What’s wrong with America’s Health Care System?

What’s wrong with America’s Health Care System?


When I first got into sales my boss at the time told me that in order to sell you had to do three things.

1. Tell ‘em what you’re gonna tell ‘em.
2. Tell ‘em.
3. Tell ‘em what you told ‘em.

Here in this first chapter I am going to accomplish step 1. I’m going to tell you what I’m about to tell you. The problem with anything that is this deeply ingrained and a part of our culture is that there is more than just one thing wrong. There are actually about fifteen individual problems all together leading up to a system that doesn’t work. It doesn’t work for employers, health care customers, doctors, hospitals, health insurance companies, drug companies, politicians on either side of the aisle or offices of insurance commissioner.

While it doesn’t work for any of them they all bear responsibility for what’s wrong.

There are four pieces of good news with all of this though.
1. It can be fixed.
2. Government can’t do it.
3. By following a simple path and doing it quickly it will work better and EVERYONE in the process will be better off within a period of months.
4. It can be done one person at a time leading to less overall chaos.

But before the solution makes any sense you’ll first have to understand how we got here, ergo the next two thousand words.

Problem Number One: Health care has been lumped in with health insurance. When you hear the numbers of people in the United States who are without health care those numbers are an out and out lie. Everyone has access to health care in this country. The hard fact is you cannot be turned down. The numbers you hear are the numbers of people who for whatever reason do not have health insurance. For some it’s that they don’t understand the need for insurance. For others it’s that they can’t afford it. And for some it’s that they don’t want to afford it. Health Care an Health Insurance should never be intermingled. Would you ever entangle car care with car insurance? No! Car insurance is there to pay for repairs due to an accident. It’s not there to pay for maintenance, gas or simple repairs. Which leads us to…

Problem Number Two: On the surface this may look like a repeat of number one, but it’s not. Health Insurance should be like other insurance it should be there to cover you in the event of a catastrophic loss. Is a $50.00 Doctor visit a catastrophic loss? No! Yet that is where roughly 90% of the claims that are file go to pay. The part that no one here wants to tell you is that premiums are based on the number and totals of claims paid. And the other part of this equation is that insurance companies need to operate at a profit. That is required by law. If an insurance company does not operate within a certain window of profit the offices of insurance commissioner shut them down. What this means to customers of health insurance is that when you pay your health insurance company to pay for your doctor visits you are paying an inflated price for that doctor visit. Plus if you are typical customer visiting roughly twice a year you are also paying for others in your risk group who use more doctor visits for their additional doctor visits. Which leads to…

Problem Number Three: Because our health insurance system is an employer based system the insured has no ownership in the policy. Ownership begets stewardship. Look for a second at rental cars. Rental cars do not get the car when they are driven that a car that is owned by the driver. The problem with not owning a health insurance policy is that it becomes an entitlement. An entitlement is ALWAYS-expected, over-used and under-appreciated. The supplier of the entitlement is generally abused over the entitlement and the entitlement is always complained about. It is never enough. It is never good enough. And it is always a source of complaint from the entitled. AND because it is called health care and not health insurance it is completely misunderstood. Even though the employee pays for it with lower wages and less choice the entitled never writes a check for the care and therefore it carries with it extra layers of abuse. The employee sees the deduction for the amount the health insurance costs him and resentment builds causing more use. “If I’m paying for it I really should use it.” The employee grumbles as he trots his family into the doctor with a slight grin of satisfaction at having pulled one over on the entitler. While there are some who do appreciate it what we are talking about is the general attitude taken by the entitled. It is generally one of dissatisfaction with the entitlement. Because health care is never paid for and taken for granted health too is taken for granted. Which leads to…

Problem Number Four: When there is no price there is no perception of value. When there is no perception of value there is no interest taken in the item received. People have come to look at their health differently because of employer based health care. Because they have no financial stake in their health care policy they have taken to looking at their poor health as something over which they have no control. The fact is that most of the things for which we take pills are lifestyle issues. Among those are heart disease, high blood pressure, high cholesterol, cancer, diabetes, asthma, arthritis - the list could go on. We have come to look at ourselves as victims of our health. When in reality of the things in our life we really have more control over than almost anything health is at the top of the list. Many of the things on the list can be overcome or avoided with diet and exercise. Others still are a function of our emotions and mindset. But because we have no stake in our health care we take no interest in it. Which leads to…

