Opinion on Medical Cost Sharing

While scouring the internet like a Four Loko powered Roomba, I stumbled across the most interesting thing.  It appears that there is a small movement to shift from medical insurance to medical cost sharing, and seems to have roots in the evangelical Christian community.  They call it “medical cost sharing.”

Here’s how it works:  at the core, a group forms and association where the members commit to share medical costs for each other through a non-profit.  Despite having a very straightforward structure, every cost sharing program I’ve found is incorporated as a non-profit evangelical Christian “ministry.”*  These “ministries” cost sharing rules are, to my eyes, a draconian incompetent doppelgänger of legitimate health insurance.  Here are my objections to participating in medical cost sharing schemes:

  1. It’s not health insurance.  While medical cost sharing websites seem to be upfront that they aren’t legitimate health insurers, they do position themselves as an alternative to health insurance.  I think of this as analogous to the idea of using dried oatmeal as an alternative to mortar for building a brick wall.  I wouldn’t want to count on it actually working.
  2. Where’s the oversight?  Health insurers (a.k.a. real insurers) are subject to a large body of law and the oversight of the state insurance commissioner.  People who want to sell insurance must be licensed by the state and have a basic knowledge of what they’re selling.  To my knowledge there is no body that provides oversight to medical cost sharing schemes, nor are the promoters required to have a minimal level of knowledge of their product and competing products (real health insurance.)
  3. There’s no guarantee of payment.  Let me say that again:  there’s no guarantee of payment.  So, you could pay in for years, have a covered health crisis, and then not receive reimbursement.  Tough luck.  Would you have recourse?  Who knows!  There’s way to farce payment that I’m aware of.
  4. There’s no contract.  Despite what cell phone sales people say, contracts are tremendously useful.  They spell out the expectations of both parties, and the commitment from one party to another.  Instead of contracts, the medical cost sharing “ministries” have guidelines, and guidelines can change.  This really worries me, because there’s a risk that the suite of risks that a customer could be exposed to could change suddenly.
  5. Naked, belligerent discrimination.  Since medical cost sharing ministries are not insurance companies, they can discriminate against applicants as much as they want for whatever reason they want.  Apparently making the unsaved unwelcome is considered a positive boon.
  6. Your health care is subject to their morals.  Prepare to be denied if you have used (for one organization**) tobacco, abuse alcohol, gain too much weight too quickly, are an unwed mother, or (I kid you not) for “participation in activities with willful disregard for personal safety.”  There’s nothing like having your health care needs judged before being cared for.
  7. With some organizations, there’s an appalling lack of privacy.  One organization publishes participant’s name and address to other participants when the participant becomes subject to the sharing agreement.**  I think this is both creepy as all get out and really inappropriate.  But, again, some people think this is a good thing.
  8. Weaselly use of benefits:  According to one organization**, participating in their medical cost sharing scheme means that you no longer are required to participate in the medical insurance requirement of recent health care legislation.  I feel that they’re a little too enthusiastic about using their pseudo-insurance scheme to avoid participation in the federal health insurance mandate.  Why do I speculate so?  The lack of popularity of other cost sharing schemes for disability or life “insurance” indicates to me that there is a contingent of participants that are there to avoid the law, legally.  If this is the case, then I would find the undermining of the intent of the law off-putting.
  9. Finally, some of these organizations use what I see as suspicious marketing.  In addition to using the term “ministry,” these organizations appeal to patriotism, the constitution, and the bible; all of which are icons meant to appeal to the unreasoning, emotional impulses of the American mind.  While this isn’t unusual for marketing and sales, I get suspicious when an organization tries to punch my emotional buttons.

While some of these objections are stronger than others, I still feel wildly uncomfortable with the whole idea of medical cost sharing schemes.  My opinion is that they are a weak tea version of health insurance that’s  designed to be extremely exclusive and appeal to people who are already prone to insularity.  My opinion is that I cannot recommend these plans to my clients at this time.

*  You’ll notice I keep putting “ministry” in scare quotes.  That because I’m accustomed to thinking of the term ministry in reference to ministering to others (generally the helpless, needy or infirm), not creating a pseudo-insurance organizations.  I suspect that ministry is just a general term they use to appeal to evangelical Christians, but I certainly can’t prove it.

**  You know, they seem to be proud of this on their website, but I won’t link to it here.  The last thing I need is a Cease-and-Desist letter.  Use your Google-Fu to find which medical cost sharing organization this is.  It shouldn’t be too hard, since it’s one of the biggest names.

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