Defrauding the public and committing health robbery

Junk science describes so-called scientific information that isn’t supported by undisputed facts. Junk healthcare describes healthcare management and treatments that are not supported by evidence-based data despite being labelled as standard-of-care. Both junk science and junk healthcare are distressingly common, increasingly tainted by identity politics and only underscore unbridled intellectual dishonesty.

Meta-researcher John Ioannidis, PhD, determined in a seminal essay that “most published research findings are false.” This stunning conclusion simply reflects the fact that most medical and scientific studies are not founded on sound scientific principles and therefore, fail to record reproducible and irrefutable facts. 

Straying from science to junk science

Healthcare, like science, is impacted by a considerable amount of misinformation because physicians have assumed that their testing and treatment philosophies are inherently valid and then design their studies to support these unfounded biases. In other words, many well-trained physicians have strayed from science to junk science in order to support tests and treatments that they believe to be effective. Sadly, the history of medicine has recorded numerous examples of treatments endorsed by physicians and their leaders (and willingly supported by the health insurance industry) that they believed to be effective but were clearly harmful. A glaring example is the radical mastectomy for breast cancer which crippled only many thousands of women and took decades to be expunged from medical teachings.

Junk healthcare and junk health plans

Another ugly side of healthcare is junk healthcare (in addition to the junk health plans being sold to unwitting consumers) and receiving more “care” than needed. This sick problem has been stoked by the flawed insurance-based, fee-for-service payment model. A payment mechanism whereby providers get paid according to the level of work undertaken and or, the number of services provided. An obvious potential conflict-of-interest as this process can influence some providers to increase the level and or, numbers of services delivered in order to obtain greater financial rewards.

The problem with insurance-based control of routine care

Adding fuel to the insurance-based control of healthcare services was its gradual evolution from covering only catastrophic care services to covering unnecessarily, affordable routine and office-based care. And, as the health insurance industry added more and more consumers to their plans with misrepresentations about the need to cover day-to-day healthcare needs they were able to exert more and more control on providers wanting access to those patients. In addition to being railroaded into  take-it-or-leave-it contracts they were also forced to accept more and more onerous insurance-based rules. These actions simply caused physicians to lose their decision-making autonomy and work in servitude. An ugly prescription for a costly, inefficient and parasitic healthcare delivery system.

The insurance-based trap for healthcare consumers

The insurance-based trap for healthcare consumers is “managed” care. Managing your care is mostly about managing health costs with restrictions, limitations and channeling you into test and treatment alternatives that save the health plan money. It’s usually not  about what’s in your best interests or what’s more expedient.

The insurance-based healthcare trap for providers

The insurance-based healthcare trap for providers was refined more and more with burdensome administrative demands favoring the insurance industry. A partial list of examples include; insurance verification, referrals, authorizations, complex coding requirements for diseases, tests and treatments, claims filing and electronic medical records (EMR) – all under the guise of patient benefit. Along with these barriers to healthcare access and delivery was the requirement for physicians to get permission or authorizations from non-medical health plan intermediaries for all tests and treatments. As a consequence of these many burdensome and arbitrary insurance-based rules, providers practice overhead was driven to 70 percent and provider burnout increased significantly. 

The burden of health plan administrative demands and frivolous lawsuits

Not only did these insurance-based administrative demands on providers erode their profit margins to the point that many could barely stay in practice, a large number were pushed towards upcoding and or, undertaking testing and treatments that delivered the greatest payments so that they could offset their losses. And, because of discounted and delayed insurance-based payments, providers were pushed to see even more patients in shorter amounts of time. A problem that also caused patients to be seen by nurses and physician assistants and only fleetingly by the doctor. Adding insult to injury, the unending threat of frivolous and predatory lawsuits (inevitabley quickly settled out-of-court with a payment) added to even more stress in dealing with insurance-based care. A process that also forced many physicians to do more testing on patients than necessary – just in case. 

The toxic fee-for-service business model and coverage of routine care

The toxic insurance-based combination of the fee-for-service payment model and the unnecessary but very profitable coverage of routine care made physicians and their practices a target of private equity groups and hospitals to work as revenue generators. These entities bought physician practices to exploit doctors and patients for use as conduits to the endless supply of health insurance dollars. The result of these practice buyouts was the incentivisation of physicians to “produce” even more services and revenue at the expense of patients. A noxious revolving door for pricey healthcare that rewards doctors more for more testing and treating and, the increased insurance payouts simply triggers greater health plan costs. 

The poison in the U.S. healthcare system

Probably the biggest poison in the U.S. healthcare system is that healthcare is an insurance industry monopoly protected by self-serving State and Federal laws. Not only has healthcare decision-making autonomy been stripped from both patients and doctors but doctors now are only puppets on a string working in servitude for their owners, the government or the insurance industry. Fortunately, there is a powerful antidote that can cure this sick and dysfunctional U.S. healthcare system shackled by insurance-based pricing and controls – a free market healthcare system supporting consumer-directed routine care.

Visit www.HEALTHdrum.com Come join our healthcare community and discover how consumer-directed, self pay care can save you a bundle of money and put healthcare control back in your hands. 

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https://healthdrum.com/blog/do-you-really-need-health-insurance-for-your-care/

 

Written by HEALTHdrum