I have a patient with no health insurance but a brand new Mercedes. He says he can’t afford health insurance. He cringes at the cost of his medications and our office visit charges. His car cost a lot of money and I know that authorized Mercedes dealers charge around $140/hour for their technicians’ (not mere mechanics) time. A routine service costs several hundred dollars, which he seems more okay with than the cost of his own healthcare visits.
His new Mercedes is under warranty, but his body is not. He is risking financial disaster if he gets seriously ill with no insurance coverage.
I have another patient who needed a muscle relaxer for a short period of time. His insurance wouldn’t cover it without a prior authorization. The cash cost was about $14. We suggested he pay for the medication and told him his condition would have resolved by the time a prior auth might have been granted. He elected to go without.
The brutal truth is that a primary care doctor’s opportunity cost, how much revenue we can potentially generate by seeing patients, is around $400/hour or $7/minute. There is no way I could request a prior authorization in under two minutes. So it would have been more cost effective to pay for his medication than to do the unreimbursed paperwork (or computer work, or phone work) on his behalf. But, of course, we can’t do that.
That patient and many others think that health insurance is such a complete package deal that everything should be covered. They feel moral indignation if they have to pay out of pocket.
Even Sweden’s socialized medicine system has copays. Why do some Americans balk at a one-time cash cost of $14 for a non-covered drug when monthly, lifelong copays for modern COPD inhalers that many fixed-income seniors depend on can be over $100?
A Country Doctor Writes: 
This thinking is likely flawed by the disproportional cost of health insurance, we don’t expect our car insurance to pay for our oil change (i.e. regular maintenance), but the cost of private health insurance is so great people expect it to pay for their “oil change.” What would it be like if preventative care was affordable and we used insurance for the purpose it was designed, unexpected costs, accidents unexpected injury/illness?
I can totally relate to this. Yesterday I saw a woman for her Medicare Wellness Assessment; as she was basically healthy, we spent a lot of time on how to improve her bone health.
Her husband had a different insurance; he hates insurance and Medicare and takes only one blood pressure. In my brief assessment of him, he is headed for an MI because of anger, diet, and abdominal obesity. He sits in his garage surrounded by his “toys”—- a Porsche, a very expensive bike, a new RV. And they have a beautiful home. But God forbid he would want to pay for a better insurance policy. People feel entitled to high quality healthcare in this country. I suggested we all need a system like I have; I am a veteran and use the much improved VA. This, however, is essentially a form of socialized medicine with the doctors and employees government employees.
I hear you Pam. I was a military wife, I and our children received some of the best care in the world, and my husband was enlisted, not an officer. Our son joined the Coast Guard, and he guaranteed his family first class care. He was at sea, when his cutter suffered a freak accident. He’s a 100% disabled from that, but as you say- he goes to a first class VA.
We had a spell, where we had several insurance policies, and I found out that when push comes to shove, each insurance company-TriCare being one- said that the other insurance company was responsible. We paid and paid. I developed that if I need the care, I’m willing to pay for it. After all, people do that for their dogs.