Had an idea and wanted to see what the folks here in Philly thought. Its potentially a part solution for providing health care for those who don't have health insurance.

Many of the uninsured are not homeless people or those at the very bottom of the financial ladder. Many times they are people who are working where health insurance is not offered as a benefit or are self employed. They are often younger folks in good health and purchasing health insurance feels more like a burden than a benefit.

The problem is that to purchase health care on a fee for service basis is often so expensive as to be out of reach.

What if you needed knee surgery, for example, but didnt have health insurance to pay for it. What if you could purchase this surgery at half the current cost on the condition that you signed a waiver giving up your right to pursue legal action against the doc/hospital for malpractice if something went wrong.

Instead you purchased your own policy which would cover you for this single operation in the event there was a mistake. The coverage would be listed for you similar to an auto insurance policy and would be relatively inexpensive because it only covers a single procedure. Rates would also be based on the risk associated with that procedure as well as that doctors history as a physician.

Docs/hospitals may not be heald financially responsible for mistakes in this system but their reputations would be on the line. They would be rated similarly to bad drivers, your premium for using doctor A would be higher than for using doctor B because of doctor A's history of screwing up. Currently, as a consumer, you can not find out if your doctor has been involved in malpractice suits. Market forces would take care of the rest.

You've just described adverse selection. Health insurance is supposed to work by having the premiums of those who don't use it pay for those who do. It's one of the problems that universal mandatory coverage would solve.

It wouldn't be half. Malpractice insurance is expensive, but it's not nearly that expensive. The reason why health care costs are skyrocketing is that what health care is able to do is improving rapidly, with many expensive new procedures and expensive new medications.

That's an interesting idea. I don't know if it would be feasible from the insurance companies' perspective, but it might be workable. There might be another form of adverse selection though: the people most likely to sue for even minor problems would purchase the private insurance more often than those who wouldn't sue.

There's a growing movement for State licensing boards to create doctor registries with lists of error rates and malpractice suits. Currently, it can't have that much of an effect, because people are typically locked into what doctors they can see by their insurance plan.

This idea has been floated around half-seriously by libertarian economists. Several people have resorted to medical tourism to Mexico to have procedures done much cheaper. Obviously, a lot of the reduction in price is due to the different economies, but some of it is due to the much more limited liability. You get a surgery down there for as low as 1/5 of the cost and stay in a private hopsital suite where you are given much more attention than you would typically get here.

Some have suggested "medical free trade zones" where you could give up some rights to sue in exchange for lower-cost treatment. In theory, I think it's a fantastic idea.

It solves the "problem" for people who need the insurance more. Those of us whose premiums pay for other people are screwed. That leads directly to the other problem...moral hazard.

Considering how many other negative consequences there are for getting sick and needing medical attention, I doubt the moral hazard would be very significant. We might even reduce costs through prevention, if people go to the doctor when they're just starting to get sick and the interventions are cheap, rather than waiting until they need to and expensive surgery and hospitalization are necessary.

No one is "screwed", because everyone's insurance is based on their individual risk. If you're a low risk person, you pay low premiums. But no one has no risk. The healthiest person in the world could get in a car accident tomorrow and end up costing the insurance company hundreds of thousands in hospital and rehab bills.

Philly has public health clinics that are free of charge to anyone who lives inside the city.

Contrary to popular misconception, its not only for poor people, or people on welfare.

My mother was a patient there for years when she lived in SP, and she got excellent care there.

As for health care, one way to reduce costs is for insurance to refuse payment for services that are not medically necessary in most cases (abortion, gastric bypass surgery, etc)

I see. And who determines what is nessisary?
Bum knee? Here is a crutch, now go away.
Facial burns? Take some silvadine ointment. It's not nessisary to do cosmetic surgery on your now hideous face.
Baby Delivery? Well an epidural isn't nessisary for delivery, is it?

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Most abortions are done for convenience, as even abortion stats have shown. I REALLY don't think a majority of abortions are necessary to save the life of the mother, or even to preserve her actual health.

Gastric bypass surgery is often done for cosmetic reasons, very rarely for true health concerns.

I didn't mention any of these things.

But I can give you more.
Woman has a mastectomy. Breast reconstruction is cosmetic
Man loses a leg. Flesh like leg is cosmetic, just give him a wood pegleg.
Facial burns scaring, are definitely cosmetic.
How about that second thumb my friend was born with? Defiantly cosmetic clipping that off.
I had my left ear cut off in a freak bike accident. The ear reconstruction is cosmetic.

But I like to think that I have led a better quality of life having a symetric head. Vanity? Definitely. Necessary? Nope.

Can a person lead a better life at 150 pounds rather than 300? Yep. Better quality of life.

I don't want insurance companies to be able to decide if it's nessisary or cosmetic. I certainly don't want them telling me cosmetic isn't nessisary. That you suggest they make life or death decisions is, frankly, scary.

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Medical insurance or not.

No one in this country is refused medical care.
Walk into any ER in the country and they will treat you for any life threatening situation

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Peace Out, Philly!