This post is really targeted to the self-employed and non-insured among you. (You lucky still-employed workers with health benefits, you're excused for now.) I just want to offer this interesting op-ed piece by Chicago-based health care writer J. Duncan Moore, Jr. as food for thought, because he gives good reasons for why it's not worth having health insurance -- and how it's possible to profit without it.

I have individual coverage by Anthem Blue Cross, who, without any notice, just upped my monthly premium 21 percent. To afford the payments, I moved from a $2,500 deductible to a $5,000 deductible last year. A month after that move, Blue Cross upped my premium 15 percent. My "who needs this crap" attitude was stoked after reading Moore's point of view.

After losing his job and seeing his $447-a-month COBRA coverage about to expire, Moore decided not to get an individual plan. His reasoning: he's a healthy person who eats right, sleeps enough and has no family history of major diseases. So, Moore decides, "Why shouldn't I create my own network and find providers who would give me a discount for paying cash?" Putting his plan into practice, he went to his doctor for a checkup. His visit was billed at $100 but discounted to $65, and routine cholesterol tests were marked down from $195 to $110. "I wrote two checks on the spot. There was no paperwork, no correspondence, no phone calls, no arguing about deductibles or co-pays, for me or for the doctor's office. And the doctor got his money immediately."

This is where he tips into a part of U.S. health care that is changing and needs to change: patients knowing the price of medical treatments upfront. " Most doctors don't like to cite a price in advance, but as the U.S. health system moves toward asking patients to pay a greater share of the bill, doctors are going to have to become more responsive to their patients' cost sensitivities."


I wish I had known that earlier. When my doctor told me I needed to do the standard blood work for cholesterol levels, STDs, etc., I went to the lab without a second thought. How much could a couple of pricks of my thumbs to put traces of my blood into five vials really cost? Turns out it cost $1,400. My Blue Cross plan covered a little under $300 of it. The lab is obviously used to this kind of sticker-shock from patients because it immediately offered me a monthly installment plan. The $1,100 I owe is split into 12-month payments of $90.95. How much could I have saved if I had asked the cost beforehand and whether it was negotiable?

My friend who is experiencing a strange gastrointestinal condition isn't going to have sticker shock. She needs a MRI but instead of going immediately with her doctor's choice, she's calling hospitals all over the Bay Area to find out what they charge and whether they offer discounts. One interesting note: She discovered the hospitals charge different rates based on what health care plan a person has -- one hospital receptionist told her she would be charged more if she had Aetna instead of Blue Cross. Unfortunately, the receptionist clammed up when my friend asked by how much.

Moore's reasoning for not having health insurance may not make sense for everyone, and woe to him if he's ever hit by a car or falls off a ladder. But, as he puts it, "Even if I bought a policy, there are no guarantees that the insurance company would pay, that it wouldn't try to weasel out of the obligation." He cites a guy who was pre-approved for pricey back surgery by his health plan -- which immediately back-peddled when they got the $148,000 bill. Only a newspaper article about it and public outrage got them to pay.

To me, Moore's reasoning about skipping health insurance the way it's structured right now for individuals makes sense. Regardless of how you feel about Obama's attempts to change U.S. health care (I must admit I favor a government option). But no matter how health care changes, one thing is for sure: we patients need to be as consumer-savvy and price-conscious when we're in the doctor's office or hospital as we are at the grocery store and shopping mall.