I am a conservative. As a conservative I believe in personal responsibility and limited government.

BUT events in the last 5 days have led me to see WHY people want the easy way of Obamacare and how tempting it would be to fall for it.

My son has been unemployed for over a year. As a healthy young man, he chose not to purchase private health insurance. We have repeatedly discussed/begged the pros and con's and he stuck with his decision.

Last Saturday he was singularly stupid and hurt himself. He thought he simply rolled and sprained his ankle. He immediately elevated and iced it overnight. He called me on Sunday and asked if I knew where the crutches were (Yes, with 3 sons of an active father we have been the proud owners of crutches for many years). When he got here I thought he should have it looked at but he wasn't convinced he needed a hospital so we visited a neighbor who is a physical therapist. There were several symptoms that led her to strongly suggest he have it x-rayed.

We had a decision to make. Go to the hospital ER or go the urgent care associated with our medical group? Knowing that urgent care is less expensive (and faster) we decide to go there. Since he was an existing patient of the group he was required to pay $50 for service and then informed that if he calls the billing office when he receives the bill and pays the balance within 30 days of the bill he would receive a 40% discount.

Yes, the x-rays revealed he broke his ankle. In as much as they were an urgent care, they splint his leg, referred him to an orthopedist and gave him prescriptions for pain meds.

Knowing he had no insurance, we had some discussions and he had some decisions to make: do we now go to the ER to get it set (at presumably no cost) or do we see the family orthopedic group? (Yes again! :) See above note re the crutches.) Ultimately we decided to wait and talk to the orthopedic group Monday morning, find out their policy for the uninsured and get advice as to his options. At that point we were leaning toward our ortho group simply because we trust them and because of the 'you get what you pay for' factor.

Their policy for existing patients without insurance is a pre-payment of $250 with a 20% discount if the balance is paid within 30 days of billing.

The doctor was terrific. He knew my son had no insurance, so relied on the x-rays that were taken at the urgent care. The bad news was that he needed surgery, he needed a plate to repair the fibula break and possibly a pin to stabilize tibia. The doctor's assistant called over to the hospital, paved the way for us to speak with a financial counselor and then scheduled the surgery for Wednesday.

The financial counselor advised us that since we did not 'come through the ER' the hospital was under 'no obligation' to provide, offer or find him some financial aid. We were informed that based on an estimated 128 minutes of surgical time the cost would be approximately $18,000. If a pin was needed we could add $2500.00. He was not eligible for aid through DSHS because he was a single male. (I must admit I didn't quite understand that part of the explanation and frankly was still so stunned at the $18,000 I'm not sure I heard it if it was explained.) The financial counselor said the hospital would accept him for charity assistance and that based on his income (unemployment benefits) he was eligible for assistance at 50%, which brought the $18K down to $9K. He then told us that he could take a loan through the hospital for the $9,000 or, if he could come up with a prepayment, they would reduce the $9,000 by another 50%. At that point good old Mom whipped out her Visa and made the payment. I would rather my son owe us $4500 than owe them $9000. This was just for the OR time and the cost of the anesthesia; it does NOT include the surgeons time nor the anesthesiologists time. We were told the anesthesiologist discounts 15% for prompt payment.

He had his surgery on Wednesday. After a more than 2 hour delay in pre-op they put in a plate with 4 screws straight in, 2 more at opposing angles and yes, that darned $2500 pin. As we waited, he remarked that he felt that instead of counting minutes he was counting dollar signs.

He has a follow up to remove stitches and to replace the splint with a full cast. He will be totally non-weight bearing for 6-8 weeks, then gradual weight bearing with a boot. At some point he will have to have the pin removed. He will need physical therapy.

Now I understand the temptation of 'free' health care.

But I am still not tempted.

All of this info begs the question: what is the TRUE cost of that surgery? Is the $18,000 the insurance cost because insurance automatically deducts a certain amount? Is the TRUE cost the $9,000 or the discounted $4500? Who knows?

Take a gander at an Explanation of Benefits to know the games that are played with health costs. If a doctor charges $150 for an office visit and he is a "preferred provider" the insurance company automatically knocks off $54. Then they come up with your portion by deducting 80% of the balance then add back in the deductible you still haven't met. It's enough to make your brain hurt. (And if you want your brain to explode try to interpret a Medicare EOB!) So, has the doctor marked up his price for an office visit in order to end up getting what he needs to run his office? Of course he has! It is these needless machinations that have made healthcare unaffordable. No one knows what any healthcare truly costs. And most don't really care either because they just pay their nominal co-pay which usually covers their 20%. It is monstrous that far too many don't know or care the cost of the services they are getting. Why are they less discriminating consumers in health care than they are in shoes? Because they can be, because there are no consequences to not knowing.

I have another younger son who is not covered by our employer's health insurance and we pay for his private policy. We pay $83.00 a month for a policy with a $3000 deductible and a 20% co pay. I am reasonably sure he will NEVER ever need pre-natal coverage, never need well baby coverage, never need childhood immunization coverage, addiction counseling, obesity coverage, holistic medicine coverage or psychiatric coverage. BUT because we have to buy what WA state mandate, he has all that unnecessary and costly coverage. In the year we've been paying for this policy, he has had exactly ONE office visit, resulting in ONE prescription.

We certainly encouraged our other son to get the same insurance. But when we thought about it, if he had paid $83/month for over a year, then paid the $3000 deductible, then paid a 20% co-pay, would that $4500 been any different? Nope, not much. BUT the insurance company would have been paying based on the $18,000 and they wouldn't be doing it out of the goodness of their heart: somewhere along the line premiums will go up and/or benefits will go down somewhere else.

