Health Insurance Does Not Equal Health Care
We need to make the distinction between health insurance and health care. Simply put, health insurance should cover you for catastrophic issues and/or chronic conditions. You pay a LARGE monthly fee for this, which is a joke. The narrative, by the insurers, is that they are your health care providers. They are not. Doctors, nurses and the rest of the medical personnel are. Just because you have insurance doesn’t mean you have health care. All you have is some mild peace of mind with a large monthly bill. You still can’t see the doctor you want and get many of the things your doctor recommends or prescribes.
This survey was done by the Doctor-Patient Rights Project and it found that:
- Almost two out of every three patients denied coverage were denied multiple times and most had to wait more than a month before their insurance provider responded to their request for a prescribed treatment.
- 70% of the denied treatments for chronic or persistent illnesses were for conditions described as “serious,” and 43% were for treatment of patients described as “in poor health.”
- Nearly a third (29%) of patients initially denied coverage reported that their condition worsened, even if they eventually convinced their insurer to cover their treatments.
- More than one out of every three patients (34%) denied coverage had to put off or forego treatment altogether.
- The largest consensus of patients (91 percent) agreed that insurance providers should not have the final say in treatment decisions, and almost as many (87 percent) felt insurers should play either a secondary role or no role at all in deciding medical treatments.
To be clear, this organization is biased. I get that. I also know that insurers can’t approve everything. I get that, too. That being said I have never had ONE person talk highly about their insurance company. On the flip side, I have never had ONE person talk badly about the Health Ministries (CHM, Medishare, Samaritan, etc.). If you are bothered that it is faith-based I would ask you to suspend judgment for a minute. These systems work. The companies profit. The patients love them. All are different and have different plans but the basics are that the patient has a yearly deductible and the plan covers nothing for free. The patient pays the first $600 of every touch point with the medical system (this is a rough estimate). They are forced to shop around and they do. Their negatives are that they tend to cherry pick healthier patients and have higher premiums and exclusions for pre-existing conditions. It may not be perfect but you can’t tell me there couldn’t be some happy medium here.
I still believe that:
- We need to put medical doctors back in charge of the medical system
- Patients need skin in the game.
- Everyone needs to be responsible and accountable for their own care but there should always be a safety net just in case.
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Health Care Ministries are the way to go along with web sites like GoodRX.com and MDSavecom.
I have said this “ad nauseum” a million times, “Until people are held accountable for their
lousy health behaviors, not a damned thing is going to change in the U.S.A.”
Except maybe med students will learn to avoid FP in droves. I’d love to see that happen.
As a physician, I provide medical care. I don’t know what “health care” is.
Some desirable things can be made into commodities – products that can be bought and sold. It is an illusion that everything can be made into a commodity.
Yet our culture is so used to this assumption, I hear it daily in my clinic.
“Who was your healthcare provider?”
“Aetna.”
“No, the name of the person.”
“I don’t know. They come and they go.”
When they go to the ER for a complaint, I hear –
“I went in and they did lots of tests and it turned out that nothing was wrong.”
I try to piece together the process that happened there, but even the complaint is murky and
hopeless.
They assume that they purchased a service for their chest pain, and received a final answer. When I suggest that they get medical records for me so that I can understand what went on there, their response ranges from blank confusion to resentfulness.
“Just look it up on the Doctor Medical Record online.” (The one that has all the facts all the time.)
It helps the money-is-no-object American approach to healthcare. If we have worked up their GERD and put the patient on PPI twice daily for Barrett’s and undergo surveillance, why, when they’re watching the game on Saturday and the ol’ belly bloats up from beers and dogs, go to the Emergency Room and buy a check-out, pay pennies on the dollar that the useless workup costs; and then complain about the expense. They get a scope, and a referral for Barrett’s surveillance which he gets, and perhaps a different band of PPI. And the patient feels wonderful – great care!
Money is no object in American Medicine. At least not for the doctor and patient. There are a horde of biting midges hoping to get their share by writing the killer app for something in medicine. As medicine cannot be managed as a product, it will never reach the efficiency of the consumer canned tomatoes market. But it may be owned by several MegaCorps who specialize in providing the lowest quality product at the highest price the customer will pay for it. Anyone offended by this approach must remember – it’s the rule of product sale. But money is no object in American Medicine. Look what we’ll have in a few short years.