The ACA is not the only health care game in town. Either because they are opposed to the values embodied in the ACA or because they are unable to afford the costs it imposes, some people are dropping out of mainstream insurance altogether. WaPo looks at some of the health care programs they are opting into instead. Of particular note are groups like Christian Healthcare Ministries. Members of CHM pool money to pay for each other’s health care bills, out of pocket and unmediated by insurance.We don’t know how many people are using this kind of system; the piece does tell us that CHM has 80,000 members, and the overall number is probably vanishingly small. But CHM and similar groups represent a kind of approach that deserves more attention than it is getting, for two reasons. First, it encourages responsible health care use. Last year, Reason explained why in a piece on Samaritan ministries:
Take Roger Stuber, a Samaritan member and residential contractor in Tremont, Illinois. He experienced a series of seizures last year that revealed a leaky vein in his brain that required surgery. Even in the midst of this terrifying episode, Stuber went to lengths to insure that he wasn’t overcharged. The hospital initially was going to bill him more than $63,000 for his surgery, which he negotiated down to just over $36,000. When he was billed $5,000 for a follow-up MRI, at first the hospital refused to offer him much of a discount. So he marched down to the finance office and demanded to see the manager in charge. She eventually agreed to accept just under $1,500 if Stuber paid cash on the spot.If he hadn’t gone to all of this effort, the bills would have been covered almost entirely by other members. “But I’m part of a body there at Samaritan,” says Stuber, “and if I can keep costs down, I’m helping the group.”
Cost-sharing groups therefore provide exactly the kind of cost-controlling incentives that an impersonal, national insurance system can’t. Perhaps more importantly, programs like this introduce some sense of social solidarity into the health care market. Of course, America’s dwindling social capital poses a significant obstacle to the formation of these kinds of health care cost-sharing initiatives. And they are for most people not a true substitute for catastrophic insurance in the case of major emergencies. But re-imagining how to provide social services in a way that builds up, rather than obviates, social capital is a hugely important project, one for which CHM is a useful model.