Out of the Strong

Musings of an Old World doctor about the New World healthcare marketplace. 

“Out of the strong”?   Let’s build on our strengths rather than always harping on about our weaknesses.

“Out of the strong came something sweet, out of the one who eats came something to eat.”  Samson, an early Jewish judge, posing a riddle to his detractors.

This morning my Outlook Inbox included an add from an insurance brokerage/consulting firm urging me to consider hospital and medical indemnity programs because “Our Limited Medical and Hospital Deductible Insurance products both meet the indemnity criteria and are therefore EXEMPT FROM HEALTH CARE REFORM.”  If only it was all this simple!

While it is true that indemnity products are exempted from current legislation as most of us understand it does not mean that this area will not be profoundly impacted by on-going attempts to force everyone to carry classic major medical coverage when Obamacare’s main provisions come into effect in 2014.  Of course, there are currently some major constitutional challenges going on to the right of the Federal Government to force an individual mandate on everyone.  None of us know what the outcome of either the court challenges or the current election cycle will do to the existing law.  What we should be focusing on at the moment is what beneficial changes we should be considering that will survive, whether or not the current law stands.  It is not enough to be against Obamacare.  We do need to look at how the current health care environment can be improved, and how costs can be meaningfully cut without reducing the quality while increasing availability of health care to all.

We need to uncover what is so eloquently stated in the title of Buckingham and Clifton’s landmark book, “Now Discover Your Strengths.”  What are the existing strengths within the American health care and health care insurance system?  I would suggest that there are many.

• Extraordinary availability of high quality medical care including much surplus capacity.
  • So how do we release the surplus capacity so as to realize the reduction in costs that would normally come into play in this situation if health care were operating within a classic free market environment?
• Compassionate national sentiment that makes the general populace willing to be taxed to see coverage provided for those less fortunate than themselves.
  • So how do we get rid of the inefficiency of the massive government systems?
  • Should private companies, such as happens in Texas in the State Risk Pool, share some of the risk of the uninsurable, as a part of their cost of doing business in the state?
  • How do we encourage and assess innovative programs run by the private sector to help with social needs, rather than just assume that government is the entity to handle the socially needy?
• As much innovation and invention, including the release of new drugs, come from the American medical and pharmaceutical industries, as from most of the rest of the world put together.  We need to find ways to increase R&D budgets, and ways of reducing the cost to bring drugs to market, without sacrificing the quality that the public rightly demands.
  •  Are there ways to encourage “health” rather than just focusing on reversing pathology? 
  • What tax incentives could be used to encourage doctors to find new ways of making their expertise available to the general public?  What studies could be done to demonstrate the cost/return value of such recent delivery systems as doctors available by phone (Doctor on Call, CallMD, and Consult-a-Doctor come to mind) and similar services that make a doctor available via the Internet and email.
  • Are there ways to reward innovative breakthroughs that are not going to provide a commercial return on investment?
• Currently, many of the incentives within the medical world are perversely aligned to discourage rather than to encourage healthy behaviors.  For example, if all people are going to be charged the same for health insurance regardless of their behaviors, it is as if we encourage unhealthy lifestyle choices.
  • What studies are being done, and what rewards are being given either through the tax system or through lower premiums, to those who choose to make health lifestyle choices?
  • What other lifestyle modification programs are being shown to work, and how do we spread information about their effectiveness.
• The private marketplace is a great place for experimentation on what types of insurance are people actually looking for.  The dramatic increase in people opting in to high deductible policies, such as HSA eligible plans, shows that the public is willing to be educated, and to make financially sensible choices, given the opportunity.
  • How do we encourage more innovation within the health marketplace?
  • Could government funding be used to help with such ideas as are out there in the marketplace, and already working in some industries,
    • Samaritan Ministries and other Christian cooperative programs protected by Obamacare could be expanded into other groups with government encouragement.
    • Reciprocal insurance experiments, already shown to work in the medical malpractice industry, could be expanded to cover major medical insurance.  Isn’t it reasonable to expect consumers to modify their behavior when company profits come to them in the form of annual premium rebates or reduced rates in future years?

In Samson’s case the riddle that he posed when he stated that “Out of the strong came something sweet, out of the one who eats came something to eat, ” was solved when his enemies paid some of Samson’s detractors to figure out what was the answer to this riddle.  Maybe we can work in a more straightforward way to allow market forces and government regulation to encourage, rather than strangle, innovation, compassionate care, healthy choices and R&D!

About The Author

Tony Dale’s

The Karis Group is best known for the Patient Advocacy services that it provides to many DMPO and Limited Medical Benefit Plan (LMBP) members around the country.  Tony is a passionate defender of all people’s right to access medical care, and their subsequent responsibility to see that the medical provider is adequately compensated for the valuable services rendered.  Recognizing that there will often be a tension between the value of the services received, and the ability of any specific patient to cover those costs, patient advocacy from The Karis Group provides a professional and dignified way for members of DMPO and LMBP to receive the help that they need when out of pocket expenses are mounting and benefits are running out!

Patient Advocacy from The Karis Group is also an invaluable part of various EAP programs.  Even when the employee may have adequate health insurance, there are often family members who are not fully covered.  Patient Advocacy provides quality help for employees and their families when medical bills are proving a serious distraction.

As well as his entrepreneurial activities with The Karis Group, Tony is also very involved in missions and church work around the world.  For more information on The Karis Group see www.thekarisgroup.com