Health Care Vs Health Insurance

I’ll be blunt and get right to the three points of this article.
Point 1. Health care and health insurance should be separated.
Point 2. If it weren’t for the fact that health insurance has come to mean health care for most Americans there would be no health care reform.
Point 3. The only way to fix America’s health care once and for all is to bifurcate health care and health insurance as they should be.

I’ll also give you three reasons why I say this so if you choose you can go to other articles and not bother with reading this further.
Reason 1. Because health care is now paid for by a third party health insurance premiums have increased over 100% since 2004.
Reason 2. On average over 60% of every health care dollar is wasted in the health insurance claims process.
Reason 3. Because of the health insurance/health care connection Americans are being robbed of their most precious birthright – their health.

By means of government and health insurance company propaganda health care has been synonymous with health insurance since most of us can remember. At some point who among us hasn’t thought we needed a job with “benefits,” or maybe better benefits, so we could go to the doctor. We have been brainwashed by a system that profits monstrously from our lack of knowledge or apathy – whichever the individual case may be. We have been taught from our first paycheck that health insurance is the be-all-end-all when it’s time to take the kids to the doctor for a runny nose.

That is confirmed within days when we get bill from the doctor’s office that says that the cost for that visit was $225.00.

The system is rigged and it’s rigged so that each and every American thinks that someone else should pay for their health care. More on that later.

Health care should be separated from health insurance like car care is separated from car insurance. When it’s time for an oils change do you reach in your pocket for your car insurance card to pay for it? “Of course not.” you say, “That would be ridiculous.”

I ask you now to stop for a second and think why that would be a bad idea.

In case you don’t know, let me give you a little primer on insurance. Insurance premiums are based on, among other things, claims – both the number and the amount of the claims. The individual states Department of Insurance ride herd over insurance companies to see that the amount paid out in claims is in proportion to the amount collected in premiums. So an insurance company doesn’t get a rate increase unless they have the claims to substantiate the increase. (That, by the way, is the one good service that the departments of insurance serve, since as individuals we don’t have the time nor the inclination nor the resources to look all of that information up.)

So let’s now go back to the oil change scenario and look at it again. Instead of the one, two or three claims that you may file in a lifetime on your car insurance, you now find yourself filing a claim every three months or 10,000 miles. What would you expect your premiums to be like? How much would they increase? Also take this into consideration; your local mechanic or oil change service would have to wait 90 to 120 days to get paid for their money for the oil change. Plus there would be layer upon layer of paperwork to file the claim. The fact is, that if car insurance was like health insurance, your local oil jockey would have to hire an entire billing department just to file the correct forms with the correct codes – not once – but maybe as many three or four times.

Do you think the oil change would still be $35.00 at your local Spiffy Lube would still be $35.00 or with the added payers of paperwork and personnel would the cost go up?

The average face time with a medical doctor in the United States in now less than 10 minutes. The average amount of office labor involved in collecting the money for that 10 minute visit is upwards of three hours. How much is that costing you? Since there are no statistics kept on this let me do the simple math for you here. Billing and coding personnel make an average of $15.00 an hour. That could mean as much as $45.00 of your health care dollar goes toward processing your claim… and that is just at the doctor’s office. To be fair it is probably close to $30.00 on average but that is still a mighty large chunk of money.

It is even larger when you look at what the doctor gets paid. (I told you earlier we would get back to this.) Don’t look at what the doctor bills, Look instead at your EOB, Explanation of Benefits that comes in a few months down the road. Don’t get caught up in the coding and insurance gibberish but instead look good and hard at the amount that was paid to the doctor. In many cases it will be something around $50.00, up to very rarely, $100.00.

So the doctor paid out $30.00 to $45.00 to collect $50.00. Does that sound right or even smart?

Then there are the processing costs added on at claims departments at the insurance companies. Most companies have at least two tiers of bureaucracy to look at every claim. The highest cost of any division at the large health insurance companies – right after management – is the claims department.

The new health care reform law (Patient Protection and Affordable Care Act )has added no less than 159 new programs, agencies and departments in between your visits and your doctor getting paid. Anyone out there really think all of those programs will save your health care dollars for health?