The Hideous Truth About Healthcare Coverage (Part 1)

“Are you !&?@#%&!!-kidding me?” 

I felt like I’d been sucker-punched. 

I fell back into my chair with the  letter still clenched in my left hand, after dropping the envelope to the floor.

A knot was forming in my stomach and I started to feel sick. A warm flush surged throughout my entire body. I’m sure I was feverish. 

“How do they expect me come up with that much money every month?” I asked myself out loud.

There was no one around to see the pained, incredulous expression on my face, but that was just as well. It was a rhetorical question. 

I knew whoever they were, “they” didn’t expect me to do anything at all.

That was the point.

Actually, a sucker-punch would have been easier a lot easier to recover from.

For more than 20 years, I’d worked in the banking industry as a white-collar, IT professional. The decision to finally step out and start a business of my own hadn’t been a hard one for me, but my first taste of reality in just how much it was actually going to cost was a serious blow.

It wouldn’t be the last whack I would take. Not by a long shot.

When I worked in the corporate sector, I took the insurance they offered me. Things didn't start out badly at the beginning of my career, but over the years, I watched as my healthcare plan options changed from comprehensive coverage to PPO (Preferred Provider) plans to HMO (Health Maintenance Organization) coverage that didn’t let me keep my preferred doctor. 

Though it was all supposedly in the name of keeping costs down, the premiums and deductibles of my coverage rose steadily eating up an ever increasing percentage of my income over time. 

I didn’t know it then, but those were apparently the “good ole days.” Now, I was outside the system and I really had to fend for myself. 

If you’ve ever left a job and been offered a COBRA plan, you can attest to the shock that paying a non-group rate for health insurance can be to your system.

To be frank, I went without health insurance for several few years while I built my income up to a point where I could afford it once again. 

That was over 15 years ago and I thought the situation was bad then… 

Things are MUCH worse now. 

The sad fact is, today more and more Americans are losing the ability to pay for healthcare — even if they have health insurance.

Healthcare costs have been rocketing out of control for decades. The cost of health insurance has continued to rise while the quality of primary care has gone  into a downward spiral. 

It’s a mess on both sides of the fence.

Medial costs for patients have risen steadily higher and insurance compensation rates have continued to drop for physicians. Doctors have been forced to see an increasing number of patients per day. 

And the problems aren’t showing any signs of easing. 

THE PATIENT'S PREDICAMENT 

A decade ago, I thought — along with a lot of other people — that the Affordable Care Act (Obamacare) was going to help resolve these issues.

We couldn’t have been more wrong.

President Obama did what he could to bring health insurance to millions of Americans who didn’t have it, but while Democrats and Republicans argued and tussled over Obamacare, a subtle, nasty, devastating change occurred that affected millions of middle-class Americans. 

Behind the scenes there was a quiet, under-the-radar, redefining of what health insurance is in the United States.

While all the public attention was focused elsewhere, premiums and deductibles dramatically increased… and employers discovered that they could lower their expenses by contributing significantly less to their employees accounts. 

This resulted in much higher expenses for those who are “lucky enough” to have insurance.

To my mind, the Affordable Care Act failed to deliver on what was presumably its primary objective: Affordability.

Though wages have barely kept up with inflation, with a paltry 26% rise since 2008, annual deductibles are rising eight times faster, with a 212% increase in the same period.

From 2010 to 2015 alone, out-of-pocket spending for people with employer-provided health insurance increased 52%. 

Since then, things have gone from worse to horrific.

Americans have been left on their own to deal with “a broken, expensive system that views illness as a moneymaking opportunity,” says Helain Olen in an article she wrote for “The Atlantic” about how “Even the Insured Often Can’t Afford Their Medical Bills.” 

In my opinion, if they ever were, health insurance companies are clearly no longer in the business to primarily serve the public good. The higher priority is serving up profits for stockholders and senior executives. (Not necessarily in that order…)

I’m not opposed to profit, but where do you draw the line? The current system of healthcare insurance has been creating ever greater barriers between patients and their doctors for years. 

That’s a problem.

The quality of healthcare even if you have insurancehas declined significantly while the out of pocket costs for patients have steadily increased.

Patients who can afford some type of medical insurance have had little choice but to deal with a system that treats them not as people or even patients, but as disposable customers in a business transaction. 

My experience with healthcare when I left my insurance isn’t unique. Few people, if any, hold a job for a lifetime. No one expects to work for one company their whole career, retiring after 50 years with a pension and a gold watch.

