How I Would Fix Healthcare – Step 3

This is a continuing series addressing the healthcare crisis in America and a possible alternative to President Obama’s healthcare solution.

Step 3: Protect Health Insurance Surplus Coffers

By Federal mandate, insurance companies must reserve anticipated surplus in a special government insured and managed, tax-free, health care savings fund (with no maximum cap) to be used to pay for policy holders’ insurance covered medical costs when premiums fall short.

What Insurance Companies Really Do with Your Money

Have you ever wondered what insurance companies do with the money you give them for premiums? When you buy insurance, you assume that your insurance company is collecting premiums and saving them securely in a large pool, only to be paid out for claims.

What do they really do? It all depends on individual state regulations, whether the company is for-profit or non-profit, and each company’s policies. In some instances, insurance companies invest the money in high risk ventures and then pay out the profits to their stockholders and CEOs instead of adding it to their surplus coffers. It almost makes one think that perhaps insurance companies are really in two businesses: the business of paying claims for health care (when they have to); and the far more lucrative business of investing with the advantage of being able to not only keep all the money, but also not be regulated in the way an actual investment firm would be.

Who can blame them? Must be nice to have all that free money.

However, having money leftover after paying out claims can be a double edged sword.

In years where claims (losses) are lower than expected, for-profit insurance companies have to pony up and pay income tax on what’s left over. That’s not fair either. No wonder so many companies are turning non-profit. Something has to be done.

In order to fix health care insurance, insurance companies must be able to save for a rainy day with no tax penalty to them. Likewise, customers must feel confident that insurance companies are not taking their surplus and investing it foolishly, or worse, taking it as profit instead of rolling it over.

The following case illustrates how some insurance companies are really in business to make money off your premiums; not in business to pay out claims:

The Case of the Hurricane Gougers

In January of 2008, the state of Florida called Allstate Corp. on the table over home insurance premium rate hikes averaging 42 percent in the fall of 2007. Governor Charlie Crist contended that insurance companies were taking advantage of Florida residents by charging extraordinarily larger premiums than necessary to cover hurricane damage, and padding their pockets with the leftovers rather than rolling them over year to year. While Florida did suffer a great deal of damage in bad hurricane years, there were many more good years which passed without hardly any damage payouts at all. Governor Crist suspected the worst – price gouging. He suspected that insurance companies were setting rates based on the worst case scenario each and every year, so that in bad years, the premiums would fully cover the damages for that year, and in good years, the leftover premiums went to pure profit.

Florida Insurance Commissioner Kevin McCarty noticed that no implementation of fines could keep companies such as Allstate from refusing to turn over the company books to prove that they were not gouging Florida policy holders. Instead, he took the radical step of prohibiting them from selling new policies until they came clean.

Allstate worked around the legislation by forming a new company called the Royal Palm Insurance Company where only Allstate agents may write policies. In April 2008, my own personal Allstate insurance agent told me that the real money is in auto policies, anyway, so Allstate was happy to stop selling new home insurance policies and instead, focus on the more profitable business of auto insurance.

In May 2008, after failing to turn over their books, Florida insurance regulators shut down all of Allstate’s 10 Florida companies for one day as punishment for not cooperating in the investigation. That did it! Allstate finally complied and promised to turn over the books. The ban was lifted: Allstate may resume selling new policies in exchange for paying a $5-million fine; writing at least 100,000 new homeowner policies over the next three years; lowering existing premiums; and not increasing rates for at least one year while the government investigates rate hikes.

Florida Insurance Commissioner Kevin McCarty and Governor Charlie Christ were correct in halting Allstate insurance sales for a day. Perhaps a radical approach such as this is what’s needed to keep health insurance companies from doing likewise. Unfortunately, the effort to keep an eye on companies has taken far too much time and still not resolved the issue. An easier way to keep an eye on insurance companies is to require them to deposit their surplus into a federally managed and protected savings account, where they can roll over surplus funds tax free.

