Ninety Dollars Per Month Per Employee

A school district in Michigan put a clinic in a converted classroom. Cement-block walls. A pencil sharpener still hanging where the kids used to crank it. Bridge Michigan walked those classrooms. The superintendent said it out loud. This is health care the way it is supposed to be.

Corunna pays ninety dollars a month for each of its 255 employees. Two days a week. No copay. No deductible. Every visit that morning was booked for at least a half hour.

Thirteen people came in. Poison ivy. Pink eye. Blood pressure. A kid's sports physical. They left with nearly $550 in medicine and paid nothing for it.

I am not anti-insurance. Keep a policy for the wreck. About 110 of those staffers still carry the school plan for the hospital. The superintendent's math is the same one we use. One family, strep in the middle of the night, one ER, and that virus can cost the pool more than a year of this clinic.

We take care of patients for a flat monthly fee. No claim. No network. You call. We see you. The number on the door is the number you pay.

Ninety dollars is a price. It just happens to live down the hall from the gym.

Twenty Million

Mississippi is standing up a new health market. Twenty million dollars. Next year. They are calling it the Mississippi Option.

It is not a public option. It is a state portal for short-term plans. A couple hundred a month. You can sign up any day and quit any day. UnitedHealthcare will sell them. The plans do not have to cover maternity, mental health, or the pharmacy. They can turn you down for a condition you already have. The insurance commissioner said it out loud. If you need a liver transplant, or a knee you neglected, you are not getting coverage out of the plan.

Twenty million is what the state is putting on the table. The old high-risk pool still has a little over twenty-two sitting in assets. Last year Mississippians took about $2.2 billion in federal premium help. Twenty million is not going to get you very far.

I am not anti-insurance. Keep a policy for the wreck. I am anti a product that looks like insurance until you need it. We take care of patients for a flat monthly fee. No claim. No short-term. The number on the door is the number you pay.

Twenty million is a price. It is not a doctor.

Forty Thousand

Same Blue Cross plan. Same knee replacement. An hour apart on a North Carolina map.

At Catawba Valley in Hickory: about sixteen thousand dollars. At Mission in Asheville: about forty thousand. More than double. Serif Health pulled the numbers out of the price files hospitals are supposed to post. Mission was built by merging the two hospitals in town. Then it lobbied the profit caps off. Then HCA bought the monopoly.

I am not shocked. When you are the only hospital, you are not a price. You are a premium.

A nurse in Asheville tore her meniscus skiing. Mission said over nine thousand for the scope. She walked. An outpatient shop did it for less than a third. That is what a posted number is for. Shopping.

I am not anti-insurance. Keep a policy for the wreck. I am anti a ZIP code that doubles the invoice. We take care of patients for a flat monthly fee. No claim. No network. The number on the door is the number you pay.

Forty thousand is a price. It just only shows up if somebody bothers to compare the next town over.

Eleven Percent

Last summer the stage was set. Insurers would cut prior authorization. Eighty percent of plans. Eighty percent of the conditions. By January. Public dashboards so you could watch them do it.

July came. The insurer trade group counted the result. About eleven percent fewer services still need that permission slip. The dashboards never showed up. Some of the same plans already say they will not keep every promise on the pledge sheet.

I am not shocked. A voluntary deal with the people who invented the delay is still a delay. The American Medical Association asked a thousand doctors whether they believed the pledges would matter. One in three said yes. The other two thirds already knew the room.

We do not ask for prior auth. You call. We see you. The fee is on the wall. Eleven percent is what a handshake buys when nobody has to show the scoreboard.

One Hundred Twenty-Five Percent

One hundred twenty-five percent. That is the fine California’s health-affordability board may vote in on Wednesday. Hospitals, medical groups, and insurers that grow faster than the state’s cap could owe as much as 125 percent of whatever they spent over the line.

The line ramps to 3 percent a year by 2029. The earliest the fine can actually land is 2028. Two years of data. Then a performance-improvement plan. Then, maybe, a penalty.

I am not cheering a state board. I am looking at the calendar. A Wichita shop with forty people does not have two years. They get a renewal letter this fall. They need a price they can read before they get the bill, not a hearing in 2028 about last year’s overage.

KFF counted the last jump in national health spending: hospitals were 40 percent of it. Retail drugs were 11 percent. That is not a mystery. That is a price list nobody posted.

I am not anti-insurance. Keep a policy for the wreck. Primary care is not a wreck. We take care of patients for a flat monthly fee. No prior auth. No claim. The number on the door is the number you pay.

California can fine a hospital in 2028. We post the fee today.