Breaking up is hard to do, what would happen if health care divorced the insurance industry? http://maglomaniac.com/breaking-hard-health-care-industry-might-consider-divorcing-insurance-industry/

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Breaking Up Is Hard To Do: Why Our Health Care Industry Might Consider Divorcing The Insurance Industry

BREAKING UP IS HARD TO DO: Why our health care industry might consider divorcing the insurance industry–a marriage of great inconvenience. A contrarian look, as the deadline nears for the new year of the health insurance marketplace. It was always an uneasy marriage, brokered by the Nixon Administration, when its patrons in the life insurance […]

Written by: Susan Weinstein

2014/12/15 5:20 AM

BREAKING UP IS HARD TO DO: Why our health care industry might consider divorcing the insurance industry–a marriage of great inconvenience. A contrarian look, as the deadline nears for the new year of the health insurance marketplace.It was always an uneasy marriage, brokered by the Nixon Administration, when its patrons in the life insurance industry wanted to get into Health Care. “We could make a killing, if only…” was probably the line. And they continue to do so, perversely from the public’s view, by denying benefits, while escalating premiums and underpaying doctors.

This is a view perhaps felt most intensely by those, who are not recipients of employer medical programs, such as the self-employed not poor enough for the breaks of the Affordable Care Act; yet not rich enough to pay large deductibles and monthly costs of not so affordable plans. For these people, coverage boils down to minimal use of health care that is also difficult to access. In the brave new world of HMO plans, updated provider lists are a rarity. For the middle-aged self-employed or recently unemployed, “Holding on for Medicare” has urgency. Dental care, of course, is the catastrophe in the wings and most coverage not worth the premiums.

How did this happen to one of the richest nations on earth? Ironically, we also rank high among nations in our spending on health care. To understand the complexities, a good place to start is TRACKING MEDICINE: A Researcher’s Quest to Understand Health Care, a book published in 2010 by Dr. John E. Wennberg (Oxford), who spent 4 decades investigating how health care is actually delivered in America. His work, the foundation of the Dartmouth Atlas, charts the nation’s health care delivery state by state. His prescription for reform is profound.

“Reforming our health care delivery system requires a translation from today’s mostly disorganized care to organized, coordinated systems of care, and from delegated “rational agent” decision making to shared decision making and informed patient choice. This will not be easy. After all, it requires transforming the culture of medicine and engineering, an industry that accounts for nearly 18% of the U.S. gross domestic product. But such is the eye of the needle through which we must pass to achieve significant reform.”

Wennberg had great hopes for The Affordable Care Act, as a giant step toward reform. It has covered the uninsured poor and the young, though progress for reform is elusive. Overuse of medical care is probably down, unless you are a member of Congress. But over proscribing remains a profit center for some doctors. And insurers are still implementing “one treatment fits all” for most conditions, though patients are unlikely to demand state of the art treatment.

The equation of insurer, provider, and patient, can be simplified. A look at the Kaiser System and doctor co-ops, where patients buy insurance directly from their providers, is hopeful for the future. Because patients pay nothing when they need medical care, there’s an incentive for preventative care and none for a hospital to fill empty beds. Recently, I heard of a Brooklyn doctor co-op from a young doctor, happy that he could determine the length of an office visit.

What if the great teaching hospitals of the East Coast started issuing their own policies? Who knows what might come out of the wilderness of hospitals offering insurance! Maybe a renaissance of the profession for disillusioned doctors. For patients, no more worry whether you’re getting poor treatment, because the doc’s underpaid. There’s also satisfaction in knowing your money goes directly to the guy who treats you.

I grew up in an era before medical insurance existed. Doctors were all proprietors. Medical care considered both the ideal treatment and a patient’s finances. Patients talked it over with the doc and their family. Could that resemble “shared decision-making” and “informed patient choice?” Can you imagine a medical world with no paperwork? What about house calls?

Nostalgia aside, the costs of medical care began to escalate for a variety of reasons. Managing it became a priority. But what if instead of the insurance model, where an industry profits from withholding payments, the model was a cooperative, such as a tax-based public library or volunteer fire company? What about a country club or pre-school financed with annual fees? Efficiency might be the same. Undoubtedly, profit would be higher without the expenses of the multi-billion dollar insurance industry. Is breaking up so hard to do?

Susan Weinstein