Obamacare

Supply Side Health Care Reform

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Could the Netflix model work in health care? A doctor's office in Rochester, New York is aiming to find out. Good MD, a primary care office set up this year, charges patients a single, flat monthly fee for unlimited visits. Monthly charges are based on age, and extra services—whether stitches or strep throat tests—are provided for an additional fee, posted online and in the office. The practice doesn't accept private insurance at all. The result is a system that benefits not third-party payers, but doctors and patients, Good MD founder Dr. Thuc Huynh, told local TV station WROC. "Insurance isn't who reimburses me or dictates what we do together in terms of our treatment. So, it's a direct financial relationship."

This is what the future of health care reform could look like: It's provider-driven. It's consumer-focused, with an emphasis on both price and service. And while Good MD isn't the only doctor's office to try variations on this model, it's happening at the margins—at individual practices across the country. 

As Obamacare's has settled into place, the Republican party's promises to repeal and replace the law have stagnated. The law is still unpopular, but the coverage expansion has made the already difficult prospect of repeal harder than ever, and despite years of promises, no obvious replacement plan has emerged. Obamacare's critics in Congress are still opposed to the law, but increasingly seem unsure about what to do instead.

Provider-driven experiments like what's happening at Good MD could help point to a different way of thinking about the problem.

"[Obamacare] repeal is at least not immediately practical," says Robert Graboyes, a Senior Research Fellow with the Mercatus Center focused on health policy. "And to replace you need something to replace it with." That's a problem too, he says, because in order to craft a large-scale replacement bill that enough people could agree on, it would likely be necessary to jettison or weaken many important provisions.

Instead, Graboyes suggests that health care reformers look to supply-side reforms—small-scale fixes that make way for innovators to improve the system. 

It's a way of thinking about health care reform that emphasizes distributed improvements over centralized solutions, and that works from the assumption that lots of minor improvements can sometimes work better than one big overhaul. 

He describes the approach as a "World War II Pacific theater island hopping strategy—where you've got ten-thousand islands, you go after a few of them now, and you keep folks surprised as to which ones you're after." The work would be done piece-by-piece, and it would be focused on small victories rather than grand plans, with the understanding that just as markets make change at the margins, so should policy reformers.

Last year, Graboyes published a short paper outlining his principles for reform. Those principles include rewards for innovators, autonomy for providers, choices for consumers, and meaningful, transparent prices throughout the system. The essential idea though, is this: Find ways to transform the health system into a market, and then let the real reforms happen from the outside in.

At full scale, some of those reforms would be politically difficult—perhaps even more so than repealing Obamacare. But that's where the island-hopping strategy comes into play.

In the paper, for instance, Graboyes urges a move toward "a seamless market," without the fragmentation that results from the U.S. health care system's layered design, with Medicare, Medicaid, employer-sponsored coverage, and now Obamacare exchange plans all working through different silos.

That's an impossibly big job. And Obamacare, which builds on top of the existing layers, "severely limits the extent" to which this can be done, Graboyes says. Indeed, it makes the problem worse by organizing exchange-based insurance into overly standardized, government-defined tiers of insurance. This creates additional "gulfs of separation" between different types of insurance. And yet with a willing administration, he argues, this could be addressed administratively, through regulatory changes, by allowing greater flexibility for health plans.

Graboyes also points to the massive problems with Medicare's pricing formula, which distorts the practice of medicine (doctors do what they are paid to do) and drives up costs. The pathologies created by this system, he writes, "comprise the single greatest challenge to America's fiscal stability and the single greatest obstacle to health care innovation."

Yet there's clearly no way to fix its problems all at once. "That task would be so huge, and so overwhelming and so hard to encapsulate in a few words that the conversation dies," Graboyes says. Reformers should therefore attack the biggest and most obvious problems first, with the goal of slowly untangling the mess left by decades of price controls.

There are other islands to be taken as well. Various laws and regulations that inhibit specialty hospitals would have to be dealt with. "A lot of the really important reforms are going to have to happen at the state level," Graboyes says. These include overtly anti-competitive policies such as professional licensing requirements and Certificate of Need rules that require providers to obtain permission from local officials, who in many cases are simply acting on behalf of incumbent competitors. In many cases, state-level reforms have the advantage of being an easier lift politically than changes to federal law.

