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Health Insurance: The-More-The-Better, Or No-More-HMO?
by: Irina

In the movie "John Q," Academy award winner Denzel Washington fights the HMO restrictions to provide the necessary cure for his dying son. When such a lackluster topic like health insurance generates enough drama for a Hollywood movie, you know that something must be seriously wrong...

The problem indeed is severe. Almost 45 million Americans are uninsured and the number continues to rise. Those still insured are frustrated by the double-digit premium increases outpacing all other sectors of the economy. High costs and HMO limitations discourage seeking an immediate medical help. As a result, "little aches" often develop into the life-threatening illnesses and financial disasters for some unfortunate individuals and further escalate already intolerably high health care costs for the rest of us.

To endure the existing health care crisis, we all must recognize one simple fact. There are TWO DIFFERENT LEVELS of health care needs that must be covered with two separate tiers of payment. One level is catastrophic illness - and for that, insurance may still be the answer. Policies that carry a high deductible (say $5,000 a year) are relatively inexpensive, even when the coverage is very high ($1 million or more) or unlimited. That is because most people do not get catastrophic illnesses or injuries.

In fact, most of us only need health maintenance and routine medical procedures that comprise a totally different level of health care needs. For these, the present INSURANCE-based model is not the answer because it is financially incompatible with any efficient HEALTH CARE system.

Everyone knows that the INSURANCE works best when the fewest number of participants actually use it (i.e. make claims). Then the system generates profit, which lowers the premium that, in turn, brings more paying participants. The participants are happy NOT TO USE the insurance, especially if it does not cost them too much. On the contrary, the HEALTH CARE system works best when the most people use it (i.e. get teeth cleaning, checkups and vaccinations).

Fortunately, back in the 1980s, the idea of so-called patient advocacy via health care savings programs was introduced to the U.S. These programs negotiate prices with health care providers on behalf of their members. Since they represent large groups, the resulting discounts are usually the same that the hospitals and physicians give to big insurance companies.

This innovative approach benefits medical providers because they get paid "on the spot" without enormous paperwork and disputes with insurance companies. It also benefits you and me by providing an access to the discounted "insurance rates" without high premiums.

Many of such programs also allow their members to contribute money to medical savings accounts that are tax deductible or not taxable. Monthly membership fee is affordable and no one can be turned down because of a pre- existing condition.

It does not look like the current health care crisis is going to have a Hollywood-style "happy ending". It's up to us to analyze the situation and find the solution... otherwise, the next blockbuster about healthcare may well be a horror movie.

(C) by Irina 2003.

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