young woman making quiet signTo insure or not to insure, that is the question. Or maybe it’s more like to disclose or not to disclose.

There’s a big discussion going on over on about what happens when people are not insured (or don’t disclose that they are insured) and get the cash or self-pay price.

The thread started with a blog post by Dike Drummond, MD, who wrote about the phenomenon of lower cash prices. (He blogs over at

The piece is interesting, but even more interesting are the comments.

Here’s one: “Almost 10 years ago several practices started offering uninsured patients the Medicare cost of services. Then they encountered the very issue that is stated in this article. Patients with commercial insurance were being charged double or triple in out of pocket cost. I personally hope that this trend continues and does not fall by the way side! Oh and if you need another reason to pay cash… How about cash transactions are not reported to the MIB (Medical Information Bureau). This means unless you are using your primary care physician(it is included with all of your other medical history) or unless you provide the information to an insurance company there is no way to truly trace pre-existing or even accurately gauge a true risk liability. “

Another: “My husband and I both work as RNs for a large hospital system in Asheville, NC.  We have a combined 25 years of service. Last year, our younger son required an adenoidectomy and myringotomy.  We were able to cover the majority of the $2600 cost with rollover HRA funds.  However, since we no longer have that HRA cushion, should we or our children require another minor procedure in the future, we plan to go to a competing hospital system, claim “no insurance” and obtain the 40% discount quoted us while researching our son’s procedure.  Sad.”

And finally, a long multi-paragraph comment: “Those of us without health insurance are demonized while those who choose to pay into a terribly broken inefficient system are responsible angels saving the country.  …

“I can afford traditional health insurance, but I don’t pay for it. Until enough of us vote with our wallets, the people making money hand-over-fist off the backs of sick people (and the rest of us) won’t listen. We have to fix the way we practice medicine. Supporting the bloated employment-based insurance company system is not the way to do that.

“What do I do? I’m a health freak who takes super good care of myself with proper nutrition, exercise, and attention to my peace of mind. I don’t run to the doctor for every virus or musculoskeletal ache. I pay for preventative services out of pocket. And when I’ve needed serious care, I’ve gone to other countries where the medicine is just as good, the prices transparent, and the cost much less. I have an account to handle unexpected medical emergencies when I’m in the States, and I’ve made it clear to my family and in legal documents that I don’t want care that unnecessarily prolongs my life. … Why should I pay for services for everyone else when I wouldn’t use them myself?

“Won’t work for everyone, you say? Maybe. And that’s how they get you. We are guilty of not taking care of others if we do what is best for us. And we want to be “responsible” good people who take care of others. So let’s let go of guilt and fear and do it smart. Let’s take care of all our people within a framework that makes sense and stop supporting a system that doesn’t.”

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...