This leads me to step 3 on how I would fix health care in America:

Step 3: Protect Health Insurance Surplus Coffers

By Federal mandate, insurance companies must reserve anticipated surplus in a special government insured and managed, tax-free, health care savings fund (with no maximum cap) to be used to pay for policy holders’ insurance covered medical costs when premiums fall short.

Terms:

Each company will have its own, separate account within the fund.

Deposit anticipated surplus at the end of each fiscal period
Companies may deposit anticipated surplus at any time, but must do so by the end of each fiscal period when they will also report this same amount on their taxes.

Tax free
Money deposited into this account will not be taxed by any government entity: federal, state, city, or county.

Roll over
Surplus money will roll over from year to year in perpetuity.

Used for medical costs only

Money deposited into this account must be used to cover policy holders claims for medical costs only, such as reimbursements to doctors, hospitals, equipment suppliers and pharmacies and may not be used towards insurance company administrative costs, be taken for profits, or go towards malpractice suit damage payments, legal costs, bad debts, taxes, fines, payroll, other insurance payouts, or other non-medical claim related expenses.

In the case of HMO's (health maintenance organizations) where the insurance company doubles as the health care provider, money deposited may also be used to cover all hospital and clinic staff and all medical building operation expenses run by that HMO, including administrative staff, accounting and legal fees, malpractice claims, bad debts, fines, payroll, landscaping maintenance, etc., as would be ordinarily necessary. However, surplus money deposited in this tax free account may not be used to cover the business of running the insurance side of the company, such as managing plans, selling insurance itself, legal fees, fines, bad debts, office expenses, taxes, etc. related to the insurance side of the business.

Withdrawal after 35 days
Money deposited may not be withdrawn for at least 35 days. This will allow the government specialists who manage the fund ample time to invest and benefit from the deposit.

Withdrawal no more frequently than once monthly
Insurance companies may withdraw money from their account to supplement claim payments no more frequently than once monthly. This is designed to decrease paperwork.

Company Mergers
In the case of a company merger or acquirement, any money leftover in the account will be merged or acquired into the appropriate company’s surplus fund account and/or used to pay off any remaining medical claims.

Company Closures
In the case of company closure, bankruptcy, etc., the account will be closed and any money leftover in the account will be absorbed by the government to be used towards health care for the uninsured and to pay off any remaining, yet to be filed medical claims.

Interest Bearing Accounts
Interest earned on the entire collective fund will be kept by the government to help pay for managing the fund and for health care for the uninsured. This will serve three purposes: First, it will prevent insurance companies from being tempted to double as an undercover investment firm. Second, the government will guarantee the security of these investments so that the insurance company and their customers can feel secure that the money will be there when they need it to pay out claims. Third, the interest earned will provide revenue for health care for the uninsured.

Federal Government agency
An overseeing Federal government agency will control the surplus fund by forming a small office of accountants and investment specialists to manage and invest the fund itself. Interest earned will be paid into a national uninsured health care fund, perhaps Medicare.

Public information
The exact amounts of surplus in each company account will be public information because companies that are publicly traded must divulge this amount to their stockholders in annual reports, as well as file this information with the U.S. Securities and Exchange Commission (SEC). Non-profits must also divulge this information.

Sources for What Insurance Companies Really Do with Your Money:

United Health Group
Annual financial reports and SEC filings.

Investor Guide:
Annual Reports are linked at the bottom of the page. Search for the company you want to see SEC filings for, such as:

• Aetna
• Wellpoint
• Cigna

Sources for The Case of the Hurricane Gougers:

Article in Jan. 14, 2008 South Florida Business Journal

Article in Jan. 17, 2008 Chicago Tribune

August 16, 2008 St. Petersburg Times

January 10, 2007 Washington Post

How I Would Fix Healthcare

Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.

Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.

