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Medical Insurance:

I am not a member of the Clergy

Patients often ask me why I do not take insurance. For me, what that means is why I do not accept payment from an insurance company for medical care rendered to one of their policyholders. The answer is simple. Insurance companies often do not value what I do because it is outside of their view of treatment by a traditional orthodox allopath physician. Insurance companies will pay a lawyer more money per hour than they will pay a physician per hour. Besides, physicians have historically spent 7 minutes per patient on average to help a patient with a medical complaint. Insurance companies have long since abandoned a patient care model that fits into my personal worldview of medical care. Besides, insurance companies insure losses, not health.

According to Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, the nation’s healthcare-dollar in calendar year 2010 came from several sources: Health Insurance (72%), out of pocket (12%), third party payers and programs (7%), investment (6%), and government public health activities (3%). The health insurance piece of the pie was comprised of private insurance (33%), Medicare (20%), Medicaid State and Local (5%), Medicaid Federal (10%), and VA and CHIP (4%). If one carefully adds up the sources of the healthcare-dollar spent that year, one realizes that more than half of the 72% was Government Funded programs: either federal, state or local. How much was spent? About 2.6 trillion dollars. Where did the money go?

Hospitals received 31% of the healthcare-dollar, physicians and clinics received 20%. Ten per cent went for prescription drugs, 7% went for dental services, 7% for government administration, 6% for investment, 6% for nursing care facilities and continuing care retirement communities, 3% for government public health activities, 3% for home health care, 3% for other health, residential and personal care, and 3% for other medical products.

In the present day, hospitals are buying out physician practices, so their piece of the pie will expand. Consequently, the physician part of the pie is going to contract. Since 72% of the healthcare-dollar is generated by some form of medical insurance, more government than private sector, it stands to reason that medical insurance what ever flavor, is driving the medical care bus. And that bus is out-of-control. Insurance is the equitable transfer of the risk of loss from one entity to another in exchange for payment. Insurance companies are for profit. They make money by hedging against the risk of a contingent, uncertain loss.

Medical insurance companies are no different than life and casualty companies. They are in the business to make a profit on medical illness. Medical insurance companies profit when they collect large premiums while avoiding losses through reimbursement for healthcare before and/or after the healthcare has been delivered. There are many ways to deny reimbursement for care. Medical insurance companies often adopt standard practice algorhythms that were created by academic experts who have assembled in medical specialty and subspecialty societies. Many times, these experts also perform research for the pharmaceutical industry as well as the US government. These physicians are self anointed saints in the field of medicine, their missionary work entails spreading their medicalogical gospel to whoever will listen. Recently, a Harvard professor wrote a book demanding that everyone in the US be placed on statin drugs, regardless of cholesterol levels. He is convinced that statins are absolutely good for everyone, which is contrary to almost every study that has been performed. He and other medical saints are spreading their authoritative opinions as gospels, and they are bound and determined to convert everyone in the industrial medical machine to their practice habits.

Standardized practice stifles creativity and discovery. This is exactly what medical insurance companies desire, so that they can accurately and systematically project costs and maintain double-digit margins for their shareholders, while continuing to make outrageous operating and administrative salaries.

The academic saints of medicine are not shy; they travel from conference to conference, espousing their worldview which is drenched in illusionary statistics to bolster their savory flavor of authority. Physicians who drink from their fountains of knowledge soon change their practice habit. They change their executive medical decision constructions to fall in line with the saints that spoke at their last conference.

Once standard practice guidelines are established and stamped authoritative, physicians whose treatment plans deviate from the standard can be judged and judged harshly. Insurance companies can levy complaints against physicians at the State Medical Board level, especially those physicians who do not abide by their rules, which are direct copies of the Saints of Medicine rules. Once a complaint is filed with the State Board, the Board may consult the Saints in an effort to find some truth to the insurance company’s complaint. I suspect most times, the Board is ignorant to the fact that their expert works for both the insurance and drug industries at the same time. If the Saint decides that the physician-in-question violated the Standard of Practice, then the Board may take action against the physician. Once action is taken, the physician will have to adjust or abandon caring for certain types of patients; or the physician will have to provide standard practice according to the worldview of the Saint who created the standard guideline in the first place.

