For years we have been paying the biggest health insurance companies more and more money to insure us against risk where there has been no risk. It's time to sever primary care from health insurance!
Risk and Insurance…
We spend nearly twice as much per capita as any other country in the world on health care yet on any given night we are treating common colds and the flu in overtaxed emergency rooms all over America.
More than a hundred million households, the fifty million uninsured, fifteen million activists, and five million business owners, all are witness to a badly broken healthcare system. We all want it to change. Ten thousand lobbyists, perhaps a thousand staffers from Congress and the White House, and less than a hundred real insiders have been working non stop on Health Reform for six months.
We’re frantically searching for waste in the system, trying to find spare dollars for all the unmet needs of the millions who have been sucker punched by the most inefficient healthcare system in the world. We know we are broke; having poured untold billions into an economy that teetered for so long at the edge of the abyss and even now is only at the dawn of recovery. Yet in these desperate hours, haunted by two generations of societal neglect and procrastination, many of us feel the moral imperative to finally get it right this time.
How can we possibly meet this challenge in these difficult times? The answer is in plain sight, right under our noses, yet we can’t see it. Even Willie Sutton knew where the money was. It’s as if we’ve been paying the mortgage on a home we’ve never gotten to enjoy, never lived in. For six decades we have been paying the biggest health insurance companies more and more money every month to insure us against risk where there has been no risk.
Think about your automobile insurance. It doesn’t cover the small stuff, the oil changes, the broken fan belts, and the tune-ups. You pay for those out of pocket. Thirty bucks for an oil change, sixty-five for a tune up, maybe one twenty-five for a new battery. Would you want to process claims like these through your insurance company with forty percent tacked on? Do you think the guy down at the car shop would mind waiting three or four months to get paid?
The reality is that your auto insurance protects you against the real risks you might face: accidents and injuries to yourself and to others, the cost of replacing your new car or someone elses, the kind of expenses that might even wipe out all your savings and more—catastrophes and near catastrophes.
That’s exactly what health insurance should do for you and your family. And that’s ALL it should do.
We DO need reliable health insurance policies that protect us against the enormous expenses of operations and procedures to preserve the quality of our lives, even to save our lives. These are the costs most families cannot budget for: serious heart disease, organ failure, treatments for cancer, and chronic illnesses—the catastrophes and near catastrophes that we all hope to avoid but inevitably some of us will not be able to.
But the rest of our health care—primary care. There’s little or no risk. We don’t need to be insured against the cost of an office visit or an examination, or simple tests conducted in the doctor’s office. Most of us already pay for lots of these anyway before we reach the thresh hold level of our deductibles. These are expenses we can budget for just like we budget for the new battery.
Yet for two generations the insurance companies have been charging us for assuming risks they really did not undertake. They simply bundled no-risk relatively inexpensive primary care with high cost specialty and catastrophic care, which of course does have risk and “insured” us for the whole package. For their troubles, they take forty per cent of the overall health dollar.
What they’ve done to the healthcare system however is far worse than if we just gave them the 40% and asked them to walk away. The insurance carriers are also the major culprits in the crippling of the delivery of primary care medical services in this country. Despite the enormous profits they’ve gained from a rigged system, post-claims underwriting (denial of claim) is standard practice for many insurers. Patients, doctors, and hospitals have been forced to navigate in a mostly paper world where insurers can delay reimbursement for ninety to one hundred twenty days for even the most legitimate of claims with a blizzard of form letters and endless requests for more information.
Doctors are also forced to spend precious time (up to twenty per cent) dealing with insurance matters, and must devote more and more staff resources to this area. This of course further raises the cost of primary care. It also means that to cover their increased overhead, doctors must take on a higher patient load, meaning less and less of the preventative care that has such potential improve our health and save trillions of dollars later on.
The insidious business practices of the insurance industry further put at risk the financial health of individuals, doctors, hospitals, and other health institutions. It is no accident that sixty per cent of all personal bankruptcies are related to medical debts, and results in billions of uncompensated care—the principal cause of financial instability in our hospitals as well.
The gross distortion of the real costs of primary care that our health care system has permitted by allowing insurance where there is no risk is the major factor in putting the overall cost of health insurance beyond the reach of millions of Americans and consigning them to the ranks of the uninsured.
It’s time to sever primary care from health insurance!
The New Paradigm.
How would the new system look? Already it is taking shape before our eyes. Doctors and Hospitals all over the country, fed up with wasting time with insurance companies are opening up pre-paid subscription-based primary care clinics. They offer high quality low cost treatment for the overwhelming portion of our medical needs. Some of them are open 24-7 to relieve the pressure on emergency rooms. And they are inexpensive, about $50 per month per person, even in the upscale Seattle area.
How do they manage that? They don’t take insurance and won’t deal with it. The time they save is enormous. Patients get unlimited access to care and short waiting periods. Doctors have cut their patient load by half and are still ahead because their overhead has been vastly reduced and …bingo: Doctors newly freed from assembly line medicine actually have the time to interact with their patients and more thoughtfully consider the advice they give and the treatments they employ.
And this will lead to huge cost savings and vast improvements in our quality of life, the “preventative medicine” our brightest health experts and economists say is so critical to our financial and personal health. And your doctor will be smiling: One hospital in the Northwest got 225 applications from physicians for the handful of jobs in their new primary care clinic.
Economic incentives to doctors, hospitals, communities, even corporations forming their own clinics could over the next three or four years stimulate enormous growth in primary care clinics like these all over the country. In the time it will take to set up the health exchanges we could be well on the way to a vibrant new subscription-based primary care health system largely free from insurance costs.
Instead of providing comprehensive health insurance for their employees, employers would be asked to pay for a health benefit per employee hour worked. The health benefit would pay subscriptions to primary care clinics for preventative and day-to-day health care. The health benefit would also be used to purchase umbrella or higher deductible major medical insurance policies to cover the real health risks that pose the potential to wipe out a family financially. Federal and state government subsidies would be preserved to supplement the health benefit where needed and in those instances where additional resources are necessary: the unemployed, the part-time and seasonal workers.
This approach should lower the overall costs enough to enable many businesses not now providing coverage to comfortably enter into the system for the first time. And it would remove the incentive for employers to game the system by cutting hours for employees so they are unable to qualify for health insurance benefits.
And finally, perhaps we should consider making it standard practice to require a formula for health benefits written into the contracts of the temporary workers, the consultants, and the independent contractors now left out of the system and hence more likely to be “uninsured”. That would get more people covered by the system. It should not be lost on us that significant percentages of all health insurance policies are sold to us by agents who themselves are independent contractors with no employer-based health coverage—perhaps the ultimate insult from a greed-driven cynical industry that has done so much harm the quality of healthcare for all Americans. It doesn’t even take care of it’s own.