Direct Primary Care (Medical)

[ericrugiero]

The latest blog post talks about Direct Primary Care. 

https://www.mrmoneymustache.com/2020/11/09/direct-primary-care/

Seems like a great option for early retirees when you combine it with something like catastrophic care insurance or a medical cost sharing plan to cover any really large costs. 

I looked and it doesn't seem like that is an option in my small town yet.  But, if it's a relatively new movement maybe it will come by the time I could potentially need it.  Regardless, it seems like a great option for many others on this forum.  Does anyone else have experience with this? 

[Dago]

I don't understand how it can work. Taking his example with 1000 subscribers paying 100$ per month for a total of 1.2 million annual. This is ridiculously low to cover all the medical needs of all these people. A single cancer treatment could eat up most of it. Do I miss something obvious ?

EDIT: removed a part that was not adding to the conversation and was needlessly judgemental.

[soccerluvof4]

I don't understand how it can work. Taking his example with 1000 subscribers paying 100$ per month for a total of 1.2 million annual. This is ridiculously low to cover all the medical needs of all these people. A single cancer treatment could eat up most of it. Do I miss something obvious ?

EDIT: removed a part that was not adding to the conversation and was needlessly judgemental.

The 100$ just covers the Visits with your General Doctor who will refer you then if needed to the next layer of Doctors at some discounts if available. So there is a whole lot of layering here. So you would for sure need additional coverage.

[SpreadsheetMan]

Lol - this is equivalent to the system that existed pre-NHS in the UK. Poor families would pay a weekly subscription to the local doctor so they could get rudimentary medical coverage.

[OtherJen]

I don't understand how it can work. Taking his example with 1000 subscribers paying 100$ per month for a total of 1.2 million annual. This is ridiculously low to cover all the medical needs of all these people. A single cancer treatment could eat up most of it. Do I miss something obvious ?

EDIT: removed a part that was not adding to the conversation and was needlessly judgemental.

The 100$ just covers the Visits with your General Doctor who will refer you then if needed to the next layer of Doctors at some discounts if available. So there is a whole lot of layering here. So you would for sure need additional coverage.

It seems like it could work for younger, healthy people if combined with a high-deductible catastrophic plan. I remain skeptical about the health-sharing ministry recommended in the blog post. There’s a lot of fine print.

[bigblock440]

I don't understand how it can work. Taking his example with 1000 subscribers paying 100$ per month for a total of 1.2 million annual. This is ridiculously low to cover all the medical needs of all these people. A single cancer treatment could eat up most of it. Do I miss something obvious ?

EDIT: removed a part that was not adding to the conversation and was needlessly judgemental.

Yes, you missed that the doctor is not going to be curing your cancer.  They're just going to be doing the things you would have done at your normal doctor's office.

[Metalcat]

Yet again, I seriously question his claim of serious health issues being rare. The lifetime incidence of cancer is astronomically probable, like 1 in 2. Granted, a lot of cancers are modulated by lifestyle factors, but the chances are still huge, and that's just cancer.

In the blog post, Pete acknowledges that he can afford most medical issues that might pop up, but that others can't, which is a great first step in recognizing the issues with his previous "just don't get sick" types of posts, but I still challenge the very basis of his claim that serious illness is rare.

It really, really isn't.

How valid is his assessment of the value of insurance if his estimation of relative risk of illness is unrealistic?

I'm all for optimism, but as someone with a healthy lifestyle who has been hospitalized multiple times, had multiple surgeries, and is on an extremely expensive medication for life, all for conditions that are unavoidable, who is also a medical professional who has seen first hand how unavoidable many medical conditions are, I cannot subscribe to this version of reality where the risk is "rare".

[OtherJen]

Yet again, I seriously question his claim of serious health issues being rare. The lifetime incidence of cancer is astronomically probable, like 1 in 2. Granted, a lot of cancers are modulated by lifestyle factors, but the chances are still huge, and that's just cancer.

In the blog post, Pete acknowledges that he can afford most medical issues that might pop up, but that others can't, which is a great first step in recognizing the issues with his previous "just don't get sick" types of posts, but I still challenge the very basis of his claim that serious illness is rare.

It really, really isn't.

How valid is his assessment of the value of insurance if his estimation of relative risk of illness is unrealistic?

I'm all for optimism, but as someone with a healthy lifestyle who has been hospitalized multiple times, had multiple surgeries, and is on an extremely expensive medication for life, all for conditions that are unavoidable, who is also a medical professional who has seen first hand how unavoidable many medical conditions are, I cannot subscribe to this version of reality where the risk is "rare".

