It is so interesting for the topic of Americans foregoing health insurance to come up, shortly after I
watched a video on TikTok from an ER doctor who is doing the same thing. User @apparentlimd
advises in his video, dated January 26, 2022, that he does not currently have health insurance
because he believes that it is a scam designed to inflate health care costs, resulting in larger
payments made for services that would be much less expensive if the patient opted for a cash
payment system. Here is a link to his video if anyone is interested:
https://vm.tiktok.com/TTPdkrxv7T/ My sincerest apologies if the link tries to force downloading
TikTok.
b b b b b b b b b b b b I personally think that this is an interesting concept. I have, fortunately, had health
coverage for most of my adult life, either through Tricare when I was active duty and now, as a
military spouse, or through the VA when I separated from the Air Force. I have very little hands-on
experience with traditional health insurance featuring premiums, copays, and deductibles. I did,
however, utilize Planned Parenthood for birth control during a lapse in coverage for approximately
one year, which was a cash payment of $50 per NuvaRing, monthly. This was a good option for me
at the time, as I was relatively healthy and had no outstanding health issues. To this day, if I could
not afford health insurance, I do not think that it would be the end of the world, as my health
status remains much the same. However, much like other forms of insurance, health insurance
may not seem necessary until you are placed in a situation where it would be vastly improved or
less bleak if the insurance were in place. The flip side of the coin is that insurance can be
incredibly expensive, even if never used. I have several friends who have insurance but must use it
sparingly because of the costs associated with copays. Davis (2007) advises that most growth in
the number of uninsured lies in working adults unable to afford premiums for insurance plans
offered by their employer. Dr. Sherry Glied advised that people without health insurance run
several risks; the risk of missing routine care, the risk of treatable illnesses becoming serious
problems, the risk of missing out on better care when they are sick, and the risk of intense or
extreme monetary losses (PBS, n.d.). Davis (2007) advises that the uninsured are also more likely
to receive care that is less coordinated, have difficulty accessing medical records when needed,
and experience other indicators of lower quality care, like not being notified of abnormal lab
results.
However, as we move into the future, it seems as though there is a subscription or a membership
for everything, including healthcare. Rasberry (2020) writes about cash pay doctors that operate
with a monthly or yearly membership, providing services on an as-needed basis while developing
the patient-doctor relationship to establish continuity of care. Furthermore, Rasberry argues that
these doctors are just as adept at addressing one’s medical issues and, in fact, can spend more
time, if necessary, with their patients to address all necessary issues (2020). This appears to offer a
nice counterbalance between having health insurance coverage and going uninsured, affordable
yet thorough.
Even though the United States has one of the most developed medical systems, modern
treatment technology, and well-trained and highly qualified doctors, the medical system in the
United States does not have to be run by the government. Most hospitals in the United States are
privately owned and operated and thus are referred to as private hospitals. Even though it is not
directly managed by the state, the health system in the United States is still strictly managed and
highly effective in providing medical care to the people. In addition to hospitals, the widespread
availability of pharmacies aided in the development of the US healthcare system. The fact that
pharmacies are widely distributed and easily accessible throughout the country is a defining
feature of them. A distinguishing feature of the US healthcare system is that pharmacies can only
purchase drugs with a prescription or a doctor's prescription.
What are the advantages and disadvantages of not having medical insurance? "To be fair, health
insurance companies, long regarded as the gatekeepers of healthcare, have recognized this and
have made efforts in recent years to improve price transparency (U.S. Center for Medical and
Medicaid Services, 2021). "In contrast to most countries in Canada, Europe, and Australia,
healthcare in the United States does not provide citizens or visitors with free health benefits. This
is a high-quality medical service that is not inexpensive. Most of your prescription drug costs will
be covered if you have health insurance. Depending on whether the drug is brand name or
generic, you pay a small fee. Furthermore, if you work in the United States, it is possible that your
employer will pay for your health insurance in part or entirely. In the United States, self-insurance
is expensive and may not cover patients with pre-existing medical conditions, so paying half is a
good deal for employees in many cases.
In 2020, 8.6 percent of people, or 28.0 million, did not have health insurance at any point during
the year. The percentage of people with health insurance coverage for all or part of 2020 was
91.4. (Starkey & Bunch, 2021). Who are the uninsured? Low-income families are more likely to be
uninsured, due to the high cost of healthcare. As a result, they are less likely to seek preventative
care compared to people who are insured. Following the enactment of the ACA in 2010, when
coverage for young adults below age 26 and early Medicaid expansion went into effect, the
number of uninsured people and the uninsured rate began to drop. When the major ACA coverage
provisions went into effect in 2014, the number of uninsured and uninsured rates dropped
dramatically and continued to fall. (Tolbert, Orgera, & Damico, 2020). However, there are still
many who are uninsured and the consequences are unmonitored chronic conditions. Part of the
reason for poor access among the uninsured is that many (40.8%) do not have a regular place to
go when they are sick or need medical advice. Uninsured people with chronic diseases are less
likely to receive appropriate care to manage their health conditions than are those who have
health insurance. For the five disease conditions that the Committee examined (diabetes,
cardiovascular disease, end-stage renal disease, HIV infection, and mental illness), uninsured
patients have worse clinical outcomes than insured patients. Poor outcomes and health can affect
economic growth, Health contributes to individual utility or social welfare in three ways. First,
people prefer to be more healthy than less healthy (i.e., health directly affects utility). In economic
terms, it is an argument in the utility or social welfare function. Second, the enjoyment of
consumption of other goods and services is partly influenced by the level of health (i.e., marginal
utility derived from consumption is partly a function of health status). Third, without good health
other economic objectives, such as producing income that allows people to consume market
goods, stand to be compromised.
