Those in control of the insurance-based healthcare system work off the backs of doctors and use patients as a conduit to help themselves to an endless supply of precious healthcare dollars. This pool of some $3.6 trillion healthcare dollars is filled up each year with your tax dollars, your and your employer’s health plan premiums and your healthcare out-of-pocket costs. A market size that has attracted the attention of investors such as hospital groups, private equity groups and insurance companies to take advantage of and profit from physician’s work ethic and knowledge.

Who’s working off the backs of physicians?

  • Healthcare is a health insurance industry monopoly that dominates and profits from its control of healthcare providers and healthcare consumers.
  • Health insurances began with policies covering only catastrophic care but have evolved since to cover routine care because it’s very profitable.
  • Health plans make doctors sign take-it-or-leave-it contracts if they want access to their patients.
  • Health plans decide unilaterally on what a doctor will get for any particular service. Different plans create different “allowables”.
  • Health plans benefit handsomely from a pay-to-play arrangement. 
  • Collusion amongst health plans for setting fees is allowed but collusion amongst doctors is against the law.
  • Health plans have created self-serving networks to control access and delivery of care.
  • Health plans have encouraged hospitals to make doctors staff emergency rooms.
  • Not only were physicians commonly not paid for their after-hours hospital emergency work but they had to pay for their own malpractice insurance. A policy that simply encouraged frivolous lawsuits and quick settlements.
  • Over time many State and Federal healthcare laws were enacted and framed as being for patient benefit whereas they were clearly benefiting only the health insurance industry and strengthening their monopoly in healthcare.
  • Doctors have to deal with endless unnecessary health insurance industry roadblocks to the delivery of care – benefits verification, obtaining referrals and authorizations for routine care access and delivery, complex coding rules, billing and claims rules, heavily discounted payments and payment delays.
  • After jumping over countless barriers, delivering care and receiving delayed and discounted payments physicians are commonly hassled after-the-fact by health plans with demands for patient records to see if they can claw back some money. 
  • The health insurance industry supported a government-mandated electronic medical records system that requires some 2 hours of non-reimbursable physician time for every hour of direct care.
  • Health insurance plan’s self-serving rules have driven physician practice overhead to 70 percent, increased workload and led to significant physician burn-out.
  • Venture capital and insurance groups have been quick to realize that they also could exploit physicians – they purchased doctor groups and then squeezed out more production and profits by instituting so-called performance criteria.

The healthcare industry is in critical condition.

Healthcare in the U.S. is very sick for several reasons. 

  • The domination of healthcare by the health insurance industry. 
  • The health insurance industry’s fee-for-service business model. 
  • The coverage of routine day-to-day healthcare needs. 
  • State and Federal Healthcare laws holding back digital health and market forces. 

The easy healthcare fix.

An easy three point prescription could fix this toxic healthcare condition. 

  • First, routine care needs should not be covered by health insurance plans but by as-needed user direct pay and market forces.
  • Second, health insurance plans should be repurposed back to their original catastrophic care-major medical framework. 
  • Third, significant changes are needed to Federal and State healthcare laws (along with new laws for catastrophic care, HSA rules and tax benefits).

Does the public understand healthcare?

  • Healthcare consumers don’t understand health insurance plans.
  • Healthcare consumers do understand direct pay and market forces for the cosmetic, infertility and weight-loss arenas – since the health insurance industry is not in the game here costs have stabilized or dropped – the same could happen for routine care.

Cashing in on doctors.

There is no other profession that is so subjugated and asked to provide free services. Clearly, it is discriminatory and hypocritical for healthcare to be framed as an individual right or in terms of Medicare-for-all while current healthcare laws support the insurance industry monopoly and the legalized servitude of physicians. 

  • The physician’s allegiance is to the Hippocratic Oath and healing. 
  • The health insurance industry’s allegiance is to shareholders and profits. 

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