From: tcmay@got.net (Timothy C. May)
Date: Wed, 18 Sep 1996 14:24:34 +0800
To: cypherpunks@toad.com
Subject: The Near-Necessity of Health Insurance
Message-ID: <ae64a320080210046e61@[207.167.93.63]>
MIME-Version: 1.0
Content-Type: text/plain


At 8:49 PM 9/17/96, Simon Spero wrote:

>I wouldn't be so proud of the US health care system; the actual quality
>of care is really pretty awful, even with insurance. Even though the
>NAtional Health Service in the uK is woefully underfunded, I've always
>had much better treatment than I have from HMOs here; even seeing a
>specialist privately, at home, with no insurance, is cheaper than getting
>an X-Ray looked at by someone who once met a radiologist a cocktail
>party.
...
>There are ideological reasons that argue  for rejecting  such
>compulsory schemes  based on that element of coercion; it's hard to
>make the case against purely on efficiency grounds.

Personally, I have not been a patient in a hospital in my entire adult
life. Nor have I seen a doctor, except for a mandatory college physical in
1970 and an insurance company physical in 1977. I just haven't broken any
bones, had any serious illnesses, or felt the need to visit a doctor, an
emergency room, or a walk-in clinic of any sort. I suppose I've been lucky.
Also, I dislike hospitals and avoid doctors unless there seems to be a
compelling need. So far, there has not been.

And, no, I don't have any health insurance of any kind.

However, I am thinking about getting some. Not so much because I'm getting
older, but because I fear a new phenomenon: hospital emergency rooms
refusing admittance of patients unless they can present the proper
patient-unit ID card (showing one is enrolled in Blue Shield, Blue Cross,
Kaiser, or whatever).

My dentist's receptionist/bill handler already seems flustered that I am
paying my dental bills with a check, rather than giving her my insurer's
account number.

I also learned from a "60 Minutes" report, since confirmed elsewhere, that
large hospitals routinely negotiate large discounts with large insurers,
e.g., Blue Shield, so that while the "list price" of a typical day in a
hospital may be an exorbitant $1800 a day ($30 for an aspirin, $75 for the
lights-out bed check, etc...it all adds up!), Blue Shield has negotiated a
fee of less than a third of that....

In other words, the person who insures himself (through savings and
investments) and who offers to pay for treatment out of his own funds, may
be at a serious disadvantage. He pays the inflated rates for services, and
may face delays in being admitted to a hospital.

(This space reserved for Duncan and others to explain how one can offer to
pay in Krugerrands and to negotiate with the hospital on the spot. Meaning
no disrespect to Duncan, but I doubt it is this easy. The mind-set of
hospitals seems to be that anyone without a valid patient-unit card is
obviously a derelict and indigent. And while all hospitals are required to
accept derelicts and indigents in suitable emergencies--not a law I agree
with--it is not desirable that one be treated as a derelict and
undesirable. I hope I am conscious enough to give the admitting staff my
financial health information.)

Anyway, I'm thinking of finally bowing to the inevitable and starting to
fork out $200-300 a month for health care I am unlikely to routinely use.

(Obviously the folks who use their insurance routinely, as one of my
engineers once used to do (he'd take his kids to the hospital every time
they sneezed), are being subsidized by those of us who avoid hospitals at
all costs.)

I'm not arguing for national health care, just noting that we effectively
are getting it, between the "Poor People" having subsidized care and the
"Rest of Us" in employer-funded or private health care plans.

Cash is already dead at most hospitals.

--Tim May

We got computers, we're tapping phone lines, I know that that ain't allowed.
---------:---------:---------:---------:---------:---------:---------:----
Timothy C. May              | Crypto Anarchy: encryption, digital money,
tcmay@got.net  408-728-0152 | anonymous networks, digital pseudonyms, zero
W.A.S.T.E.: Corralitos, CA  | knowledge, reputations, information markets,
Higher Power: 2^1,257,787-1 | black markets, collapse of governments.
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