And while it is in some ways a different task, reforms at the Food and Drug Administration could help too. "We have built an information structure [at the FDA] that forces everything through narrow strictures," he says. That might have made sense decades ago when information was hard to acquire, but now we have the opposite problem: an excess of information. The old approach, which relies on centralized chokepoints, is out of date.  

Ultimately, it's the profusion of chokepoints that have taken hold of the health system that Graboyes wants to get rid of. The hope is that doing so, bit-by-bit, over time, will free up providers and consumers for even more experiments, many of which we can't even conceive of now, above and beyond Good MD's direct-care model. "There are so many small pieces we could begin doing now," he says. The first step is to start doing them.

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  1. Excellent idea attacked for being anti-poor in 5, 4, 3, 2…

    1. This excellent idea is anti-poor.

    2. It is a fine idea, but it isn’t a solution. It is part of a solution because it is a process. And no one is attacking it for being anti-poor. The problem is that health care does not exist, and never has in the modern sense of the term, within a simple market. Health care is not toothpaste or cellphones that is a simple supply and demand of goods and services. It also is not national defense or fire protection which most people agree (even hyper-libertarians) are a bit beyond normal market forces. Health care is somewhere between the two and no amount of free-market chants can change that basic aspect of health care. By the way, I don’t particularly like Obamacare – but it might have actually helped for the far right to actually honestly engage in health care reform rather than abandon its responsibility to lead. It is lazy to blame without a solution.

      1. The problem with “Healthcare Reform”, like the problem with “Campaign Finance Reform”, as well was a great many other reform issues, is that the sensible way to go about it would be to remove, all at once, all the Government Meddling in the market, and then take a short time to see where that leaves us.

        The Healthcare situation has, for decades now, been a matter of whomping up a new “Reform” package to deal with the dislocations caused (at least in part) by the last “Reform” package. So we keep slapping on band-aid on top of another without examining the actual wound. The same is true for Campaign Finance. We are never going to straighten these ongoing clusterf*cks out until we dismantle the pile of failed regulations they stagger under.

        But admitting that the Government has been making things worse for decades would make the status quo seriously seasick. So the Political Class isn’t eager to do it.

  2. We can wage war all over the globe, killing millions of people over time, and physically and mentally maiming people for life, but when it comes to talk about healthcare, the subject is treated almost as if it were “evil”. Apparently war must be “good” and healthcare “bad”. Anyway, when the Republicans gain control of the country again (probably as a conservative dictatorship posing as a democracy), they will get rid of healthcare reform, and probably a host of other things.

    1. It’s pretty obvious by your comment that you never read (or maybe didn’t comprehend) the article. It’s inconceivable that anyone with two spare brain cells could defend the bloated dysfunctional system we have.

      1. I like defending bloated dysfunctional systems.

        1. Oh, I see. The person spoofing your handle at 10:44 just dropped the period off.

      2. the article was about people who
        have money, goober

        1. Don’t waste your time responding to me unless it’s something pertinent. I don’t waste my time responding to obvious trolls.
          That is all.

    2. On The Road to Mandalay:

      We can wage war all over the globe, killing millions of people over time, and physically and mentally maiming people for life, but when it comes to talk about healthcare, the subject is treated almost as if it were “evil”. Apparently war must be “good” and healthcare “bad”. Anyway, when the Republicans gain control of the country again (probably as a conservative dictatorship posing as a democracy), they will get rid of healthcare reform, and probably a host of other things.

      Yeah, that’s my read on the USA: America is screwed up, and by screwed up, I mean republicans.

      I feel sorry for people who don’t grow up enough past middle to school to see past the two-party system.

      1. if your talking libertarians, they are a bunch of wackadoo’s whose ideas
        have no basis in reality, that’s why they
        are part of the lunatic fringe

      2. War is about breaking things; that’s fairly simple. Health Care is about fixing people; that’s relatively complex.

      3. Right on, man. It’s better voting for self-righteous third parties who get 1% of the vote. They don’t have to bother pandering for votes so they can appeal to right-wing cult group members like you.

        even better is to tell people I don’t vote at all. Some might call me a smug asshole, but fuck them, because I know I’m right and they’re just a bunch of no-nothing duopolists

  3. The problem is always going to be the outliers. Sure any of us who have a job can afford catastrophic insurance to cover big unexpected healthcare crisis and pay as we go for check ups and maintenance medication. It will make healthcare more profitable to physicians and cheaper to clients, but the people with rare diseases and true disabilities like cerebral palsy, will always be used as the excuse for universal healthcare and laws requiring hospitals to give care away for free. The obvious answer is charity but good luck getting people to have faith that it will all workout for the most vulnerable. The people want assurances and that is what politicians offer. They may not be able to back it up, but they will make the promises. That is why I’m not too optimistic about a free market in healthcare.