Step 3 – Protect Health Insurance Surplus Coffers

Step 4 – Preventative Healthcare Maintenance Schedule

Step 5 – Improve Healthcare Access

A. Institute a “public option”;
B. Regulate rates with blind menu pricing; and/or
C. Provide free clinics and access to community health centers

Stay tuned for steps 6 and 7

How I Would Fix Healthcare – Step 2

This is a continuing series addressing the healthcare crisis in America and a possible alternative to President Obama’s healthcare solution.

Step 2: Maximum Non-Medical Costs Per Policy

By Federal mandate, insurance companies may retain no more than $40 per enrollee's health care insurance policy for administrative costs and profits.

Covering the extra costs of healthcare

Walk into an insurance company to buy health insurance. Where does the money that you pay for premiums go?

When you buy health insurance, you are buying more than just healthcare. The individual who sells you the policy receives commission on the sale. The company who brokers the policy receives their cut. The insurance company hires administrators to decide how your healthcare is managed, approving this test and that procedure, this referral, and that prescription. These administrators are overseen by highly paid executives. Staff is hired to assist. Buildings are built and maintained. Advertisements are bought in newspapers, magazines, TV and other venues. Events are sponsored to further advertise services as well as improve community relations. Indemnity insurance is purchased to cover malpractice lawsuits. Lobbyists are hired to go to Washington. After everything it paid for, anything left over is profit to investors and stockholders if the company is a for-profit insurance company.

According to a November 2008 study by the California Department of Managed Health Care (DMHC) and the Center for Medicare and Medicaid Services (CMS), health insurance companies on average retain anywhere from 14 to 18 percent of insurance premiums to cover administrative costs and profits. The average California enrollee in 2006 paid $3,565 per year for their policy, which averages out to only about $300 per policy holder per month. On average, insurance agencies gleaned anywhere from $42 per month to $53 per month to cover administrative costs and profits, or $500 to $641 per year.

Nationally, policy holders paid an average of $3919 per year, about $326 per month, and insurance companies retained 11 percent, or about $36 per policy per month, or $431 per year to cover administrative costs and profit.

The state of California is considering regulating the health insurance industry in their state so that insurance companies may not charge more than 15 percent per enrollee for administrative costs and profits.

This appears to be a fair number. However, where it falls apart is in the percentages.

Flat fees vs. percentages

If you are diagnosed with a serious disease, your insurance company can raise your premium. How high? As high as they want. The higher the better, in their minds, since higher premiums not only bring in more money for medical care, they also equal more money for profits and administrative costs.

In a system where commissions and profits are based on a percentage, prices are bound to go up. Why would I want to sell you an affordable $300 health plan and get $45 a month, when I can tack on risk factors, raising your premium to $2000 and getting $300 a month? I wouldn’t. I’d sell you the $2000 plan – every time.

By taking percentages in profit, rather than a flat fee, insurance brokers are motivated to sell higher priced policies.

However, convert this figure to a flat fee per “enrollee” and you suddenly have no incentive to artificially raise premiums. If an insurance agent understood that no matter how much your policy cost, he would still walk away with only $40 in his coffers, he has no incentive to pad the policy with unnecessary costs. Quite the contrary, he will offer you the absolute lowest priced policy he can which will suit your needs so that you don’t go to “Brand B” to buy your insurance instead of from him. In addition, he might even be inspired to shave off some of his commission so that he is more competitive. He will do better selling 100 policies at $300 per month per policy, than he will do selling 80 policies at $1000 per month per policy. He will be motivated to give you good service and keep his customers happy so that he can get referrals and win over even more customers.

Win-win for insurance companies

Since insurance companies nationwide currently glean about 11 percent on average from insurance policies, or $36 per month per average $3919 policy, limiting their potential profit to $40 per month per policy will essentially feel like a raise.

Only companies who are garnering significantly more for profits and administrative costs will feel the pinch. This regulation will inspire them to cut corners, pare down unnecessary administrative costs, and perhaps even slash a few salaries to highly paid executives.

Although this regulation will not solve the problem of increases in premiums for high risk policy holders, it will reduce one motivation for these increases – the one of profit. Healthcare costs will continue to rise as always, but will be based on actual medical costs, and not on the cost of operating the insurance company.

