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Let’s Fix the Business of Medicine

And Stop Wasting Time Figuring Out How to Maintain the Profits of Health Insurance Companies

I work as a business consultant for doctors, health, and wellness practitioners. I was supposed to be the 5th generation of doctors in my family until I flunked high school chemistry. The legacy ended there.

The questions surrounding health insurance and who pays what is complicated. We are all faced with rising premiums and are paying more and more for less and less coverage. I say this because, the problem with healthcare insurance is that it is corrupt. All legislative acts currently being negotiated are addressing how we can continue to have insurance pay for care and still keep it a profitable business. Wrong approach.

We need to stop confusing heath care insurance with healthcare. Insurance is only one method of payment and not the treatments, procedures, or healthcare itself.

An underlying problem is that medical care and medical practices need to be profitable businesses. In many situations, they are not. The selling price for services in a medical practice should not be primarily influenced by medical device manufacturers, pharmaceutical companies, or insurance companies. These manufacturers and insurers seem quite able to charge whatever they want for their products at the expense of the medical practice and consumer.

As consumers of healthcare, we have somehow wound up with an agent between us and our doctors. This agent (insurance) tells the doctor what they will be paid for services rendered (by discounting their bills) and tells us (the consumer) what we have to pay them to pay that doctor. I cannot be a profitable business if I receive only 40-70% of what I bill, can you? How is this efficient or beneficial for either the provider or the patient? It's not making us any healthier; it is driving up the cost of services to protect insurance profits.

The average family of four pays $1200 per month for insurance, not including deductibles. This same average family of four might use $2500 per year of care depending on the age of the parents. Sounds like a slush fund to me. Does this sound like I am angry? Well, I am. I have clients across the country who echo these sentiments.

I believe we can resolve this situation. It requires that we, as consumers take increasing responsibility for our personal healthcare. The answer lies in primary care and family medical practices and their involvement in preventive healthcare. In my mind, preventive health care clinics of the future should be primary medical clinics; operating on a membership basis and should grow to include all preventive healthcare, lifestyle services, and Complementary & Alternative Medicine (CAM) up through metabolic testing, blood panels, and EKG. Preventive Healthcare Clinics will take a more holistic approach to healthcare by helping and educating consumers to lead healthier lifestyles and achieve optimum health. This will significantly decrease the current allopathic model of “heal me, I’m sick”. These preventive healthcare clinics will be able to offer programs and address the lifestyle issues of pain management, stress management, weight management, skin health, fitness, and sound sleep.

If we carve out primary care from health care insurance, and have insurance cover catastrophic care, acute conditions, and diseases. the price of medical services will come down and primary care practices will flourish instead of declining to the point of disappearance. This will require that everyone be a participant in some sort of membership Primary Care Clinic instead of being forced to pay for insurance they don't need. Health care can be affordable and we don't need an agent to pay for it. As preventive care improves our overall health by teaching us to live healthfully, the need for catastrophic care insurance will be reduced. With the money saved by lower health care premiums, consumers can save money in an HSA for the high deductible of catastrophic care insurance. This will right the market, increase accessibility to quality healthcare, be affordable, and increase the health of Americans.

Our focus needs to be on the profitability of medicine and not how we are going to continue to pay into a broken and corrupt system for the benefit of healthcare insurers. In the meantime, I'm working to improve the business and profitability of medicine, one practice at a time.


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