Problem Number Five: Unnecessary and overused doctor office calls. Stand by for a bit of news insurance premiums are based on payment of claims. Doctors visited because insurance covers it leads to an overuse of claims which leads to excessive health insurance AND health care costs. Too many doctor visits are paid by insurance companies for things that should never walk into a doctor’s office. If you go to the doctor for high blood pressure pills the doctor should tell you that you need to lose weight and exercise, but that would mean the doctor would lose another appointment from you in six months PLUS he would probably lose you across the street to the doctor who would give you what you want which is a quick and easy fix – a pill. Which leads to…

Problem Number Six: Too many medications – both prescribed and available. The drug companies have got so much invested in research and regulatory approval that they must pump out a new drug it appears every week. You cannot turn on the TV without seeing an ad for a drug. (Do we really need the shots of the lurid glances and the symbolic bathtubs overlooking the ocean, accompanied by the disclaimer about erections lasting more than four hours?) It seems that everywhere you look there are drug pushers. Drugs on TV, your doctor and his ever handy prescription pad, even your next door neighbor telling you about her latest prescription. People here is a hint, we all have anxiety. Get used to it. There are some estimates that claim that over 90% of the drugs that are prescribed are unnecessary. Some estimate lower. I have been in the health insurance industry for more than half a decade and I go for the higher number. I’ve seen people that are apparently very healthy at the age of 35 already loading up in the pills. I have met with older people who started out with a high blood pressure medication ten years ago who now carry a pharmacy with them. Here is the most frightening fact about prescription drugs I have ever come across; in order for a drug to get FDA approval it MUST be a toxin! Do you get that folks? In order for a drug to be a drug it must also be a poison! Which leads to…

Problem Number Seven: Doctors get paid so little for what they do that they have to see many more patients every day than they can properly treat. PLUS it’s the health insurance company that is really making the call on your treatment anyway. Doctors treat symptoms only. They don’t offer cures. Go ahead ask your doctor next time to give you a cure rather than pill. See how he answers. Which lead to…

Problem Number Eight: Health care – because treatment is prescribed by the health insurance companies – is inferior. Both HMOs and PPOs tell your doctor how you should be treated. Now the doctor is free to tell you whatever he wants but at that point he is liable for costs should you pursue that option and the health insurance company doesn’t approve of his recommendation. Remember doctors too have a business to run. If it is costing them money to treat you – even though you may believe he really, really, likes you, and you are his favorite patient – he probably will stick with the treatment course for which he knows he will get paid. This is – with the rare exceptions of cancer – always the treatment of symptoms. If your doctor tells you to toughen up and get therapy instead of complaining about your anxiety attacks he won’t get to see you for a meds check and you probably will go to another doctor to get pills anyway. Which leads to…

Problem Number Nine: Doctors get incentive from the drug companies to give you pills. Trips, gifts and sometime even cash go to doctors who prescribe certain pills for their patients. Enough said about that one.

Problem Number Ten: What you are billed and what the insurance company pays are really very different. You want to have the insurance company pay for your doctor visits, because you see the bills from the doctor that says you owe $250.00 for the five actual minutes you had with the doctor. You don’t care that the insurance company only paid $50.00. You’re just glad you didn’t have to fork over $50.00 per minute! Because of what has happened with health care in the U.S. there is no transparency or honesty in billing. The doctor has to bill you $250.00 to get the $50.00 from the insurance company. That is part of their deal! Doctor agrees to bill $250.00 for a certain type of office visit and also agrees to accept $50.00 as payment in full. In reality the visit was worth only $30.00 but with the added costs of billing the insurance company the doctor needs to collect $50.00 just to keep the shingle on the side of the building.

There are more and I will get into them plus all that I’ve just mentioned deeper over the next few chapters. Remember – I just told you what I’m gonna tell you. Next comes me telling you.

Copyright 2009 Dennis Rowley