I recently heard a BC/BS representative talking about the "old" insurance model of covering needed medical costs and services in exchange for premium payments by insureds to the "new" insurance model of prevention and education. This shift to a prevention rather than a treatment model works against all consumers because it allows insurers to engage in promoting saving money by forcing checkups and education on their insureds instead of effectively providing financial assistance IF a consumer becomes sick and needs medical services.
The BUSINESS OF TREATING THE HEALTHY has become enormous with insurance companies paying out livelihoods to physicians who do nothing more than force healthy patients into getting all sorts of testing and checking while providing the physician with a justification to engage in defensive medicine, unnecessary testing, etc. in order to protect themselves.
As a result, you can't really get a cheap physical anymore, you're going to be run through the gamut, with both the physical wear and tear, the time commitment, and ultimately a likely referral for MORE testing (not covered for free) and MORE referrals (not covered for free) because let's face it, SOMETHING is likely to show up. (If nothing else you'll hear that you might have some autoimmune thing going on or something--at least as far as what I'm hearing about lately).
Now, prevention is important but it is argued here that PREVENTION--medical care of the healthy is NOT an insurance company job. Whether it's vaccinations which health departments could provide or drug store clinics, cholesterol or blood pressure screening, these things should not be covered by health insurance which RAISES the prices for covered services.
As a government payer of benefits under entitlement programs like Veterans benefits, Medicare, Medicaid and Obamacare, the designers of Obamacare enacted a LAW making health care for the healthy a legislatively supported policy and made things even worse by giving insurance companies the seal of approval for REDUCING their coverage of NEEDED medical care and services for the unhealthy. So we see the prices we pay even for covered care have gone up exponentially under Obamacare with the deliberate permission and endorsement of having consumers pay more in the form of deductibles, copays and coinsurance--that's the whole "skin in the game" nonsense.
Without coupling preventive services, health care for the healthy, with affordable treatment, the OLD insurance model of preventing people from going broke IN CASE THEY NEED MEDICAL CARE, preventive care became the primary PURPOSE of health insurance, no longer a product effective for covering the IFs, but a model that permitted the cottage industry of TESTING and DEFENSIVE MEDICINE--because after all, once a provider recommends "further" testing, or refers you to another provider for a closer look you are, under Obamacare paying higher copays and coinsurance because that too was part of Obamacare in order to "help" insurers provide "free" prevention by allowing them to raise those costs to individuals.
And so Obamacare was an enormous step backwards because it DEMANDS BY LAW that we purchase a financial consumer product (health insurance) that many of us CANNOT afford to use UNLESS we're healthy--the exact opposite of what health insurance WAS and should go back to being.
In a best-case scenario individuals must be able to pay for deductibles, copays, coinsurance, balance billing (amounts consumers must pay for services of people like anesthesiologists and such whom we don't know if they participate or not), out of pocket maximums which go up every year (currently in addition to other payments your emergency fund must have (2016, $6850 for an individual, $13,700 for a family).
The first reform towards competition is to REMOVE the individual mandate--No one should be forced to purchase a product that works best if they don't need it--you can buy a toaster that doesn't work, a lawn mower that doesn't work, but why would you?
The second reform is to incentivize bringing the cost of treating the sick down through competition in negotiation whether it's government or insurance companies making sure that the SICK are covered for procedures, medications and care and REMOVING the insurance company excuse of Obamacare that the cost of treating the healthy in the form of checkups for "free" is one of the reasons why insurance cannot effectively cover the costs of treatment of the ill.
A third reform would be the mandatory participation of medical providers in insurance programs or charge them a TAX. Many providers happily advertise that they "DON'T ACCEPT INSURANCE." Well, since we're required to purchase the product, industry providers should be required to accept at least one or two of those products (plans) otherwise again, we're buying something we can't use--paying for something that's not usable when you need it--more broken toasters.
A fourth reform would be that all consumers MUST be informed whether a provider is or is not a participant in their plan with a signed consent OR ELSE that provider must accept what an individual's insurance covers--No more balance billing without full consent.
Health insurance MUST be a financial product with the primary purpose of covering the unexpected costs of NEEDED medical services and care instead of a "preventive" and "educational" model that more often than not ends up being unhelpful for those who PAY FOR the PRODUCT as a means of protecting themselves from financial ruin in the event of illness.
