In the example I provided, could you really find a doctor to accept a $270 payment as payment in full, for a procedure that typically runs around $5,000, absent healthcare insurance?

That is, after all, a 94.6 percent discount...

The example you cite has nothing to do with an absence of insurance though. A more apt analogy is using a cell phone outside of your providers coverage. At that point you'd be paying "roaming" rates, as opposed to what would normally be considered "free" under your plan, and I'm sure we've all seen at some point just what we get charged for roaming.

We don't know what things would cost without the all-pervasive insurance companies that have insinuated themselves into every single transaction we have with our doctor. They would certainly be much cheaper if we paid out of pocket for routine things and left the catastrophic stuff up to insurance, which is the whole point I'm trying to make.

The example I provided has everything to do with the absence of healthcare insurance.

Unless you intend to posit that, absent healthcare insurance, that $5,000 procedure would likely be driven down to a mere $270.

Somehow, I just don't believe that any amount of competition could shave almost 95 percent off the current price of anything.

Not that much cheaper, surely.

Moreover, many who live from paycheck to paycheck (or from Social Security check to Social Security check) would likely be dissuaded from seeing their primary-care doctors regularly, for preventive care (as, for instance, with annual physical examinations), as a purely practical matter, if healthcare insurance did not pay the bulk of the charges.

In addition to which, some of us visit specialists very often, for one disease or disorder, or another; and we are very glad that healthcare insurance pays toward it.

An out-of-pocket catastrophic cap (for us, it is $5,000 per year for the family) seems to me to be the way to go; especially since the Submitted Charges frequently exceed $200,000 per year, in our case...

No, I don't see it coming down that much either, but such drastic reductions are unrealistic.

As for dissuading people from seeking preventive care... the point of this is that such routine things would be priced well within afforability once they're removed from the purview of insurance companies. If you don't have the wherewithal to scrape together enough cash to get a routine checkup, well, you've got bigger problems. Don't even get me started on welfare (and yes, that includes social security).

You say you have that co-pay of $270 for your $5000 procedure. You act like that's all it costs you. What are your premiums? Are you on a group plan through your employer? Are you by some chance soaking up medicare/medicade? Does your employer pay for your benefits? One way or another, you're paying more than that $270 you're so enamored of. More than likely the rest of us are shouldering some portion of your load too.

Once medical insurance is put back in its rightful place as a catastrophic only type policy, the prices of those policies will drop precipitously. The routine crap that is overused (to say the least) won't be soaking up so much of those premiums you pay, and people will start making more informed choices about how and where they spend their healthcare dollars.

Medical insurance being overused for smaller issues is a real problem. Take the military for instance. More and more hospitals, and doctors time, is taken up with the common cold or sniffles. Things the doctor can do nothing about, and all that could be prescribed is OTC meds. Dependents are known to flood the hospital and ER for these issues though, which in turn has made the powers that be start looking for ways to make dependents instead take medical insurance from their own jobs, and no longer be given the free option through their spouses coverage plan.

The military tried to incorporate a slew of programs to deal with this issue, before it truly got out of hand. One was the 24 hour nurse line, in which people could call, and get free advice from an RN, as to whether or not their problem was worthy of an ER or DOC visit. That failed, and the program went away. The other was a class that dependents could take which once the class was taken, you would get a health book that addressed ailments and how to treat them. Plus being placed on a list for FREE OTC meds by just requesting them. The thought there was that lower enlisted, who may not be able to "afford" OTC meds could get them free at the clinic w/o doc visits. That too failed, as dependents wanted to continue making doctors appointments for colds/flu.

Something definitely needs to be addressed in order to curb these issues, but I haven't seen anything yet that has addressed them properly and worked.

__________________
In God we trust, all others we check out...

The only way to enjoy anything in this life is to earn it first...

Progressive policies equals regressive world.

Then you tacitly admit that a good PPO (such as ours) is a much better way to go...

Why would you suppose that healthcare-insurance companies (somehow) drive up the cost of medical care?

We do.

But some do not.

Many live from paycheck to paycheck, or from Social Security check to Social Security check, as noted previously.

I thoroughly disagree with your characterization of Social Security as mere "welfare," as it is not an example of redistributionism.

Nonetheless, I would prefer not to digress...

Actually, that's the coinsurance. The co-pay is a fixed amount--currently, $20 for an office visit to a primary-care physician; and $30 for an office visit to a specialist. The coinsurance, by contrast (which may not be charged, in addition to a co-pay, for the same procedure) is 15 percent of the Plan Allowance among Preferred Providers; or 30 percent of the Plan Allowance among out-of-network providers.

The premiums are currently $400.97 per month for the family plan.

That amounts to $4,811.64 per year.

The annual catastrophic (out-of-pocket) cap is $5,000.

Since the deductible ($300 per person; and there are two of us) no longer applies toward the cap--that is new for 2010--we could conceivably pay as much as $5,600 in out-of-pocket expenses to Preferred Providers. (And we choose not to go out-of-network.)

Altogether, that totals a maximum of $10,411.64 annually that we could have to pay in out-of-pocket expenses, including premiums.

Not bad, considering the $200,000 or so we typically expect in Submitted Charges each year...

It is Blue Cross/Blue Shield of Tennessee, through FEHB. (My wife is a retired federal employee.)

We both have Medicare Part A only (which is a freebie--it is paid for through employer deductions, during one's working lifetime, and therefore carries no monthly premiums). The benefits are twofold: (1) It obviates the necessity of asking BC/BS for pre-approval for a hospital stay, since Medicare is the primary provider; and (2) it eliminates the (usual) $200 hospital admittance fee; after which, BC/BS pays 100 percent of all hospital charges. (Note: Doctors' charges--whether those of a hospitalist, or those of a physician with hospital privileges--are typically billed separately; and BC/BS pays 85 percent of the Plan Allowance toward these charges.)

There are high-deductible policies currently available, if that is what you prefer...