Is it cheaper to pay for medical care without health insurance? – NBC News

Analysis of Healthcare Affordability and its Impact on Sustainable Development Goals

Introduction: The Challenge to Universal Health Coverage (SDG 3.8)

Rising health insurance costs in the United States are prompting a critical evaluation of healthcare financing models, with some individuals considering self-pay options as an alternative to formal coverage. This trend presents a significant challenge to the achievement of Sustainable Development Goal 3, particularly Target 3.8, which aims to ensure universal health coverage, including financial risk protection and access to quality essential health-care services for all. The potential expiration of enhanced subsidies for the Affordable Care Act (ACA) and rising premiums for employer-sponsored plans are key drivers of this phenomenon, forcing a re-examination of how to maintain progress toward equitable and affordable healthcare.

The Self-Pay Option: An Assessment of Viability and Risks

While paying for medical services directly with cash can sometimes offer discounts for predictable, low-cost procedures, this approach carries substantial risks that conflict with the principles of the SDGs.

1. Loss of Financial Protection (SDG 3.8 & SDG 1): Cash payments do not contribute to annual deductibles or out-of-pocket maximums. This leaves individuals entirely exposed to catastrophic costs in the event of a medical emergency or unexpected illness, undermining financial risk protection and potentially leading to debilitating medical debt, a direct contradiction to the goals of SDG 1 (No Poverty).
2. Erosion of Negotiated Rate Benefits: Health insurers negotiate lower rates with providers. Uninsured patients paying cash often start from a much higher base price, and even with a discount, the final cost may exceed the insurer’s negotiated rate.
3. Forfeiture of Preventive Care (SDG 3.4): A core benefit of health insurance is coverage for free preventive services, such as cancer screenings, vaccinations, and annual physicals. These services are critical for non-communicable disease prevention and management, as targeted by SDG 3.4. Opting out of insurance removes this vital public health benefit.
4. Exacerbation of Health Inequalities (SDG 10): The self-pay model is most feasible for healthy and affluent individuals who can absorb the financial risk. This creates a two-tiered system that disadvantages those with chronic conditions and lower incomes, thereby increasing health and economic inequalities, contrary to the aims of SDG 10 (Reduced Inequalities).

Socioeconomic Implications and Alignment with SDGs

The decision to forgo health insurance has broad socioeconomic consequences that directly impact the achievement of multiple SDGs.

• Medical Debt and Poverty (SDG 1): Experts warn that forgoing insurance is a high-risk financial strategy. A single emergency room visit or hospitalization can result in tens of thousands of dollars in bills, pushing individuals and families into poverty and reversing progress on SDG 1.
• Barriers to Access (SDG 3): Without insurance, individuals may face obstacles in accessing non-emergency care. Providers may require full payment upfront or refuse service, limiting access to the consistent primary and specialty care necessary for maintaining good health and well-being.
• Systemic Inefficiency: The complexity of navigating cash payments, which can involve separate negotiations with doctors, anesthesiologists, and labs for a single procedure, highlights systemic inefficiencies that hinder the delivery of streamlined, accessible healthcare for all.

Existing Support Mechanisms and Policy Considerations

To mitigate these risks and support progress toward universal health coverage, several mechanisms and strategies are available, though they do not replace the security of comprehensive insurance.

1. Federally Qualified Health Centers (FQHCs): These centers are a cornerstone of the public health infrastructure, providing low-cost primary care to underserved and uninsured populations, directly supporting the objectives of SDG 3.
2. Hospital Price Transparency and Charity Care: Federal regulations mandate that hospitals make their discounted cash prices public and that non-profit hospitals provide free or reduced-cost charity care to eligible individuals. This serves as a critical safety net, although access can be difficult to navigate.
3. Emergency Care Mandates: The Emergency Medical Treatment and Labor Act (EMTALA) requires Medicare-participating hospitals to provide stabilizing treatment to anyone in an emergency, regardless of their insurance status or ability to pay. This law upholds the fundamental right to emergency care.
4. Informed Patient Engagement: Individuals are encouraged to contact hospital billing offices to inquire about payment plans and financial assistance programs. However, this places a significant administrative burden on the patient, particularly during a health crisis.