    1. if only we were smart enough to realize what outliers are. instead, we crafted the system based around the worst case scenario. it’s like we crafted the system on the assumption the entire country is going to get cancer at the same time.

      1. The people I feel bad for is those born with a disease that makes them unable to be productive. No insurance company is going to cover someone with a lifetime debilitating illness. I would expect an organization of charitable hospitals would get enough donations to operate but I can’t be sure. I know the American people donated tons of money to the Red Cross to help Thailand, I am skeptical that that they would be less willing to help fellow Americans.

        1. St Judes only gets about 10% from government grants based on my research.

          Local hospitals should have charity drives and/or local and state governments should take care of their own as well.

          1. in other words, your fine, screw the poor

          2. Yeah and doctors should be paid with chicken and root crops ? time to leave the 13th century my friend. The beginning of large heath care systems in the West began when Charlemagne helped set up hospitals that were funded and managed by the Catholic Church. That was NOT by donations because tithing back then was the same as taxation now. Charities never have supported urban hospitals anymore than they supported fire departments or road construction. St Judes only exists with that model because it is a small part of a fringe segment of a much, much larger health care market. Guess what would happen to St Judes if it had to compete with EVERY hospital in the country?!

        2. Avik Roy suggests richly subsidized high-risk pools for these people.

          Supporting Americans who are born with a debilitating disease is something I’m willing to pay some tax dollars for, as long as those people get a stipend or voucher for efficiently administered quality care and supervision as needed.

          1. If you could direct taxes, I would mind paying them. But what politicians do is skim tax dollars and underfund popular items. That way they can always call for more taxes to fund what is popular.

          2. Supporting Americans who are born with a debilitating disease is something I’m willing to pay some tax dollars for, as long as those people get a stipend or voucher for efficiently administered quality care and supervision as needed.

            This is one of the most inane lines of argumentation, and yet so many people use it.

            Taxes are coerced. If you want to pay for something, then just fucking pay for it. You don’t need somebody forcing you to do things you already find worthwhile to do.

            1. “If you want to pay for something, then just fucking pay for it. You don’t need somebody forcing you to do things you already find worthwhile to do.”

              Hmm, I think you just topped the list of inane arguments right there.

              1. Reading comprehension isn’t your strong suit, is it?

    2. I believe (and follow) the catastrophic health insurance approach, my policy has a $10,000 deductible. The ACA will probably force that policy to be canceled.

      As to the outliers, it’s not just the people with “rare diseases and true disabilities” that had trouble getting health insurance prior to the ACA — even catastrophic plans. I speak from personal experience as somebody turned down for coverage, as was my spouse, and as a licensed insurance agent since 1983.

  4. Right. Go ahead and propose that to the American people…a new system that will replace the one they have. And in this new system, you STILL would be dealing with third party payers, because you still would need at a minimum catastrophic insurance, because you really don’t want to be paying for that transplant out of pocket, do you?

    And in some of these concierge systems, doctors are charging as much as $2500 to even $15,000 per year. By the way, note below that its physicians using it to boost their income…not to provide more cost effective service.

    http://www.physicianspractice……ice-income

    Tell me, Peter, if this is the face of a new health care system, such as you say it is, are you willing to take your family off of the health insurance you currently have in order to take part in it? At least if you said yes, it means you are willing to do what you suggest others should eventually do. Somehow, I doubt it.

    1. The only solution is to turn all of healthcare into the model of efficiency and efficacy that the VA represents.

    2. I would certainly be willing to if it was still legal to purchase catastrophic insurance. But since it’s not, I have to maintain the bloated, unnecessary policy that I currently have.

      Regardless, though, your point is a non-sequitur, since there’s room in a true market for all kinds of policies. One can buy service plans for cars that cover routine maintenance if they wish to. Most people choose not to for some mysterious reason.

      1. I don’t disagree…let them create those practices. No problem. But if you think that system will replace what we currently have, I would disagree.

