<p>I recently finished Ron Paul’s “The Revolution”, and he mentions that, while practicing medicine, insurance was only used for serious procedures. Patients would pay out of pocket for visits and RX’s, and this was sometimes done on a case by case basis.
Anyone more familiar with this pre HMO insurance policy? My parents were also unfamilair, and I have not been able to find much published on the topic. It seems that, based on the few pages in Paul’s book, that the out of pocket charges were lower than many of today’s co pay’s.
With so many health reform propositions, I would like to have a better understanding of the pre gov intervention insurance era, and why and how medical costs have skyrocketed the past few decades.
If anyone has experience, insight or could refer me to publication on the topic I would greatly appreciate it!
Thanks</p>
<p>I don’t have your answer but I think there’s a large difference in health care offerings between the 60s and today. There are a lot more expensive machines now (MRI, Cat Scans, etc.) that have been a huge benefit to patients. There are also a lot more procedures available now including routine joint replacements, angioplasty, transplants, etc. and there are a lot more life-saving and quality of life drugs available now. There are also huge lawsuit judgments now requiring expensive malpractice insurance that gets passed on to patients.</p>
<p>I grew up in the 60s, and my father, a union man, had health insurance. From what my mother used to say, this was not so common. A doctor’s visit cost very little relatively speaking, and many doctors worked in a small office in their home. If your broke a bone, or cut your head open (as I did when I was a kid) the doctor opened the office, even at 8 pm and fixed you up. No expensive er visit. The regulations that exist today were basically non existent. Of course, the lawyers contingency fee, and lawyer advertising were not what they are today. These two things drive personal injury lawsuits. </p>
<p>Medicare did not start until the 60s, I think, and this also made insurance more prevalent.</p>
<p>In the 80s, when I personally became a consumer of health insurance, the law firms I worked for offered a policy with 100 deductible and 80/20 insurance. They even paid for the whole cost of the policy. This soon was changed by HMOs, which in NYC, started in the mid 80s.</p>
<p>HMO insurance, because it is often first dollar coverage, is expensive, compared to high deductible, catastrophic event type insurance, at least around here. Insurance can take many forms, and there is alot of debate today on what it is supposed to provide. Additionally, for doctors offices, the administrative burden for HMO and network insurance adds a fortune in additional employees compared to the old indemnity type insurance where you paid the doctor, and worried about the reimbursement yourself.</p>
<p>The approach in Singapore is to keep health care inexpensive, sometimes with government supports. We were there many years ago and our son had something that he needed looked at (some kind of insect bite) so we went down to the clinic. I checked coverage with my US provider and they said go ahead and apply for reimbursement. The charge for the visit was so low that I didn’t bother with the reimbursement. Singapore supposedly has the most efficient health-care system in the world.</p>
<p>This is an interesting topic.</p>
<p>If anyone is really interested, Paul Starr’s book “The social transformation of American medicine” is a must read. It stops just short of the managed care revolution.</p>
<p>When I read it, I was surprised at how much of our current system evolved as a deliberate effort to empower physicians. That part has not changed all that much. (you thing “trust your doctor” comes naturally? Think again. We were taught that.)</p>
<p>OP, at one time, much health insurance was of the kind called “major medical” which covered major things, mostly hospitalization and associated physicians bills. Routine office visits were paid by the individual. And you might note, especially if you read Starr’s book, that blue shield once covered docs, blue cross hospitals. you can get a simplified history here: [Blue</a> Beginnings](<a href=“http://www.bcbs.com/about/history/blue-beginnings.html]Blue”>http://www.bcbs.com/about/history/blue-beginnings.html)</p>
<p>Back in the day, I remember my parents only using health insurance for major incidents. Our doctor did work out of his house, and set my fractured ankle at night on a weekend!. I am taking a leap of faith this year and did sign up for the high deductible health insurance with a health savings account. With the super high HMO premiums, I think this lower premium option may the future of employer sponsored insurance.</p>
<p>Health insurance? I was the first one in my family to have health insurance, when I got my first job in 1975. I remember how impressed my mother was that I had dental insurance as well.</p>
<p>My mother saved every single piece of paper that came in, starting with HER first job in 1937. We were a remarkably healthy bunch, judging by the slim file of medical bills that we found after she died in 2003. It included the bill for my birth in 1955, which I remember as being about $100, at a time when she earned $600 for ONE article she wrote for the Ladies Home Journal. She got a $2000 advance for her book on pre-natal care at about the same time. (It advocated natural childbirth, quite unusual in those days.)</p>
<p>My husband and I have only catastrophic medical insurance and pay most of our medical bills upfront. We have only exceeded our $1000/yr deductible in three of the last eight years–once for his chemo for lymphoma ($7000/treatment, six treatments), once for my knee surgery (to remove a bone cancer), and this year, for my physical therapy after the knee surgery.</p>