Only Rumors - Fixing Healthcare
What this Document is About
When a problem is big and many attempts at solutions have failed, it is time to step back and take a more comprehensive look at the problem from different perspectives. Healthcare and health insurance in the USA are both broken. You can't fix an existing paradigm; you have to create a new one. I don't have all the answers but I believe this document provides missing pieces of major underlying issues that must be examined before the problem can be solved.
I am a Doctor of Chiropractic, but that is not what I do for a living any more. I am a member of Mensa and a gifted troubleshooter. I worked as a Customer Service Representative at King County Medical Blue Shield long enough to learn the basics of how medical insurance works. Of course I have been an insurance customer and medical care consumer. I have experienced both paying for my premiums myself and having my employer pay my premiums. I am one of those rare folks who almost always reviews the EOBs. I have been pondering healthcare and health insurance in the USA for more than 35 years.
Outline of the Issues:
Healthcare crisis is really a combination of several crises.
How Insurance Drives Up Cost of Healthcare
- Crisis in economics greed/poverty (affordability).
- Rich are getting richer, poor are getting poorer - how that plays into healthcare.
- Insurance drives up cost of healthcare - how that works.
- Preferred provider and other special cases.
- Drug companies test their own drugs - financial incentive to maximize positive results and downplay harmful effects.
- Financial incentive to keep patients in managed care rather than cured.
- Crisis in education, attitude, and disempowerment.
- Relying on medical doctors to know the right tests and the right medicines.
- Modern medicine being focused on curing sickness rather than promoting health.
- Medicine focused on symptoms rather than promoting optimal functionality.
- Doctors not spending time educating patients (need a new field of patient education).
- Patients not rewarded for getting involved, participating in their own healthcare.
- Information withheld from patients: unlabeled toxins in medicines, entire treatment plan not discussed in detail, expected outcomes not discussed, lab results not shared, lack of access to medical records.
- Patients not permitted to correct errors that doctors have written into their records.
- Practitioner fear of Patient discovering their weaknesses, ineptitudes, mistakes, etc - fear of litigation and loss of reputation reinforces keeping patients ignorant.
- Crisis in health.
- Toxins in air, water from industrial waste - greed, special interests.
- Toxins in food, GMO without long term research .
- Microwave radiation from cell phones and other devices.
- Pesticides, herbicides and wind drift - uncontaminated soil and seeds disappearing.
- Drug companies test their own drugs. Toxin in medicines, many unlabeled.
- Information withheld from consumers - unhealthy substances engineered for maximum addictiveness.
- Marketing/advertising disinformation.
- Insurance favors established solutions and disempowers innovation by not funding it. They create a "standard of treatment" and will pay for that and nothing else. This restricts patient choices and fosters an erroneous "one solution for all" approach.
- Due to bad priorities and bad practices we have become less healthy as a nation than we were more than a century ago, especially in cancer, iatrogenic disease, heart disease, diabetes.
For a business to be successful, it must turn a profit. In order to turn a profit, it must take in more money than it pays out for equipment (x-ray machines), supplies (gauze), operating expenses (electricity), salaries, employee benefits, taxes, etc. Of course the doctor who has an office in Downtown Seattle is going to pay a different price for rent (or building), taxes, utilities, salaries (because employees pay higher rents) and other incidentals than a doctor who practices in Maltby. Imagine that the Doctor who lives in Seattle figures that she will be working 200 8-hour days per year and that the average patient will get 30 minutes of her time per appointment. That means she needs to find a price that when multiplied by 1600 will cover all her business expenses, plus pay herself a decent salary. She also checks to see what other practitioners in her area are charging for the same service. The Doctor in Maltby does the same, and he comes up with a number that works for him.
A patient with insurance goes to the doctor in Seattle. A patient with insurance goes to the doctor in Maltby.
Insurance does not pay what the Doctor charges. The insurance does not even BASE their payment on what the Doctor charges. The insurance BASES their payment on a ten year old xherry-picked survey of that service as priced by all practitioners in an area that includes both Maltby and Seattle. In other words, the insurance disregards the Doctor's price, unless it is lower than the predetermined "allowed amount", and then pays the 75% that the insurance is going to pay, minus the copayee amount or minus the deductible. If the patient does not have "Preferred Provider" insurance, the patient is supposedly responsible for the difference between what the insurance pays and what the doctor charged.
BOTH the Doctor in Maltby and the Doctor in Seattle are shorted by the insurance because expenses have changed in the last decade and prices have inflated. The patient who goes to the Doctor in Seattle is especially upset at the price gauging by her Doctor, whose charge is almost double what the insurance "allows".
