Why we cant fix health care in America

Will will never solve the problem of health care in the US because we don’t understand it; my 47 years designing and managing health benefits tells me that. My equal number of years hearing claim appeals tell me average people have expectations that are both unrealistic and counter to good, affordable health care. Why are oral contraceptives, or an elective vasectomy insurable medical risks any more than a boob job? Why do we insure routine child care and immunizations? When I was raising my four children in the 1970s those items were not covered by insurance and we had to pay 20% of the retail cost of a prescription rather than a $10.00 copay. It was part of the cost of raising children like buying them food and clothing Yet, today anything and everything remotely related to health is expected to be paid by someone else whether it be the employer or insurance company and we can’t figure out why health insurance premiums keep rising. Oh, right, it’s the CEOs pay at least according to the leaders of Congress.

Now that we are about to turn the definition of covered benefits in health care plans over to the Congress, we have created the worst possible scenario for cost management. To see where this is headed simply look at the history of coverage mandates from the states. Our policy makers do not appear to see the connection between benefit coverage and premiums or between the cost of a service and premiums or the frequency or intensity of health care and premiums.

This legislation solves for the uninsured and believes the problem is high insurance premiums. Both of these miss the mark. Further when you see ads decrying anyone coming between you and your doctor you know we don’t understand health care. In fact, you probably do want the right someone coming between you and your doctor on occasion It takes over a decade for a new medical procedure or improved practices to filter through the system with 700,000 physicians and your doctor may just be near the end of the list.

We want more competition and we forget that to get the best discounts an insurer needs to deliver volume to providers so what do we do, we make that more difficult by increasing “competition,” again based on the false assumption that premiums and not the underlying costs are the problem.

Americans actually don’t care what health care costs they just want to be insulated from the true costs so what do we do, we add more subsides for middle class people and further remove a reason to care about costs.

As we move health care further into the
bureaucracy (any organization in which action is obstructed by insistence on unnecessary procedures and red tape), we simply make people more dependent on subsidies. Why in the furture will families seek higher incomes if in the process it means loss of a government health premium subsidy thus causing them to take a step backward in living standard?

Are we helping America toward mediocracy and disincevtive for individual achievement? I suspect Limbaugh and friends see a plot in all this. I prefer to see it as a collective political ignorance trying to solve a very real problem tainted by political opportunism.

The simple truth is we are in the process of perpetuating the worst of health care in America and reinforcing the popular misconceptions of who the bad guys are who and how we should pay for health care ….and in the future we will pay the price.

Too bad the folks that caused this likely won’t be in office when we understand what we have done.

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