Feeling regarding health insurance WAS Re: FYI Re:Wall St

[Guest guest]

Great letter. Imagery is fantastic. I stopped taking Medicare

on Independence Day 2006. Every time I see fireworks I

celebrate my decision. When insurance becomes too

onerous I happily opt out. I currently deal with four

companies. The list gets smaller every year.

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

www.idealmedicalpractice.org

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> > * OPINION The Health Insurance Mafia By JONATHAN KELLERMAN

> > April 14, 2008; Page A15

> > Most discussions about the rising cost of health care emphasize the need

> > to get more people insured. The assumption seems to be that insurance –

> > rather than the service delivered by doctor to patient – is the important

> > commodity.

> > But perhaps the solution to much of what currently plagues us in health

> > care – rising costs and bureaucracy, diminishing levels of service – rests

> > on a radically different approach: fewer people insured.

> > You don't need to be an economist to understand that any middleman

> > interposed between seller and buyer raises the price of a given service or

> > product. Some intermediaries justify this by providing benefits, such as

> > salesmanship, advertising or transport. Others offer physical facilities,

> > such as warehouses. A third group, organized crime, utilizes fear and

> > intimidation to muscle its way into the provider-consumer chain, raking in

> > hefty profits and bloating cost, without providing any benefit at all.

> > The health insurance model is closest to the parasitic relationship

> > imposed by the Mafia and the like. Insurance companies provide nothing other

> > than an ambiguous, shifty notion of " protection. " But even the Mafia doesn't

> > stick its nose into the process; once the monthly skim is set, Don Whoever

> > stays out of the picture, but for occasional " cost of doing business "

> > increases. When insurance companies insinuate themselves into the system,

> > their first step is figuring out how to increase the skim by harming the

> > people they are allegedly protecting through reduced service.

> > Insurance is all about betting against negative consequences and the

> > insurance business model is unique in that profits depend upon goods and

> > services not being provided. Using actuarial tables, insurers place their

> > bets. Sometimes even the canniest MIT grads can't help: Property and

> > casualty insurers have collapsed in the wake of natural disasters.

> > Health insurers have taken steps to avoid that level of surprise: Once

> > they affix themselves to the host – in this case dual hosts, both doctor and

> > patient – they systematically suck the lifeblood out of the supply chain

> > with obstructive strategies. For that reason, the consequences of any

> > insurance-based health-care model, be it privately run, or a government

> > entitlement, are painfully easy to predict. There will be progressively

> > draconian rationing using denial of authorization and steadily rising

> > co-payments on the patient end; massive paperwork and other bureaucratic

> > hurdles, and steadily diminishing fee-recovery on the doctor end.

> > Some of us are old enough to remember visiting the doctor and paying

> > him/her directly by check or cash. You had a pretty good idea going in what

> > the service was going to cost. And because the doctor had to look you in the

> > eye – and didn't need to share a rising chunk of his profits with an insurer

> > – the cost was likely to be reasonable. The same went for hospitals: no $20

> > aspirins due to insurance-company delay tactics and other shenanigans. Few

> > physicians became millionaires, but they lived comfortably, took

> > responsibility for their own business model, and enjoyed their work more.

> > Several years ago, I suffered a sports injury that necessitated an MRI.

> > The " fee " for a 20-minute procedure was over $3,000. My insurance company

> > refused to pay, so I informed the radiologist that I'd be footing the bill

> > myself. Immediately, the " fee " was cut by two thirds. And the doctor was

> > tickled to get it.

> > A few highly technical and complex procedures that need to amortize the

> > purchase of extremely expensive hardware will be out of reach for any but

> > the wealthiest patient. For that extremely limited category, insurance might

> > work. A small percentage of indigent individuals won't be able to afford

> > even low-cost procedures. For them, government-funded county facilities are

> > the answer, because any decent society takes care of the weakest among us.

> > But a hefty proportion of health-care services – office visits, minor

> > surgeries – would be affordable to most Americans if the slice of the

> > health-care dollar that currently ends up in the coffers of insurance

> > companies was eliminated.

> > When I was in practice as a psychologist, I discussed fees up front with

> > prospective patients, prior to their initial visit. People appreciated

> > knowing what to expect and my bad debt rate was less than 1%. That allowed

> > me to keep my charges reasonable and, on occasion, to lower them for less

> > fortunate patients. And I loved my job because I was free to concentrate on

> > what I went to school for: helping people, rather than filling out

> > incomprehensible forms designed to discourage me from filing them in the

> > first place.

> > Physicians and other providers need to liberate themselves from the

> > Faustian bargain they've cut with the Mephistophelian suits who now run

> > their professional lives. Because many doctors are loath to talk about

> > money, they allowed themselves to perpetuate the fantasy that " insurance is

> > paying. " It isn't. There is no free lunch and no free physical exam.

> > If substantial numbers of health-care providers shook off the insurance

> > monkey on their back, en masse, and the supply of providers was

> > substantially increased by opening more medical schools, the result would be

> > a more honest, cost-effective system benefiting everyone. Except the

> > insurance companies.

> > Dr. Kellerman, clinical professor of pediatrics and psychology at USC's

> > Keck School of Medicine, is the author of numerous crime novels and three

> > books on psychology. His latest novel is " Compulsion " (Ballantine, 2008).

> > See all of today's editorials and op-eds, plus video commentary, on Opinion

> > Journal <http://online.wsj.com/opinion>.

> > And add your comments to the Opinion Journal

forum<http://forums.wsj.com/viewtopic.php?t=2135>

> > .

> > *

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> Durango, CO

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