Reporting and regulation

Insurance companies will be required to submit monthly reports to an overseeing agency within the Federal government, listing the numbers of policies they have sold, the revenue they made, and how much was paid in non-medical vs. actual medical costs. Government accountants will audit each insurance company's books once a year.

Each year, the overseeing government agency will also re-evaluate the maximum $40 per policy per month maximum and adjust it for inflation or deflation, as the case may be.

How I Would Fix Healthcare

Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.

Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.

Step 3 – Protect Health Insurance Surplus Coffers

Step 4 – Preventative Healthcare Maintenance Schedule

Step 5 – Improve Healthcare Access

A. Institute a “public option”;
B. Regulate rates with blind menu pricing; and/or
C. Provide free clinics and access to community health centers

Stay tuned for steps 6 and 7

How I Would Fix Healthcare – Step 1

Although I did vote for him, I am not a fan of President Obama’s healthcare solution. I agree that we are in crisis in this country due to rising healthcare related costs. However, I feel that Obama’s plan is far too complex and misdirected so that it unfairly burdens the very people it's intended to help. In the next few blogs, I’ll try to suggest an alternative.

Step 1: Employee Healthcare Plan Allowance

By Federal mandate, each employer should provide a healthcare plan allowance of a minimum of $300 per month, per employee of all classifications.

Choices in coverage

The employee will then be able to shop on their own for a plan from an independent insurance agency or managed healthcare company. They will make their own choices to spend this money on a plan that fits their needs the best.

Several years ago, when I needed to provide health insurance for my employees, I devised this system. It worked well for me as an employer because it was affordable, I could easily budget for it, and I wasn’t sucked into a contract with an insurance agency for an expensive company-wide-plan which really didn’t cover what everyone needed. I based the amount of the allowance on the entire cost for one sample employee of the oldest age to cover themselves from head to toe at a local HMO, including dental and vision care, and a co-pay of $10 per visit. At the time, this was $240. For a small additional fee of $80, employees could add up to three dependents on their plan, or pick a more expensive plan and pay the difference from their paycheck.

My employees loved feeling empowered to pick their own plan. Insurance agents visited our office and dropped off brochures and set up meetings to discuss options. Everyone was happy.

Most employees opted for a Blue Cross plan which had a percentage co-pay and deductible, but allowed them to go to whatever doctor they chose. However, one ad salesman, whose husband had lost his job and his benefits, instead chose a plan from another company that covered her entire family of four for catastrophic insurance only. Unfortunately, one employee smoked and was not able to get as much coverage with his allowance because his health was at a higher risk, so he went with Group Health, the local HMO. What was not an option was getting the money added to their paychecks, however I did offer to pay an actual medical bill for an employee who forgot to sign up for a plan. In all my years as an employer, I never heard one single complaint that the plan wasn’t working. Everyone loved it.

No Employee Left Behind

Every employee, no matter their status: full time, part time, permanent, temporary, seasonal, or contract should be given this benefit during the months they are employed. A Department of Labor survey in 2004 showed that only 60% of employers offer healthcare of any sort, and only 69% of all employees had access to participating in an employer plan.

While large companies are usually required by varying state laws to provide health insurance of some sort for their full time employees, they are usually not required to provide health insurance for their part-time, temporary, or contract help. In most states, companies with small numbers of employees are not required to provide any health insurance at all. Unfortunately, this mandate leads to less jobs and fewer paid hours as employers purposely cut hours, making employees work 34 hours instead of 35 to 40, just so that they can classify them as part time; or hiring temporary or on-site contract employees instead of permanent ones, all so that they are not required to pay for their health insurance. By requiring all employers to cover every worker, they will be inspired to promote some part time or temporary workers to full time permanent, which will also help to increase employment.

Employers will not be required to pay healthcare for workers they hire who are technically self-employed specialists, even if that worker does not have a business license. For instance, the man who comes and waters your plants once a week would not be considered your employee since he theoretically can hire himself out to water plants for several companies.