Why in heaven's sake shouldn't we have choice when we buy health insurance? We have our house and cars covered out of a company in Connecticut. We have our life insurance through a company in Illinois and serviced through an agent in Oregon. We made those specific decisions based on our specific needs and financial ability.

I believe the BEST way to reform health care is through pre-tax dollar Health Savings Accounts. HSA's would be easier for all employers in the cost of time they no longer spent on insurance, government forms and accounting. A HSA would go with the employee if he left his job. They could easily be continued though similar pre-tax dollar deductions in unemployment, welfare and social security. And, as incentive to use health care wisely, unused dollars, after a reasonable period of time, could be transferred to retirement accounts or prepayment in advance of possible extended care.

I get tired of folks whining about profits in the medical, pharmaceutical and insurance industry. Doctors spend a lot of time and money to be able to provide their service and they should expect a return on that investment. It's funny; we all eat many times every day and one could say that food is as much as a necessity as medical care, yet no one begrudges Kraft Foods profit on their mac and cheese. One could even say that Americans use toilet paper far more often than health care yet no one begrudges Proctor and Gamble their profits. Furthermore, competition and choice has made mac and cheese and toilet paper more readily available and cheaper.

There has been a lot of noise lately about WellPoint and their profits. What most haven't heard and don't know is that they sold a division and those dollars were included as profit in their bottom line. Instead we are all led to believe they are vile fat cats laughing all the way to the bank on the backs of dying citizens. I also learned recently that the health insurance industry operates on an average profit margin of 2.2%. 2.2%. Think about that. Could your business survive on that meager margin in this economy? Kraft has a profit margin over 35% and P&G has a profit margin over 51%. Are food and toilet paper shareholders somehow more deserving or more important than shareholders of the insurance industry? Are their employees more deserving than insurance industry employees?

There is absolute proof that Health Savings Accounts would make patients better consumers. Have you ever had to buy prescription eye glasses? YOU get to choose how much you are willing to spend on frames, YOU get to choose what material you want for your lenses, YOU get to choose if you want anti-glare coating, tinted lenses or whether you want transition lenses. One would assume YOU make those choices based on what you can afford. And you have many places to compare the prices of all those options: you can do so through your doctor, you can get a Lenscrafter coupon, go to Sears, JC Penney's, Walmart, Costco or many other places.

Now clearly no one would or should 'shop' for health care for every single symptom or illness. There are clearly continuity of care concerns. But competition amongst doctors for your (healthcare) business would bring costs down and greatly improve care. The proof for that is both Lasik surgery and cosmetic surgery. When first introduced Lasik Eye Surgery cost close to $8000 for both eyes. Now you hear it advertised for $999/eye. And the technology and quality of the surgery has improved dramatically as the price has come down. Here is an excellent video that makes the case far better than I can: How to Fix Health Care: Lasik Surgery For The Medical Debate The same thing has happened in cosmetic surgery: the doctors have to compete for your cash business and consequently the prices has become more affordable and their abilities have skyrocketed because those same abilities are their reputations and hence their profit.

And I will concede that there will never be across the board choice in health care: when you choose a specific doctor, you are probably limiting yourself to the lab he uses and the hospital at which he has privileges. But, again, competition lowers prices and they cascade downward as competition increases. Hospitals will be competitive in order to woo the doctors who will refer the patients. Look at prescriptions. Walmart stunned the industry when they instituted $4.00 prescriptions. Almost immediately other pharmacies fell over themselves to do the same thing in order to remain competitive. And what's happened since? Walmart has upped the ante by advertising free shipping on those same discounted prescriptions. Are these great prices "loss leaders"? Probably. But so what? They want to get you into their store but no one is forcing you to buy anything else when you get there. This is all great news for the consumer. Again, when shopping prescription prices it's important that the pharmacist KNOWS everything you may be taking via your prescription history and unless you are responsible (or anal) enough to keep and carry scrupulous track of your history, it behooves you to establish a history and continuity of care with one pharmacy.

I understand there are those who, unlike my son, don't have families that can help them. I do. And I firmly believe we need a mechanism for those FEW cases. I say few because I also believe that far too many find and take every easy way out compared to the number that are truly needy. I'm not convinced that the mechanism to help those few needs to be through the government and especially the federal government, but no longer am I quite so quick to dismiss it. One brochure we were given at the hospital was called "Life is Sharing" which was detailed explanations of how the hospital accepted charitable contributions and different ways to give, up to and including through estate planning. I like that. Normally we only give though Catholic Charities, but now I'm inclined to include programs such as this. It takes work to find help when you're needy. But there is help out there though public and private charities, through hospitals, through pharmaceutical companies. I truly believe that competition in healthcare through such ideas as HSA's would actually serve to increase that private help for the truly needy.

I've read several articles that much more artfully say what I've tried to express.

A Better Way to Reform Health Care

"To bring down costs, we need to change the incentives that govern spending. Right now, $5 out of every $6 of health-care spending is paid for by someone other than the person receiving care--insurance companies, employers, or the government. Individuals are insulated from the reality of what their decisions cost. This breeds overutilization of low-value health care and runaway spending."

Let free enterprise take over health care

"Health insurance has its place, but payment for day-to-day normal treatments is not one of them. We buy car insurance to protect us from a catastrophic event. We don't buy insurance that pays for oil changes or new tires."

Will Obamacare Kill Miracle Cures?

"While it is easy to demonize the profits of the pharmaceutical industry, the reality is that lives depend upon the ability of the industry to fund research and development of new cures at risk of losing that investment. While these cures are expensive, the surgeries and other medical care avoided often are just as expensive, not to mention the human suffering avoided."

Why Washington Can't Reform Healthcare

"It's not for lack of will. It's not for lack of power. It's not even for lack of money. Washington can never effectively "reform" healthcare for one simple reason. The healthcare industry runs on fake prices."