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Comment by vishbar | Hacker News Reader

I think this is applying a "car insurance model" (sorry in advance for the car analogy) to healthcare. Ignore third-party insurance for the moment as it's not really applicable to health. You don't generally make an insurance claim for something like an oil change, 30/60/90k mile checkup, or something like that. On the other hand, if a tree fell on your car and smashed the engine, that's when insurance kicks in: for the catastrophes.

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I think it's the exact inverse of what you describe. The article describes something like a subscription model for the oil changes that also satisfies the legal requirement for health insurance under 26 U.S.C. § 5000A. The enormous liability and collision part of auto insurance in this analogy is not covered by the plan described in the article.

On one hand, it seems like a great idea for those whose employers don't provide subsidized insurance coverage. If it's truly affordable, it should allow more people to get routine care. Especially for women, who generally need more routine doctor visits than men. OTOH the things that bankrupt people are hospitalizations and real insurance plans are generally there to help mitigate that.

The last paragraph of the linked blog post mentions that it should be combined with an HDHP to cover things like hospitalizations.

I understand what would happen for routine check-ups and serious accidents.

How would such a model handle predictable-but-expensive medical needs, like hip replacements for the elderly and monthly prescriptions for HIV and cancer patients?

The hip replacement can be covered under another policy like a home warranty. At the same time, without coverage, the prices have to come down. If they don't, all of those expensive doctors are bringing in near $0. Such an economic position is untenable.

The other two are probably going to be fixed through direct market forces. If the people of America can only pay $X, then the makers of the drugs can only charge $X + small premium to have a market. Since they would face a similar price pinch abroad, they'd have to adjust their prices.

We've seen the inverse of the price pinch with the epi-pen scandal. The makers knew the price could go up since insurance would absorb the cost.

Hiv cost over a lifetime is only 340k and 1:300 in the US has HIV, so the subscription would only have to cover a little over a 1k in lifetime risk; actually less, since HIV is overrepresented in the homeless and poor segments.

In either case, two components that could be separated: a service plan (preventative care) and catastrophic coverage.

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