Yes. And he lives in the US, which makes his assessment even more questionable. Not only is the likelihood of a serious condition as high (or higher) here as in Canada, but here, we don't have national insurance on which to fall back. It's lovely that he's apparently wealthy enough that $10K per month out-of-pocket for cancer treatment (a drug cost quoted to an acquaintance a couple of years ago) is no big deal. Most people aren't in that boat, and even most FI people don't have that kind of cash laying around.

[ericrugiero]

Yet again, I seriously question his claim of serious health issues being rare. The lifetime incidence of cancer is astronomically probable, like 1 in 2. Granted, a lot of cancers are modulated by lifestyle factors, but the chances are still huge, and that's just cancer.

In the blog post, Pete acknowledges that he can afford most medical issues that might pop up, but that others can't, which is a great first step in recognizing the issues with his previous "just don't get sick" types of posts, but I still challenge the very basis of his claim that serious illness is rare.

It really, really isn't.

How valid is his assessment of the value of insurance if his estimation of relative risk of illness is unrealistic?

I'm all for optimism, but as someone with a healthy lifestyle who has been hospitalized multiple times, had multiple surgeries, and is on an extremely expensive medication for life, all for conditions that are unavoidable, who is also a medical professional who has seen first hand how unavoidable many medical conditions are, I cannot subscribe to this version of reality where the risk is "rare".

Yes, but if you combine the direct primary care with a catastrophic care insurance then you are covered at both ends of the spectrum for potentially less money than a regular insurance plan.  You also build a relationship with a doctor who has your best interest at heart because you staying healthy keeps you from lots of extra visits. 

My big question is what does the $100/month cover?  Obviously it covers well checks and obviously not cancer treatments.  Where is the cutoff and how well defined is it?  This is all theoretical for me right now but if I ever have to shop for my own insurance it has some potential. 

[stashja]

Apparently it doesn't cover contraception, so one can only assume that if MMM is in a relationship, it's either with someone who doesn't need that, or he's letting her pay for it  by herself via some means other than the health ministry.
Ministry medical coverage won't work not only for women and couples who need contraception (remember MMM's long ago "one child is okay" post?) or women who need hormonal contraception to control chronic debilitating conditions not caused by personal choices, such as endometriosis, because headaches, cramps, and vomiting at work isn't conducive to earning enough to FIRE.

[Metalcat]

Yet again, I seriously question his claim of serious health issues being rare. The lifetime incidence of cancer is astronomically probable, like 1 in 2. Granted, a lot of cancers are modulated by lifestyle factors, but the chances are still huge, and that's just cancer.

In the blog post, Pete acknowledges that he can afford most medical issues that might pop up, but that others can't, which is a great first step in recognizing the issues with his previous "just don't get sick" types of posts, but I still challenge the very basis of his claim that serious illness is rare.

It really, really isn't.

How valid is his assessment of the value of insurance if his estimation of relative risk of illness is unrealistic?

I'm all for optimism, but as someone with a healthy lifestyle who has been hospitalized multiple times, had multiple surgeries, and is on an extremely expensive medication for life, all for conditions that are unavoidable, who is also a medical professional who has seen first hand how unavoidable many medical conditions are, I cannot subscribe to this version of reality where the risk is "rare".

Yes, but if you combine the direct primary care with a catastrophic care insurance then you are covered at both ends of the spectrum for potentially less money than a regular insurance plan.  You also build a relationship with a doctor who has your best interest at heart because you staying healthy keeps you from lots of extra visits. 

My big question is what does the $100/month cover?  Obviously it covers well checks and obviously not cancer treatments.  Where is the cutoff and how well defined is it?  This is all theoretical for me right now but if I ever have to shop for my own insurance it has some potential.

I'm not questioning the strategy he's proposing, and I'm happy that he's finally proposing *something* as an alternative to self insuring.

I'm very, very much questioning using language like "extremely rare" to describe serious illnesses or injuries, which is what he uses as the very basis assumption of this whole endeavour.

I'm all for challenging the value of expensive insurance, but his followers reading see statements that he got out his spreadsheets and analyzed the risk vs the cost, which makes it sound like he's being objective about this and actually crunching real actuarial type data.

If he is, I would like to see him share those numbers, which he usually does, but I would also like to see why he can possibly call a serious healthy issue "extremely rare" when they are, in fact, extremely common in a lifetime.