The pros for not having insurance are less utilization of medical resources, this causes a less
financial burden for the government and state. The uninsured avoid paying high premium rates for
medical coverage. Most people who are uninsured come from low to fix income households.
Another perspective is the idea of being young and healthy. We are a reactive society and only
seek medical attention when we are sick. If we eat right, remain active then there is no need to go
to the doctor and seek care. However, the lack of preventative care can be costly and drain the
healthcare system if people's chronic conditions are left untreated.
Though the number of uninsured Americans has dropped, many people still do not have any type
of healthcare insurance coverage (Williams,2002). If you choose to remain uninsured, you may
face a penalty unless you qualify for an exemption. Most importantly, not having health insurance
means you would have to pay the full cost of any medical services you need if you are sick or
injured. If you choose to remain uninsured, you may face a penalty unless you qualify for an
exemption. Most importantly, not having health insurance means you would have to pay the full
cost of any medical services you need if you are sick or injured. Pros of health insurance are
Cashless hospitalization, Network Hospitals, No Claim bonuses, Add-ons, or Riders, Financial
Protection, Peace of Mind, Affordable healthcare. One of the main cons of having health insurance
is the cost, Pre-Existing Exclusion, Waiting Period, Increase in Premiums, Co-Pay. b
Full disclosure: I have strong opinions about health insurance in general. Based on extensive
experience in the health insurance industry, I think insurance is a good idea, but it should not be
the primary mechanism for paying for health maintenance. Instead, it should be a safety net for
catastrophic illnesses or injuries. I realize that medication cost is one reason people seek health
insurance. However, there are a few key reasons that people in the U.S. pay higher costs for drugs
than other countries. 1) In the U.S., no single entity can negotiate with drug manufacturers on
behalf of the American public (Picchi, 2015). So, a lack of bargaining power disadvantages
American consumers. 2) High marketing cost (Picchi, 2015). In the U.S., pharmacy companies can
market directly to consumers (Picchi, 2015). That is not so in other countries. 3) In the U.S., there
are no caps on cost or price increases (Picchi, 2015). “Some European countries and Canada cap
cost increases for drugs (Picchi, 2015).”
DeBenedet (2012) wrote that when people have insurance, they are more likely to access and
utilize healthcare resources, and it is a logical leap to think that would help people be healthier.
However, increasing evidence shows that much of the care we receive does not provide
measurable clinical benefit, and more care is not always better (DeBenedet, 2012). DeBenedet
(2012) explained that having health insurance probably does not correlate with better health
because people are more in control of their health than they realize. Staying healthy is generally
the result of good personal lifestyle choices and suitable environments rather than insurance
coverage, doctors’ advice, medical interventions, or medications. Except for strongly penetrated
genetic diseases, lifestyle choices can reduce the risk of chronic or severe illness even if a person
has a family history stacked against them (DeBenedet, 2012).
Studies on avoidance of medical care and insurance have revealed numerous factors that influence
behaviours in the U.S. One of the top reasons reported is a lack of time to seek medical care or
apply for insurance (Taber et al., 2015). The second most reported reason is the financial burden
of medical care and insurance premiums; most individuals who believe they are healthy have
difficulty paying for medical services they will rarely utilize (Kannan & Veazie, 2014). Additional
reasons reported for avoidance are the inconvenience in making appointments, lack of
appointment availability, lack of transportation, and language barriers (Taber et al., 2015). Some
personality and emotional factors have also been mentioned. Some individuals report a dislike or
uncomfortableness with how doctors behave, communicate, or empathize (Taber et al., 2015).
Others avoid the doctor because they fear getting bad news or having to be subjected to medical
treatments (Kannan & Veazie, 2014). As a result, a significant population in the U.S. goes
uninsured and goes through life believing they are healthy. This makes me question whether
universal healthcare would be effective knowing that so many individuals would not sign up.
Without a mandate for coverage, our country would still suffer from a population that chooses to
go uninsured.
Several benefits to being uninsured could be identified. First, this population tends not to seek or
utilize medical care, which reduces the cost to the medical system. Second, uninsured individuals
avoid the financial burden of paying rather high insurance premiums. Third, employers pay less for
insurance when they have individuals who choose to waive coverage. However, the uninsured
population creates a burden on the health care system. Delays in disease diagnosis can worsen
prognosis, require more extensive treatments, and reduce the effectiveness of treatments for
cardiovascular disease, stroke, cancer, and infectious disease (Kannan & Veazie, 2014). In addition,
the delays result in more frequent and longer hospital stays or emergency room visits that stress
the health care system and increase costs (Kannan & Veazie, 2014). The problem lies with an
assumption that someone is in “good health,” since many illnesses and chronic diseases can show
no symptoms in the early stages and are often considered silent killers. Many cancers are usually
first detected by a routine blood test before a patient even exhibits symptoms. This is why regular
doctor visits are critical, especially when preventive medicine is the goal.
