Zeke Emanuel and Rand Paul should talk subscription based health care

What do you mean by subscription based?

I pay a monthly fee for the right to get care at hospital X?

What about the people who don't subscribe and can't afford care?

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That would be good until the hospital had a bad year and ran out of money- they operate on very slim margins as is. Then what? Extra charges apply?
They shut their doors until they can operate again/up the subscription cost at the next open enrollment period?

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The same thing as happens when any business closes. You would simply shop for another subscription.

What happens today? They close today.

I don't see why there needs to be enrollment periods. Sign up anytime.

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The same thing as happens when any business closes. You would simply shop for another subscription. 

What happens today? They close today. 

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So you suggest that in rural areas of the USA, hospitals should, by law, charge a nominal fee instead of charging for the services they provide and if several high-demand years follow each other, they should have no way to recover the income they would have otherwise been able to charge for, so now the one hospital in a 30 mile radius closes?

How is this different than insurance?

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How is this different than insurance?

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Because it provides a consistent flow of cash to the Hospitals and staff.

No more waiting around on the middle man (insurance) to pay the bills. It's a good idea IMO. I'm just not sure how the hospitals in poor areas make it.
It kind of sets up a natural class bias to health care.

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Because it provides a consistent flow of cash to the Hospitals and staff.

No more waiting around on the middle man (insurance) to pay the bills. It's a good idea IMO. I'm just not sure how the hospitals in poor areas make it.
It kind of sets up a natural class bias to health care.

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That is right about cash flow.

Why it matters if it is rural or it is urban is unclear to me.

Sounds like people are dreaming up problems that will probably never happen.

That's basically a capitated model and only works if that hospital has a healthy population.

It's not the perfection you seek. It's actually not even close.

Would you be assigned to a hospital based on where you live?

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Seems like it might lead to a chain reaction where hospitals in poor areas who don't get enough paying subscriptions to offset the cost of EMTALA-mandated ER care fail, thus sending those costs to the next-nearest hospital, etc.

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There is no might to it.

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Why it matters if it is rural or it is urban is unclear to me

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Smaller populations served means bigger variations in costs and capital. On a fixed revenue stream, it's much easier to go way over/under, again in the setting of some form of outbreak, a common one being an active flu season with poor immunization rates/poor match to circulating strains.
Currently, these hospitals bill more for the people they see. Thus, when their costs go up for taking in more patients, their income goes up because they charge for each patient they see.
These are problems that affect a 50 bed rural hospital much differently than a large, urban 400+ bed center.
Your proposition would probably lead to more dollars in the hospital pocket without dealing with insurance at all, killing an industry entirely.
Of course, the flip side is that the income stream margin is too low, and you cause hospitals to be unable to cover their costs, or raise the price of their buy-in to the point of unaffordability.
Here's the thing- if that hospital has an ER, it has to treat people who show up regardless of their ability to pay. So if the number of people using the ER because they can't pay because it's unaffordable, you'll see skyrocketing prices to be part of the group with dwindling numbers of people buying in.


Paying for what you use yourself just seems to be a better option given the number of small, community hospitals around the US that would likely essentially be driven out of business without being able to bill for what they provide.