I think people need to rethink health insurance. Like most insurance, it should be to help pay for unmanageable expenses which in health care include surgeries, hospitalizations, and unfortunately even emergency room visits. Somewhere along the way however, many people became spoiled and became used to health insurance paying for office visits and medications as well as the catastrophic expenses.
There are a host of reasons health insurance costs as much as it does, (the CEO of Anthems $42 million dollar bonus last year comes to mind). The bottom line is that the more any insurance covers and the lower its deductible, the more it will cost. Just think for a moment what would happen to your auto insurance premium if it had to cover oil changes, tune-ups, and repairs.
It is very natural for people to want to get the most for their money (looking at people eat at a buffet should illustrate this nicely). If you feel you have paid greatly for your health insurance, you want to be able to use it freely. You want to be seen for even minor complaints, you want the most modern tests, and you want to see the specialist. I would too.
That is why the medical savings account (MSA) makes the most sense for most people. You put money in just like you pay for traditional health insurance premiums and money is paid out to cover routine expenses with the insurance company covering catastrophic expenses. If you have few health care expenses from good lifestyle choice, good genes, or just flat out good luck, the majority of the money stays as yours.
Your health insurance is a contract between you and your insurance company. If a doctor has signed a contract with the insurance company they become a participating provider and agree to abide by all the insurance companies rules when it comes to referring patients to other doctors, prescribing medications, and obtaining prior authorization to order expensive imaging tests like an MRI or CT scan. Your doctor no longer works just for you; he also works for the insurance company.
By not being a participating provider with any insurance company I am able to be a complete advocate for my patients. I have no inherent conflict of interest when it comes to referring patients, prescribing medications, or authorizing needed tests. I also greatly limit my overhead cost by not having to hiring additional personnel to constantly be on the phone with the insurance company, by not having a delay in reimbursement from the insurance company, and by not having extra paperwork that being a participating provider entails.
These cost savings are why I can charge so little compared to other doctors. The majority of simple visits cost less than most patients' monthly cell phone or cable/satellite television bill. In many cases it is very close to patients' office co-pay charge. If you have a $30 co-pay you are $30 out every time you visit the doctor. If your insurance reimburses you 50% on doctor visits that are not participating providers, you are out $21 of a $42 office visit charge. The only drawback, which is necessary for me to make this work, is that you need to pay the $42 at the time of service and wait for you insurance company to send the portion they pay back to you.
Obviously this relatively small expense can be a burden to some. Generally the people with health insurance have good jobs and can afford an office visit. The people without health insurance are punished when they incur large expenses and when they are forced to pay the inflated charges at most doctors' offices as I explained in a previous article. This can work if physicians do their part and charge a reasonable and fair amount for an office visit.
For health insurance to become affordable we will need to rethink its role, especially in primary care. Health insurance is clearly indispensable when it comes to covering the expense of catastrophic illnesses and injuries. It should not be expected to cover smaller, manageable office visit expenses. If you think it should, then you should not complain about the cost of health insurance.
