you argued that individuals who take out health insurance are at a "power" disadvantage compared to insurance companies. This is not true for car insurance, and I see no evidence that it holds for health insurance.

Perhaps I am misunderstanding the comparison, but individuals who self-insure their cars are indeed at a bargaining disadvantage relative to insurance companies. I can attest that auto body shops do not quote the same rates to an uninsured individual as those accepted by State Farm. This seems analogous to other commenters' anecdotes of paying higher medical prices with an HSA.

Bill

I restate my observation that HSA's do not provide a consumer any bargaining advantage for drugs, for example. The auto example is a good one--there is price discrimination. Moreover, since most individuals do not pre-negotiate their medical costs--they do not know when they are going to have an incident, unless it is a chronic condition--there is no way to pre-negotiate drug costs. Now, one of the respondents did mention that their Blue plan did have a program for drugs. It would be useful to look into that, because some of the Blue plans have spun off their drug procurement business into a for profit model--taking with them some very well compensated executives who now get stock options in the new business! Maybe this will all sort out over time, but, given that McCarran limits purchasers from creating national plans, don't hold your breath. What you are more likely to see is opportunistic price discrimination and the lack of any consumer countervailing power.

Bill

By the way, this is an opportunity to conduct an experiment: see what drug prices you get when you purchase individually, and what prices you get when you purchase as part of a health plan.

Krzysztof

I don't think that statesments about higher cost of medical services for high deductible plans vs traditional (HMO, PPO) are true. I had 2 different high deductible health insurances (with HSA accounts) and in both case I paid insurance company negotiated rates, just like with my previous PPOs and HMOs.
Both of my HSA/High deductible plans came from companies that put some money into HSA accounts and monthly cost of HSA/High deductible was much lower than PPO or HMO plans.

phistphight

www.runnydiarrhea.com

Dude

I think Becker & Posner fail to understand how incredibly short-sighted many ordinary people really are. For them insurance is a waste of money. Have they ever talked to ordinary people who lack insurance? Most of them can't even spell HSA!

abigail

That's very true...Its not possible for everyone to take benefit from this opportunity.

Joe Merchant


I don't know about "power disadvantage" of individuals vs insurance companies, but I certainly know that participation in group insurance can amount to 75% and greater savings as compared to individual insurance - that certainly seems to be a "power disadvantage" ot the individually insured.

Also, while I have never heard of a major group insurance premium tripling due to a single illness and hospitalization (that has no prediliction for recurrence), I have personally experienced this at the hands of Blue Cross while individually insured.

In a world where other industries compete based on price differentials of 25% or less, 2x, 3x, and even 5x disparities in cost seem to be more in the realm of power abuse than economic incentive.

www.runnydiarrhea.com

www.runnydiarrhea.com

David Locke

With automobile insurance, you have an accident, a random event, and you then get your car fixed, unless you are ensured with a company that thinks you give it money to do something other than cover your risk, so you get ripped off.

With health insurance, you get old, sick and die. It is going to happen. There is no risk. It is going to happen. You'd probably be better off not buying insurance, but getting annuities of some means. Then, you have the health insurance companies spending more time on denying claims than paying cliams. The employer gets away with this failure to honor the employment contract, because a third party is screwing you over, not them. And, of course, the insurance company isn't interested in paying claims at all. Doctors get paid well beyond any net-30 concept, and their cash flow cannot be factored or borrowed against.

If you do get old and sick, you will no longer be able to buy insurance. This just shows very clearly that medical can't be insured. You are really buying insurance, because you are well and healthy, and that doesn't carry any risk. How did medical insurance ever come to be?

corwin

Re'Not buying health insurance until you're old
1)The catastrophic coerage is a necessity,if you have any assets.
Re'the cost of medications.I can be minimized by buying larger sizes and splitting pills.For instance;Liptor 80 mg=$100/month;same price for a month of 20 mg.My patients are on 1/2 pill alternate days for a 75% saving.Blood pressure;beta blockers,Ace's are generic.Cost=$15/month.Baby asa$1/month.Oral diabetic meds=$12/month.
Certainly not everything can be downsized,but the vast majority can.But the patients have little inceentive to try to save and the doc has none.

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