A Call for Patient-Centered Health Care

December 28, 2007 at 6:57 pm

As Americans, we spend more on health care than any other nation and get less. Why is this the case?

Just for a second, I’d like to ask you to tune out all that you’ve heard about health care and to think like an insurance company. I used to work for an insurance company and here’s a bit of inside information on how they do business. Some of this may be obvious, but bear with me.

To make the most money in the insurance business:

  1. You want more money coming in than being paid out (duh)
  2. To accomplish this, you want to insure as many healthy people as possible and limit payouts
  3. There are many ways to limit payouts
    • Write exclusions into a policy
    • Cap payouts and/or include a co-pay
    • Transfer the risk to the individual
    • Deny coverage to people with pre-conditions or based on age

Here’s an example from the trucking insurance business. Truckers who are overweight tend to suffer from above average knee injuries as a result of jumping down from the cabs. Our group determined that this was costing too much money.Here were some proposals:

  • Deny occupational accident coverage to truckers of a certain weight
  • Ask people who weigh more to pay more
  • Exclude these certain types of truck cab knee injuries (difficult to prove)
  • Start a wellness program to help incentivize truckers to lose weight

Now what the insurance company that I worked for did was the right thing. They started a wellness program. But they did it because of government regulations. Government regulations that specifically state that it’s illegal to deny coverage to people based on their weight.

Big bad government regulations.

Government regulations that protect your rights. Otherwise, insurance companies could simply choose to deny coverage to you based on your weight. Or age. Or anything else they wanted to for that matter.

Let me repeat: Insurance companies want your money when you’re healthy and want to deny or limit payments to you when you’re not.

Unless there is an incentive to operate differently, this is how insurance companies work. Why? It is how you make the most profit off of healthcare.

The important point here is that their interests and the interests of those they serve are not the same.

So how do insurance companies sell this to us if they are the ones making money? They will tell you that you’re getting more “choice” and they’ll work hard to characterize any alternative as “socialized medicine.” And they’ll say that they’d do better if only they didn’t have so many government regulations to deal with.

The answer for insurance companies is to always roll back government regulations and let the free-market do its work. This is basically the Republican plan. The problem with this plan is that it ignores the interests of the people.

Do you want a company that is trying to make money off of you responsible for paying for your healthcare?

I don’t unless there is an incentive for them to make sure they have my interests and not their profit at heart.

When it comes to healthcare we need to start asking questions about what is wrong with this system:

  • Why do we get so little for what we pay to insurance companies?
  • What is the role of government in health care? Is it to help insurance companies make money?

Now to be honest, I don’t fault the insurance companies for acting in their best interest. This is what businesses do.

But we, the people, need to start acting in our best interests and looking for a health care system that is patient-centered. And we should hold our government’s feet to the fire to represent the interests of the people, not the insurance companies. Because we, the people, are not getting our money’s worth from the current healthcare system.

As President Bush is so fond of saying: All options should be on the table.