Insurance Is Part Of The Problem, It Is Not The Solution
The Institute of Medicine, a prestigious body, has released a new report building on previous reports issued between 2001-2004 which have all concluded that the lack of health insurance in our society is putting a lot of pressure on our current health care system and leading to skyrocketing costs. The current report concludes that when local rates of people without insurance are relatively high, even people with insurance have difficulty obtaining needed care.
According to the report, the number of people who have health insurance continues to drop, while employment-based coverage — the principle source of insurance for most Americans — is failing. The average amount of money that employees paid for year for family coverage has doubled in the past decade to $3,354 in 2008. The IOM committee concludes that if there is no intervention, the decline in health coverage will continue, costing the health care system more money down the line in terms of delayed diagnoses and poor outcomes.
My take is somewhat different. Here’s why:
* I don’t assume that increased health coverage automatically leads to improved health outcomes. Our system is currently clogged with insured patients who overuse their coverage precisely because they don’t feel the pain in their pocketbooks. Recent studies have shown that it is these folks who unnecessarily fill our ERs, often with minor ailments.
* There is a great and growing shortage of doctors, especially primary care doctors. Current medical school graduating classes average only 2 percent going into primary care. So who is going to practice all the preventative medicine that IOM has in mind by extending insurance coverage?
* The current system of health care is far too intervention-oriented. This means that we wait until people get sick and then use our insurance coverage to absorb the cost of disease-modeled intervention. Did you know that over $460 billion – that’s right BILLION – was spent last year in the U.S. on cardiac and vascular interventions. Until we transition to a real preventative-oriented model, where hospitals are NOT the focus, extending coverage will only extend the problem.
* Making the system more prevention oriented is not a function of extending a generic disease model to more people. Instead, it means disruptive innovation, altering the system itself, with a new focus on prevention through the use of genetic technology, biotechnology, personalized medicine, and most importantly, increased development and use of screening tools that lead to catching a cancer or heart disease before it occurs, or at least before expensive chemotherapy or elaborate stenting procedures are required.
* With the current managed care/employer-driven health model, there is no way to protect the patient/consumer from shoddy care. Extending that will only extend the shoddy care.
Let me give you an example of how the current system doesn’t work – (as if you don’t know it already from your own health care difficulties):
A producer here at Fox had an earache – he wanted to see his primary care doctor, but the doctor was all jammed up with patients. So he went to a mini-medicine mart, a doc-in-the-box, and was quickly given an antibiotic, and his ear has started to improve.
But ears are tricky, and are easy to misdiagnose or mistreat. I send many of my patients so afflicted to ear specialists. The producer may not have needed the antibiotic or he may need more care than just an antibiotic. Either way, I am wary of the care he received, and am concerned that in the end he could end up costing the health care system more money, and himself more aggravation, than if his primary doctor had been available. And keep in mind that his doctor WAS not tied up with the uninsured, but with the kind of coverage that IOM thinks should be extended to more people.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear
Tags: health coverage, Institute of Medicine, Insurance, managed care, primary care doctor
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I’m not an expert, I’m not in the medical profession. But I have friends who are and I’ve heard nightmares about how people abuse the system. I also have several friends who are Canadian, and they absolutely HATE their health care system (every one of them) … so that is obviously not the solution either.
But when people like Dr. Siegel start talking emphesis on preventative medicine, I start to twitch. I am with him to a point … but Government and the “do gooders” can’t help themselves. There is a line we cross, where government, and “well meaning” people start telling me how to live my life. How much I can weigh, what foods I can consume, what foods I can feed my children, whether I can smoke or drink, what my sexual habits should be, what pets I can have, what sports I can play and at what age I have to stop playing them.
First they start with advertisements, and publicity campaigns about how its to our benefit. Then when that works, they start the fear-mongering. Then when that doesn’t work, they start in with the “sin taxes” (and government so loves “sin taxes”). And when those don’t work they start passing laws and criminalizing it.
We’ve seen it with alcohol, with cigarettes, we’ve seen serious efforts to ban fast food restaurants in some cities, we’ve seen birthday cupcakes banned from schools. Here in Los Angeles we had one idiot try to pass a law dictating restaurant menus.
I’m with you to a point Doc … but you make me very nervous.
Well, the cost of medical procedures, hospital stays and medications are also part of the problem. Some medications cost more than a house payment for a months supply. A single medical procedure can cost a years salary and a hospital stay can cost more than a house. Such medical costs growing at astounding rates cannot be ignored.
Insurance is part to blame but take a look at who else could be blamed. Congress passed Medicare with no restrictions, today its funds are dwindling. Congress pushed for HMO’s to reduce cost again without restrictions. HMO’s have not reduced the price we pay for medical coverage but it has restricted physicians that can be seen, medications used, treatments allowed and tests to be done. Congress passes legislation for show as a facade of true interest and concern. Congress has failed to cap medical malpractice suits, limit lawyer’s fees in a suit. Lawyers deny this increases health costs. Obviously they don’t pay for malpractice insurance. When people think something is for “free” it is abused. Increase in use of Medicaid, treatment of “illegals” along with a population increase has all added to medical costs. Have you noticed that Congress disallows pharmaceutical companies giving physicians pens, but lobbyists can still pay for congressional jaunts? Have you noticed that physicians must tell a patient of a financial interest in a testing facility [conflict of interest] but lawyers in Congress can hinder Tort reform. There use to be health stations established for young children for vaccines, exams, etc. These were terminated as unnecessary. Today they would be “politically correct”. It seems that we do not learn from history.
