Insurance is something we get "just in case" but we hope that we never have to use it. In any given universe, a certain number of insured will experience a loss of some kind for which the pooled resources of many will be used for compensation. When the loss occurs, a claim is made and, if valid, is paid. Verification of the claim is required before payment is made.
In the case of "health insurance", this system is reversed. The insured decides when to make a claim before the loss by visiting some health care facility and receiving services. The insurer has no prior involvement in verifying the validity of the need for the services for which the claim is made. This system invites liberal utilization and results in payments for services which many times are not needed. This is the equivalent of paying for an accident which never happened. Not only does the insured have complete control over claim initiation, but those providing the services have the ability to perform, and charge for, almost any thing remotely connected to what is wrong with the patient.
The problem is obvious. The individual should have the right to seek help if they feel it is necessary. But in most cases, the individual doesn't have the knowledge to decide whether or not to seek help and waiting for someone else to approve getting help may delay needed care while usurping a personal right. These conflicting interests are the root of the health care dilemma. The only solution is to require substantial front end deductibles to discourage the "running to the doctor for everything syndrome". In other words, catastrophic insurance only.
If everyone could afford those heavy deductibles, the problem would be solved but for those who cannot, a different system is required. This takes us back to the original problem, that is, over utilization. Medicaid for the poor, even with controls, experiences utilization rates which would bury private insurers. This cannot be controlled with charges which might discourage unnecessary care so abuse would be, and currently is, rampant. At the same time that demand is high, the low reimbursement rates have discouraged many providers from accepting these patients.
There is no easy solution. A beginning would be to require heavy utilizers to attend health classes which would teach staying healthy techniques and providing information about when it is necessary to go to a doctor. Fear, from lack of knowledge, and easy access invite abuse.
In the case of "health insurance", this system is reversed. The insured decides when to make a claim before the loss by visiting some health care facility and receiving services. The insurer has no prior involvement in verifying the validity of the need for the services for which the claim is made. This system invites liberal utilization and results in payments for services which many times are not needed. This is the equivalent of paying for an accident which never happened. Not only does the insured have complete control over claim initiation, but those providing the services have the ability to perform, and charge for, almost any thing remotely connected to what is wrong with the patient.
The problem is obvious. The individual should have the right to seek help if they feel it is necessary. But in most cases, the individual doesn't have the knowledge to decide whether or not to seek help and waiting for someone else to approve getting help may delay needed care while usurping a personal right. These conflicting interests are the root of the health care dilemma. The only solution is to require substantial front end deductibles to discourage the "running to the doctor for everything syndrome". In other words, catastrophic insurance only.
If everyone could afford those heavy deductibles, the problem would be solved but for those who cannot, a different system is required. This takes us back to the original problem, that is, over utilization. Medicaid for the poor, even with controls, experiences utilization rates which would bury private insurers. This cannot be controlled with charges which might discourage unnecessary care so abuse would be, and currently is, rampant. At the same time that demand is high, the low reimbursement rates have discouraged many providers from accepting these patients.
There is no easy solution. A beginning would be to require heavy utilizers to attend health classes which would teach staying healthy techniques and providing information about when it is necessary to go to a doctor. Fear, from lack of knowledge, and easy access invite abuse.
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