Monday, November 18, 2013

Health Insurance is not Health Care.

Please, stop using the absurdly confused premise that health insurance equates to health care, or even quality of health care.

Conflating government-regulated insurance scams with health care is like confusing federal educational funding with a student getting a real education. Beyond having enough funding to keep a student safe and happy enough to learn, and to attract quality teachers, everything else is just a frill.

Funding is certainly an issue, but the effect of all this knee-jerk reacting by neglectful and passive-aggressive leadership at the top, is that influence peddling rules. Medicine is not being practiced by professionals who understand their business models or the practice of their trade. Ask a doctor how much a common procedure will cost, and good luck getting a straight answer. Ask a doctor to show up on time for a scheduled appointment, and good luck spending any meaningful time developing preventative strategies. The profession and the business models of delivery have been undermined so much by reacting to insurance requirements, that they no longer have a clue.

Ask a good roofer to show up for an appointment, and they're going to be there early if at all possible. Ask that roofer for an estimate, and they'll inquire in detail about your actual needs and give you an estimate you could take to the bank - or home insurance company. Go to any number of good trades people, and you can find examples. There are plenty of amateurs and pretenders, but real trade professionals have a clue.

Patients are no longer the customers. The customers are now government institutions and insurance companies. They pay the bills, and they dictate the terms under which they will allow transactions to occur. What incentive is there then to keep costs down, or for that matter to get patients healthy: the government and the insurance companies get an increasingly larger slice of the pie as the systems grow more convoluted and inefficient, requiring ever more management and external regulation.  

The fault for the currently messed-up state of the profession can be put squarely on the formation of the 30+ years of insurance-owned HMO/PPO networks. These attempts to move toward "managed" health care under the thumb of insurance companies screwed up every facet of the profession, from the doctor-patient relationship and billing to the ethics of how, when and why treatment is delivered.

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