The Unhealthy Side of Health Insurance In America

The Unhealthy Side of Health Insurance In America

The American healthcare system prioritizes speed, cost, and efficiency—not the patient.

For people lacking employer-provided insurance, open enrollment can be a stressful addition to an already stressful season. Scrolling through “affordable” policies designed for the many—not for the individual—with nothing catered to your unique medical needs can feel like an exercise in futility. Even if your employer offers health insurance, you are still missing a portion of your paycheck in exchange for a policy you had no input into when it comes to benefits selection.

We can all agree health insurance is essential for staying healthy. Right?

Or can we?

Suppose for a moment, health insurance is more detrimental to your wellbeing than it is helpful? Sounds crazy? It might not be.

Here are a few reasons rethinking your approach to healthcare isn’t as crazy as it sounds.

1.    American health insurance is designed for catastrophic events, not routine care:

Suppose you wake with a scratchy throat, fever, and runny nose. What’s the first thought that comes to your mind? For the majority of us, the answer is, “I’d better go to the doctor.” And why shouldn’t it be? Relying on a doctor to stay healthy is the obvious choice. Based on the way our current health insurance system is designed, however, it may not always be for the best.

Let’s take the flu for example.  Flu season is no laughing matter. It is highly contagious, can result in serious health issues, and impacts between 5 and 20% of the U.S. population each year.  Let that number sink in for a moment. This means during any given year, one-fifth of the total population of our country is carrying the flu virus.

Needless to say, the Center for Disease Control takes the flu seriously. There is, however, a distinct and alarming difference between what they recommend and what your insurance provider recommends regarding appropriate treatment.

The first thing the CDC suggests people do to avoid spreading the flu virus is to stay home and eliminate close contact with others. To the contrary, the first thing insurance-driven practices and health hotlines will tell you to do is see your doctor.

On the surface, this doesn’t sound like a bad idea. Taking a closer look reveals a problem: now you have to sit in a waiting room with potentially infected patients, and risk catching the virus yourself or spreading the illness to others. All this for a sickness that is best treated at home. And, you’re likely to spend substantially more time in the waiting room than with the actual doctor.

From there, you will undergo expensive and, in all likelihood, unnecessary tests and procedures.  The way our health insurance system is designed, patients are incentivized to use their insurance as much as possible to meet deductibles and make the most out of their premiums.  On the opposite end of the spectrum, doctors are pressured to push testing and high-cost procedures whenever possible to avoid malpractice suits and appease insurance companies. Let’s be clear–for serious, life-threatening illnesses and injuries, having catastrophic health insurance for comprehensive and in-depth care is essential. For “routine-maintenance” it can often cause more trouble than it’s worth.

2.    Hospitals aren’t as safe as you might think:

Hospitals can be dangerous. In 1999, a groundbreaking report conducted by the Institute of Medicine concluded nearly 100,000 hospital deaths occur every year as a result of medical errors. Later studies suggest even higher figures, bumping that number up to 500,000. Keep in mind; the deaths were due to mistakes, not the condition that brought victims into the hospital in the first place.

There are a few theories as to why this number is so high, but the prevailing thought is that tired and overworked physicians make the mistakes. These doctors suffer from what’s been appropriately termed “burnout.” Overworked doctors are a direct result of the American health insurance system.

Insurance companies pay doctors based on volume and not by the quality of care.  This puts pressure on physicians to take on as much work as possible, as quickly as possible. Also, as mentioned above, patients are pressured to wring every drop out of their premiums and demand more treatment than what is necessary, further overwhelming the healthcare system. This leads to burnout, which by some estimates, can double the likelihood of a medical error.

3.    You’re not getting what you pay for:

Healthcare in America is expensive. The cost of healthcare in this country surpasses the rest of the world, and the high price tag doesn’t equate to a higher quality of care.

The American healthcare system is riddled with inefficiencies. Another Institute of Medicine study found that upwards of $750 billion was wasted on inefficient healthcare spending in 2009, one-third of which was on unnecessary treatments and services.

Another factor is the amount of administrative inefficiency that gets tied up in dealing with insurance companies and the different policies they provide. Physicians spend much of their time dealing with insurance companies to make sure procedures and care is covered.

“We waste a lot of money on administration, doctors, and patients [report] wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce the administrative burden for providers and ensure that patients face predictable copayments.” – David Blumenthal, President of the Commonwealth Fund

Again, this ties back to overwhelmed doctors performing unnecessary treatments resulting abysmal care at a higher cost.

There is an alternative.

The American healthcare system remains stagnant and complacent, plagued with inefficiencies, red tape and profit-driven insurance companies. As political gridlock only seems to worsen, it is unlikely that the health insurance practices we have come to know will change for the better anytime soon.

A concierge approach to healthcare provides patients with individualized care, on their schedule, only when it’s needed. Patients pay annual fees and with that comes 24/7 access to experienced and dedicated physicians, through phone, video or in-person appointments. No more long waits rushed visits or penny-pinching insurance policies. With the concierge method, routine procedures work on your schedule, with doctors that are attentive to your individual needs.

While catastrophic health insurance is necessary for any thorough and complete plan, concierge medicine is the free-market solution for day-to-day health needs.

Break away from the inept practices and dangers of the current healthcare system by opting for concierge medicine through First Internal Medicine. Discover what truly personalized, efficient and patient-focused healthcare can do for you.