Front Page — Above the Fold — NY Times
With a headline like this—Insurers Alter Cost Formula, and Patients Pay More—it’s certainly going to attract a lot of attention. After reading the entire 1000-word plus article, I concluded that it was just another ploy by health insurers to bolster their profits. The 4-24-12 article leads off:
Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.
If you’re interested in all the gory details of this situation, I have provided a link to the complete article below. But the headline and the above paragraph tells the story. And as long as we have a system that does not provide financial incentives for making a patient healthy, then no one is ever going to be completely happy with the system.
In a perfect world, all entities comprising our extended health-care system would be rewarded only for making people healthy. But since we have no such incentives, our system perpetually strives to create a perfect balance of misery—system optimization. That occurs when every person and every organization within the system reaches the exact same level of dissatisfaction. Sadly, that’s about the best we can do with this badly flawed system—that includes all of the following”
Our “system” of treating symptoms and calling it healthcare is never going to work effectively. Until we learn to deal with the root causes of all disease, the best we can hope for is a common level of dissatisfaction for all concerned.
Promoting Health? Back to incentives for making people healthy for a minute. You may be thinking that the insurance companies have an incentive to help people get healthy so that the claims will be less.
At first blush, that seems logical. That is until you understand “how the business really works.” As an exasperated insurance rep explained to Dr. John McDougall about twenty years ago:
We, the insurance company, gets a piece of the overall health care pie (of dollars)—the bigger the pie, the more we get.
That single statement explains everything about why our system is not working. I first used it in our book, then later in one of my blogs—provided here for your convenience. Do insurance companies “really” want us to be healthy?
The Bottom Line. It has been said that it would be easy to design an effective health-care system—if we were starting from scratch. But, with each passing year, our politicians demonstrate that we’ll never get there via the legislative route. There are just too many special interests involved.
So the only solution is for enough citizens to take charge of their own health. As the number of people doing that approaches a critical mass—with lots of high profile people like President Clinton, things will begin to change. And 100 years from now, our health care system as we know it today will not exist. Disease care will gradually give way to health-promotion and the need for most of our current medical procedures will simply disappear.
4-24-12 NY Times article Health Insurers Switch Baseline for Out-of-Network Charges
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—J. Morris Hicks, board member, T. Colin Campbell Foundation