With the health insurance reform “debate” going full tilt this week in Washington, I think it’s important to recognize that we need to prioritize the issues of access and affordability.  The problem isn’t that we have “the uninsured”, but rather, we have too much health insurance!

imageThat’s right, too much health insurance. Insurance was designed to transfer risk, taking an unknown potential  future liability and amortizing it via premiums for a risk pool so the insured was not exposed to a catastrophic loss.  We knew that coverage as Major Medical insurance, and somehow, over the years, it evolved into “Health Insurance.”

Health insurance has become a preventive and maintenance tool to try and avoid a deterioration of individual health status. Physician office visits and diagnostic testing is now part of the deal. One question is, should it be?  Too often, the discussion regarding health care in this country really focuses on health care financing, i.e., health insurance, where the risk of health is transferred to a third party, a third-party who pays for treatment services. There resides one of the underlying problem. We have the people requiring care divorced from who’s paying for care. When predictible services (such as routine office visits) are covered services under a plan of insurance rather than protection against unforeseen loss, it ceases being insurance and becomes a system of guaranteed transfer payments. Affordable health insurance will never be possible as long as there is an unquenchable desire for medical services and a third-party payor who receives the bill. Sickness insurance, however, one with a high deductible of $3,000 -$5,000, is very affordable and can carry an average premium of between $60-$100 per month.

The trick in this approach will be to re-program consumers to accept that preventive services are their responsibility, and not to avoid them because they have to open their checkbook (www.wbcbaltimore.com). This is in conflict with 35 years of learned behavior stemming from the HMO models of health services.

The advent of Consumer Driven Health Plans is a partial attempt to reconnect the dots. By exposing plan participants to financial consequences, then, maybe they become more informed, and more discerning, consumers of care. The irony is that the evolution of the consumer-centric model, what has become the foundation of Health 2.0, may be a contradiction for the current health reform movement being proposed by the Obama administration.  Health 2.0 wants to empower patients with open-sourced tools and dialogue between patient and provider. Dr. Donald Berwick, a Harvard pediatrician and president of the Institute for Healthcare Improvement in Cambridge, Mass., states “[We] would all be far better off if we professsionals recalibrated our work such that we behaved with patients and families not as hosts in the care system, but as guests in their lives.”http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w555

Health 2.0 is user-generated health care. A system where patients are sharing in the diagnosis and treatment process even, when sometimes in conflict with evidence-based care. This permutation is not compatable with the plans being discussed in Washington. Patients will not be allowed to take control of their own health. A national health plan option or single-payor system will require a global budget and an advisory panel to determine which care is sanctioned, similar to The National Institute for Health and Clinical Excellence (“NICE”) in the UK. http://www.nice.org.uk/. That’s why there is such a current focus on Comparative Effectiveness. (http://www.hhs.gov/recovery/programs/cer/index.html)

Which brings me back to my original premise: we have too much health insurance. The momentum of Health 2.0 is toward prevention and patient enpowerment. Insurance should not be a financing tool for routine prevention. Patients should pay out-of-pocket for predictible services. We need a system to incorporate everyone into the risk pool  for sickness coverage. Serious sickness coverage only.  Maybe we even create a financing agency for patient loans, when necessary.  It could be like student loans. It could be called “Healy Mae” or some such nonsense.

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