The Affordable Care Act is known for many things but it has yet to become known for improving affordability or improving care. What we have seen since its introduction is the consistent growth of insurance premiums year after year without a tangible growth in the amount of healthcare being delivered. The reason, in my opinion, this has occurred is due to the misunderstanding of how health insurance and health care interact. Confusing the two into a single factor is why the ACA is failing and why all state sponsored health programs worldwide are more expensive and more restrictive than their free market alternatives.
When the word ‘insurance’ is commonly used, it refers to a financial arrangement that helps buffer the cost of an expensive but unlikely event if it were to occur. For instance, when a tree falls on your house you should have home owners insurance so that you can repair or rebuild your house without having to pay for it directly from your bank account. We carry car insurance so that if we hit an icy patch on the road and rear end the car in front of us we can pay for their car (and our car) to be repaired without having to pay that directly out of pocket. In both of these situations, the risk is relatively small even if the expense is relatively large. The events covered by these types of insurance are not guaranteed to happen. In fact, some people go their entire lives without having to utilize their home owners insurance.
However, insurance as related to health has come to mean something completely different. Health insurance has come to be equated with the delivery of health care. It is as though having health insurance is required before being able to obtain health care. This is like home owners insurance meaning the same thing as routine maintenance, i.e., changing a burned out light bulb. As such, we would not be able to change a burned out light bulb without first consulting with our home owners insurance agent. Imagine how much more home owners insurance would cost if it covered every burned out bulb or furnace air filter.
In another analogy, what would the monthly premium be for car insurance if it covered all our fill ups at the gas station or oil changes? Even now we can see the restrictions put in place by these types of insurance companies to justify the repairs on claims made. When our car is wrecked often we are directed to auto body shops that are the preferred vendor for our insurance. Isn’t that like saying a repair shop that is ‘in-network’? If car insurance covered our fill ups, wouldn’t they likely mandate we use an ‘in-network’ gas station? Perhaps there would be a copay required for high octane fuels or even a ‘non-preferred’ status such that there was no coverage for fuel not recommended by the manufacture?
As a society, if we separate health care from health insurance two amazing things happen. First, the price of health care plummets. Individuals would be able to purchase desired health care at a less expensive cost. We have only to look at the plastic surgery industry to see this is true. Plastic surgery is one of the few fields in medicine that is not widely covered by health insurance plans. As such, most of their services are performed as out of pocket to the patient. Therefore, the pressure from patients to offer a lower price has driven their prices down over time. They are one of the only areas within healthcare at large that has seen a shift to lower prices. Personally, I have found this to be true in another, less glamorous setting. Routine labs, coronary calcium scoring, and CIMTs are fairly complex and powerful diagnostic tools I use daily that are not covered by insurance plans. They cost roughly 10-30% of what a similar complexity test might cost which is covered by insurance. The market forces drive the cost of care down.
The second amazing thing that would happen would be the quality of care would actually go up. The local gas station has to fight for my business every day. They can only move the cost of gasoline up and down so much so they offer other benefits. One advertises the best coffee in town. Another offers always fresh doughnuts or an always clean restroom. If they were guaranteed my business because my car insurance company had already agreed for me to purchase my gas at that station, then they would have no need to keep me happy by offering these other amenities. In healthcare today, we are moving away from serving the patient as our first concern and are instead moving towards serving the insurance company and government regulation. The patient is the recipient of that care, which in truth is generally incentivized for the patient’s good, but the patient is the driver of that care.
What I hope this administration and my fellow Knoxvillian’s might come to understand is three things. Health insurance has never equaled health care. Health care can always be delivered regardless of health insurance. Everyone should serve the patient. Starting our DPC practice has opened up a tremendous amount of opportunities to take care of patients who have previously been out of luck. We care for everyone regardless of insurance status at a cost that is typically less than 1/3rd what is commonly charged in our community.
Please give us a call or come to our next open house this Friday, March 10th at noon, to hear more about how our DPC program is providing honest to goodness primary care to patients regardless of insurance status. Let’s build a health care system that doesn’t rely on insurance because insurance isn’t needed.