Duplication of coverage

Due to legislation and insurance agency contracts, there is a great deal of duplication of coverage, causing prices to be much higher than necessary.

For instance, spouses who both work full-time are usually required to both carry full coverage, usually partially deducted from their pay, even when they work at the same company. This is completely unnecessary and I blame insurance agency company contracts, which require employers to cover everyone, with no exceptions, for this gross overcharging.

The two employers should be able to work with each other to reduce their costs, perhaps splitting the cost of the family coverage between the two, or even allowing the couple to get a better plan for their household by pooling their allowances.

Likewise, if an employee works at more than one part time job where they will receive coverage at each of their jobs, the two or three or so employers should be allowed to split the costs.

Currently, employers must provide on-the-job injury and accident insurance for all employees of all statuses, no matter if they are full time permanent or just working for the day. In some ways, this is a duplication of coverage. The money that is allocated for this type of insurance could be reallocated to basic health insurance.

Is $300 enough?

The more people who are covered, the lower the prices are for everyone.

Most of us are fortunately healthy, and $300 x 12 months is $3600 per year, far more than what is needed to cover the basics.

Clinics can afford to offer low cost healthcare at phenomenally low rates by employing nurse practitioners instead of doctors. I was self-employed for many years and went to two different affordable clinics for basic care. I checked online for the current prices: yearly physical exam with GYN exam ($75 at a clinic), blood and urine test ($20), flu immunization ($12 at a drugstore), and medications (mine are $120 a year for generics). The most expensive cost was teeth cleanings ($160). Eye exams are $40 at a retail store, but I found basic prescription eyeglasses online ($28 with shipping). Other appropriate medical exams and tests would cost more. However, most people could get by with less than $500 in total costs per year. After deducting the $10 per visit co-pay, and having the patient pay for their own medications and eyeglasses (such as with my current plan), the insurance company would only have to pay around $300 for me per year, far less than the $3600 they would collect in premiums. (I should mention, that my current plan costs me nearly $500 per month, which is $6000 per year).

While it is true that pregnancy, catastrophic injuries, and serious illnesses can cost a great deal more to treat, few of us are frequently in need of these extras, so we never spend all of the money we contributed to the plan over the years. The extra money (and there is a lot of it) is supposed to be pooled so that those who need it can receive more coverage, and not supposed to be taken as extra profits by insurance agencies, as is currently done... which will be Part 2.

How I Would Fix Healthcare

Step 1 – Employers must provide a minimum $300 health insurance policy allowance for each and every worker.

Step 2 – Insurance agencies may not take more than $40 per policy for profit and administrative costs.

Step 3 – Protect Health Insurance Surplus Coffers

Step 4 – Preventative Healthcare Maintenance Schedule

Step 5 – Improve Healthcare Access

A. Institute a “public option”;
B. Regulate rates with blind menu pricing; and/or
C. Provide free clinics and access to community health centers

Stay tuned for steps 6 and 7

Health Insurance Companies – Making Money off Your Misery

$1650 PER MONTH!

Yesterday, my good friend Lorie, who lives in Central Florida, confided in me that she and her self-employed husband pay $1650.00 per month for their healthcare plan for two adults, pre-retirement. Neither have any serious or unusual conditions – just age – they’re both in their 50’s.

$1650.00. That’s insane! That’s one thousand, six hundred, and fifty dollars. Not $16.50, about what you’d pay for a 12 pack of good beer.

This plan covers catastrophic (you have chest pains and you need an angiogram, Stat!) and point of service (a $10 co-pay for regular doctor visits and prescriptions, plus a portion of charges for hospital stays and procedures). Lorie says she shopped around virtually everywhere and tried to get only catastrophic, but was could not. In fact, this plan is actually a discounted plan purchased through a business trade group in Pennsylvania.

About five years ago, Lorie says they were only paying about $500 per month for the same coverage before the prices skyrocketed.

