Health insurance injustices suffered by patients, employers and physicians at the hands of the domineering health insurance industry are discussed in our podcast attached below.

What are health insurance injustices?

Health insurance injustices are abuses of power that enable the insurance industry to take advantage of patients, employers and physicians.

Insurance industry domination of healthcare

  • The cost of health insurance grows faster than the cost of medical treatments.
  • The eight largest publicly traded health insurance companies have some of the most highly compensated executives in the business world.
  • The health insurance industry makes huge profits by controlling healthcare access, delivery and pricing of services. 
  • The health insurance industry is about the only insurance that covers unnecessarily, generally affordable routine services – your car insurance doesn’t cover the cost of a new tire.
  • The insurance-based coverage of easily affordable routine office-based healthcare services is flawed and torpedoes the very basis for insurance which is to cover only against unlikely costly and catastrophic events – not day-to-day routine needs.
  • The health insurance industry invented the term “allowables” to justify their pricing controls.
  • Healthcare spending has catapulted to $3.9 trillion dollars because of anti-competitive insurance-based controls and pricing.
  • The domination of U.S. healthcare by the insurance industry was secured by State and Federal laws that were carefully designed to benefit them.
  • Insurance-based rules and pricing have prevented market forces from stabilizing or lowering healthcare costs.
  • Although the health insurance industry gets millions of taxpayer dollars to enable government-sponsored healthcare they deny potential employment opportunities for American workers by outsourcing and sending some of their work offshore. 
  • Healthcare is an insurance industry monopoly.
  • Because the insurance industry controls healthcare pricing, access and delivery, our healthcare system is grossly inefficient, dysfunctional and unsustainable.
  • “Healthcare is a terminal illness for America’s governments and businesses” – The Innovator’s Prescription by Clayton Christensen.

Health insurance injustices suffered by patients.

  • One third of all healthcare spending (billions of dollars) is wasted on outdated insurance-based administrative services – designed only to ration care and control payments.
  • Health insurance has failed to significantly improve overall health outcomes.
  • Healthcare decision-making for tests and treatments are made by your health plan and not by you or your doctor.
  • Two thirds of all the health services delivered in the U.S. are generally affordable routine office-based or outpatient services.
  • 50 percent of the healthcare public uses only two percent of available healthcare dollars meaning that many consumers are over insured and overpay.
  • Incredibly, despite being so-called covered by an expensive health plan consumers are paying for their routine care anyway with copays and deductibles as well as paying for the care of pre-existing conditions and non-covered services.
  • Insurance plans are confusing by design and many consumers are unclear about what is “covered”.
  • Some health insurance plans are junk health plans that entice potential consumers with worthless give-aways but have narrow provider networks as well as severely restricted access to specialist care and services.
  • Health plans deny patients certain advanced but costly tests and treatments by calling them “experimental”.
  • Health insurance plans have moved many expensive drugs into higher tiers making them unaffordable for their participants.
  • Drug pricing is significantly influenced by the health insurance industry (through their predatory pharmacy benefits managers or PBMs) for their benefit.
  • Health plans partner with drug companies who often fail to perform quality control testing on generic medications manufactured in foreign countries.
  • Health plans commonly collude with hospitals to set prices for services. These prices have nothing to do with actual costs or quality of service.
  • Medicare “advantage” plans are a big disadvantage for consumers as they represent watered-down medicare coverage because health insurance companies have siphoned off big profits before rationing care.
  • Many tax-paying consumers pay for two health plans – medicare and their own or an employer-funded plan.

Health insurance injustices suffered by employers

  • There is no moral or ethical reason why employers should be forced to provide employee health benefits or face a severe tax penalty.
  • Insurance-based control and pricing have resulted in employers paying about $20,000 dollars to cover a family of five.

Health insurance injustices suffered by physicians

  • The health insurance industry has hijacked the medical profession and physicians are now working like puppets on a string.
  • Health insurance middlemen have virtually destroyed the sacred doctor-patient bond.
  • Physician practices have been bought for the sole purpose of using them as conduits to an endless supply of healthcare dollars. 
  • Insurance-based rules have stripped healthcare decision-making autonomy from physicians. Virtually all tests and treatments ordered by physicians have to be approved by non-doctors working for health plans.
  • Insurance-based rules have driven physicians’ overhead to over 70 percent.
  • The problematic electronic medical records systems have added hours of unpaid work for physicians and few if any benefits for improving overall health.
  • Insurance-based rules have forced physicians into practicing defensive medicine.
  • Insurance-based gaming of physicians’ payments are endless. Arbitrarily discounted and delayed payments, clawbacks and denials – along with many other insurance industry tricks.
  • Health insurance companies employ complex healthcare coding systems in order to game the business and deny payments.
  • Insurance-based rules have resulted in increased physician burnout and suicide.
  • Insurance-based rules have trampled on the rights of physicians.
  • The insurance industry has been given license to have physicians bonded in servitude and profit from their expertise.
  • Insurance-based control of healthcare pricing, access and delivery is unjust,  immoral and violates the basic principles of the medical profession.

How to cut health insurance industry control and costs

Healthcare consumers can lower healthcare costs considerably by using cash pay (discounted) for routine healthcare needs and keeping an insurance plan to cover only costly and catastrophic care. Medical and healthcare cost sharing programs (often in association with direct primary care services) can be an alternative to burdensome and costly traditional health insurance plans. These options allow you to reclaim your healthcare decision-making control, stop being over-insured and stop overpaying – your body, your rules.

Read more 

Health insurance injustices podcast – we welcome your feedback as we try to find solutions to the domination of healthcare by the insurance industry.