One additional bonus for the insurance company is that they can file suit against the physician for the past fees he has collected from them for practicing a “substandard brand of medicine” on his patients who were policyholders of the insurance company. They will first demand that the physician return all received payments in full. If the physician does not comply, then they will sue for damages. Armed with the decision of the Saint, the courts rarely rule against the insurance company, and some deal is struck between the insurance company and the physician. Nowhere in this activity is the patient’s well being considered in the matter. The patient may have essentially been cured of their disease, but because the physician used outside-the-box treatment, the physician remains liable, not the patient.

By its nature, medical insurance is corrupt. Those who believe in pooling large amounts of money from millions of people to offset the cost of care for individuals are absolutely ridiculous thinkers. The current debate about healthcare reform is about the cost of care, not the quality or outcomes of the patients, and not about how much effort and time goes into helping people who are severely affected by their disease. Under the current system, most doctors encourage patients to continue an unhealthy life style by just recommending medicine to relieve them of their illnesses. Their illnesses remain, but they are “managed”. Most doctors don’t know what a healthy life style is since they are the same prey as patients when it comes to advertising and false information about health. To suggest that sugar rich fruit and starch rich grains are healthy for us while our nation faces an obesity epidemic of the first order is not only incorrect, it is absurd. To continue to suggest that breakfast is the most important meal of the day, and then recommend waffles, pancakes, cereal and milk as the ideal breakfast foods for our children, is just creating a mindset that fuels illness and increases the number of potential victims of disease. Thereby creating a great and powerful way to expand the market for the industrial medical model and at the same time rob individuals of their health. Everyone benefits but the patient.

As much as we as a nation have advanced in medical care, health insurance has polluted the waters of wellness. It still gets back to simple truths of individualized care, compassion and cost effective medical care delivery. What we have now are layers of ineffective management standing in the way of patient-physician relationships, high cost due to waste, greed on the part of the purveyor’s of medical necessities, ineffective practice guidelines created by self-appointed medical Saints, and restrictions that curtail the creative solutions to illness and disease. The people deserve better. I suspect all of this will change in the future, but not anytime soon.

Until the sun rises on a westernized medical tradition that embraces applied science and medical wisdom, we will all have to struggle with each recommendation, and question the true necessity of each prescribed therapeutic adventure. We must all be mindful that medical insurance is just a business designed to hedge that you won’t get sick; and when you do, the companies will do everything in their power not to pay for your losses due to your illness. Once illness has befallen you, the medical insurance companies will raise your premiums almost to a level that puts the infirm in financial ruin, after all the margin or profit must be maintained at all cost.  Be aware that each standardized approach to the evaluation and treatment of disease has been designed with the input of many different authorities; there are compromises by drug companies, academic researchers, and insurance companies, each one with a single goal in mind, profit on their investments. There is no such thing as evidence based medicine, although those physicians who latch on to those assurances are ultimately/by association/conversely just as corrupt as those who created the evidence folklore. Patients usually have more than one disease, and studies are performed on patients who only have one disease.

Patients are people with illnesses who wander the modern catacombs of healthcare with statistical smoke and mirrors clouding their judgment. They often project blind faith onto their physician, their hospital, and their medicines; hoping and praying their way to recovery they beg that some religious authority will reveal the answer and they will recover. Not much has changed from the Middle Ages when physicians were members of the Clergy. Modern medicine has become a religion of sorts and medical insurance companies have become the denominations of the Church of Medicology. Different Medical Insurance Companies have different practice guidelines, different hospitals, different physicians, different pharmacies and different formularies. However, they have one central focus: profit. And if healing occurs while making profit, excellent. If not, healing was not meant to be.

Patients often ask me why I do not take insurance. What that means is why I do not accept payment from an insurance company for medical care rendered to one of their policy holders. The answer is simple. I am not a member of the Clergy.

Doc

Posted by Katie Reed at 8:27 AM
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