HURRICANE INSURANCE FOR ONE YEAR!

$1650.00 PER MONTH? That’s about what I pay each month for my mortgage! That’s $19,800 per year – more than a person earning minimum wage makes working full-time!

It’s also about what I pay for my home insurance, which includes hurricane coverage, PER YEAR! “And you’re much more likely to need hurricane insurance than I am to need to go to the hospital,” My friend Lorie pointed out. She’s right. I live on the coast of Florida unlike healthcare insurance, home insurance prices are regulated by the State of Florida.

Where does that $1650.00 per month go? It’s certainly not going to the doctors. It’s not going to the hospitals. I’ve seen the cars those insurance salesmen drive – BMWs, Jaguars, Audis, big SUVs (they can afford the gas.)

NO CONTROL

My husband works full time at a company which provides health insurance for him and myself. We pay about $250 per month which sounds like a good deal, but it’s not. I’d rather take the money and pay doctors of my choice directly.

The company picked two plans for us to choose from
Both are HMOs (one stop clinics) which can be good, but in this case, are horribly deficient. It takes months to schedule an appointment and doctors sometimes cancel only days before the date you are expected to go. Doctors make diagnoses based on talking with the patient and perform few actual diagnostic tests, which can be expensive. Doctors assume that symptoms point to the most common ailment, even when there are other symptoms present which do not match their diagnosis.
- We picked the cheaper plan, but were placed with bad doctors. The good doctors are no longer accepting new patients.
- We have heard from coworkers that the other plan is even worse.

Plans don't cover everything, so you're still paying out of pocket
Neither plan covers vision care, the only coverage I really use other than dental, for which we pay an extra $28 per month. Even then, we had to pay about $6000 for non-cosmetic dental surgery because the costs were higher than the insurance would pay.

The company decides our premium
Over the past twenty years, we’ve paid between a $150 and $600 per month premium for our company's chosen healthcare plans, or between $1800 and $7200 per year. The lowest figure was when I worked briefly for a public school system, a.k.a., the government.

We cannot opt out of the plan
It has always been mandatory for both my husband and myself to pay towards the company healthcare plan. 

Working couples pay double

After getting married, we had double coverage, but were not allowed to drop one of the plans. Even spouses working at the same company could not get out of paying double.

Not everyone pays the same
At one job, my husband was charged about $200 per month for his insurance. He was on an employment contract with guaranteed raises each year which matched the average rate of inflation. The company got into serious financial trouble, but could not take away my husband’s raise, so instead, they increased my husband’s healthcare plan charges to about $600 per month beginning in 2006, essentially taking away all the raises he’d received.

At Christmas, the company issued a lay-off notice with a letter explaining that employees would be allowed to participate in a COBRA plan where you can continue paying for your own healthcare plan after you are laid off. The plan cost $1200 per month. Some employees lamented that this would be four times what they were currently paying at $300 per month. That’s when my husband found out he was paying a higher charge for the same healthcare plan than some of his coworkers.

Unaffordable to unemployed and working poor

A person earning minimum wage at $6.55 per hour makes $13,624 per year if allowed to work 40 hours per week for 52 weeks per year. After taxes, this amounts to around $1000 per month. This worker cannot afford to pay for health insurance, even at $250 per month. 

Unemployment pay varies by state. My husband's pay after being laid off in Washington state, about $2000 per month after taxes, covered only our mortgage and utilities. We could not even consider health insurance. In Florida, unemployment pays about half that, or about $1000 per month.

If given the choice, most will opt out

The problem with insurance is that you are paying towards a rainy day which may never come. If given the choice, most people on limited budgets will not buy health insurance, but will instead prefer to pay their own doctors as needed and gamble that they will not be hospitalized.

INSURANCE COMPANIES CONTROL DOCTORS

Our current system employs a middleman (the insurance company) to make medical decisions for us. The middleman is a businessman, not a medical practitioner. They hold in their hands the power to approve or deny a test or procedure which might save your life. Their decisions are based on the bottom line, not on the patient’s welfare.

