Wednesday, October 14, 2009

Health Care Failure- The Cause

Things we know:

1. Health care system is an astronomical failure yet many benefit.
2. Our people (we) are really suffering!
3. Insurance is at the heart of influence of medical treatments and costs.
4. We have allowed this to happen and hence share responsibility.


This isn't easy to expose because those of us who have gotten into positions of influence are clever at this kind of thing. These are ambitious people, striving for principle or wealth or fame, maybe with a few criminals thrown in. Where the buck stops is with our top executives and politicians.


A lot of people are hurting. But, some are suffering badly-- children, single parents, families without jobs, low paying workers. Suffering related to money and related to lack of good and proper care. A side of suffering we often neglect is humiliation and not being able to assert ourselves, especially within the health care establishment. The establishment is a monster that hurts.


There was a time when there were not many people who had medical insurance.
There was not a problem of medical access and although we thought medical care was expensive it was only an tiny percentage of our paychecks. It's not clear just what logic was used to finagle insurance into something that was predictable like getting sick. Perhaps it started out covering only unexpectedly high medical bills. But, even just this brought about an aberration of sick people's usual treatments because to contain their costs and protect their profits insurance had to begin finding ways to limit their coverage and limit what they paid out. Claims denials, rigorous proof requirements and counter claims and certifications and paperwork began causing others to begin getting crushed under the burden. Those under the crushing weight are the doctors and staff, hospitals and company HR departments, and patients.


Investment Institutions, Government, Oversight, Wars, Torture, Environment, Energy, Usury and Credit Card, Justice, Healthcare, Consumer, Pension Funds, etc...

We keep allowing by not being involved socially, not applying critical thinking, not challenging fine print, not challenging authority, not having time, by acting selfishly, not saying NO. If each of us does not treasure being free from oppression, manipulation, having choice, others will take it from us. They will use it to their own ends (and these people are our leaders and sisters and friends).

Just Some Noticing about Politician's Role in all this.

Why should we keep believing our politicians? (think about this)
Surely we view our politicians with skepticism and general disbelief. Like car salesmen who don't care about our needs and wants and simply want to sell what they have. We have caught so many of them deceiving us over and over and over, we scab over and over.

Are they subject to the laws they 'fight for' for us?
Their Motivation:
A . To Be Re-elected.
B. Image (say things that 'sound good' to all),
C. Support- have lots of political backers, trading favors (influential people, lobbyists, etc.).

But, politicians are really a cross-section of ourselves. Won't you admit that we also grasp for power and position and material comforts. We also want to be secure and insulated from the unknown. We also are not so honorable as we could be when it comes to acquiring or protecting.

You will undoubtedly be able to add knowledge and experience to this. So much the better. See if you don't agree that this brief is a sound place to start. Let's see if we can use the symptoms to get to a CAUSE, and Not Just Keep Treating Symptoms. Surely we're aware, if we take a pill to deal with our symptoms and that pill causes it's own reactions or symptoms, and then we take another pill to deal with those symptoms, and so on, and so on, it doesn't take long before we're spending lots of money on pills. And we're confused about why we took the first pill. Ironically, this construct can aptly represent our giant top-heavy and teetering no-ballast Titanic - Healthcare System. And it can also represent the long and enormously hungry and ruthless serpent of dependence on Prescription Drugs.


Wordle: Healthcare Hurts

Consider the simplicity of direct medicine. This is where, as a patient, I am treated, then billed for medical services. Note the alternative of being charged for the enormous cost of overhead to support an insurance middle-man being involved to make sure I don't spend more than he thinks is required. Most of this latter cost would be the middle-man and his affect on medical administrative micromanagement load.  Consider one's control of costs: If the bill looks accurate I pay for it... that's all!  If it doesn't, I question it.  This, versus not knowing or understanding costs or treatments or coverages ahead of time, or reimbursement.

If I can't pay, I seek alternatives as there are in all businesses. Some people won't pay and there will be these losses. Again same in all businesses.

If there are those who should need help to manage their health care let there be help available as would naturally occur in a free market. If people want insurance to help them if they unforeseen incur high medical costs, let them purchase policies.

