In the latest episode of the Balls Deep podcast, Dr. Joe Pazona and co-host Cat Williams deal with a matter many older folks would agree is a concern: the American healthcare insurance market, which is overly conservative. Dr. Pazona explains why the system in place is not working for the patients, its doctors, or even the health of the country. Keep reading to learn more about the profit epidemic in medical insurance.
Profits from Health Insurance: Where Did It All Start?
Dr. Pazona first goes into the dark history of health insurance, saying that it was invented so that a group of people can share the risk so that nobody will suffer financial ruin because of health. Back in the “good old days” as he puts it, any medical service had to be paid for by the patient or their family members, and it came in a package and terms that were very simple. However, with the growth of medicine, and the complexity as well as high prices of service, health insurance companies have become the ones to charge, and the cost of the services spread out more than to one individual.
Now, things have turned out completely differently than anyone expected. Medical liability companies care more about profit rather than worrying about the health of the patients. In the opinion of Dr. Pazona, there is no such thing as having an insurance company whose objective is to make as many people healthy as possible. A classic example would be United Healthcare — being among the top in the industry, it is regarded as one of the leading five profit companies in the country. But while these types of companies bring in high sales, patients pay out higher costs for lower levels of coverage.
We Already Know That We Are Spending More. Are We Healthier?
For many, bankruptcy remains stable or even increases due to the fact that medical debt caused bankruptcy in most cases is a weapon adopted in particular by the USA. Money issues are not answering why people go bankrupt — the issue goes deeper than that. They declare that over 60 percent of those who file bankruptcy say that it is because of medical debt or medical bills.
Dr. Pazona suggest that we currently excel in the treatment of infectious diseases, the likes of which include managing many infections with campaigns that push for vaccinations and treatment with antibiotics. Nevertheless, there is a very little improvement in treatment of more chronic diseases such as heart and lung illnesses, malignances, or cancer. For every dollar spent in treatment, millions of dollars are taken with no encouraging results on the same. So, what entails the reason for such level of expenditure without their appropriate outcomes? The response is settled within a system where disease treatment — otherwise called sick care — is rewarded rather than dissuasion in the first place.
The Difficulty of the Middleman
Health insurance schemes are the third parties that connect individuals with their physician and the hospital set up; however, such companies are now the ones controlling how much must be paid and what measures must be taken. The picture Dr. Pazona draws is disturbing when it becomes clear that for doctors, such conditions entail long periods and extensive follow-ups, only to ask for payments. And, even after doing so, it is possible to get just 30 percent of the payments for the procedures that were performed.
He cites one of his own cases in urology. For basic procedures like the removal of kidney stones, you need very costly devices such as scopes worth $20,000 and lasers worth up to $100,000, yet it’s the insurance companies who have all the power in negotiating reimbursement. Hence, the doctors want to pay the minimum costs as possible while the patients are not able to see the value of the care rendered, On the other hand, however, this remains consistent with widespread dissatisfaction with current care, and it makes it impossible for patients to get the actual value of the care provided due to the opacity of the system.
Direct Primary Care: The Way Out?
Do we have the answer then? It could be, but there is Dr. Pazona’s conviction on that. Direct payment model replaces the need for insurance, which is one of the most interesting options. Patients, instead of being insured and making co-payments, will pay doctor’s fees for services rendered. This type of model, especially in the form of direct primary care (DPC), enables doctors to provide them with the level of care they need without charging high fees.
In DPC, practices operate on a subscription model where patients pay a monthly subscription fee which is usually below $100 at most for all primary care services offered. This system cuts administrative costs and makes the doctors focus on spending time with the patients in a preventive mode rather than a curative mode.
Final Thought: A Pleasing Fascination
The episode closes with Dr. Pazona calling for both groups of patients and doctors to entirely stop depending on insurance companies. He relates the desire to implement such models to the engagement of the offered DPC models. Most likely, primary care would be the easiest to reform because it is in the sector that there lies a promise of more clarity and less cost in the future.
While insurance dominates and regulates cost and availability of care, both a patient and a physician suffer in a broken system.
Key Takeaways:
Health insurance is not for health — It is for the bottom line. In order for the insurance firms to be making profits, they have to minimize the amount of money that these clients spend on their health while increasing the costs of the firms themselves.
The system is broken for everyone — Patients and doctors alike suffer in a situation where the insurance firms are the employers regulating both how much care can be provided and how much of it will actually be accessed.
A sign of hope is in direct payment models — No drunks in the bar means cheaper, more straightforward and more useful healthcare directed on primary care.
This thought-provoking conversation has shown that there are reasons for change in the American health care system. The direct primary care model and other innovations are steps in the right direction towards a more patient-oriented and less opaque care system, but as many, this will take efforts of both the physicians as well as the public to change that.
Learn more about Dr. Pazona and Pazona MD.
Disclaimer: The content of this podcast is intended for general purposes and is not intended to be a substitute for medical advice, diagnosis, or treatment. Medical attention should always be sought for any concerning medical issues or conditions.
