Healthcare is a $3.6 trillion (2018) health insurance industry monopoly. The health insurance industry has failed to improve overall health and delivered only out-of-control costs. In fact, the restrictive practices of “managed” care have created a completely dysfunctional healthcare system benefitting just the health insurance industry.

The problem – U.S. healthcare costs.

  • The insurance-based healthcare system is highly inefficient and wasteful.
  • 1/3 of the $3.6 trillion healthcare market is spent on administration services controlling access to and delivery (or, denial) of care.
  • These wasted “administration” dollars could be channeled towards coverage of more consumers for catastrophic care needs.
  • Insurance-based pricing and control of healthcare is unsustainable.
  • 2/3 of all the healthcare delivered in the U.S. is generally affordable routine office-based and outpatient care.
  • No other insurances cover low-cost routine services except for the health insurance industry – and profits very well from doing so. 
  • Routine cosmetics, infertility and weight-loss care are usually self pay and not controlled by the health insurance industry. Here we see market forces and cost control.
  • Health insurance plans are not all equal – there are many junk health plans with narrow provider networks and narrow lists for prescription drug coverage.
  • Health plans have promoted opaque pricing to limit price shopping.
  • Health plans often deliver surprise bills.
  • The health insurance fee-for-service business model encourages over-delivery of care while capitation plans can lead to under-delivery of care.
  • Healthcare consumers pay hundreds of dollars in unnecessary coverage for routine care – they pay for routine care anyway with copays, deductibles and non-covered services while their insurance rarely kicks in.
  • The odds of millennials having a major medical or catastrophic event is low.
  • There’s no easy way for consumers to find and access as-need cost-transparent routine care.
  • Employers and particularly small business owners struggle to afford health benefits for workers or don’t provide health benefits as they can’t afford them.
  • Access to and delivery of care is tightly controlled by health plans and their non-medical intermediaries every step of the way – often working against your doctor.
  • Doctors and patients have lost their healthcare decision-making autonomy. 
  • Your health insurance plan is now your doctor.
  • Health insurance doesn’t mean healthcare.
  • Health insurance has not improved overall health.

The health insurance industry’s profiteering middlemen.

The healthcare arena is filled with middlemen who siphon off fees for “services” that offer little or no benefit to either the healthcare consumer or doctor and only drive up costs. Here’s a few of the players who profit from getting between the patient and the doctor:

  • The health insurance industry itself and its many junk plans.
  • Health insurance brokers.
  • “Managed care” networks.
  • Pharmacy benefit managers.
  • Healthcare billing agencies.
  • Owners of hospital chains and outpatient surgery centers.
  • AMA and it’s licensing of burdensome CPT codes – made them $71 million (2001)

The solution – free market medical care.

A cost-transparent healthcare marketplace product for routine care.

Putting healthcare control back in the hands of patients and doctors with a direct patient-provider connection. 

Revising State and Federal healthcare laws.

Reserving health insurance plans for childbirth and catastrophic care needs. 

Visit 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. 

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Written by HEALTHdrum