Insurance company cancelled a policy for a patient suffering from cancer reports NPR.

The payments from the insurance company stopped while patient was still in the process of receiving treatment. This was part of Healthnet’s incentive program in which it paid bonuses to an administrator for meeting targets of policy cancelations.

This yet again exposes the bottomline approach of the insurance industry.

Consumers of healthcare need to assume the risk of their own care and take control of their medical decisions and expenses.

Archana Dubey, MD

This is a call for all the consumers of Healthcare aka. patients, please get to know the mandatory ‘Universal’ Healthcare solution, either you will be within network or without one.

Dear Consumers of Healthcare:

1. If you thought ‘Universal Healthcare’ increases our access to heathcare then be ready for unpleasant surprises.

There is a difference between universal coverage and actual access to medical care. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain’s Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that “access to a waiting list is not access to healthcare.”

The solution of mandatory purchase of health care products from private for profit insurance companies is a simply unjust. Those who can only afford the minimal plans will remain largely exposed. The premiums are still too high and can cause real economic hardship for those who do not qualify for subsidization. The program increased the number who qualify for subsidization but had no provision to fund them. The cost of that legislative blunder is already being passed on to those who can least afford it in the form of more penalties in 2008, a discriminatory and possibly illegal act that essentially raises the income tax rate for a targeted population.

2. If you thought insurance improves the quality of healthcare then think again.

The New England Journal of Medicine study in 2006 found that- “health insurance status was largely unrelated to the quality of care.”

The Access Project, based in Boston, released the findings of its recent independent study of the health insurance industry- “The Illusion of Coverage.” The report demonstrates the specific ways in which health insurance products deliberately fail to protect people financially and fail to guarantee their access to needed care.

Our dangerous obsession with universal coverage will lead us to neglect important consumer reforms, such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets — that could truly expand coverage, improve quality and make care more affordable.

Healthcare isn’t really a priviledge or a right, it is actually a choice.

Archana Dubey, MD

New study finds-cancer diagnosis linked to insurance….

People who are uninsured or on Medicaid were more likely to be diagnosed with cancer in later stages. This includes common cancers that can be screened early like prostate, cervical and breast cancer.

This study further validates the negative impact of uninsurance, that has become a disease worse than even cancer. It also validates the negative impact of insurance- private or government.

The application of insurance in US Healthcare is very unlike in any other industry. In any other industry, consumers take control of their routine expenses and insurance is utilized for catastrophic needs. In Healthcare, consumers have come to expect utilization of insurance for routine care also, this has made us depend largely on insurance to prevent illness. When we land up with uninsurance, we do not take control of our health and lag in preventitive care and results are evident from the study.

This calls for shift in market, from the monopoly of insurance (private or state sponsered like Universal healthcare) to a free market. This shift will also enable us to address the huge problem of rising cost of Healthcare and will support quality Healthcare.

Shifting paradigm from “you manage my care” to “I manage my care”.

Working on it,

Archana Dubey, MD

Lets talk about California Healthcare reforms…really it is deformed:

1. California ranks 45th among U.S. states for the percentage of residents who receive health insurance coverage through an employer, according to a study by the Economic Policy Institute that used data from the U.S. Census Bureau. Only 55.7% of California workers had employer-sponsored health care coverage in 2006, compared with about 63% of workers nationwide. About 18 million workers in California were covered by an employer in 2005-2006, nearly half a million less than the amount covered in 2000-2001. Almost 40% of California’s uninsured work for small employers.

2. Nearly 1 in 3 uninsured have family incomes of $50,000 or more. The five-year decline has primarily affected middle-income workers, according to the study. Researchers also noted that more than 600,000 fewer children in California were covered by their parents’ insurance last year than in 2000.

Now these uninsured patients become ’self-pay’ when they seek medical care. You would think that, like any other industry, they should have access to cost and quality data. Not really, because the ‘Law’ prevents a healthcare provider or a services company to share this critical information, since they are not part of any insurance network.

Are these laws are meant to ‘protect’ the consumers or the monopoly of the Insurance industry? Unless you are part of one of the insurance network (that you can’t afford or have been denied care from) you have no clue where you should seek care from and how much it will dent your budget.

I appreciate Mr. Governer’s healthcare initiative and the efforts of California endowment, but maybe we should look into reforms to free the Healthcare market and provide access to information and access to care, rather than creating another ‘insurance package’ and let the people fall through the crack and suffer.  

A perspective from a healthcare reform supporter…

Archana Dubey, MD

So we talked about scoring your health at the Health2.0 conference. Handing out another tool to the insurance industry to deny you of one of the most basic necessity- access to Health Care.

Besides, FICO score, Genome, DNA direct and the likes provide negative reinforcement to the average patient, who is already aware that he/she is failing in many more of these scores like BMI, Lipid panel, Hemoglobin A1C etc. To bring the change is so overwhelming for a patient that he gives up and spirals down to poor health.

In this Health2.0 generation we need to approach this with a disruption. Empowering patients with self care attitude and developing a happiness index as a score. This might ease out the stress of ’stress management’. This needs to parallel the example of healthy unconditional parenting where bribes or time-outs have a limited role and making the ‘right decision’ itself is the incentive.

So before we bring out these FICO scores to the table please think what really works for you.

The patient’s advocate,

Archana Dubey, MD

A recent 20/20 report on the healthcare assesses the critical condition of this market. The healthcare cost soaring to $2 trillion ( the size of entire economy of China) is unable to provide optimal care to the patients, leaving the patients, physicians and employers unhappy. Employers have seen insurance premiums rise 87 percent over the last seven years and that has affected their revenues. General Motors now spends more on its employees’ health insurance than on steel.

Comparing the healthcare markets where there is universal healthcare the report found that free is not cheap. Providing free health insurance coverage still doesn’t address the rising cost of healthcare. It also increases the wait time to get appropriate treatment.

The solution is in consumer power that will bring the cost to healthy levels and encourage timely treatment. Some facts that drive us to this opinion are:

• Out of every dollar that the United States spends on health care, only 12 cents comes out of the pocket of patients, according to the Centers for Medicare and Medicaid Services.
• While in nearly every other field of medicine, prices have gone up faster than consumer prices in general, the price of Lasik has fallen by as much as 30 percent (due to free market and this service being paid out of pocket).
• Whole Foods’ health-care costs dropped by 13 percent the first year the plan (high deductible catastrauphic combined with “wellness account” was put in place … 77 percent of team members voted in favor of this plan over tranditional insurance … allows them to spend the money how they want to spend it.

…the pulse of our healthcare market is asking for a consumer driven market.

Archana Dubey, MD