Patients As Consumers To Battle Health Insurance Dependence - Mayo Center for Innovation

How To Drop Your Insurance Addiction

Post Written By Kat Quinn

We all love to get the most out of our health insurance policy. Premiums are continuing to spike so why not get our money’s worth, right? As we use our insurance, we also recognize that the quality of healthcare in our country is mysteriously lacking, regardless of the fact that we spend more money per capita on healthcare than any other country.  And we continue to get sicker.

Movement towards empowering patients as consumers

Something’s gotta give. We can pretty much all agree on that. But what? I argue, that it has to be a movement towards empowering patients as consumers.  Over the last several decades, our medical system has done a very good job turning patients into passive recipients. Don’t trust your body. Don’t trust your judgement. Don’t make decisions for yourself. Don’t pay for your medical care directly. Listen to what we (doctors) have to say, don’t question it and do whatever we tell you, or risk being branded the ‘noncompliant’ patient.  

So how does insurance play into this culture shift?  To be clear, insurance plays an important, valuable role for catastrophic events.  The major, unexpected and rare circumstances where you find yourself in the hospital, ICU or surgical suite.  Where it gets complicated, is when consumers start to rely on insurance to pay for everything else.  When we rely on a third party to pay for things like primary care, medications, and x-rays, suddenly we are removed from the process and stripped of our power as consumers.  

This is a call to change, to break this insane cycle

How does this impact our health care?  When a third party is responsible for paying for routine, common health needs, it creates a system that’s bloated from bureaucracy and inefficiency.  It drives the costs up, diminishes quality and creates barriers to care.  Imagine, if suddenly your car insurance company sent you a letter stating that from now on, they would be paying for all of your fuel.  Great, grand.  Fuel prices are no longer displayed out front, and you stop caring how much it costs.  Behind the scenes, the gas station now has to hire several new employees to address the new paperwork involved in billing, coding and collecting from insurance companies.  Every time you want to take a trip out of town, you spend an hour on the phone trying to get it approved.  Gas prices go from $3/gallon, to $5/gallon, to $10/gallon.  Your insurance premiums go from $800/ year to $1200/ year to $2000/ year.  Now you can’t afford your car insurance, so you drop it. When you go to pay cash for your fuel, you can’t afford to pay $10/gallon and realize in a panic that you need to get your insurance back in order to pay for the fuel.  

This is a call to change, to break this insane cycle.  When we continue to depend on third party payers for our routine medical care, we are giving them the power to determine the what, where, how, why and who we receive care from.  We are no longer afforded cost transparency.  We are powerless, as consumers as well as patients.  

Connect the dots

We all assume that insurance companies have incentive to keep healthcare costs down.  We’ve all been there, trying to get something covered, with limited time and know-how, fighting and arguing while an insurance company refuses to pay.  As the Affordable Care Act was introduced, there was legislation passed requiring insurance companies to pay out 85% of the money that was collected in the form of premiums, otherwise they would have to return the difference.  Sounds like a great plan.  But in reality, it actually provides more incentive for insurance companies to pay out MORE, not less.  That way, there is justification to raise premiums and increase the 15% they are allowed to keep.  If you’re feeling nauseous right now, you are not alone.  Corporate hospital systems and pharmaceutical companies have no incentive to lower costs.  Insurance companies no longer have any incentive to lower costs.  So who’s getting screwed in this scenario?  I’ll let you connect the dots.  

So how do we break this addiction to insurance?

So how do we break this addiction to insurance?  Well, for one, start by reading your policy.  What kind of restrictions are placed on how, where, or from whom you receive your care?  If you disagree with it, start tapping into your consumer power and drop insurance companies that are controlling you.  Next, start shopping!  When you need a medical service, a medication, or procedure, start asking questions about cost and quality.  Look for alternative, independently owned businesses that offer fair cash prices.  If patients are empowered consumers, it won’t take long (I’d say nanoseconds) for people to notice that the same MRI costs $4000 at one place, and $400 at another.  The free market will force competitive prices and higher quality.  Start paying for your medical care and rely on your insurance only for the catastrophic events.

We have no problem planning ahead for our household or car repairs.  Medical care is an expense - a very important one.  Plan accordingly.   

Happily, insurance free with Direct Care

I myself am a family physician and business owner.  I was determined to create a primary care practice that did more than just ‘sick care’ while making it affordable and accessible to everyone.  I built a yoga studio into the practice with daily classes and have an herbal pharmacy that I use to mix medicinal herbal teas for patients.  There is access to discounted labwork and generic medications (80-90% savings on the average cost).  Patients see me whenever they need and have direct access to my advice via text and email.  They have time to talk, ask questions and collaborate to come up with a plan for optimal health.  Patients pay a flat monthly fee of $60/ month ($20/ month for children, up to the age of 18).  Happily, insurance free.  This model, called Direct Primary Care, is gaining traction all over the country. Just look for a local DPC doc near you!

About Author:

Dr. Catherine M. Krouse - board certified family physician, Founder of Lotus Family Practice, LLC Direct Care practice located in Falmouth, ME.  Dr. Krouse is committed to providing the tools and support that allow patients to heal on many levels.  “Every person is unique in their experience and thus requires a unique path to health and healing.” ~ Dr. Krouse

About Editor:

Kat Quinn, MBA is a digital health start-up specialist with a focus in HealthIT and Direct Primary Care (DPC) start-ups and co-founder of SheepGuru.com, social media's leading DPC voice.  Her primary objective is to successfully launch digital health start-ups and Direct Care practices through Sheep Guru's DPC Startup mentorship-driven incubator program. Her passion is health and wellness, and she is an advocate for empowering the doctor-patient relationship.