Health care is really sickness care

 According to John Shier RN in his book “Choose Today Live Tomorrow” The current American medical system of hospitals, clinics, physicians, nurses, insurance companies, pharma-ceutical companies and equipment manufacturers is not a real “health care” system.  It is rather a “sickness care” system.  Few of the $billions invested in medical care go to the creation and maintenance of health.  The primary focus of medical care is to keep patients alive – whether they want to or not.” 

“In other words, those who are chronically ill with diabetes, lung cancer, or any of a number of medical conditions will still live nearly to the full extent of that 90 to 100 year projected life span, but their years will be filled with medications, procedures, tests, hospital stays, pain, and the gradual elimination of all of the activities they enjoyed throughout life.”

How did health insurance come about?

The following are the steps health insurance has followed since it originated in the 1930’s. While some steps may not be in exact order, this is the flow that has occurred over time.

Hospitalsrealized that people weren’t paying their bills because they often didn’t have enough money for hospital care, so they created state-wide pre-paid hospital plans called Blue Cross that they sold door-to-door to individuals. Individuals would pay each month in advance to cover any future hospital bills.

Surgeons, who practice in hospitals, saw that the Blue Cross plans were working well so they created Blue Shield to cover surgical/medical bills to cover docs for in-patient hospital care. Often Blue Cross and Blue Care plans were packaged together for sale.

Since Blue Cross and Blue Shield plans found it expensive to collect monthly premiums from individuals, they asked employers to withhold monthly premiums from pay checks when authorized to do so and pay the plans a monthly lump sum. Virtually all employers agreed to this practice.

Unions then successfully negotiated with Uncle Sam to make employer payments for medical/surgical plans tax deductible to the employer and tax-free income to the employee. This meant that employers became the payers for employee group medical plans rather than employees.

Insurance companies wanted to get in on the act so they came up with “Major Medical” plans that would cover not only hospital and in-patient care but also prescription drugs and medical care in doctors’ offices.

So far only docs and hospitals were covered in prepaid group medical plans. Then other providers such as chiropractors negotiated for coverage as well.

Somewhere along the way spin-doctors renamed group medical coverage as “health insurance” because these words sounded so much better. But did the plans promote or assure good health? Not really, because there was and is no money in it for providers or insurance plans if you and I stay healthy.

As health insurance (medical treatment) costs kept on rising faster than inflation, employers attempted to cut their costs by shifting expenses to employees via higher deductibles and more co-insurance. That means that employees had to pay for “first dollar” annual expenses before annual coverage kicked in. Did that assure good health? No. but it mean that employees paid more for their annual medical care.

Some employers have attempted to control costs by negotiating with certain groups of doctors and hospitals to contain costs for their members. Has this helped overall costs or made people healthier? Unfortunately, no.

HMO’s(health maintenance organizations) then came along for which employers were charged flat monthly amounts for members rather than “fee-for-service.” That worked for a while. However, we know of one doc who was fired from his HMO for spending too much time counseling with his patients (clients). While good health advice is beneficial long term, it didn’t pay off short term for his HMO.Some HMO’s at some times have limited certain tests for covered members because the tests are their costs rather than the employer’s costs when fee-for service was the method of payment. For example, a blood test for liver enzymes called GGT is now excluded from typical test panels because any “false positive” result has to be followed up at the HMO’s expense rather than the employer.

Larger employers found that they could self-insure their employer group medical costs thereby save some money that would go to insurers. However, those self-insured employers do use “third-party-payers” which may or may not be insurance companies.

In recent years health plan redesigns have come about that are called “Consumer Driven Health Care.” Uncle Sam now allows plans to have high deductibles before medical care is covered with a sum up front paid by the employer for which the individual has the option of spending the money on medical care that year or saving for the future. If the cumulative annual savings portion is not used up before retirement, the total savings portion can roll-over at retirement to be used for any purpose.

People who have chronic illnesses do not “make out” with the consumer driven health plan because they use up the up-front    money paid by the employer and any deductible thereafter. However, it is conceivable that our health tips  could help even these people to reduce their annual medical costs and save for the future.  With the new  Consumer Driven Health Care plan design we are actually motivated to take care of ourselves because there is   money in it for us, perhaps big money, if we stay healthy.Has it worked to reduce the inflationary cost of health   insurance? Yes, according to the Humana health plan which has had such plans in place for the last five years.   They claim that their plan costs have recently only gone up 5% a year compared to much higher costs for other plans.

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