Insurance Companies and Healthcare

There are powerful and wealthy forces within the Healthcare industry that are working hard to keep your healthcare costs rising and the quality of your care substandard. And they’ll keep doing it as long as we all put up with it. Drug companies are one of those forces and it’s easy to understand their motivation. They are about sales. If you get better and don’t need to take medicine, they don’t make any money off of you. Therefore, they like treatments that reduce symptoms but don’t heal and resolve the core issues. That way, you get relief from the drug so you have good reason to take it, but then you have to keep taking it. Allergies, asthma, diabetes, hypertension, heart disease, strokes, hypercholesterolemia, osteoporosis, auto-immune diseases, thyroid problems, Alzheimer’s, depression, addictions and such fall into the category of conditions for which you would be given medications for the rest of your life even though there are proven cures and/or preventions that are steadfastly ignored (and even demonized) by conventional medicine.

As part of their business plan, the drug industry now has major control over medical research, the medical literature and medical education. It is an ingenious and very successful business plan. Train a carefully selected corps of caring practitioners to follow your every order then tightly control what information they have access to and manipulate your market to suit your purposes. Your poor health is their market.

But even though the tactics of the pharmaceutical industry are deplorable, their motivation is clear from the perspective of corporate behavior. But there are many more players in the healthcare industry who are equally responsible for the healthcare crisis but are even more devious in their tactics.

Hospitals, pharmacies, drug companies, surgical and medical supply houses, labs, physicians, naturopaths, chiropractors, rehab centers, supplement manufacturers and distributors…these are also obvious players who make more money the more people are sick and the longer they stay that way. And we wonder why healthcare costs are so hard to control.

I used to think that the only factors in the healthcare equation that wanted to cut costs and increase quality were 1) the people who bought their own insurance and/or healthcare, 2) the employers paying for insurance and 3) the insurance companies. I was wrong.

(People who get their insurance paid for have no incentive to save medical resources. As an extreme example, here in the Northwest, people with Microsoft’s Cadillac plan are at high risk for being over-tested, over-exposed to x-rays, over-scoped, over-surgerized and over-medicated. Microsoft is self-insured and they’re getting taken to the cleaners, not only by their employees and their families, but also by the medical community.)

I thought it was strange that the insurance companies didn’t do what the drug companies did and take control of medical research and education, pay for studies of the preventative strategies and start to really support preventative measures that are proven to keep people healthy and reduce healthcare costs. They certainly give a lot of lip service to cost containment. But I recently had an experience that opened my eyes to another major corporate force working to increase healthcare costs and degrade care. They’ve pretty effectively stayed hidden behind the smoke screen they’re spreading with all of their advertising.

My practice is very different from most physicians’. I’ve gotten interested in getting to the root of people’s problems and searching for ways to treat those roots so that people’s issues resolve. I’m not satisfied with just helping someone limp along with their health issues if there is anything in our power that will help that person.

Over time, I’ve moved away from the regular family practice model: running madly between exam rooms; to spending an hour with each patient, deeply listening, tackling multiple, complex and interrelated issues, doing a lot of education and such. As you might imagine, my practice stood out in the insurance companies’ data mining. They audited me to see what was going on. They couldn’t understand the one hour visits. They wanted me to do the ten-fifteen minute visits like everyone else.

I told them that I was saving them a lot of money, that when these complex patients started seeing me, they often didn’t have to keep seeing their expensive panel of specialists. I thought they’d be happy to hear that. I was shocked by their response. When they heard that the way I practice might be decreasing how much their enrollees are spending, their faces actually blanched at the idea. After that meeting, they redoubled their efforts to drive me out of their networks.

In that moment I realized just how wrong I’ve been all these years. I learned that the insurance companies make a percentage of what you spend on your healthcare, especially if they just administer the plan, as with Microsoft. All of their “cost-saving procedures”, such as prior authorization, just add layers of paperwork and administrative overhead to the costs of healthcare, giving them the public image of wanting to cut costs, but in reality just giving them a bigger slice of the pie. Arguably, the most powerful and most subversive force keeping your costs high and eroding the quality of your care are the health insurance companies, not the drug companies. 

If you’ve ever gone to your practitioner with a list of problems and been told to pick one to work on today and come back another day for the rest, thank your insurance company. If, during your visit, your practitioner interacts more with their computer than with you, thank your insurance company. If you’ve ever felt herded through your doctor’s office, thank your insurance company. If you feel like your physician never has time to really consider the details of your case, thank your insurance company. If your physician has low morale and is over-burdened with paperwork, thank your insurance company. Short of corporate profit, there is no excuse for the damage they’ve done to the healthcare profession.

And if your insurance company calls themselves non-profit, don’t believe it for a moment. All that means is that they keep all the money for themselves. Those executives are paid exorbitant salaries and bonuses. Most insurance companies run a 26-28% administrative overhead. Obamacare is going to require them to keep it to 20% (still much higher than most other industries). That is one reason the insurance companies are fighting Obamacare so vigorously.

If your insurance company is for-profit, well…there are lots of other ways to make money in this economy, why should some investor be getting a share of your hard-earned premiums? The answer is absolutely clear in my mind: health insurance companies need to go away. There are much better ways to deliver healthcare, ways that incentivize wellness and high-quality healthcare. We’re not a third-world country. Why do so many Americans continue to suffer from a lack of quality healthcare as if we were? I see two reasons: corporate greed and a kowtowed populace.

Corporations’ primary purpose for existing is to make money. Any product or service they provide to do that is secondary. Greed is in their nature. It’s not bound to go away any time soon. But just like any good citizen of the community, corporations need to learn to control their bestiality. That’s what laws and regulations are for. If, on one side of the equation, a corporation doesn’t want to be regulated, then, on the other side of the equation, they have to choose to do the right thing. I’ve got some ideas about how to help corporations do that, but that’s a topic for another blog. Right now, I’d like to speak more about the kowtowed populace. That is something we can all do something about.

When insurance companies misbehave and screw you over, they protect themselves by throwing up as many paperwork roadblocks as possible. Millions of hours are spent each year by people just trying to get their insurance companies to meet their obligations. The insurance companies set up a gauntlet, hoping that you won’t survive the running of it and thus give up and go away.

Don’t give up. If you have a grievance with your insurance company, please make it your business to be the biggest burr in their bra they’ve ever seen.

• Write formal letters to the state Insurance Commissioner (One of my patients did that during my audits and the insurance company actually wrote their own letter to the Commissioner asking him to please disregard my patient’s letter. It was groveling and pathetic. If the Commissioner received dozens of similar letters asserting the same complaint, they’d investigate.)
• Lodge a complaint with your employer and their benefits department, if you have insurance through work.
• Write letters to your state and national representatives.
• Write letters to the editor of your newspaper.
• Write a blog.
• Post on your Facebook page.
• Get the word out any way you can about how your insurance company is treating you.

Stories have power. You have power.

Believe it or not, medicine is a consumer-driven industry. If enough consumers demand it, eventually medicine will change.

Steven M. Hall, MD

Copyright 2012 Steven M. Hall, MD