My Experience With Free Market Healthcare

Free market medicine is already here, and this Montana family has been enjoying it for years. It is time to get the word out so other Montanans can benefit as well.

I saw a meme the other day I thought was probably funny in every country mentioned because of the reputations our respective health care systems have.

It isn’t a secret the United States spends more money on health care than any other nation, and our individual and collective American response is often: “Yeah, but we have the best health care in the world.” I don’t argue this point, but what many Montanans don’t realize is America not only offers the world’s best health care, we also provide some of the least expensive health care as well. Unfortunately, very few Montanans know about how to find it, and even fewer believe it is true.  I am talking about “free market” medicine like America enjoyed before government began making it (un)affordable.

Recently, my wife Linda went in for her annual physical, and her doctor discovered blood in her stool sample. My brother recently passed away from colon cancer, so we were immediately concerned. Her doctor told her our local hospital had a waiting list for a colonoscopy due to a shortage of providers. It would take several weeks, if not months, to have a routine colonoscopy conducted locally. We don’t have health insurance (more on that later), so we started calling around to find out how much if would cost if we paid cash rather than through a third party such as health insurance, Medicare or Medicaid. At first, it was very difficult to even find the actual cost of the procedure, as our local hospital required a special code from our doctor before they could give us their price.  Linda called her doctor’s office, and his assistant did some research to find the proper code, as there are many different codes for the same colonoscopy based on how the patient intends to pay. After several days, the doctor’s assistant discovered a suitable code, and we learned our local hospital would do the procedure for $3256.00, but the anesthesiologist would be an additional $910.00. There would also be a room fee, but the hospital couldn’t tell us what it would be until after we incurred it.  The pathology report could be several hundred dollars more depending what was found. However, if we paid cash, we would enjoy a 35% discount for all medical services provided in the procedure. A discount of that size sounded reasonable, but we called our health care sharing ministry, Samaritan Ministries, and they recommended we use ColonoscopyAssist.

ColonoscopyAssist is a national program the helps uninsured and self-pay patients to schedule low cost and convenient gastroenterology procedures with local providers. Via their user-friendly online tool, we discovered a gastroenterology clinic in Lewiston, Idaho that would do the entire procedure $1275.00 (minus lab fee) if we paid at least 7 days in advance. If that deal wasn’t impressive enough, we were directed to another facility in Oregon that cost only $900.00! Because Lewiston is only a 6-hour drive from our home, and the motel rates and gas would be more expensive in Oregon, we opted to go with the much closer Gem State Endoscopy in Idaho. We scheduled an appointment, and we were able to get right in. In fact, we were able to schedule based on our needs, not the availability of the provider.

From beginning to end, the whole experience with Gem State Endoscopy was easy and professional. They were friendly and efficient with no institutional feel. They didn’t have reams of paperwork for us to complete, and their staff answered all our questions. To the extent that colonoscopies can be enjoyable, Gem State Endoscopy exceeded our expectations, in spite of being a bonafide low cost provider.

Driving back from Idaho, I was frustrated Montana didn’t have a high-quality, low-cost provider available locally for us. For years, I have been an admirer of the Surgery Center of Oklahoma, another free market health care provider offering a variety of high quality surgical procedures at an affordable cost, and I don’t understand why every major city in Montana doesn’t offer similar services for Montanans who have opted out of the more expensive, lower customer satisfaction third-party payor models.

While it is true my family doesn’t have health insurance, we are in fact members of a health care sharing ministry (HCSM). HCSM’s are not-for-profit religious organizations that act as clearinghouses for people who hold similar strong beliefs and wish to share their medical expenses with each other. HCSM’s organize the efforts of their participants by funneling financial support towards those participants who incur medical expenses. They are in fact mutual aid societies like Americans used prior to our current system to share the risks of costly medical expenses. In our most recent case, colonoscopies are typically not covered by our HCSM (they don’t cover preventive care); but because Linda’s procedure was doctor directed, Samaritan Ministries agreed to cover the costs; and because we saved the HCSM more than $750 by finding a lower cost provider, they waived our co-pay too. As such, we paid nothing out-of-pocket.

The most important thing Montanans need to understand about HCSMs is they are NOT insurance. Whereas the relationship between a policyholder and an insurance company is contractual, the relationship within an HCSM is a covenantal agreement between individual participants. There are no financial reserves, no legal protections, and no lawsuits; there are only thousands of participants helping each other with medical expenses, organized by an HCSM.  Eleven months of the year gifts are sent to participants, and one month a gift is sent to the HCSM to cover the costs of running the organization.

Here’s how our plan works:  Each month Samaritan Ministries publishes a newsletter which it distributes to all participants. The newsletter lists participants who have incurred legitimate medical expenses, and it directs other participants to send a previously agreed amount of money to those with medical expenses. The gift givers are also encouraged to pray for those to whom they send money.  Recipients are given a list of participants the HCSM has assigned to send them money, and when they receive it, they cross that gift giver’s name off the list. Those assigned gift givers who are late in sending funds are reported to the HCSM who reminds them of their commitment, and if they continue not to send gifts as they agreed, they will be dropped from the program.

HCSM’s are not for everyone.  They hold strict lifestyle and moral guidelines for participation: no tobacco, drug use, or sex outside of marriage, and only moderate alcohol use is allowed.  Some require overweight participants to demonstrate good faith efforts and progress towards losing weight.  All participants are ultimately responsible for paying their medical bills, and participants are expected to negotiate lower fees from their health care providers before submitting a medical share need to the HCSM.  HCSM’s don’t pay for preventive care, mammograms, pap smears, (routine colonoscopies) or annual physical exams; all these services are paid for by the participants themselves. In our HCSM, participants must be active church attendees, and every HCSM requires a pastor’s signature verifying a participant’s commitment to the HCSM’s lifestyle and faith obligations.

There are many attractive features of HCSM’s.  First, is the cost.  HCSM monthly sharing requirements are oftentimes considerably less expensive than conventional insurance premiums, particularly for the self-employed, larger families or older individuals.  In our case, our monthly responsibility for the most expensive option is 40% of the cost of Obamacare regulated insurance. Secondly, the paperwork and bureaucracy of HCSM’s are a fraction of those associated with conventional health insurance: no double-talk, reams of applications or defective government websites. And finally, most HCSM participants appreciate the personal touch of sending not only money, but prayers and encouragement to those who are suffering from medical challenges. We know dozens of Montana families who have participated in HCSM’s over the years, and we don’t personally know any participant who has been dissatisfied.  The primary reason for participants quitting an HCSM is when they can secure health insurance coverage paid for by someone else (employer, Medicare, etc.).

While my initial motivation for joining an HCSM was to avoid the health care mandates of the Affordable Care Act (Obamacare), I have been a satisfied member since 2011. We have saved well over $100,000 in premiums, and our customer satisfaction has been very high. Although most established HCSM’s require religious affiliations, there is no government requirement for one. Like co-ops, credit unions, and mutual aid societies, Montanans could easily organize along affinity lines to provide similar medical protection and avoid the inefficiencies and higher costs associated with highly regulated third-party payor schemes like Obamacare.

By avoiding government regulated health care options and pursuing free market medical options, our family has saved the equivalent of a Montana college education, including grad school; and equally important, we have avoided much of the bureaucratic frustrations too often characterized by conventional medicine. For the last 14 years we have enjoyed the best health care in the world at unit costs similar to Denmark or the United Kingdom.  Free market medicine is already here, and this Montana family has been enjoying it for years. It is time to get the word out so other Montanans can benefit as well.