Insurance reform?

I have been frustrated by the whole health care reform debate. Now that health care reform is "over" perhaps it is time to reflect a little. It seems to me that the debate was not so much about reform as about insurance. To reform the system would be to change the basic structure of how care is provided and what is paid for. Clearly we are not ready for that! When talk of looking at end of life issues conjures up discussion of "death panels" and adjustments of insurance coverage are defined as massive reform, I don't think either side gets it. As long as we do more and more complex procedures for more and more people who (by virtue of what we are doing) live longer and longer, costs cannot go DOWN. Now if we actually focus on prevention, keeping those same people from getting sick initially, THEN maybe costs can go down.

I believe insurance is the wrong model for health care. I have fire insurance on my house, collision insurance on my car, but I really do not want to use either of them. I don't know the statistics, but I'm sure almost everyone who has health insurance uses it every year. This is not insurance but pre-payment. To be sure, few of use could afford a serious medical evaluation without insurance, but why do we want it to cover everything? All we are doing is offering to pay someone else for for giving our own money back to us (less a substantial fee!). Can you imagine loaning money to the bank and they paying them to keep it for you? With the exception of catastrophic coverage, that is essentially what we are doing.

As a physician, I recognize that fewer people would see me if they had to pay out of pocket, and that is indeed one of the struggles of a primarily wellness business. the ones who do, however, are motivated to transform their lives. This is true health reform.