HEALTHCARE WITHOUT HEALTH INSURANCE….Dr. Mark Smith, CEO of the California Health Care Foundation, speaking to a gathering of the health insurance industry a few weeks ago:

It’s a strange business you’re in. What you are selling is four different things. Why do we want people to have health insurance? I always get some variant of four answers. 1) …. 2) …. 3) So you can get discounts, and don’t have to pay rack rate at the doctor. But that’s not insurance, it’s market leverage.

This is probably the least important part of what Smith said, so click the link to read the whole thing. I’m only highlighting it here because it’s a relatively little known problem: if you don’t have health insurance, you will almost certainly pay 2x or 3x more for hospital care than you would if you were covered. There is, as near as I can tell, no real justification for this aside from the fact that hospitals can get away with it. If you’re uninsured and you have a heart attack, you go where the paramedics take you, and when it’s all over you get a bill. And that’s that. There’s no way to bargain beforehand and no way to fight the bill afterward.

Question: is there a business opportunity here? Could Blue Cross, say, offer a “coverage” plan that does nothing except get you their standard discounts on healthcare? You wouldn’t pay premiums to Blue Cross, you’d just pay them directly for any costs you incur. Blue Cross would make a little bit of money on each patient (i.e., whatever markup they decided on) and you, the customer, would get lower cost healthcare even if you don’t qualify for an actual insurance policy. I don’t imagine this would be a huge business, but with more and more people losing their employer plans, it might be a growing one.

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