I did some research on this recently. Read all about "Sedera" (
pdf, if you care to read about specifics). The idea seemed to be that you sign up with a doctor you go to that's not doing the current/broken insurance model where they can only charge for a sick code combined with a service code (aka, the sicker the better). They help you find "Direct Primary Care", a local practice where they collect a monthly amount from everyone, use it or not, and they just do your medical stuff. That monthly fee, plus the payment to the cost sharing group can be about half of what you'd pay (rack rate) for insurance. So as long as the cost sharing paid for the unexpected/big thing, you'd be fine. I read another, very detailed PDF, and they said if they didn't have enough to pay everybody's claims, everyone would get less.
Frankly, I think that would work. I'd say you'd get MUCH better service (some of these Direct Primary Care practices pick up the phone 24/7, and you can always get an appointment in a reasonable time, not 2 months out). Also, rather than trying to slap a sick-code on everything, they just do what you want to maintain and improve health. I'm even considering joining a Direct Primary Care practice while on ACA. It doesn't count towards deductible, but with HDHI, any historically few services needed, I don't get close to the insurance paying for anything anyway.
The cost sharing company supposedly can help you negotiate for things, either before or after the fact. They have resources to get an insight on pricing of things (they have exactly what Medicare would have paid, and they often have access to the secret prices that are set-up between insurance companies and healthcare providers). It's like the situation with other "real" insurance...you've got someone on your side who does this stuff every day; you're not on your own. So true, you do not have access to the pricing negotiated by the insurance companies, but if it's before the fact, you can probably get a pretty good price up front with the help of the cost sharing company, and if it's after the fact, if they try the "charge master" BS on you, the cost sharing company will slap that down in a hurry.
One other concern is "what if I get some horrific disease that requires lots of expensive treatment?" Of course the cost sharing should help you out, but even if it doesn't, that would only last 6 months, on average, because open enrollment would be upon you again, and you'd make a decision based on the current calculus with the horrific disease.
Most of the people that are on this board buy traditional insurance, and don't want to hear that they've been "doing it wrong" (cognitive dissonance). I get it. Any change is going to be an uphill battle. Some people "need" contractual. Me, less so. I tend to explore ideas like this in a modeling/decision tree kind of format. This is a tough one, but when I assemble all of the decision nodes and chance nodes, the health and cost is leaning toward the abandonment of the broken insurance / medical industrial complex and going to something else. Of course it makes a big difference what value you place on health, and what the likelihood is of having better health outcomes if you have someone who's trying to make you healthy, rather than someone who only gets paid if you're sick. Not a model any two people will build the same way.
