Whose needs are they serving?

A nurse-educator friend of mine teaches her students to ask the question, “Whose needs am I serving?” It is a simple but profound question, one that insurance companies ought to be answering to the American public.

Insurance was originally designed to provide health care treatment for people, but has evolved into something that serves a very different purpose. We should take it back to its original purpose.

We have relied on private enterprise to provide insurance in the US.  The theory is that innovative, energetic individuals can invent ways to deliver faster, less expensive, and better service.  It’s a good theory, but like all theories it can be perverted and this one has.

Under the guidance of insurance companies, US health care has become the most expensive in the world, and by many measures the least effective.  We certainly have some very effective techniques for treating critical illnesses, but judged by the standard of wellness the American public is not being well served.  The US ranks 37th in the world in health care delivery, 41st in infant mortality, 45th in longevity and even the AMA admits that 98,000 people die every year due to medical error.[i] 

We arrived at this position because the primary purpose of private enterprise is to create profit.  That can be a motivation for delivery of innovative service, but in this case the system has been perverted.  Instead of looking at the long term benefit of the patient, insurance companies look to their own short term gain.

Why does this matter?  Because in order to create short term profit insurance companies act contrary to the best interest of the people that they purport to serve.  CEO pay is based on continual increase in next quarter’s, next year’s profit.[ii]  To achieve this they hold on to your premium dollar as long as possible, waiting until you become sick before providing care.

While that may have been a reasonable model at sometime in the past, it is outdated today.  We know for sure that many diseases can be treated much more effectively and cheaply by early detection and intervention.  If treated early, diseases such as diabetes and heart disease can prevented or managed well, but in our current system we often wait to treat until the patient very sick, the point at which treatment is much more costly.  While at first glance, this would appear to contrary to the interests of the insurance company as well as the patient, there is one “catch” in this system.

Insurance companies don’t have to provide the care that the patient needs when he/she becomes sick.  In our current system the patient’s problem doesn’t become the insurance company’s problem because by the time the patient gets sick, he has moved from one job to another, lost health insurance all together or his insurance is just plain “cancelled” by the insurer.

US health care needs a course correction.  We need medical care provided at a time and place which benefits the patient, not the insurance company.  Other countries have this and their health care costs much less than US health care.[iii] 

While it often makes sense to trust the “experts,” it doesn’t make sense to continue to trust those who lead us to the place in which we find ourselves.  This place is a world in which patients more and more often lose all financial resources when they become sick,  leading not only to the death of the patient but financial devastation to his family.

But the insurance companies want you to trust them one more time.  They have solutions for this problem such as “consumer driven care,” insurance with new guidelines that require the patient to pay 35% of care, a figure that would bankrupt most patients in our current system, and a plan that would allegedly increase competition by allowing them to sell insurance across state lines.  All of these plans are designed to benefit the insurance company, not the patient.  If you will follow along with me, I will explain how they do that over the next few days and weeks.

Susan Robinson is a former nurse, attorney, author, and baby-boomer, a combination which allows her to evaluate the interrelated factors leading to the health care crisis and motivates her  to help solve it in a way that benefits the patient. Absent a fix, the country will continue on an unsustainable path toward ever increasing medical costs until only the extremely wealthy will be able to afford what used to be and can become again, “The Best Health Care in the World.”  Hopefully forums like AARP and Vibrant Nation can help us explore the facts to do just that.  To learn more about the author, go to sjrobinson.com[iv]