Or is he just proposing this until his actuarial data puts him in a demographic of higher risk? Because he hasn't said that, which is again out of character with his normal "let me show my work" type approach.

Or is none of this based on data, and his claim of calculations is more of a vague understanding of the various costs of illnesses compared to insurance premiums, and his gut instinct that he just won't get cancer, or ever throw a clot, or get hit by a car.

Contrary to a lot of people, I'm actually very open to understanding if there is a reasonable argument for not paying absurd premiums for health insurance. I'm Canadian, so the US system sounds insane to me. I just *insist* on transparent accounting of risk and cost from someone who made themselves famous by breaking down exactly this kind of math into understandable format for readers over whom he has enormous sway.

I don't challenge what he's proposing, because I don't really understand it. I'm Canadian, so it's mostly jibberish to me, but I see a blatant issues with the presuppositions of the basis argument underpinning all of it.

I normally come away from reading MMM content thinking "I get exactly what he's saying" even when I disagree with the delivery, timing, or whatever. But this just leaves me scratching my head going "wait...what?"

[chemistk]

DPC seems like an interesting concept, and perhaps a stepping stone to Americans realizing that a healthcare system apart from traditional insurance is, indeed, possible.

But a lot of commenters on the blog post pointed out the issues behind health sharing - most glaring of which was that just about all health-sharing plans explicitly exclude those with pre-existing conditions. That's a huge hole to fill if you or a family member you're looking to cover has anything more than a healthy lifestyle. From Sedera's website:

Needs that result from Pre-Existing Medical Conditions are subject to sharing limitations unless 36 months immediately prior to membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed.

And taken from their guidelines (https://sedera.com/wp-content/uploads/2020/04/Sedera-ACCESS-Guidelines-20200402.pdf), this is a non-exhaustive list of limitations (aka you pay entirely out of pocket for these):

ADD/ADHD treatment
Alternative medical practices (exception for some Chiro.)
Alcohol and drug abuse treatment and recovery
Counseling
Almost all Dental
Therapy of any kind (physical, speech, psychological) over $3k per year
Treatment for self-inflicted injuries
Nutritionists
Immunizations (all)
Abortions (that one is obvious)
Some organ transplants (bonus, rejection meds are only covered for 12mos post-op!)
Long term care >90 days
Medications for chronic conditions
Any medications that last >120 days for the 'scrip
The first $5k of normal delivery pregnancy expenses, or the first $7500 of c-section. There's actually a note that suggests alternative delivery methods can cost you less on the plan. WTF.


There's more there, but the point is that's a bad system unless you're healthy and don't have high risk factors for long term conditions.

Also pointed out in the blog comments, removing yourself from the pool of insured if you're healthy and young(er) only serves to cripple the ACA entirely.

[Metalcat]

^apparently they also don't guarantee payment even for medical services that are included in the plan. They can legally just not pay out if they choose not to.

I read quite a few of the comments, and this stood out to me most.

[KarefulKactus15]

That is a scary thought.

On the other hand it makes sense why they can't say "we guarantee any".  I'm sure there's a freak incident that would wipe out the funds for the entire group.

"We will pay almost anything but do have the right to refuse extreme things...." - no that doesn't read well either.

I'm not sure what the solution is.  Maybe they need a lifetime cap and guarantee all covered payment to that cap.    I realize we want to get away from lifetime caps but I can't imagine trying to operate a business with an un capped liability.

[Metalcat]

That is a scary thought.

On the other hand it makes sense why they can't say "we guarantee any".  I'm sure there's a freak incident that would wipe out the funds for the entire group.

"We will pay almost anything but do have the right to refuse extreme things...." - no that doesn't read well either.

I'm not sure what the solution is.  Maybe they need a lifetime cap and guarantee all covered payment to that cap.    I realize we want to get away from lifetime caps but I can't imagine trying to operate a business with an un capped liability.

What they're really doing is preventing the legal costs of having to defend rejecting a claim. Insurance companies deny legitimate claims all the time, but you can fight them on it legally if you have the capacity, finances, and don't die in the meantime.

[Imma]

@Malcat as someone who also has several severe medical issues and is legally disabled (although I've found a way to work anyway) that is also my main issue with MMM. I fear that he thinks that people like you and me are extremely rare instead of pretty common.