        1. But if you think that system will replace what we currently have, I would disagree.

          The current system does have the competitive advantage of being compulsory, so you’re probably right, you’re just incredibly fucking stupid.

          1. when it comes to stupid your no slouch
            without the current system (obamacare)
            you’d have single payer, airhead

            1. “You’re” is a contraction of “You Are.” “Your” indicates possession. I’ll give a pair of examples: You’re stupid. That is your stupidity.

    3. The third party point is a good one. It could be handled with catastrophic coverage policies and direct reimbursement to the customer, who would then pay the other parties, allowing the market to work efficiently.
      I would leave the current system, pay for services out of pocket and pay for catastrophic coverage. Oh, wait. That’s exactly what I’ve been doing for years. Obama promised I could keep my plan. That’s a huge relief.
      I had to have MOHS surgery a few years back and the physician could barely answer a simple question about the cost involved. Somehow I doubt the same doctor would permit me to install a wood floor for him without having some idea of the cost beforehand.

      1. I had MOHS myself. I wonder it that would be considered “catastrophic” under most plans, since it took about just an hour. Maybe, because its cancer. But there are plenty of other medical procedures that cost plenty and are not catastrophic. Just paying for them out of pocket would put a severe crimp in anyone’s budget.

        1. I wonder it that would be considered “catastrophic” under most plans, since it took about just an hour.

          What does or does not constitute “catastrophic” would normally have absolutely nothing to do with the length of the procedure. But that aside, there’s really no need to wonder: you could always read your policy.

        2. But there are plenty of other medical procedures that cost plenty and are not catastrophic.

          Largely attributable to the fact that both consumers and providers are completely disconnected from the price in our current system.

        3. Just paying for them out of pocket would put a severe crimp in anyone’s budget.

          If saving your own life is not worth a little crimp in your budget, then I guess you don’t really value your life that much.

          And if the procedure isn’t life-saving, then it’s a luxury not a necessity and there’s no reason for other people to subsidize it.

          1. kbolino|9.30.14 @ 1:29PM|#
            “If saving your own life is not worth a little crimp in your budget, then I guess you don’t really value your life that much.”

            Yep.
            I love the nitwits who bemoan that ‘people go bankrupt paying for life-saving medical care!’.
            I guess bankruptcy is far more appropriate when you overpaid for the 60″ flat-screen.

      2. To be fair your doctor doesn’t know because depending on who pays the bill the price changes. If it was cash for service then it would always be the same price. Some outpatient surgery centers are listing cost for service and not taking insurance as a real world example.

        1. My MOHS scenario happened at a local Dermatology PA. I explained that I had a catastrophic, high deductible plan and inquired what my costs would be. It was quite clear that the doctor was not prepared for the question but he did manage to muddle through something well enough for me to decide. Instead of going to the hospital, the practice could do it at their other facility, within a mile of my home, for less than my deductible level.
          I thoroughly welcome the scenario you mention. It works for my dentist.

    4. Tell me, Peter, if this is the face of a new health care system, such as you say it is, are you willing to take your family off of the health insurance you currently have in order to take part in it?

      This is the same horseshit argument people use in school choice debates. “Hurrr durrrrr, you’re a hypocrite for participating in a system you’re compelled to support by force”. I’m actually really impressed you were able to regurgitate it in multiple contexts though.

      1. Thanks.

      2. I really like the “did you got to public school when you were a child? Yes. Then you owe taxes until you are dead.”

        Never mind I never asked to be born, had no choice in where I grew up and my parents are forced by law to send me to school. But hey who ever expected an honest debate by a statist.

        1. I disagree…Peter is not a statist. But your point about him being unfair, since he would not opt out of his insurance for this new plan, is a good one.

          1. Like he has a choice about giving up his plan. People with guns have forced him into his plan.

            1. Wow, you are why most people don’t trust libertarians.

          2. I was referring to the social contract you sign by being born argument, not to any particular person.

          3. So is it unfair that Barry takes a charitable deduction on his taxes when he thinks the rich should pay more? Yeah, thought so.

  5. Some doctor(s?) in New York tried that Netflix version of basic health care a couple of years ago and were forced by someone — city, state, can’t remember — to raise their prices. I read it in the Wall Street Journal, can’t remember any other details.

    Anyway, good luck to anyone wanting to provide basic healthcare at a reasonable price.

  6. Looks like someone (since yesterday) has assumed my posting identity, thus having me as posting things which I did NOT post, and do not originate with me.

