Why are insurance companies not “really” promoting health?


“How Insurers Can Help” was the headline.

According to the 9-30-12 article, they can help reduce the cost of health care by replacing “fee for service” with “fixed budgets” that reward doctors for delivering less service.

This is what they’ve done at Blue Cross & Blue Shield of Massachusetts, where the results of such a scheme have been encouraging and the strategy is now spreading to other states—and even to Medicare. The New York Times article leads off:

Private insurance companies should be leading the way in the struggle to control health care costs. They know about every contact a patient has with the health care system and can see how much is wasteful or redundant. By altering the way they pay doctors and hospitals, they can potentially push providers to reduce costs, improve quality and even transform the whole culture of American medicine.

One problem. Eliminating waste and redundancy is not the same as promoting health. It’s  kind of like having a big gaping hole in the bottom of your ship. Instead of plugging the hole—all of the smartest people on board are busy at work—designing better pumps to constantly remove the gushing waters to keep the ship afloat.

Eliminating waste and redundancy is not the same as promoting health.

We know from many studies that a truly health-promoting diet will enable us to cut an estimated two trillion dollars a year from our health care tab in the United States. So why don’t we hear the insurance industry talk about truly promoting heath? Wouldn’t they make a lot more money if medical claims were suddenly slashed by 80%?

A step in the right direction for reducing waste; but precious little in terms of promoting health.

The simple answer is NO. That’s because the health insurance industry is comprised of many independent companies, all of whom are competing for our business. As with any form of insurance, when risk approaches zero, the cost of insuring against that risk moves in the same direction.

So what would happen to the health insurance industry if everyone adopted an optimal diet and our nation’s health care expenditures suddenly dropped from $2.8 trillion to less than one trillion—a 75% drop? Simple arithmetic tells us that within a short period of time, the size of our entire health insurance industry would shrink by 75%. You see, the heath insurance folks get a piece of the total health care “pie.” If the pie shrinks by 75%, so does the insurance industry.

What other industries would suffer if we all got healthy and our cost of health care took a nosedive?

    • Pharmaceutical industry
    • Cancer research industry
    • Cancer treatment industry
    • Heart surgeons
    • Hospitals and nurses
    • Manufacturers of devices to “manage” diabetes, heart disease, etc.
    • The huge organizations who “fight” our chronic diseases
    • The food producers who sell the disease promoting foods
    • The advertising industry that promotes all of the above
    • Nutritional scientists who can’t seem to agree on what we should be eating—while our nation gets fatter, sicker and deeper in debt.

One of the victims of people taking charge of their own health—the giant international pharmaceutical industry—now gathering steam in the wonderful world of personalized medicine made possible by the Cancer Genome Atlas.

Beginning to get the picture? While doing research for our book, we discovered that that there are some 35 million people in the above collective “system.” And not a single one of them has a financial incentive for us to be healthy.

Back to the Blue Cross story. From the article:

The results from the first two years of a five-year contracting period are quite encouraging, and this strategy is spreading to other places. More than 225 health care provider organizations around the country have entered into agreements with public or private insurers for some form of budget-based contracts. And Medicare has started demonstration projects like the Blue Cross model with 32 organizations.

Under fee-for-service, which still dominates American medicine, insurers pay doctors a separate fee for each office visit, test or procedure they perform, giving doctors incentive to do more rather than less.

Consecutive daily blogs (Numerals from N.J.)

The Bottom Line. Without a doubt, there are billions of dollars of waste and redundancy in our health care deliver system. But those dollars pale in comparison to the trillions in savings that would accrue from an urgent shift in the direction of a truly health-promoting diet for all Americans.

Proponents of the Blue Cross strategy predict trillions of dollars of savings over the next few decades—by eliminating waste.

But by promoting health, we eliminate trillions of dollars of costs within years—not decades.

Want to help save a quick $2 trillion in just the United States? If every adult followed the simple advice from this handy kit, the annual savings within just a few years would exceed one trillion dollars. So what’s our return on investment (ROI)?

  • Investment = 200 million x $50 = $10 billion
  • Annual return = Over one trillion dollars a year
  • Return on investment; ROI percentage = Over 10,000 % a year. Not too shabby.

Handy 4-piece take-charge-of-your-health kit—from Amazon.com

Want to find out how healthy your family is eating? Take our free 4Leaf Diagnostic Survey. It takes less than five minutes and you can score it yourself. After taking the survey, please give me your feedback as it will be helpful in the development of our future 4Leaf app for smartphones. Send feedback to jmorrishicks@me.com

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To order more of my favorite books—visit our online BookStore now

J. Morris Hicks, working daily to promote health, hope and harmony on planet Earth.

For help in your own quest to take charge of your health, you might find some useful information at our 4Leaf page or some great recipes at Lisa’s 4Leaf Kitchen.

Got a question? Let me hear from you at jmorrishicks@me.com. Or give me a call on my cell at 917-399-9700.

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Blogging daily at hpjmh.com…from the seaside village of Stonington, Connecticut – Be well and have a great day.

—J. Morris Hicks, board member, T. Colin Campbell Foundation

About J. Morris Hicks

A former strategic management consultant and senior corporate executive with Ralph Lauren in New York, J. Morris Hicks has always focused on the "big picture" when analyzing any issue. In 2002, after becoming curious about our "optimal diet," he began a study of what we eat from a global perspective ---- discovering many startling issues and opportunities along the way. Leveraging his expertise in making complex things simple, he is now seeking corporate clients who are interested in slashing their cost of health care. In addition to an MBA and a BS in Industrial Engineering, he holds a certificate in plant-based nutrition from eCornell and the T. Colin Campbell Foundation, where he also sits on the board of directors.
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One Response to Why are insurance companies not “really” promoting health?

  1. Darcy says:

    Our insurance carrier, Anthem, encourages us to fill out a “Health Survey” every year to identify health problems and possible early interventions to encourage good health. Last year my score was 97%. This year only 3 things changed…I am 1 year older, (but by my blood test results…clearly healthier than last year), I do not eat “lowfat dairy at least once/day” and I do not eat “lean meat or chicken at least once/day.” My new score? 93%
    Talk about insurance companies NOT getting it….on so many levels!

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