I encounter tons of people like him in my daily life, so I'm not surprised, but they don't have weblogs where millions of people can read that all you need for health are bikes, barbells and salads. Salads actually aren't that good for me and there are less and less days that bikes and barbells are something I can still do. And all of that is because I was born with the wrong set of genes. I understand it's hard for healthy people to accept though, because it means that they'd have to accept that the same thing could happen to them too.

I'm actually a bit surprised that this Primary care thing is so radical. Isn't that what a GP is? My GP is covered by my insurance but I think the subscription is about €5/month? In Europe so a totally different healthcare system.

[Metalcat]

@Malcat as someone who also has several severe medical issues and is legally disabled (although I've found a way to work anyway) that is also my main issue with MMM. I fear that he thinks that people like you and me are extremely rare instead of pretty common.

I encounter tons of people like him in my daily life, so I'm not surprised, but they don't have weblogs where millions of people can read that all you need for health are bikes, barbells and salads. Salads actually aren't that good for me and there are less and less days that bikes and barbells are something I can still do. And all of that is because I was born with the wrong set of genes. I understand it's hard for healthy people to accept though, because it means that they'd have to accept that the same thing could happen to them too.

I'm actually a bit surprised that this Primary care thing is so radical. Isn't that what a GP is? My GP is covered by my insurance but I think the subscription is about €5/month? In Europe so a totally different healthcare system.

The primary care model is a bit different from the Canadian and European primary care models.

We have something similar in Canada, which is a "concierge" private primary care service with an annual membership fee, it's closer to what Pete is describing.

It has some serious, serious issues though, which are mentioned in the comments on his article. It's largely seen as a very unethical way to practice since it really focuses on over utilizing diagnostic tests since that's where they make their money. There really is basically a "menu" to choose from, which just spits in the face of ethical, best practice, evidence based medicine.

The thing is, the public fucking love their tests, so they can't understand why it's such an irresponsible way to practice.

I don't know if this is how all of them work in the US, but clearly it's how the one Pete is seeing operates as he recieved a diagnostic test that there was absolutely no indication for, which even if it had shown a finding, there would be no change in treatment.

That's bad medicine for the sake of padding a bill. Even if it costs less, it's just another form of exploitation for profit.

[KarefulKactus15]

That is a scary thought.

On the other hand it makes sense why they can't say "we guarantee any".  I'm sure there's a freak incident that would wipe out the funds for the entire group.

"We will pay almost anything but do have the right to refuse extreme things...." - no that doesn't read well either.

I'm not sure what the solution is.  Maybe they need a lifetime cap and guarantee all covered payment to that cap.    I realize we want to get away from lifetime caps but I can't imagine trying to operate a business with an un capped liability.

So here is what I found on "maximum".

"There is no specific annual maximum dollar amount or lifetime maximum limits per member, though certain dollar amounts and/or visit limits apply to specific types of medical care and therapies. Sharing is only limited to the cumulative contributions received from participating members in any given month. There is, however no limit on the number of needs that an individual member or household may have. Additionally, no single need may consume more than one third (1/3) of the total number of shares available in order to assure ample shares for all members."

A max of 1/3rd makes sense.  As long as you arent the one that needs it!  Wonder what 1/3rd looks like.   Is that Monthly share price x 1 million sharers?    IDK... 

[Imma]

That sounds pretty different from a regular GP. I guess I was just a bit shocked that going to the same primary care doctor who knows you personally was so special to him. That's normal here.

I'm not a big fan of these unnecessary diagnostic tests either.
My gastroenterologist knows by know he needs to come up with a good reason to order more tests. Thankfully in my country doctors are pretty conservative with treatments, tests and antibiotics, but there's a growing market for for-profit private tests like these. The only reason why they're not more popular is because they cost €€€.

[Metalcat]

That sounds pretty different from a regular GP. I guess I was just a bit shocked that going to the same primary care doctor who knows you personally was so special to him. That's normal here.

I'm not a big fan of these unnecessary diagnostic tests either.
My gastroenterologist knows by know he needs to come up with a good reason to order more tests. Thankfully in my country doctors are pretty conservative with treatments, tests and antibiotics, but there's a growing market for for-profit private tests like these. The only reason why they're not more popular is because they cost €€€.

I think he enjoyed not having insurance as a middle man dictating who he can see, what he can have done, etc.

I worked in a private health industry with a much less convoluted private insurance system where patients and providers have much more control than in the US, but even then, insurance was often a frustrating middle man, and dealing directly with uninsured clients was so much more pleasant...assuming they could afford care of course.