    Well, you got your wish. Have to hand it to you. You are clever. You are getting rid of someone only because you don’t like their opinions.

    Looks like you win, and I really will have to QUIT this site. Have fun kissing each others’ libertarian assholes.

    1. On The Road To Mandalay|9.30.14 @ 12:34PM|#
      …”You are getting rid of someone only because you don’t like their opinions.”…

      No, it’s your abysmal ignorance.

    2. Is this your last post ? Again ?

  7. Since when does everyone buy into this “replace” nonsense? Do you really want to replace AIDS with cancer? Because that’s essentially what these douchebags are talking about with this “repeal and replace” talk. Radical idea: a market-driven health care system.

    1. “Radical idea: a market-driven health care system.”

      Can we spring Bernie Madoff to run the thing?

      1. craiginmass|9.30.14 @ 4:52PM|#
        “Can we spring Bernie Madoff to run the thing?”

        “Since 1991, Madoff and his wife have contributed about $240,000 to federal candidates, parties and committees, including $25,000 a year from 2005 through 2008 to the Democratic Senatorial Campaign Committee.”
        http://en.wikipedia.org/wiki/Bernard_Madoff

        Yeah, we need more D’s handling the money.

    2. Radical idea: a market-driven health care system
      hey, goober, that’s what got us into this mess in the first place…DUH

  8. Wait!

    That sounds exactly like an HMO or most private insurance!

    They pay per month per patient.

    Now you’ll have to make up why it isn’t the same……sure, insurance companies have to do admin (15% cost under ACA), but I suspect that this is a cost which is hard to avoid – billing will cost someone money.

    Good One!

  9. I’ve looked at some of docotor’s offices that have Netflix style care. They were all far more expensive than any other doctor I’d ever seen. They charged as much for one month as many other doctors charge for a single visit…probably due to moral hazard. They will not the future. Pay-per-service will probably be the cheaper alternative.

  10. Ok, so he’s reinventing the HMO, …

    …the system destroyed by changes in tax code in the US during the Reagan years to make it possible for for-profit insurers to compete with not-for-profit Blues which were doctor and hospital coops that did what Good MD is doing as a group of doctors owning a prepaid service payer, and not-for-profit HMO that had the doctors and facilities getting prepaid for caring for patients directly.

    In health care, nothing is new, just the same old things rewarmed and delivered as innovations a decade or two after the same conservative groups attacked them and progressively destroyed them.

  11. Good luck. The Left would fight even the smallest market-based change from the current pathological system. It would have to be shoved down their throats.

    A lot more likely scenario is that the system will continue to be made worse and worse, with more meddling from insurance companies, politicians, etc.

    1. Healthcare reform circa 1965; “We tried the free market and it didn’t work! The remnants of New Deal era wage and labor policies represent a market failure that requires state intervention to fix.”

      Healthcare reform circa 2010; “We tried the free market and it didn’t work! The grossly inflated prices brought on by the AMA price controls and the Medicaid/Medicare bureaucracy represents a market failure that requires state intervention to fix.”

      Healthcare reform circa 2064; “We tried the free market and it didn’t work! Obamacare represents a market failure that requires state intervention to fix.”

      Healthcare reform circa 2084; “We tried the free market and it didn’t work! The reform of 2064 represents a market failure that requires state intervention to fix.”

      Healthcare reform 2100; “The humans had their chance at civilization and it didn’t work! Now those who remain must kneel before their new robot overlords! All hail President 01010101010101!!!”

    2. “A lot more likely scenario is that the system will continue to be made worse and worse, with more meddling from insurance companies, politicians, etc.”

      Yeah, with any luck we can go back to the GW days when premiums advanced double digit each year and you got turned down or thrown out because you were born with a wayward gene!

      That would be heaven on earth! Soon we could get to 25% of GDP, then 30%. Imagine all the jobs!

      1. craiginmass|9.30.14 @ 4:54PM|#
        …”Yeah, with any luck we can go back to the GW days when premiums advanced double digit each year and you got turned down or thrown out because you were born with a wayward gene!”…

        Yep, asshole. Your fave lying bastard got us right there with even higher premiums and a whole new federal bureaucracy to boot.
        I’m sure assholes like you are just thrilled.

