My father was in advertising and often spoke about human nature. In a case where some entrepreneurial if not ethical individual tapped into that nature, he told us of the ad that ran: "Last Chance Send a Dollar!" and had a place where to send such dollar. The ad promised nothing but merely noted that time was running short. Until stopped by law enforcement, the happy ad-runner collected money for nothing. So it is with insurance trends.
The simple truth is that nobody wants to insure anyone for health services but that all claims to marketing insurance are directed towards the ultimate goal of providing nothing for something. Couched in vacuous terms such as empowerment, privatization, efficiency, policy, education, and that age old sell of scarcity, we consumers are buying in, and when we choose not to, we have benevolent states such as MA telling us we must.
The consumer stakeholder wants the best care measured in terms of access, affordability, and quality (further broken down into time, cost, and number of tests used in diagnostic stage, the same for treatment, and then measured outcomes). Politicians tend to look at gross numbers, (number of insured), forsaking every aspect of the consumer concern and leading to goals of "some" insurance no matter how economically wasteful because of a lack of concern for access, and quality. Physician stakeholders want mandated testing and coverage because these "preventive" services are money makers, finite costs for finite time without any measure of outcome (having the test is enough), physicians seek thereby to maximize profit through low level services, annual exams and testing with maximum opportunities for payment. Insurers seek maximum profit, ultimately providing the imaginary "peace of mind" rather than actually being called on to pay anything at all. NOBODY shares consumer goals.
This oppositional relationship could be worked out in a marketplace where opposing forces had equivalent power, same sized gorillas on both sides of the v (where v is versus), but this is not the case. Governments, insurers and medical services providers are in search of revenue and the easiest way to do that is to offer less for more, or nothing for more...last chance send a dollar.
In confirming this trend, check out www.ahrq.gov, which declares their mission statement as "To improve the quality, safety, efficiency, and effectiveness of health care for all Americans." Really? At more than first glance, Agency for Healthcare Research and Quality appears to be another tool in the teaming up of Insurance companies, government and health services providers in deciding that preventive care (testing), mass insurance coverage (less coverage for more dollars) and insurance company interests in paying for less and less (that's what efficiency and effectiveness mean by the way). Consumers are addressed with lists and lists of what they can do to make sure that they save their money and maybe their lives...confirming that we have gone back to the let the buyer beware days of lawless commercialism that prompted waves of consumer legislation in the marketplace over the years.
It is up to consumers to ask what incentives are there for any of the profit-motivated stakeholders to change their undercoverage, overbilling, disqualification and exemptions of needed medical services, and nit picking out of individuals from smokers to motorcycle drivers for insurance coverage if the three gorillas: government, health care services providers, and health insurers have combined to achieve maximum revenue by creating endless expectations, requirements, and hoops for consumers while ignoring their own waste, fraud, and greed? We are now being encouraged to maintain their incomes and when we dare to opt out, we have states like MA telling us we will be fined (called a tax) for such a choice.
This website for all intents and purposes looks like the BC/BS website I wrote about yesterday, (http://conoutofconsumer.blogspot.com/2008/04/bluecross-blue-shield-what-theyre.html) showing us that the trend in the health services industry is last chance send a dollar, promising nothing for more and more money and disguising that as education, policy, privatization, efficiency and every other excuse justification for we just want your money. Comparing the similarity should be a warning to consumers...we are being bamboozled. So for those guys at the Agency for Health Care Research and Quality, I ask the same questions as to why it is only through reducing the coverage of risk of illness for more money is the only thing you guys are willing to regulate? Where are the stiff penalties on physicians who put off seeing patients for months, should they not be obliged to recommend at least two other providers? Where are the stiff penalties for insurers who stall, delay and put off consumers creating stress and the need for psychological assistance as they have to battle illness AND their insurers? Where are the penalties and reforms from government for WASTE? And by the way, I want a reimbursement to my health insurer and myself for the expense of Vytorin which apparently works not at all...I'm sure that's not part of your effectiveness formula.
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