So I completely understand the appeal of directly paying the doctor, but in my case, the care I provided didn't differ from insured patients to uninsured patients, the ethics and care were identical because I had enough freedom with both systems to be able to and sustain profitability.

[stashja]

The first $5k of normal delivery pregnancy expenses, or the first $7500 of c-section. There's actually a note that suggests alternative delivery methods can cost you less on the plan. WTF.

Oh, I see. Try the risky at home birth, especially if the hospital is inconveniently far away. If the Mrs. and/or baby dies, you can always find/conceive another one. There are reasons why maternal and infant mortality in the US is surprisingly high for a developed country.

[habanero]

I have a GP who is my sole point of contact with the health care system. Unless its some emergency, he's the first person I contact. I actually can't even contact anyone else, except for going to the ER of course or calling 113. Every person in Norway has (or should have) a dedicated GP, you can choose yourself which one in your area and you can change I think it's once or twice per year if they have capacity. If you don't have one, you have to go to the ER. Whenever I go to see him I pay some token sum dependet on what he did, its like 15 bucks + a few bucks extra if there is some test taken or some special equipment used or whatever. Under 18s dont pay anything. If I should require something he cannot do, he refers me to a specialist or directly to a hospital if needed. There its the same drill with me paying some token fee and they get the rest reimbursed from the government.

If my total health out-of-pocket for a calendar year exceeds ~250 dollars (including ER visits) i don't pay anything more for that year.

[jim555]

Unless you are super loaded I don't see the appeal.  Insurance is so a 30 day stay in the ICU doesn't blow out your stack and kill your retirement.  DPC doesn't mitigate this risk at all.

[KarefulKactus15]

Unless you are super loaded I don't see the appeal.  Insurance is so a 30 day stay in the ICU doesn't blow out your stack and kill your retirement.  DPC doesn't mitigate this risk at all.

DPC doesn't.

But the health share should.

[kite]

Apparently it doesn't cover contraception, so one can only assume that if MMM is in a relationship, it's either with someone who doesn't need that, or he's letting her pay for it  by herself via some means other than the health ministry.
Ministry medical coverage won't work not only for women and couples who need contraception (remember MMM's long ago "one child is okay" post?) or women who need hormonal contraception to control chronic debilitating conditions not caused by personal choices, such as endometriosis, because headaches, cramps, and vomiting at work isn't conducive to earning enough to FIRE.

Plenty of options for contraception are just not that expensive.  For one thing, condoms can be had for free or for next to nothing. 
I worked on a paper arguing that hormonal contraception should be available OTC in the US, as it is in Mexico.  A study of women in El Paso found that many would cross the border and pay out of pocket because it worked out to be more convenient for them than missing work for an unnecessary clinic visit to get their pills "free" in the US. 

[FINate]

Our family of four is a DPC subscriber and we love it.

As others here have stated, it is NOT INSURANCE. It does not cover catastrophic events like major trauma or cancer treatment. Our DPC makes this abundantly clear in their literature and when we went in for our initial consultation. Do not assume that DPC covers such things, and don't assume these never happen. Instead, make sure you have another layer of coverage for such events, like catastrophic coverage or similar.

So why bother with DPC if you still need another layer of coverage? Because it's difficult to have a relationship with your dr in a traditional setting. This is even more of a challenge if you have anything but a gold plated health plan.

Most dr visits for most people are not for major things. They are for minor things: check-ups, stitches, getting a mole examined/removed, UTI, etc. A DPC is wonderful for these things, and they can refer to someone else if it's something more serious.

[Queen Frugal]

We have a few DPC provider in our area and I would sign up in a heartbeat if they were taking patients. They aren't. They have plenty already.

I have been on ACA HDHPs since the beginning. Now that I'm over the hill, I get one free checkup a year. But I pay for 100% of EVERYTHING else. So far, knock on wood, I haven't ever hit my deductible. The most useful benefit of my health insurance is that I get to pay the negotiated health insurance contract rate and not the poor sucka doesn't have any insurance out of pocket rate.

I do end up going to the doctor on occasion for this or that and it still costs me $200 just to sit in front of my doc for a few minutes. He usually just offers tests or meds. Because that's what we do here in the US. But I spend too much time being a cheapskate and not calling on the doctor when I probably should because I don't want to pay for a doctor's visit.

On average, it would have been cheaper for me to pay the DPC fee out of pocket than it would have been to pay my regular primary care doctor. And I probably would have received better care. Mostly because I wouldn't be afraid to call my doctor and be seen.