  12. Misuse of the term supply side, this is “marketplace” healthcare.

    The problem with marketplace healthcare is it doesn’t address the real need for insurance, which is serious injury which leads to crippling financial debt. Most American’s don’t require insurance for basic medical needs, but overtime the insurers have co-opted the system for profit.

    I’m good with this, but it doesn’t address the following:
    1) Serious injury that leads to financial bankruptcy or close
    2) cover those who don’t earn enough to afford basic medical because they are to young to work, or because there wages are so low they don’t visit the doctor and many times only go to the emergency room, which we all pay for in the long run.
    3) Such private companies have the right to refuse and therefore those with disabilities or pre-existing conditions will soon be relegated to the sidelines so companies can enhance profit growth.
    4) Not sure what is covered and as anyone who has dealt with both providers and insurers can tell you, because of the complexity of Health Care it’s difficult for the consumer to actually understand what they are buying and what’s excluded. In situations such as this, putting some government standards and regulations always trumps the free market because consumers are at a disadvantage in knowledge for services that are complex, costly, and infrequently used.

    1. The problem with marketplace healthcare is it doesn’t address the real need for insurance, which is serious injury which leads to crippling financial debt. Most American’s don’t require insurance for basic medical needs, but overtime the insurers have co-opted the system for profit.

      It’s only financially crippling because of healthcare restricting policy. Ask yourself why it is that in every other industry in existence, innovation lowers costs and increases access to goods and services. But in healthcare this is the opposite. So either there is some sort of system-wide unnatural distortion taking place in this industry or the healthcare industry is magically exempt from the laws and principles of economics.

      2) which we all pay for in the long run.

      Yes taxation to cover private debts does unnecessarily increase costs.

      . In situations such as this, putting some government standards and regulations always trumps the free market because consumers are at a disadvantage in knowledge for services that are complex, costly, and infrequently used.

      It’s complex because of that regulation! Free markets incentivize entrepreneurs to make their products more salable. Regulatory bureaucracy incentivizes entrepreneurs to use the coercive hand of the state to build and keep market-share. The only trumping of the free market that the government is capable of is kind where a man with a gun trumps a man without a gun.

    2. So you are arguing that a system largely fucked up by government since Roosevelt requires more government to fix it….BRILLIANT/progderp

  13. What do you do if you’re out of town and need medical care?

  14. There’s a viable solution just sitting there waiting:

    1) Allow cross-state purchases of insurance, as regulated by State Insurance Departments.
    2) Indiana is very advanced in Catastrophic/Health Savings Accounts products
    3) Cat/HSA was added to the menu for Indiana’s State Employees in 2005. That year 4% chose them.
    4) Cat/HSA was chosen by 92% last year. They have over $40 million of THEIR OWN money in their accounts, and the State has saved tens of millions because HSA’s FIX INCENTIVES.
    5) Watch the shift over, the Death Spiral of Obamacare and PPO/POS products, and drink a toast….

    Should add Cat/HSA’s to Medicare as well, to fix that program. Indiana put Cat/HSA into Medicaid and it’s working out well for them there as well….

    1. Just abolish the FDR era tax incentives for employer provided healthcare, abolish the Medicaid/Medicare bureaucracy and eliminate the AMA’s authority to price fix procedures and accredit medical schools. Basically every single problem is traceable to these policies.

      1. “Basically every single problem is traceable to these policies.”

        Actually, most problems are traceable to hot dogs, breakfast cereal and milk since it’s well known that all who have partaken in them created this mess!

    2. your number one is hilarious
      did you even bother to read what you wrote?

      1. I am loathe to give credence to this troll, but I must agree that the first point (“Allow cross-state purchases of insurance, as regulated by State Insurance Departments”) is kind of self-defeating. State departments of insurance can regulate providers within the state, but my commerce with providers in other states is not subject to their jurisdiction.

  15. That system is what we have here in Mexico. I have govt. insurance for $29/month which covers everything, but of course is bureaucratic and slow.

    So we often go to private doctors and clinics which charge as little as $2 to see a real doctor. Specialists charge from $14 to about $40 for a visit.
    All lab-work and most medicine is available WITHOUT prescriptions. Drug prices are highly competitive.
    Come on down and try it! Back in the 80’s we flew from the USA to Mexico for surgeries etc. and a nice vacation because we had no insurance.