In both cases the Doctors are incentivized to raise their fees. Why? Because at some point soon, the insurance company is going to be forced to take another survey. The current one is out of date. And when THAT survey is taken, the Doctors want to make sure that their prices are high enough so that the "allowed" amount covers all their expenses plus gives them a salary. The reason for this is that they don't want their lower income patients to have to pay more out of pocket, and sometimes the patient portion is difficult to collect and if you send a patient to collection, you have just lost a patient and their potential referrals, and then there are the rich people like Donald Trump, who also won't pay.
This becomes MUCH WORSE if the patient has "Preferred Provider" insurance or Medicaid. In those cases, the insurance company caps the charge for the Doctor's service at their "allowable amount" (the one based on the lowest prices for the same service from ten years ago). NOW the Doctors MUST raise their rates because the insurance payment and the patient's portion are no longer paying the price that the Doctor determined she needed to cover her expenses plus give herself a decent salary. So she raises her rates and all her patients who do not have Preferred Provider insurance or Medicaid wind up supplementing those who do. In MOST cases, the folks who have Preferred Provider insurance are the ones who are better off financially anyway. The people who are most harmed by this are the working poor; folks too poor to have good insurance, or maybe any insurance, and earning just enough money to keep them off Medicaid.
Components Towards a Solution
- Who should pay for healthcare?
Not just big Pharma, but many corporations have been granted the rights to make big profits at the expense of the health of the citizens of the USA. They need to be held accountable and be made to pay into a National healthcare fund for the conditions that they have caused or contributed to:
- Air polluters - fracking, industrial waste, smoke stacks, trucks, airplanes, cars, boats, etc.
- Water polluters - fracking, mining, industrial waste, untreated sewage, garbage dumping, cruise ships off-shore dumping, oil spills, etc.
- Radiation polluters - cell tower, cell phone, smart meters, microwaves, x-ray machines, etc.
- Food contaminators - insecticide manufacturers, herbicide manufacturers, GMO manufacturers, etc.
- Industrial safety violators - mining, sweatshops....
- Addiction promoters - advertising companies, tobacco, sugar loaded foods (soda, breakfast cereal, candy, packaged foods), etc.
- Big Pharma - for suppressing effective alternative healthcare, for marketing drugs that cause conditions worse than the original complaint, for gauging.
- ANYWHERE IN THE WORLD - regardless of where these corporations do these practices, they need to pay into healthcare at USA rates.
- Yes, of course the people who consume healthcare services should pay for them, and/or pay for insurance, or through taxes; but they (we) should not be forced to shoulder the entire burden from those who made profits by making these people sick. And if the Congress doesn't have the guts or stomach to make the Destroyers of Health (their special interest campaign donors) pay for the healthcare directly, then they need to make them pay indirectly.
- Create additional "rights" for all citizens. As fundamental to the health of our nation as "life, liberty, and the pursuit of happiness" is free or affordable access to clean air, clean water, healthy food, protection from man-made radiation. We also have the RIGHT to know the ingredients and components of everything that goes into our bodies: food, pesticide, GMOs, herbicide, ingredients in medicines, ingredients in vaccines (including "matrix"). We have the RIGHT to copies of all of our own medical records, and the right to correct those records when applicable.
- Take drug/treatment testing out of the hands of those who have a vested financial interest in success or failure. Originally the FDA did some of this but then it was handed over to the drug companies. There is much opportunity for bribery here. One of the important ways to oversee this correctly is to continue the research after a product is marketed and survey those who have taken it.
- Recognize that individuals react differently to different treatment. We should not be looking to treat the disease, but the patient. Those who have chronic conditions need the work-ups to figure out how to boost their immune system, and classes on how to handle their conditions, and should be permitted to contribute to the knowledge base about their conditions. Force the insurer to make an allowance for alternative treatments when a patient elects to do something different than the insurance's "standard of care".
- Eliminate "Preferred Provider" insurance or any insurance that forces practitioners to create a fee structure that penalizes the working poor. Single payer would fulfill this directive.
- Better price control on prescriptions and all medical services.
- Punish providers (including hospitals) that produce a high percentage of iatrogenic consequences as severe or more severe than the original complaint.
- Create incentives for patients to participate in their own healthcare.
Find ways to financially incentivize the following behavior:
- Yearly checkups.
- Regular teeth cleaning and good dental hygiene.
- Learning basic first aid.
- Regular exercise.
- Maintaining a healthy weight or dropping pounds if needed.
- Doing research or taking a class to learn about any condition that they have.
- Contribute to drug reaction surveys for drugs they have taken.
- Contribute to treatment surveys for treatments they have received.
- Breaking addictions and bad health habits.
Created: July 18, 2017
Updated: July 30, 2017