While DCPs are great, it's stupid nuts to have a DPC provider and no health insurance. Stupid nuts.

[iris lily]

I have a direct primary care physician. I choose to pay her $800 a year rather than A traditional GP who fusses with insurance for every tiny thing.

She would also bill me monthly on a month-to-month subscription basis if that’s what I wanted, but I prefer to just pay it all at once.

And of course I have health insurance because I want to protect my stash.

[markbike528CBX]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

[iris lily]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

A few people have enough money to self-insure. Pete is one of them. I have a friend who does it as well and has had so many major hospitalizations in the past five years you wouldn’t believe it. This includes an incident where she was hit by a car. She was on foot. You can imagine who won that altercation.

 But she keeps trucking on not getting insurance.She pays her hospital bills and negotiate them  down either 2/3 or 1/3 I can’t remember what she said. The thing with the car was billed a few hundred thousand dollars. And since then she’s Had emergency gallbladder surgery, major jaw surgery, she developed diabetes from her previous treatments, Prior to their car accident she had extensive and serious cancer treatment.

People who can afford this kind of thing kind of course talk about self insuring which is what you’re talking about. A Direct care physician is the least of it.

Remember, I have a direct Care physician.

Do you really have enough money to self-insure? I mean, what are your net assets then?

Of course we know that health insurance is not health care. We know that. Health insurance is to protect your assets. If you don’t have any assets, it may be fine to go without, what are you risking? Only you can figure that one.

You were also behind the curve because the much acclaimed ACA eliminated catastrophic care insurance policies. Of course that’s what most MMMers would’ve done back in the day.

[markbike528CBX]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

A few people have enough money to self-insure. Pete is one of them. I have a friend who does it as well and has had so many major hospitalizations in the past five years you wouldn’t believe it. This includes an incident where she was hit by a car. She was on foot. You can imagine who won that altercation.

 But she keeps trucking on not getting insurance.She pays her hospital bills and negotiate them  down either 2/3 or 1/3 I can’t remember what she said. The thing with the car was billed a few hundred thousand dollars. And since then she’s Had emergency gallbladder surgery, major jaw surgery, she developed diabetes from her previous treatments, Prior to their car accident she had extensive and serious cancer treatment.

People who can afford this kind of thing kind of course talk about self insuring which is what you’re talking about. A Direct care physician is the least of it.

Remember, I have a direct Care physician.

Do you really have enough money to self-insure? I mean, what are your net assets then?

Of course we know that health insurance is not health care. We know that. Health insurance is to protect your assets. If you don’t have any assets, it may be fine to go without, what are you risking? Only you can figure that one.

You were also behind the curve because the much acclaimed ACA eliminated catastrophic care insurance policies. Of course that’s what most MMMers would’ve done back in the day.

In reverse order:
Yep, I'd love to have an affordable catastrophic care policy. 
I get the impression that most people, not the smart ones here on the forum :-)  , DO conflate health insurance and health care.
Liquid NW $2.5M + small pension + Social Security + paid house (for worst case scenarios only).

[iris lily]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

A few people have enough money to self-insure. Pete is one of them. I have a friend who does it as well and has had so many major hospitalizations in the past five years you wouldn’t believe it. This includes an incident where she was hit by a car. She was on foot. You can imagine who won that altercation.

 But she keeps trucking on not getting insurance.She pays her hospital bills and negotiate them  down either 2/3 or 1/3 I can’t remember what she said. The thing with the car was billed a few hundred thousand dollars. And since then she’s Had emergency gallbladder surgery, major jaw surgery, she developed diabetes from her previous treatments, Prior to their car accident she had extensive and serious cancer treatment.

People who can afford this kind of thing kind of course talk about self insuring which is what you’re talking about. A Direct care physician is the least of it.

Remember, I have a direct Care physician.

Do you really have enough money to self-insure? I mean, what are your net assets then?

Of course we know that health insurance is not health care. We know that. Health insurance is to protect your assets. If you don’t have any assets, it may be fine to go without, what are you risking? Only you can figure that one.

You were also behind the curve because the much acclaimed ACA eliminated catastrophic care insurance policies. Of course that’s what most MMMers would’ve done back in the day.

In reverse order:
Yep, I'd love to have an affordable catastrophic care policy. 
I get the impression that most people, not the smart ones here on the forum :-)  , DO conflate health insurance and health care.
Liquid NW $2.5M + small pension + Social Security + paid house (for worst case scenarios only).

