Healthcare is a terminal illness for America’s governments and businesses – Clayton Christensen, “The Innovator’s Prescription”.
Health insurance for catastrophic care makes sense.
Health insurance emerged in the 1920s and makes sense to hedge against the cost of unlikely hospital care for a financially catastrophic illness.
Health insurance for routine care does not make sense.
Health insurance to cover low cost, routine care that has a high probability of recurrence and is not financially devastating makes little sense. For example, your car insurance doesn’t cover the cost of a new tire.
- Some two thirds of the healthcare delivered in the U.S. is generally affordable office-based and outpatient care.
- To control access and delivery of care health insurance companies “rules” have resulted in 1/3 of the $3.6 trillion dollar healthcare market being spent on administration services – these costs are passed onto patients and providers and make insurance-covered routine care very expensive.
Who accounts for health costs?
Only a few people account for big health related expenses.
- 20 percent of the population accounts for 80 percent of health costs.
- 5 percent of the population accounts for 50 percent of health costs.
Most people overpay for healthcare by being over-insured.
- The chance of a financially catastrophic illness is low.
- Most people pay for their plan and still pay for routine care with copays, deductibles and non-covered services.
- For most people their health insurance plan kicks-in little or nothing.
Health plans are confusing by design.
- There’s a trail mix of various health plans from good plans to many junk plans.
- From HMOs, PPOs, EPOs, POS, HDHPs, Medicare, Medicaid etc.
- You get what you pay for – the more “affordable”, the more “advantage”, the more “entitled” the less you get in real coverage.
- Health plans also come in several tiers and with “preferred” drug lists.
- Most healthcare consumers have no idea what sort of plan they have been sold.
- Health plans are in the business of making money and not improving health.
HSA (Health Savings Accounts).
- HSAs are useful with HDHPs (High Deductible Health Plans).
- Both you and your employer make contributions.
- You have control of your HSA healthcare dollars for routine care.
- You budget and manage healthcare spending and shop for prices.
- The combination of shopping for prices and making healthy lifestyle choices can save you money.
- You can invest this HSA money as you do for your 401(k) and earnings will compound tax free.
- When you retire leftover HSA money is yours to use anyway you want.
Prescription drug coverage is broken.
- Most prescription drugs and generics are manufactured overseas and often, without strict oversight for quality.
- Health plans have “preferred” lists of drugs – many drugs bypass quality control mechanisms once imported and distributed in the U.S.
- Health plans use PBMs (pharmacy benefit managers) as middlemen who profit from manipulating drug prices at patient expense.
- Many costly prescription drugs have marginal if any real patient benefits.
- Many drugs should not require burdensome and costly prescriptions – patients could save money if many more drugs were OTC (over-the-counter).
Health plans control testing and treatment.
- Health plans often deny payments for new and innovative tests and treatments claiming they are “experimental”.
- Health plans commonly authorize treatments identified as “standard-of-care” or “standard practice” although these treatments may not have been scientifically proven to be safe and effective.
- John Ioannidis MD, has established clearly that, “most published research findings are false” because they fail to provide irrefutable and reproducible data.
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124
Is health insurance a benefit?
- Health insurance plans can make you a target.
- Both patients and doctors understand someone else is paying for “care”.
- Health plans create barriers for patients by controlling or denying access to care.
- Health plans create endless barriers for doctors trying to deliver care.
- Health plan providers are not incentivised towards prevention and wellbeing.
- There’s no evidence that health insurance plans have improved overall health.
What can be done to fix the broken healthcare system?
- Save money and stop paying for insurance to cover routine care needs.
- Get high-deductible plans to cover only unlikely catastrophic illnesses and shop and pay for routine healthcare needs.
- Take back control of your healthcare – you decide who you want to see or what you want done.
- Stop letting non-medical intermediaries working for health plans limit or deny your care.
- Healthcare consumers shop and pay for cosmetic, weight-loss and infertility care as they are not usually covered by health plans – patients understand these healthcare arenas and market forces here have stabilized or lowered costs. Free market forces for routine healthcare will do the same.
Visit www.HEALTHdrum.com Come join our healthcare community and discover how consumer-directed care and self pay for routine care can save you a bundle of money and put healthcare control back in your hands.
Read more.
https://theconversation.com/why-insurance-companies-control-your-medical-care-62540
Written by HEALTHdrum