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Health Insurance Is Not Health Care

Daniel Paull MD explains why health insurance is not health care.

March 8, 2024

Health insurance is not health care. Many people often confuse the two.

You can have “great” health insurance and very bad medical care. You can also have no health insurance and get very good medical care.

When you do have health insurance, and insist on using it as much as you can, you will of course see a physician who takes your health insurance. That physician will also probably take every other health insurance.

Insurance based practice are having trouble staying afloat as they need to hire at least 5 employees per doc, and often times it’s more than that. 10 to 1 is not uncommon and I have seen as much as 21 to 1.

Because their overhead is so high (because of health insurance requirements in terms of people: coders, billers, prior auth), they need to see a lot of patients.

 

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What you are left with is waiting an hour in the waiting room for 7 minutes of facetime with the doc. Sometimes you are lucky to even see the doc. Can you practice good medicine this way? It’s hard, even if your doctor is the best around.

If you decide not to use your insurance for every little thing, and go to a direct care practice, you will very likely get an hour of facetime and all of your questions answered.

Can you still use your insurance for the expensive stuff? Of course, but for the less expensive stuff you may be doing yourself a disservice.

Paradoxically, using direct care can often also be the most economical option for smaller things if you have a high deductible that you almost never meet.

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All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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2 Responses

  1. Health Insurance = Healthcare as the biggest farce in the space. Politicians, leaders, companies speaking about how they “care about healthcare” when all they are really talking about is insurance just furthers this misconception. Insurance is simply a business of moving money ultimately from point A to point B and usually in as convoluted a process as possible with as many hands in the cookie jar siphoning off as much as possible before reaching point B (the person who actually provided the actual service of care). So many middlemen and potential for problems (ie change healthcare cyber attack. Anyone even heard of them before all of this?). All becomes a game of smoke and mirrors with no true transparency or consistency for the people receiving care. Insurance as the game of doing everything possible to increase the # of members/premiums ($) while then making it as difficult snd delayed to then transfer said $ to the people providing the actual services so that they can have max time to invest and earn from this $. It is a game fo deny and delay care to maximize time to earn on investments. Throw in that an insurance companies fiduciary responsibility is to the share holders and not its patients, and they actually have more to lose from a liability/legal responsibility for not acting in the best interest of their share holders than their patients/members. No responsibility or liability to insurers if they wrongfully or fraudulently deny “coverage because it still ultimately comes down to those who actually provide healthcare to be the ones to fight, appeal, do prior auths, and are the only ones ultimately responsible for “healthcare and the patients they serve”. If you rely on “health insurance” and those who take on the onerous job of accepting this, then you need to accept the level and style of care that this allows. Amazing actual healthcare clinicians work with insurance, but the system no question hampers them and the overall experience that they can offer their patients which so often leads to such burnout as all in the actual healthcare space ultimately want to provide the best and most personalized care we can to the patients we serve. Sadly this is so often not possible when so many moving parts and other parties stand between the seemingly simple act of working directly with someone who chooses to utilize your services. In the, I feel that health insurance should be nothing more than a “reimburser” to a given patient (for subsidized based plans, they could still provide authorized fund directly to their members to use more similar to food stamp programs on debit cards like an hsa program). This would require all of “healthcare” to gets it head out of the clouds and provide clear, consistent and transparent pricing of all services. (Not that we can’t as all can still be tied to existing CPT codes and even today if pressed, even institutions come up with pricing and have to abide by the newer but still worthless “no surprise billing” act). Any actual provider of a healthcare service has clear, transparent, upfront pricing listed and patients can then check with their “insurer/reimburser” (as insurance is the patients and not the providers in the end) to see what they “reimburse” for a given service/cpt code and they can then make their own decision about where or with whom they wish to seek care based on any number of factors for them be it reviews, time to first appt, location, aesthetics of the practice, wording on the website, outcome data, etc just as they do for every other decision they make in life

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