People who consider themselves in good health are purposefully avoiding medical insurance. The
pros to avoiding medical insurance saving yourself money. Insurance can become expensive,
especially when paying for a family. Many can feel like it is a waste of money when they rarely get
sick. The same way some people feel when purchasing flood insurance if they are not in a flood
zone. "Health insurance is not cheap, and it can be tempting to go without coverage, especially if
you never get sick. With the expensive monthly cost and out-of-pocket expenses, you may be
wondering how much you really need coverage" (Caldwell, 2021). The con to not having insurance
is not having it if you were to become sick. You should try not to be in a position where you need
it and do not have it. According to Caldwell (2021), "being hit by a car and becoming seriously
injured, or even just missing that last stair at home and dislocating an ankle could cause an injury
that costs you thousands of dollars in medical bills, and it can quickly climb higher if you need
surgery or any kind of ongoing rehabilitation."
On the contrary, having medical insurance can save you so much of money. Like myself, I do not
get sick often, but within these past two weeks, I contracted COVID-19 from the hospital when I
went to be with my grandmother in her last moments. Having insurance saved me money on the
visit to see the doctor from the "emergency visit", as well as medications that I needed to become
well. Annual visits that once costed me $150 before I had insurance, now costs me $25 for copays.
The cons to having medical insurance can be not all facilities will accept your insurance and some
insurance companies exclude imperative medical treatments from the plan (2021). You can still be
responsible for big fractions of the costs and as you get older, your premiums can increase in price
(2021). I do think that medical insurance can be a big rip off, but has its benefits.
25 important pros & Cons of Health Insurance. E&C. (2021, August 6). Retrieved February 2, 2022,
from https://environmental-conscience.com/health-insurance-pros-cons/
Caldwell, M. (2021, October 12). Do you need to have health insurance? The Balance. Retrieved
February 2, 2022, from https://www.thebalance.com/why-do-i-need-health-insurance-2385890
Kannan, V. D., & Veazie, P. J. (2014). Predictors of avoiding medical care and reasons for avoidance
behaviour. Medical care, 336-345.
Taber, J. M., Leyva, B., & Persoskie, A. (2015). Why do people avoid medical care? A qualitative
study using national data. Journal of general internal medicine, 30(3), 290-297.
U.S. Centers for Medicare and Medicaid Services. "Trump Administration Announces Historic Price
Transparency Requirements to Increase Competition and Lower Healthcare Costs for All
Americans, https://www.cms.gov/newsroom/press-releases/trump-administration-announces-
historic-price-transparency-requirements-increase-competition-and." Accessed Oct. 22, 2021.
DeBenedet, A. (2012, July 2). Does health insurance make people healthier? Retrieved February 6,
2022, from Time Magazine: https://ideas.time.com/2012/07/02/does-health-insurance-actually-
make-people-
healthier/#:~:text=It%20seems%20logical%20that%20when%20we%20have%20insurance%2C,benef
it%2C%20and%20that%20more%20care%20isn%E2%80%99t%20always%20better.
Picchi, A. (2015, December 1). 5 reasons why Americans pay so much for drugs. Retrieved
February 6, 2022, from CBS News: https://www.cbsnews.com/news/5-reasons-why-americans-pay-
so-much-for-drugs/
Williams, T. (2021, September 27). Do not have Health Insurance? what's The worst that could
happen? Investopedia. Retrieved February 4, 2022, from
https://www.investopedia.com/articles/personal-finance/120815/dont-have-health-insurance-
whats-worst-could-happen.asp
Institute of Medicine (US) Committee on the Consequences of Uninsurance (2002) Care without
coverage: Too Little, Too Late National Academies Press. Website:
https://www.ncbi.nlm.nih.gov/books/NBK220636/
Starkey, K. & Bunch, L. (2021) Health Insurance Coverage in the United States: 2020 Website:
https://www.census.gov/library/publications/2021/demo/p60-274.html
Tolbert, J. & Orgera, K. (2020) Key Facts about the Uninsured Population Website:
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
Davis, K. (2007). Uninsured in America: Problems and possible solutions. BMJ (Clinical research
ed.), 334(7589), 346-348. https://doi.org/10.1136/bmj.39091.493588.BE
Public Broadcasting Service. (n.d.). Healthcare crisis: The uninsured. PBS.
https://www.pbs.org/healthcarecrisis/uninsured.html
Rasberry, J. (2020, July 31). The rise of cash pays doctors: What they are and how they work. Point
Health-Smart Healthcare Platform. https://www.pointhealth.com/post/the-rise-of-cash-pay-
doctors-what-they-are-and-how-they-work