Well the outrageous cost of medical care in this country cannot be ignored. Medications which are much cheaper in other countries cost more than a house payment for a months supply. A single medical procedure can cost a years salary and a hospital stay can cost more than a house. We need to address all aspects of our medical system as a profit driven system like ours is not serving our country very well and its getting more expensive every year.
Insurance should only be available for catastrophic coverage, not everyday ailments. People should pay out of their pockets for that… that will reduce unnecessary trips to the doctor. Any system where people think other people are paying for them promotes abuse. Also, hospitals/doctors should set fair pricing – there is no way some of these fees are realistic/actual.
Insurance IS the problem. Insurance has one outcome, Inflation. When everyone “has to” have insurance then the providers can charge whatever they want. Just look at all of the kinds of insurance one “must have” just to function in today’s society. What happened to personal responsibility? I would be willing to bet that 50% of a normal person’s paycheck ends up in the hands of an insurance company somewhere.
Imagine: You (insured) leave your home (insured) in your car (insured) driving on city streets (city is insured) to go to the store (insured) and buy a loaf of bread. The bread was delivered from the bread company (insured) by a truck (insured) with a driver (insured) who has kids (insured) using highways (state is insured).
Gee, where’s the margin for profit? Up goes the price of bread…
A friend of mine said once, “Insurance is communism. You give into it as you can and they give back as they see fit.”
I think writing an insurance policy should be a felony punishable by a mandatory sentence of five years turning big rocks into little ones.
I have felt the same way for years now. Why do I pay the same as everyone else who has the same insurance as I do at work? We don’t all live the same health lifestyle, but we pay the same rates. We don’t do this with auto insurance, so why with health insurance? If you are a bad driver, and take bigger risks behind the wheel, you pay a higher rate because you are at more risk of the insurance company having to make a pay out. The same should be for health insurance. If you live a healthy lifestyle, you should pay less. No, I do not mean raise rates for those who live unhealthy, I mean lower rates for those who do live healthy.
And the more unecessary claims you make, the more you should pay. Why should I pay the same amount as someone who goes to the doc/ER for every little cough, hiccup or sneeze, when I don’t go unless I feel it’s ABSOLUTELY necessary. I only go when I’m injured and know I can’t heal on my own, and for physicals. I don’t even go most of the time when I really should get stitches. I clean the wound myself and bandage it up good. Stitches for me would just make the scar smaller, and that’s not worth the money to me.
As Americans, too many of us have gotten to the point where we feel we deserve everything without working for it.
The last comment by Jeremy was poignant. The US has become a nation of entitlement. It is imperative that we regain the idea that we are responsible for our actions, not blaming others.
Only then will the country improve. It doesn’t help that those in charge in DC feel that they should continue the myth that government will do all from cradle to grave. Nothing is further from the truth, unless you wish to become a socialist country. I do not think that our founding fathers would too pleased. After all, they fought a Revolution in 1776-1781 to prevent that.
I have gone to ehealthinsurance.com several times to price individual plans. I learned something interesting. The premiums for major medical are cheaper. Now, this is only for hospital stays–really major stuff, hence the category name. And if you can’t meet the premium then of course you go into debt. It doesn’t cover preventive care, it doesn’t cover maternity, etc.
That seems bass-ackwards to me. And I know FOX skews conservative, but wow, for being conservative and everything y’all sure don’t make any effort to learn how things work. It doesn’t make any sense to make it more difficult to get into a doctor’s office. That’s where bad diseases get caught early and treated while they’re still cheaper to treat. If you wait to deal with your diabetes or heart disease or cancer risk factors til you’ve got the full-blown disease, it’s too late. All hospital care does in that case is buy you a few extra years. You’re already dead.
Seriously? Engage brain cells.
Couple more points. One, the difference between auto and health insurance as to who pays what is that unsafe driving and vehicular damage are things that everyone can agree on. Everyone can look at a guy going 80mph in a 40mph zone and agree that he’s speeding dangerously. Everyone can look at a busted windshield and agree that it’s busted. On the other hand nobody can seem to agree on what behaviors are healthy and what aren’t. There’s a lot more disagreement on this matter than the media’s letting on. Do you want your life in the hands of people who don’t know diddly about human health? Because there are a lot of those folks out there making insurability decisions and health-related public policy.
Two, if I’m sick and I go to the doctor about that, I AM taking responsibility. The trouble is the expense, and that’s going to be a problem no matter who is paying for it. We have three options here. Continue insurance coverage, government pays for it, or government tells doctors and hospitals to drastically reduce their prices. The latter is the ONLY way individuals can take full fiscal responsibility for their health care. And then we’ll be a third-world country because people will be dying in the streets. It’s not like buying a house. Illness and injury can occur at any time with or without warning and you can’t always save up in time. I say we treat healthcare like national defense, since illness kills more than war does. Beats bombing Iraq.
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