The Haggler’s Guide to Cheaper Health Care

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A 53-year-old man who used to cover the health insurance industry as a journalist purposefully decides that health insurance isn’t worth the money, and so he goes without it. He negotiates with doctors, haggles over the costs of services, and asks for discounts because he’s paying in cash. Over the course of a year, he’ll save $6,000.

The man in question, J. Duncan Moore Jr., writes about his choice to forego health insurance in the LA Times. After quitting his job more than a year ago, Moore received insurance through COBRA (which bites, btw), paying nearly $450 a month. When his access to COBRA ended, he simply decided to not bother paying for a health insurance on the open market. Why? He looked hard at the costs and his health history, and decided insurance was a bad deal. He explains:

I’ve always been a naturally healthy person. I eat right and get plenty of sleep. All my life I’ve avoided unhealthy behaviors like crack cocaine and yoga. My parents are in their 80s and in great shape. There’s no cancer or heart disease in the family history. My Scottish grandparents lived to be 87 and 91.

Like a lot of guys who were not especially athletic in their youth, when I hit my 40s I decided to become a stud. I taught myself to swim and started lifting weights. I sold my car 10 years ago and started taking public transit. In warm weather, I ride my bike everyplace I need to go. I’ve never been overweight. I’m fit, trim, well-proportioned. My body mass index hovers around 24.7. (At 25, you are borderline “overweight,” but people with strong bones and lots of muscle mass like me tend to tilt toward overweight in that metric.)

If I were going to develop a chronic disease, I’d have it by now. My blood glucose tends toward the low end, so I’m not going to become diabetic. I have some lower back pain and stiffness from a herniated disk 15 years ago, but I manage it with strengthening exercises and stretches. Knee or joint surgery? I don’t like to run. Cancer? I never smoked. I had a colonoscopy at 51 and saw for myself on the video monitor that I’m clean as a whistle down there.

So he’s not only healthy, he’s got a sense of humor: “All my life I’ve avoided unhealthy behaviors like crack cocaine and yoga.”

Though I can understand the rationale behind his decision, his day-to-day life must be beyond nerve-racking. You think of the typical “by choice” person without health insurance as someone who is young and carefree, someone who doesn’t know better. This guy is 53. He does know better.

Because he knows the industry, having covered it as a journalist, he’s much more prepared than the average person to get value out of the money he’s spending on health care. His knowledge of doctors and health services helps him decide to go without insurance. “I know how to be a savvy medical consumer,” he writes. Moore understands that nearly all health service bills are dramatically inflated (regularly marked up by as much as 40%), and so he negotiates directly with those providing care and offers immediate cash payments. The plan works for doctor and patient alike. An example:

A month ago, I went to the doctor for a checkup. My “intermediate” visit, billed at $100, was discounted to $65, and some routine cholesterol tests, billed at $195, cost me $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.

The argument goes that if everyone had more “skin in the game,” as the phrase goes, and everyone was more mindful of the costs of health care, costs would come down across the board. As it is, the typically insured person cares only about the costs of one’s insurance policy and any expenses you’d have to pay over and above that—co-pays and what have you. But because the consumer doesn’t care about the actual costs of services, prices for those services keep increasing, and therefore prices for premiums keep increasing, up 131% in the last ten years.

On the other hand, who wants to shop around for doctors and do price comparisons on things like skin grafts? More people are bartering for health care services, but this isn’t for everyone. Who would feel good about picking a doctor based mostly on price or whether the doc is willing to deal? Are you supposed to go browsing for doctors the same way you’d hire a mechanic or a plumber? Health care is serious business, and most people don’t have the amount of industry knowledge and experience that Moore has. Most folks haven’t a clue as to how to evaluate the costs of health services and decide whether their kid really needs that one extra test, or whether, official recommendations aside, you can postpone the colonoscopy for a few years. We rely on doctors’ guidance for these things. We rely on doctors to keep us alive, not to fix a clogged toilet or diagnose that clicking sound in the car engine. What’s at risk is at an entirely different level.

Even with his understanding of health care and his haggling ways, Moore worries a lot about his no-insurance status, and understandably so. Over a year’s time he’ll save about $6,000 that otherwise would have gone to insurance companies, but he also keeps his fingers crossed—probably more so than the rest of us—that he doesn’t get hit by a bus or discover a lump somewhere. Moore is not anti-insurance. He’s actually just asking to get his money’s worth:

I’m looking forward to the day when all of us will qualify for good medical insurance at reasonable prices, with a firm regulatory hand behind it. If we all have to pay into the system in order to make health reform work, so be it. I’ll gladly pay if I’m assured of getting the services I contracted for.

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