  16. This experiment is fine and may even be some benefit to people as it will encourage them to visit the doctor for wellcare. It could prevent some large expenses down the road.
    It is no solution to health care for our country though. What happens when you visit the doctor and he discovers a serious problem. Almost no person in the US can afford to pay for any serious, prolonged disease out of pocket.
    That is what insurance is for. We can all have opinions on what form insurance should take but it is absolutely necessary.
    Those that tout “charity” as an answer are delusional.
    Libertarians have a lot to add to a political discussion because self interest is a powerful motivator. Some of those ideas may actually be incorporated if they would stop pretending self interest and the profit motive were the only considerations.

    1. We can all have opinions on what form insurance should take but it is absolutely necessary.

      So we can all have opinions in the narrow box you provide. How generous of you!

      Those that tout “charity” as an answer are delusional.

      Well yes, after you systematically destroy the viability of charity hospitals and clinics, it is unsurprising that so few of them remain.

      At the end of the day, though, if you can’t do it for yourself and you can’t convince somebody to do it for you, then you don’t deserve it. Anything else is theft.

      Some of those ideas may actually be incorporated if they would stop pretending self interest and the profit motive were the only considerations.

      Self-interest is the only consideration in a human being’s mind. The politicians you elect? Self-interested. The people you appoint as tax collectors? Self-interested. The doctors who will treat you? Self-interested.

      The foolishness you have is thinking that there is some other motive. That you can somehow find perfect or at least perfectible people through sufficient application of good intentions. They don’t exist; never have, never will.

      1. One quibble. Insurance is a legitimate part of a free market in health care. Of course I am referring to catastrophic or emergency insurance.

  17. I am a doctor who just left the field, partly because of bureaucratic BS and declining pay for the same services over my 28 years of practice. This practice’s “experiment” is illegal almost everywhere in the US, as it constitutes the unlicensed provision of insurance. I wonder who these docs had to blow to get those regulations waived?

    1. “his practice’s “experiment” is illegal almost everywhere in the US,”

      And so is direct to consumer drug advertising and a lot of other stuff.

      Here it’s all about skewering everyone – docs included. That’s the “free market”. If some fat cat behind a desk somewhere is smarter than you, has more capital and political connections and is more ruthless and predatory, all your “caring doctor” stuff goes out the window to the altar of profitability.

  18. As someone approaching 70 who has lived a life never making enough money to be vested in SS or Medicare , I welcome the blooming of a retail health market , essentially just ignoring as far as possible the elephantine bureaucracy governmental interference in the medical market has created . I look forward to online shopping for the best service at the best price I can find around the CO Front Range .

    I think there must be many others , eg , immigrants and visitors , who also would welcome more retail competition .

    I saw when last in NYC that some drug stores now have a doctor in residence . That seems a damned useful vertical integration given the horrendous burdens placed on just getting appropriate medicines for clear-cut symptoms thru the USA prescription proscriptions .

    1. “As someone approaching 70 who has lived a life never making enough money to be vested in SS or Medicare ”

      Really?
      !0 years of working with you and your spouse?

      That’s not much of a barrier.

      At the same time, I like the idea of all these retail health services for most common needs. It’s underway already – got my shingles vaccine at the rite aid.

  19. Obamacare is impossible to repeal because something has to replace it. That really says it all.

    The entire debate has been framed by the statists/leftists. Reform is essential! The government must involve itself MORE! Right from the get go, the entire debate ignores the question of whether rolling back regulation instead of adding to it was thrown aside. The Democrats argued that reform was essential, the media towed the line, and the Republicans caved on that point. Now, we are stuck in a situation where they must present an alternative to something that wasn’t necessary to begin with. Dems addressed a problem created by decades of government bungling with more government bungling.

    Libertarians are a fringe. Libertarian ideas aren’t even considered worthy of debate. Meanwhile, progressive ideas which have mostly failed everywhere implemented are front and center. This is how the pendulum in this country increasingly swings to the left, and why the right somehow gets viewed as having become unreasonable while the Dems have moved further on their platform.

    There is an alternative from the right/libertarians – it just involves the government doing less, which is inconceivable to most Americans.

    1. “This is how the pendulum in this country increasingly swings to the left, and why the right somehow gets viewed as having become unreasonable while the Dems have moved further on their platform.”

      BULLSHIT.

      Heck, Nixon suggested employer paid health care (forced) and we on the left have been shooting for universal health care for decades – if not longer.

