Looking forward in health insurance

Health Benefits Report

We all know that Einstein said that doing the same thing over and over and expecting different results is the definition of insanity. Well, that’s what we’ve been doing in healthcare for the past 40-plus years. Now we see mega-hospital chains who own all the doctors, we see insurers that have become monopolies telling us what medical care we are and are not entitled to while they rack in record profits. We see drug companies charging paralyzing prices for drugs by changing a molecule or just mixing two old drugs together, driving medical costs higher and higher — all while pretending to care about you.

Never lose sight of the fact that they are in this for the bottom line — not for you. The harsh reality is that government in general has become a wholly owned subsidiary of the carriers, the drug companies, the hospitals and the pharmacy benefit managers. Spend some time on the ELEC page and check out who the largest political donors are in NJ. It will then become clear why we can’t control medical costs.

Any textbook will tell you that the insurers make money off the costs of healthcare. The larger the volume of costs, the more they make. It’s called the spread: the difference between the true cost and the amount they broker the service to us for.

This is why I want to break the system. I want us to pay true costs and engage in health benefit systems that produce health, which will in turn reduce costs. I want to stop the “big brother” health care systems that pretend they know what is best for us (kind of like the government does). We need to destroy the ability of the carriers to determine who is the best doctor for us by their network status alone. We need to directly contract with drug manufacturers and make it illegal for providers to take one dime in incentives from the drug companies. We need to destroy the ability of facilities to overcharge by setting the market rate for what we will pay, not some third-party carrier who has private plans intertwined with our dollars. We need to make the insurers fiduciaries who have a legal obligation to act in our financial interests, not those of their soon-to-be stockholders.

I said it 10 years ago when Chris Christie said he wanted us to have “skin in the game” — it would someday be their worst nightmare. That day is coming, and I promise you that change will be good. For now, question your doctors. Ask them why they are prescribing that certain drug, and ask if there are lower-cost alternatives with proven efficacy. Appeal the denied MRI and ask why it’s being delayed. Most importantly, treat all health care institutions from the standpoint of a consumer. Let them know that it is a privilege for them to care for you, not the other way around.