According to the Bureau of Labor Statistics, the average worker currently holds ten different jobs before age forty. Forrester Research predicts that today's youngest workers will hold twelve to fifteen jobs in their lifetime.

Many workers spend five years or less in every job. Each time you change a job, you’re at the mercy of whatever insurance coverage your new employer provides, if anything. Even if they do, when you retire at age 65, you still have to find coverage for yourself.

So what we’re talking about affects practically everyone, sooner or later.

The situation is not getting better.

THE DOCTOR’S DILEMMA

“Massive patient load. Long hours. Treatment  restrictions and constraints. I didn’t sign up for this.”

If the situation for patients is pathetic, the outlook for physicians has been even more bleak. 

For years, doctors have increasingly lost ground to the point of being told how to practice medicine by outside entities led by insurance companies and corporate health systems, followed closely by politicians and bureaucrats. 

Over the last few decades, physicians have seen their ability to treat patients as they see fit greatly diminish along with their ability to earn a decent living or create a balanced lifestyle. 

Insurance companies dictate which procedures and treatments are acceptable under what conditions, even going so far as requiring doctors to follow a narrow set of treatment options that the insurance companies themselves define. 

They’ve effectively restricted the amount of time physicians have to see a patient. 

The current standard for patient encounters of 10 minutes or less is not a matter of choice for doctors, but rather a matter of financial survival. 

With insurance reimbursement rates as low as they are, physicians are required to see ever more patients in less time in order to keep their practices fiscally viable. 

If that weren’t bad enough, in 2017, the NY Times reported how young, new doctors are being trained to limit their time with each customer.

Most doctors want to deliver more personal, nurturing care, but this is becoming all but impossible with the crushing patient loads they carry. Depending on who you talk to, the typical urban doctor has between 2,500 and 4,000 patients on his/her roster. 

Forced to deal with what some have described as the “crippling rules and regulations of health insurance companies,” physicians — especially general internists — are being severely squeezed on multiple sides. 

Back in 2011, HealthAffairs.org declared that the average amount spent per US physician per year dealing with insurance companies was $82,975 to address administrative problems, investigating delayed payments and other ever increasing hassles in processing claims. 

Do you think it’s gotten better since then?

Add to this low reimbursement rates and the already high cost of maintaining a practice, then you can begin to see how these factors are driving more and more physicians to consider alternative ways of operating and financing their practices.

Healthcare coverage as we know it is not the creation of doctors and patients. It is the construction of those who have been writing the checks for care: in general, insurance companies and the government. It is not a system designed by — or even for — patients or the doctors who provide service to them.

Consequently, we have a deteriorating environment in which doctors are asked to practice medicine. That is precisely why an increasing number of primary care physicians are "opting out" of the traditional, insurance-centric practice model.

At the same time, individuals, families, churches, businesses even counties have begun to piece together better and more cost-effective solutions for their own healthcare coverage needs. 

Healthcare coverage as we know it is not the creation of doctors and patients. It is the construction of those who have been writing the checks for care: in general, insurance companies and the government. It is not a system designed by — or even for — patients or the doctors who provide service to them.

Physicians (especially primary care physicians) have been regulated to being cogs in the wheel of the “traditional” healthcare system. Many are little more than devalued employees with no job security, forced to sign unconscionable non-compete agreements, while they watch business and finance executives enrich themselves from their efforts.

(See “Blue Cross bosses rake in green” for one recent example: https://www.chicagobusiness.com/health-care/blue-cross-bosses-rake-green)

As a consequence of these issues, we’re dealing with a deteriorating environment in which doctors are asked to practice medicine. That is precisely why an increasing number of primary care physicians are "opting out" of the traditional, insurance-centric practice model.
At the same time, individuals, families, churches, businesses, even counties have begun to piece together better and more cost-effective solutions for their own healthcare coverage needs.

Why? Because our society has quite literally relinquished oversight to companies that make more money as costs go up. Frankly, it’s no surprise that our healthcare delivery system is out of control, too expensive and unsustainable.

It’s time to put primary care back where it belongs: back into the hands of primary care doctors and their patients. We aren’t served well by this atrocity of a healthcare delivery system that is the construction of insurance companies, corporate healthcare enterprises and the government.

Let me be absolutely clear: Health insurance and healthcare are two very different things. This isn’t about who you trust with your healthcare. What I’m writing about is who deserves your trust with your money and how you pay for that care.

The status quo isn’t cutting it.

Fortunately, there’s a revolution afoot that is bucking and gaining ground against the traditional delivery system…