If a doctor tries to fight the system and insist on care for his patient, he can be “let go,” his name “removed” from the list of approved doctors for these patients. As a result, few doctors challenge the insurance company. They have to eat, too.

For years, I submitted to the healthcare plan my company provided for me. I went to their doctors who would never refer me to a specialist. I suffered from numerous symptoms, but was usually told to take an aspirin, relax, de-stress, soak in a tub, etc. I was once even given the wrong medication. A few years ago, I had had enough and decided to go to my own doctors and pay for it out of pocket. I was given stellar service and no stone went unturned in diagnosing my disease. I now know that I suffered from a serious medical condition which could have been treated if caught in time.

WE NEED SOCIALIZED MEDICINE

This week, both U.S. Presidential candidates Barack Obama and John McCain released their healthcare plans. Both involved the use of health insurance companies as a middle man to control our current healthcare system. Not a good idea. It won’t work! It will simply build up the middle men by boosting the health insurance business. We’re just feeding the patients and the doctors to the lions!

The United States Government needs to do what most other civilized countries do and offer free basic healthcare as a public service, similar to the way public schooling is provided. Yearly checkups, immunizations, disease screenings, and standards treatments would be included. Each state government can decide how to do this, whether to run their own clinics or contract this through private companies. If a patient wants something special, they can go to a special doctor (just like a special school) and pay for it out of their own pocket.

WHO WILL PAY FOR IT?

Americans are already paying for the healthcare for not only themselves, but also for the uninsured and under-insured. It's possible the bill for socialized medicine might even be cheaper than what we currently pay for no-choice medicine. We are paying for it through higher medical costs, insurance premiums and taxes.

Eliminate the middle man
If we took the money we’re already paying to health insurers, we will come out ahead, for we will eliminate the middle man who’s making money off of our misery.

Health costs don’t need to be as high as they currently are
Most hospitals and doctors don't charge the same for everyone. They charge on a “sliding scale.” If they think you have more money, you get billed higher than if you don't. I paid $35 per visit out of pocket when I went to the eye doctor with no insurance. My insurance company paid $169 per visit (I paid a $10 co-pay) when I went back to the same doctor through my insurance.

If you can’t pay your medical bills, you may lose your house
Even if you do have healthcare insurance, but your medical bills cost more than what is covered, you may be forced to sell your house to pay your bills.

If you don’t have insurance or assets, medical is free anyway
If you're really sick, you could lose your job and hence, your insurance. Then you could become impoverished and qualify for free medical care! Who pays for this? The taxpayers. So, we’re paying for this system already.

Even doctors have a hard time getting paid by insurance companies
Even if you have insurance, a doctor will sometimes require you to pay them out of pocket and make you attempt to get the money back on your own. They say they require this because the insurance company takes too long to pay. My husband made the mistake of giving a doctor a personal credit card, and before we knew it, $700 was charged that should have been sent to insurance.

WE CAN HAVE CHEAPER AND BETTER CARE

In conclusion, I don't think the American worker, nor their employers, would have to pay any more for healthcare than they do now if the system were shifted to a government mandated free clinic system. Yes, taxes would have to go up. However, I think the system would save money because the insurance people would no longer take a huge share.

The best medical care I ever got was when I became self employed and took my healthcare into my own hands and paid doctors out of pocket.  I chose my own HMO clinic where I went for checkups, immunizations, and regular illnesses. If needed, I went to doctors at the UW Medical Center in Seattle and the University of Chapel Hill Medical Center in North Carolina. Both are teaching hospitals with all the latest gadgets and treatments. Neither will tell you don’t need a procedure or test, unless you really don’t need it. Both are affordable. In one year, I paid about $800 out of pocket for two clinic visits and four UW Medical visits. Compare this to the company healthcare plan where I paid $3000 per year, but was not referred to specialists.

We have the ability to offer the best medical care in the world to our own citizens. We just need to eliminate the middle man.