And what about people in need right now who have high or very high medical costs? This doesn't appear to lend itself to an insurance solution (see below). However, I would be open. If it takes our tax dollars or beefing up Medicare for this, so be it- a far more palatable solution to what we have now. In my opinion it would be the right thing to do if we tackled this as a social problem, separately and intently. This approach is intended to free us from the mistakes chaining us to an untenable healthcare system with it's unreasonable cost inflation history, its diminishing value, and its arrogance toward human dignity.

Let's aim for simplicity so all will understand and be a good health care consumer.


Insurance is a service and a business. It needs to have profits to attract investors and grow. Investors are speculators who essentially want to make money or gain influence and therefore demand business growth. Growth/leverage potential seem limitless. It sells, loosely defined- security, or piece-of-mind, typically aimed at protecting people against unpredictable significant financial loss. However, this doesn't fit well our current model of "health care insurance." For regular insurance most people hope they will never need to make an insurance claim.

For health care insurance everyone has claims regularly, even predictably. As a business-only Insurance will do what is legally minimum to satisfy it's contractual obligation to it's customers and whatever is necessary to satisfy their primary charge- to cover expenses and earn increasing profits. Non-profit organizations are still businesses and as such most are motivated by similar human gains of position, salary, power, fame, etc. via 'good scores', notwithstanding the rare altruistic individual. However, altruism and any other morality is an individual characteristic which does not translate to any organization whatsoever.

It is frightening to consider (and I'm terrified now of) organizations so audacious and reckless to believe they can make sound and caring decisions (manage health care) for others and at a net savings in cost. But, they don't care about us personally!

Medicine is a also and service and a business. It is mainly one skilled person who dispenses medical diagnosis, consultation and treatment to another person. (Of course, there follows an industry that supports this construct.) Because the doctor cannot be cloned there is limited potential for growth/leverage of a single doctor, yet a practice can grow in numbers. Implied is a responsibility to be competent and do their best, irrespective of cost, to save a human life, to do no harm. There is implied public trust that medical professionals care about people, yet are objective and detached to the extent that treatments and products are not 'sold' but rather they are dispassionately called-for or 'needed'. This is one of the few businesses that doesn't 'sell'. It sometimes has investors, but is predominately a Practice of individuals. And, they do care about us.


Insurance.  A business that has first loyalty to its investors or principals does not seem a likely choice to make personal health decisions. It is not difficult to see how there would be gigantic overhead imposed on all parties: in duplicating, protecting, sending, tracking, receiving, tracking and verifying medical information from the patient, the doctor, the lab, the hospital, multiple government agencies, disputes, claims, limitations, rules, deductibles, co-pays, pre-pays, authorizations, penalties... to name some of what's obvious. This morass imposes costs and stresses beyond reason.
B2B Business

1 comment:

  1. Medical reform....yes most certainly. I see this as a business problem but also one of human motivation e.g., ego. Why must the doctor earn $1mm a year? Why must the hospitals be showplaces with original art sculptures? Why must I wait for months to see a doctor? Why must I get approval to be really sick?
    I live in Thailand. Here Insurance companies and pharmaceutical companies have not taken over it seems. The hospitals are quite modest. The doctors appear more compassionate and available. (I can walk into see a doctor and most time wait 20-30 minutes and leave costing me 350 baht or $10usd). The doctors are well trained, the hospitals are well equipt and the nurses number 2 per doctor.
    Doctors are not required to write prescriptions for anything except narcotics. Pharmacies dispense medications usually on advise from a doctor. The medication is generally a couple of us dollars. My boyfriend recently had a test for inner ear problems called the electrocochearography. The cost of the test was 700 baht or $20 us. This is an advanced method of diagnosing Meniere's decease. So state of the art and cheap. This test is several hundreds of dollars in the us. Another example is the asthma inhaler which was refilled for $15 us and in the states was costing $250. The same product. Why?
    Very few people in Thailand have insurance, however I see some inroads. AIG is sponsoring soccer teams in Thailand and giving away T-shirts with their logo by the hundreds. why do support that is? What is to come? A new market.