      And what did we get? The Newt Gingrich/Heritage Foundation plan. Weak, but arguably better than nothing because we are adding real health-based reforms to it (preventative care, health education, science-based approaches, limits in profiteering, clamping down on fraud).

      Framing that as “the left got it’s way” is unReasonable….

      I will agree that Libertarians are a fringe….currently one that would not exist without both funding from a few billionaires as well as some GOP’er who can’t admit they are part of that scheme any longer. Everyone needs to belong to a club it seems.

      1. So, libertarians wouldn’t exist without the GOP and are just pawns…

        Funny, because I have never voted for a Republican, and outside a small consideration to vote for Rand Paul if by some miracle he made it through the primaries, I won’t be voting for any Republicans.

        And yes, the left has gotten its way over the last century. We have shifted farther to the goals of progressives (aka pseudo socialists).

        As for the supposed benefits you just mentioned, I can only laugh. Never has fraud been reduced by more government involvement.

        1. “Never has fraud been reduced by more government involvement.”

          Maybe not – but it certainly has been increased by lack of it! Read about Madoff and the sad GW Bush excuse for an SEC at the time. THe Gubment said “hands off” and we got a Great Depression II and the largest frauds in history.

          Heck, you guys elected Medical Fraudster in Chief Rick Scott as Gov – and are about to return him to office!

  20. I expect between licensing and lobbying, this won’t last if it actually works.

    It’s much easier to understand why the ACA is so screwed up once you realize that it is basically a law that guarantees doctors, pharmaceutical companies, health insurers, and hospitals high incomes. The fact that it fails to reduce costs isn’t an accident, that’s its whole purpose.

  21. How To Opt Out Of Obamacare. Know your options and become savvy self-pay patients. Join a health care sharing ministry. These are voluntary, charitable membership organizations that agree to share medical bills among the membership. They function similar to insurance, and are probably the best alternative to conventional health insurance. There are four of them, at least that I know of. Three are open only to practicing Christians (Samaritan Ministries, Christian Healthcare Ministries, and Christian Care Ministry) while a fourth, Liberty HealthShare, is open to anyone who agrees with their ethical commitment to religious liberty. They operate entirely outside of Obamacare’s regulations, and typically offer benefits for about half the cost of similar health insurance. Members are also exempt from having to pay the tax for being uninsured. From the article by Sean Parnell
    http://thefederalist.com/2013/…..iM_o.email

  22. Will Obamacare be repealed or won’t it? Will Congress fund it or won’t it? Will the web site be fixed or won’t it? Blah, blah, blah. We the people just need to do what we need to do and Congress be damned. Resist. Refuse. Revolt. EXEMPT OURSELVES! We did not comply with Prohibition and we simply should not comply with Obamacare. For religious reasons. For privacy reasons. For the cause of liberty and freedom and in protest of the idea that the federal government (under one party rule, no less), can force private citizens to purchase anything with our own money. Are we citizens or subjects? Mice or (wo)men? Just say NO to socialism and to the corrupt, unionized, far left IRS, the gestapo of America’s political class. After all, the federal government ignores millions of illegals who are breaking U.S. immigration law every day. Our Founders pledged their lives, their fortunes and their sacred honor. All we have to do is just say no to a scheme we all know is un-American and a violation of our most basic founding fundamentals of privacy, self reliance, limited government and individual freedom.

  23. right on, Devan! Govt, leave us alone!

  24. Watching headinass, and Micheal Hinh debate is like watching to giant, unflushable turds fight over who is king turd in their little turd stained toilet bowl.

  25. I think one of the first things you need to do is make it illegal to have different prices depending on who pays.

    IE the cash price, insurance price, and government price should all have to be the same. And they should all have to be posted.

  26. Get government out of the health care business as much as possible. Limit them to limited regulations and financial support to those who need it.

    Obamacare, Medicaid, Medicare and VA hospitals should be abolished.
    People under these programs and those who are financially below the poverty level should be given a yearly amount that they could use to purchase health insurance.
    Keep the Federal regulation stating that insurance companies have to cover pre-existing conditions as long as the person had previous insurance.
    Allow people to purchase insurance from any state.
    Deregulate state health insurance markets.
    Unhinge medical insurance from employers in the tax code.

    Getting government out and increasing competition in this way will lower health care costs. It cuts the bureaucracy costs, cuts the fraud costs and improves competition and quality of care.

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