My friend, $ 2.5 million is chump change when it comes to medical emergencies. I have very similar net assets, a little less with liquid because I am tied into a family farm.

But I’m also probably many decades older than you, covered by Medicare, but I still would not go without a supplemental insurance policy plan because I know that $2.5 million can disappear very quickly.

Pete has much more in assets and just as important, a huge income from this website.

[Queen Frugal]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

A few people have enough money to self-insure. Pete is one of them. I have a friend who does it as well and has had so many major hospitalizations in the past five years you wouldn’t believe it. This includes an incident where she was hit by a car. She was on foot. You can imagine who won that altercation.

 But she keeps trucking on not getting insurance.She pays her hospital bills and negotiate them  down either 2/3 or 1/3 I can’t remember what she said. The thing with the car was billed a few hundred thousand dollars. And since then she’s Had emergency gallbladder surgery, major jaw surgery, she developed diabetes from her previous treatments, Prior to their car accident she had extensive and serious cancer treatment.

People who can afford this kind of thing kind of course talk about self insuring which is what you’re talking about. A Direct care physician is the least of it.

Remember, I have a direct Care physician.

Do you really have enough money to self-insure? I mean, what are your net assets then?

Of course we know that health insurance is not health care. We know that. Health insurance is to protect your assets. If you don’t have any assets, it may be fine to go without, what are you risking? Only you can figure that one.

You were also behind the curve because the much acclaimed ACA eliminated catastrophic care insurance policies. Of course that’s what most MMMers would’ve done back in the day.

In reverse order:
Yep, I'd love to have an affordable catastrophic care policy. 
I get the impression that most people, not the smart ones here on the forum :-)  , DO conflate health insurance and health care.
Liquid NW $2.5M + small pension + Social Security + paid house (for worst case scenarios only).

My friend, $ 2.5 million is chump change when it comes to medical emergencies. I have very similar net assets, a little less with liquid because I am tied into a family farm.

But I’m also probably many decades older than you, covered by Medicare, but I still would not go without a supplemental insurance policy plan because I know that $2.5 million can disappear very quickly.

Pete has much more in assets and just as important, a huge income from this website.

Absolutely agree that $2.5 mil is chump change in the face of big medical emergencies.

But even if you had more than $2.5 mil like Pete - 2x more, 4x more, 10x more, whatever - enough to pay any medical bill - why would you threaten your hard earned fortune by not having health insurance? The piddly amount of the premium compared to your assets is totally worth it for asset protection purposes.

[markbike528CBX]

It is interesting to see that MMM  Himself is getting the same sort of hot blow-back I did when I started the thread:
https://forum.mrmoneymustache.com/welcome-to-the-forum/self-insured-specifically-health-insurance/

As an update to that thread, we (DW and I) are skating around insurance free this year.
Note that this is not the same thing as health-care free, as we have been seeing our primary care physician on our normal schedule, and going in for extra's too when needed.

I see insurance as basically giving it to the Mob as protection money.   You really don't know if it will help when you need it.
Plus, Mob/insurance has bad accountants who have a huge bureaucracy who really eat up the money, not even getting it to the bosses/shareholders.

Insurance is NOT heath-care, it is the promise to pay for certain, not all, heath-care costs.

Maybe MMM should have stated what I did in the opening post...
(puts on flame suit )

All that being said both MMM and I recognize that some/many/most? people cannot do this.

A few people have enough money to self-insure. Pete is one of them. I have a friend who does it as well and has had so many major hospitalizations in the past five years you wouldn’t believe it. This includes an incident where she was hit by a car. She was on foot. You can imagine who won that altercation.

 But she keeps trucking on not getting insurance.She pays her hospital bills and negotiate them  down either 2/3 or 1/3 I can’t remember what she said. The thing with the car was billed a few hundred thousand dollars. And since then she’s Had emergency gallbladder surgery, major jaw surgery, she developed diabetes from her previous treatments, Prior to their car accident she had extensive and serious cancer treatment.

People who can afford this kind of thing kind of course talk about self insuring which is what you’re talking about. A Direct care physician is the least of it.

Remember, I have a direct Care physician.

Do you really have enough money to self-insure? I mean, what are your net assets then?

Of course we know that health insurance is not health care. We know that. Health insurance is to protect your assets. If you don’t have any assets, it may be fine to go without, what are you risking? Only you can figure that one.

You were also behind the curve because the much acclaimed ACA eliminated catastrophic care insurance policies. Of course that’s what most MMMers would’ve done back in the day.

