Is a Free Market in Medicine Still Possible?

When the debate over the Graham-Cassidy bill that was intended to “repeal” the Patient Protection and Affordable Care Act (aka Obamacare) was in its full fury, I had some very mixed feelings. I very much wanted the command and control provisions of Obamacare to go bye-bye, especially the individual mandate requiring individuals to be covered by health insurance that met the centrally planned specifications of our “fearless leaders,” as well as the mandate for employers with at least 50 full-time employees to provide that coverage.

I was anxious to enjoy that sweet breath of freedom in which I could make my own health insurance coverage choices and would not be severely restricted in my choice of doctors. Because I worked for a small business in 2015 through 2016, and am now an independent contractor and blogger in 2017, I would not qualify for employer insurance, and my husband’s part-time employment status at this time does not give him the opportunity to have health insurance coverage through an employer either. In Iron County, Utah, where I live, there has only been one insurer in the Obamacare exchange since 2016.

That insurance, SelectHealth, is part of a large monopoly in Utah because it is a subsidiary of Intermountain Healthcare, which is supposedly a “non-profit” organization, although it engages in very monopolistic behaviors to herd patients to its facilities and away from more reasonably priced unaffiliated facilities.

Rather than facts and figures this time, I am going to relate a personal story about my own displeasure with the “command and control” policies of Washington and the behavior by insurance companies that it allows.

I certainly have not been very happy with my SelectHealth “coverage,” which includes an $11,500 annual deductible that, to date, I have not even come close to meeting because I try my best to be as healthy as possible.

One other issue I had with SelectHealth in my coverage this year was one little problem with an ongoing cough. I finally gave way to my husband’s insistence that I see a doctor and saw one (a new one that was more like a family practice by three doctors in the same family). He prescribed a certain kind of inhaler to see if that would help, saying that if it did not help, he would probably order some x-rays and other tests. He said that the inhaler itself was quite expensive (and it was), but he tried to find a sample in his supply cabinet.  He couldn’t find that, but he did find a coupon, that would  result in the medication costing me only $10 every time I filled it, if I ran it through my insurance.

I usually prefer to pay for my medications without using my insurance coverage because of the hopelessly high deductible, but thought it might be worth it for once, considering that I could get a medication that was normally about $367 per fill for only $10 each time. Besides, I was just expecting to try it for a month to see if it helped.

So I presented the prescription to my pharmacy, and because it was one of those very expensive prescriptions, the pharmacy naturally had to get an approval from the insurance company. I could live with that because it wasn’t like I was dying or something, just an annoying cough. However, SelectHealth refused to let me have the prescription that my doctor offered me. They said they could only let me get a prescription for a somewhat similar inhaler that was just as close to being that expensive ($316), and asked me to have the doctor prescribe that instead.

My plan this year does not pay for prescriptions at all until I reach my HUGE deductible, and I didn’t have any big plans for that, and hopefully I won’t even come close to it this year.

I was very irritated that the insurance company was telling my doctor what to prescribe. I don’t know what his reasons were for prescribing that particular medication, but whatever they were, I did not feel that it was the place of the insurance company to tell him what to prescribe. After all, an insurance company IS NOT a doctor; it just thinks it is these days. When I was going round and round with the insurance representative, she actually said something like, we like to have “our patients” try this other medication first. I informed her that I was not the insurance company’s patient.

Since the blasted insurance company was NOT going to let me use the coupon the doctor gave me, I decided that, as annoying as the cough was, it was probably not so bad that I needed the expensive medication the insurance was trying to force me to buy.  So I did an aggressive home remedy of cough syrup plus cough drops, day and night (although the nighttime syrup made it very hard to wake up in the morning). Eventually, the cough went away.

That experience taught me to inform my doctor that I am not interested in pricey medications unless he feels that it is the only way to treat my problem. I guess I was lulled into a false sense of security with my coupon. Well, there is a lesson learned.

2 thoughts on “Is a Free Market in Medicine Still Possible?”

  1. Sorry that you had that experience. But did you have your doctor call your insurance company and try to go to bat for you? Maybe it would have helped.

    I’m sorry that you have only one company offering ACA policies in your area. We still have three in central Ohio. My deductible went up (from $1200 to $2000, the premium increased (but Trump refusing the extend cost-sharing subsidies probably made the increase worse that it had to be), the price of generic drugs went up by $5/month (whether retail or mail order) from $15 to $20, and it now costs $75 to see a specialist (up from $50). Drugs, the $25 for primary care providers, and the $75 to see specialists don’t count toward the deductible.

    Yes, we need to something different about how we deliver health care. The Canadian and UK models aren’t probably right for us, but perhaps we can learn some lessons from the French and German health care systems, or even some ideas from the systems of other Western democracies. I definitely do not want to return to the “free market” system as it existed in the 50s and 60s. Growing up in a low-income family during the 60s, we had no health insurance except a major medical policy with a high deductible. He and one of my sisters developed lasting health problems that could have been treated and cured if we had had health insurance that provided preventive care and subsequent care at reasonable rates. No one should have to live like that — ever.

    I would be thrilled to pay more in taxes for a more stable health care delivery system for all Americans.

    1. I very strongly disagree with you First of all, when I was growing up in the 60s, there were public health clinics that offered inexpensive preventative care, and my mother often took us six children to those, especially basic childhood immunizations. Then we had a pediatrician for other routine care. In fact, even when I was in my early twenties, a simple doctor’s visit was not more than $25, and that was in California (a more expensive state).

      I recommend that you read some of my other posts in which I discuss the spreading of Direct Primary Care (a free market solution) that charges a low monthly fee for a wide range of basic primary care including preventative care and does not use insurance.

      I will never approve raising taxes for government-controlled health care. I believe, that as much as possible, the government should butt out of people’s individual health care decisions. There are even good ways for low income people who very much need the government’s assistance (for lack of their own resources) to get their health care needs met in an economical and common-sense way. Healthy Indiana provides the able-bodied low-income people with generous Health Savings accounts, as well as high deductible health plans. The more insurance interferes in our daily lives, the more expensive it will continue to be.

      The average American, even low-income Americans (which I am currently) have the intelligence to shop for value in doctors and other health care providers, and I will always fight to make my own decisions, rather than having the government tell me what kind of insurance I should have.

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