Conclusion: The Imperative of Comprehensive Coverage for Sustainable Development

The analysis indicates that while self-pay options may appear attractive for minor, predictable health services, forgoing comprehensive health insurance is a fundamentally unsustainable strategy that jeopardizes individual financial stability and public health outcomes. It directly conflicts with the global commitment to the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-being), SDG 1 (No Poverty), and SDG 10 (Reduced Inequalities). Achieving universal health coverage through robust, affordable insurance systems remains the most effective path to ensuring financial protection and equitable access to quality healthcare for all populations.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article’s central theme is the affordability and accessibility of healthcare in the United States. It directly discusses the rising costs of health insurance, the financial risks of being uninsured, and the trade-offs between paying for insurance versus paying for medical services with cash. This connects directly to ensuring healthy lives and promoting well-being for all at all ages.

• SDG 1: No Poverty

  The article highlights the significant financial burden that healthcare costs can impose on individuals and families. It mentions how unexpected medical emergencies can lead to “major medical bills” and cause savings to “disappear fast,” potentially pushing people into financial hardship or poverty. The discussion of charity care and low-cost clinics for the uninsured also relates to protecting vulnerable populations from the impoverishing effects of healthcare expenses.

• SDG 10: Reduced Inequalities

  The article implicitly addresses inequalities in healthcare access. It notes that the “self-pay option will be most attractive to the healthy and well-off patient,” suggesting a system where healthcare choices and financial risks are unevenly distributed based on health status and income. Furthermore, it mentions “federally qualified health centers” designed to serve “underserved populations, including the underinsured and the uninsured,” pointing to existing disparities in healthcare access.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

    The article is fundamentally about the challenges of achieving this target in the U.S. context. It discusses the struggle for “financial risk protection” through insurance, with rising premiums and high deductibles. It also covers “access to quality essential health-care services” by mentioning preventive care, primary care, emergency visits, and prescription drugs, and how the decision to forgo insurance can jeopardize this access.

• SDG 1: No Poverty

  • Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.

    The article references the Affordable Care Act (ACA) and its “Enhanced subsidies” as a key social protection system designed to make health insurance more affordable. The fact that these subsidies are “set to expire” highlights the vulnerability of this system and its importance in protecting people from high healthcare costs that could lead to poverty.

• SDG 10: Reduced Inequalities

  • Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.

    The discussion of ACA subsidies, which “kept Affordable Care Act premiums lower for many middle-class people,” is an example of a social protection policy aimed at reducing inequality in healthcare access. The existence of “federally qualified health centers” that “provide low-cost care to underserved populations” is another policy mentioned that aims to achieve greater equality in health outcomes.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.8 (Universal Health Coverage)

  • Indicator 3.8.1: Coverage of essential health services.

    The article implies this indicator by discussing the range of services people risk losing without insurance, such as “free preventive care, such as cancer screenings, annual physicals and routine vaccinations,” as well as access to emergency rooms, hospital stays, surgeries, and prescription drugs. The number of people with access to these services could be a measure of progress.

  • Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income.

    This indicator is central to the article’s narrative. The text is framed around the “cost of health insurance,” “higher premiums,” high deductibles, and the risk of “major medical bills” that can be financially devastating. The debate over paying cash versus using insurance is a direct reflection of households trying to manage their health expenditures.

• For Target 1.3 (Social Protection Systems)

  • Implied Indicator: Number of people covered by health-related social protection schemes.

    The article’s focus on “ACA enrollees” and the impact of expiring “Enhanced subsidies” implies that the number of people benefiting from these government-supported insurance plans is a key metric for measuring the reach and effectiveness of this social protection system.

• For Target 10.4 (Policies for Greater Equality)

  • Implied Indicator: Availability of subsidized or low-cost health services for vulnerable populations.

    The article’s mention of “federally qualified health centers” that “provide low-cost care to underserved populations, including the underinsured and the uninsured” points to a measurable indicator. The number of such centers, the populations they serve, and the affordability of their services could be used to track progress toward reducing health inequalities.

SDGs, Targets, and Indicators Table

Source: nbcnews.com