The 3 Ps of Health Care
As a former insurance agent and pre-licensing insurance instructor focusing on health insurance, I began to see the Health Care Industry as a system consisting of Payers, Providers and Patients. These are the three units in this system that is meant to provide for our medical care, including treatment for disease, accidents, dietary and all manner of preventative care. Does our system in the U. S. adequately provide for those objectives? I think not.
Note the order in which I’ve laid out the system placing Payers first and Patients last. This is intentional to show the priorities we have established in our country. Our first concern is that the insurance industry receives its share of profit from a system that is supposed to be concerned with the care and health of the Patient. The health insurance industry has done well indeed, sucking up 5% of our Gross National Product (GDP), over and above the cost of care. That’s 5% of every dollar, public and private for all spending in the U.S. If only the Patients, for whom this system was supposed to be designed, were faring so well! One can only say that the Health Care Industry is very healthy while the Patient is receiving less than adequate care.
To see how inefficient our system is, go to www.kingsfund.org.uk/... for an easy to read graphic. Most countries shown spend from 6% to 10.5% of their GDP on health care, both public and private. The U. S. stands head and shoulders above the rest at close to 17%, twice the costs of the others. Yet when we look at outcomes, the U. S. ranks “dead last” according to Forbes magazine. “It’s fairly well accepted that the U.S. is the most expensive healthcare system in the world, but many continue to falsely assume that we pay more for healthcare because we get better health (or better health outcomes). The evidence, however, clearly doesn’t support that view.”[1]
I will admit that there is an exception (as always) for the wealthy and well insured. In those instances where money is no object, excellent care can be found and given. Indeed, the U. S. has pioneered and provides some of the best care in many areas. However, it is only in those cases where cost is not an issue or a charity or an “angel” steps forward and provides for all the cost.
But in a society of over 300 million people, the bulk of the population is faced with costs that remain a major concern, even among those with adequate incomes and excellent employer-provided Health Care. Why do we allow our employers to determine how we will be insured? Aren’t we the country where choice is one of our driving motives for our purchases? Yet many have no choice when it comes to a health care plan and within a given plan, choices may be made narrower by limiting the choices of Providers, (e.g. HMOs or PPOs). Heaping on more, we are also left with shortfalls due to private companies limiting payments or claiming certain costs to be excessive or experimental. In the end it is the patient who is left trying to figure out why there are so many costs left for them to bear when they were told they have “excellent coverage”.
So here we have a cost that comes to 17% of GDP with nearly 1/3rd of that being insurance company profit, a factor that contributes nothing to bettering our health outcomes, providing a product that does little to improve our overall health.
So we all know the issues and problems and I am not one to complain without offering some kind of solution. It’s really quite simple, do what the others are doing to reduce costs and improve outcomes, use the government as a payer. Currently our government runs two of the best run, most efficient health delivery systems in the country, Veteran’s Affairs and the Medicare program. No private Payer comes close to their costs and efficiencies.
Whatever we do, we must put the Patient first, making certain all citizens receive the best care possible, freedom of choice when it comes to that care, provide for preventative care as well as aftercare and do it all in the most efficient way possible. Let’s face it, the private sector does not care about preventative care, in fact they make more money by not providing for it because when claims cost more than what they rake in, the insurance companies simply charge more and make more money. This is the nature of the private sector whose interest is not the patient but the profit.
Advocating for a single-payer system will only lead to a huge argument about “socialism”, and the “dad-gum gummint getting their hands on my health insurance”. The Public Option, an option for the patient to purchase a government plan; a choice where we may buy our health care insurance and we can compare which will do the better job of providing for our needs. Then we may finally turn our up-side-down system back onto its feet and provide for the Patient first.
Jerry Kolasinski
© 13 December 2016
[1] Dan Munro, contributor to Forbes Magazine, June 16, 2014