In reverse order:
Yep, I'd love to have an affordable catastrophic care policy. 
I get the impression that most people, not the smart ones here on the forum :-)  , DO conflate health insurance and health care.
Liquid NW $2.5M + small pension + Social Security + paid house (for worst case scenarios only).

My friend, $ 2.5 million is chump change when it comes to medical emergencies. I have very similar net assets, a little less with liquid because I am tied into a family farm.

But I’m also probably many decades older than you, covered by Medicare, but I still would not go without a supplemental insurance policy plan because I know that $2.5 million can disappear very quickly.

Pete has much more in assets and just as important, a huge income from this website.

Absolutely agree that $2.5 mil is chump change in the face of big medical emergencies.

But even if you had more than $2.5 mil like Pete - 2x more, 4x more, 10x more, whatever - enough to pay any medical bill - why would you threaten your hard earned fortune by not having health insurance? The piddly amount of the premium compared to your assets is totally worth it for asset protection purposes.

Is that you Suze O?

https://forum.mrmoneymustache.com/antimustachian-wall-of-shame-and-comedy/suzie-says-you-must-be-a-$9-million-manwoman-to-retire/

Not totally on topic, but similar enough headline.
https://www.mrmoneymustache.com/2012/06/07/safety-is-an-expensive-illusion/

Can I pay for ALL possible medical expenses. Nope. 
Can I pay for many likely expenses, and still leave my wife more well off than she ever was previously, probably.

.......why would you threaten your hard earned fortune by not having health insurance?

Because that is why I have a hard earned fortune, to not have to live in fear.

I refuse to live in fear.

[Queen Frugal]

Is that you Suze O?

https://forum.mrmoneymustache.com/antimustachian-wall-of-shame-and-comedy/suzie-says-you-must-be-a-$9-million-manwoman-to-retire/

Oh man - you got me! I may trash the FIRE movement publicly, but I secretly know ya'll have the right ingredients in your sauce.

[sam123]

I think it is an interesting idea.  I worry sometimes that people with high-deductible insurance don't do regular screenings which could prevent illness from becoming catastrophic. Perhaps this could fill in some gaps.  I am thirty years and very healthy. They caught the beginning signs of cervical cancer at a routine pap smear.  My chances of survival are so much higher since it was detected early.  However, if I didn't have health insurance and no savings I might not be able to pay for the follow-up treatments. 

Also, I wonder about long-term conditions.  I have some nerve damage to my eyes following laser surgery which likely requires long-term management for my entire life.  I don't think this would help folks with chronic conditions as MMM notes.  I get a little bit frustrated when I see MMM endorse no insurance or high deductible insurance for "healthy" people.   I had no idea I was going to get nerve damage or cervical cancer until the day that I was diagnosed and previously considered myself very healthy.  You can go very quickly from being "totally healthy" to having a serious condition. 

Speaking from personal experience, the last thing I would want to be worrying about is money when dealing with these types of diagnoses as they are hugely emotionally tolling on their own.

[kite]

I think it is an interesting idea.  I worry sometimes that people with high-deductible insurance don't do regular screenings which could prevent illness from becoming catastrophic. Perhaps this could fill in some gaps.  I am thirty years and very healthy. They caught the beginning signs of cervical cancer at a routine pap smear.  My chances of survival are so much higher since it was detected early.  However, if I didn't have health insurance and no savings I might not be able to pay for the follow-up treatments. 

Also, I wonder about long-term conditions.  I have some nerve damage to my eyes following laser surgery which likely requires long-term management for my entire life.  I don't think this would help folks with chronic conditions as MMM notes.  I get a little bit frustrated when I see MMM endorse no insurance or high deductible insurance for "healthy" people.   I had no idea I was going to get nerve damage or cervical cancer until the day that I was diagnosed and previously considered myself very healthy.  You can go very quickly from being "totally healthy" to having a serious condition. 

Speaking from personal experience, the last thing I would want to be worrying about is money when dealing with these types of diagnoses as they are hugely emotionally tolling on their own.

I’ve had a High-Deductible policy for a decade. It’s true that awareness of the deductible does act as a bit of a filter.  I know I’m going to be paying, so I seriously consider whether or not my complaint needs a doctor or is something that will resolve with time & rest. And there are lots of things that do.  Even when we’ve spent thousands in out of pocket costs for health care in a given year, it is still less cost for us than the alternative health insurance premiums would have been.
Preventive screenings are baked into the ACA, so cost avoidance isn’t what drives people to skip them.