There should be a better way to keep our families healthy…
Let’s begin with terminology. The generally accepted definition of an “insurable event” – be it a traffic accident,Is Your Insurance HEALTHY? Articles a house fire, or an earthquake – is something that (a) comes without warning; (b) is very unlikely to happen and (c) is definitely undesirable. Now try to apply this definition to any routine health maintenance event like teeth cleaning or annual physical and you will discover that the very term HEALTH INSURANCE contains a built-in contradiction.
From financial considerations, any INSURANCE system works best when the fewest number of participants actually use it (i.e. make claims). This way an insurer makes profit and is able to lower the premium which, in turn, brings more paying participants who are happy NOT TO USE the insurance, especially if it does not cost them too much. Remember, we are talking about real insurance and truly “insurable event” – something that is definitely undesirable. On the contrary, the HEALTH CARE system ambetter health works best when the most people use it (i.e. get checkups, tests and vaccinations). The financial structure and goals of the two systems are incompatible.
It was in an attempt to reconcile these differences that the concept of managed care was developed. Unfortunately, that system satisfies nobody. It enrages health care practitioners and consumers alike when it limits or denies payments on the grounds that the particular treatment or service is not medically necessary. It also frustrates insurers by mandating payment for routine services, whether they are really necessary or not.
There’s another basic problem with the current system: it’s the assumption that health care is a benefit of employment. So if you are unemployed, self-employed or employed by someone who lacks the negotiating power of big businesses – health insurance is not for you. Even if one has an employer provided coverage, recent premium hikes can price him/her out of the range of affordable health insurance. Why? Unlike virtually any other commodity, contracts for health care services are negotiated not by the affected parties (physicians, hospitals and consumers) but by insurers and employers.
The list goes on, but even without considering numerous other “symptoms” it should be clear by now that the current fundamentally irrational HEALTH INSURANCE system is designed for conflicts and lawsuits rather than providing the best health care at the best prices.