Why Does Health Insurance Dictate Medical Care?

Why Does Health Insurance Dictate Medical Care

This is true whether it is Medicare, ObamaCare, private health insurers, or any of the Western European socialized systems. Yet it makes little sense.

A week or so ago, Dr. Mike promulgated the screed (copied below) to his patient email list. It deserves a wider audience.

The main premise is that health insurance, of whatever form, is merely a means of spreading the risk. We, as in We The People, pay for it all (and then some). In spite of this, the availability and quality of medical care are not determined by us. They are determined by the entities that collect and disperse the money. The insurance companies and the governments. But it’s our money, and we are not getting a good deal. Here is what Dr. Mike had to say. I’ll chime in again at the end.


Dear Patients,

After my second tirade to an unsuspecting patient on the topic of healthcare in two days it dawns on me I have something to, as the saying goes, get off my chest.

After listening to decades, intensified in the last few years, about the terrible condition of ‘healthcare’ in the United States, I can no longer hold my peace. 

None of the discussions, whether political, professional or moral have anything to do with healthcare and everything to do with how healthcare is paid for. Health insurance is a financial tool – nothing more – and not a medical tool. I make what should be an obvious point after watching my professional peers lament the wasted money spent on late life health issues, not because late life health issues aren’t important, but because they are expensive.

This inversion of values plays out in many ways: many respected medical science journals have ‘research’ articles about the least expensive way to avoid even treating many diseases, along the lines of: “How can we get people to quit using more expensive, more effective medications when there are less expensive, less effective medicines that work almost(!) as well. This, at the same time that ads for every expensive medication you can imagine is sold in the media as standard bill-of-fare for consumer medical needs. Any price for forehead lines, nothing for end stage cancer. Something is wrong here. The cosmetic medications are not entangled in the financial instrument of ‘health insurance’ – a truly fraudulent term – and thus pass unscathed by the ravenous medical establishment that wants to corral all medical expenses and thereby control everything that is permitted to even be called ‘healthcare.’ Nota bene: “is permitted to even be called ‘healthcare.'” You want to prevent, to add value and pleasure to your own life, diabetes or the progression of coronary artery disease? Well, good luck with that; since such a plan is not covered by insurance it must not be ‘healthcare.’ Want to take every drug dreamed up year on year? No problem; that is healthcare, as your insurance says so. 

Many dollars for treatment, not a penny for prevention. That is, unless it is a shot to prevent the flu. (As an aside I am all in favor of flu shots, so do not misunderstand my point.)

OK, I am calming down now and realize some of my remarks are obscure and, you will have guessed, I have much more to say. For now all I hope to achieve is to help you untangle the two functions: 

  1. Health Insurance is not healthcare; it is a sand-poundingly simple thing. It is a financial instrument to amortize healthcare expenditures, and it is a pernicious perversion of its purpose to be the surreptitious instrument of virtually fascist control of healthcare delivery. 
  2. Healthcare is, or should be, the highly principled, very professional delivery of every and anything within the bounds of science, technology, morality and competence that extends and enables a good and healthy life. 

To Good Health. L’chaim,

Dr. Mike


I called spoke with Dr. Mike after I got the letter, challenging the idea that cost should be less relevant. He made several interesting points. In enough volume, most things become very cheap. The newer CT (“cat”) scanning machines are a good example. The latest, with great resolution and very low radiation exposure cost between half a million and a million. Such a machine would save lives, yet there is only one such machine in all the bay area—one per 6 million people. Why? Primarily because insurance does not pay for preventive scans.

This is tragic. Such scans can catch many cancers early, when they are still conquerable, and can detect numerous other life-threatening problems. Why not have a scan every year or so. The radiation hazard is low, especially for those over 65. Now suppose every blood draw lab had such a machine. This would mean a couple of hundred in the bay area instead one a single machine. Production at such volume would probably cut the cost 10-fold or more. Due to volume alone, the total cost would be less, and a lot of lives would be saved. Yet we do not do this. What if every doctor’s office had one? These machines are vastly less complex than, say, a Toyota Yaris.

And, of course, prevention is always cheaper than treatment. But prevention seems to be the black sheep of the medical industry, with little done beyond the usual homilies like, “eat right and exercise.”


  2 comments for “Why Does Health Insurance Dictate Medical Care?

  1. Jim
    October 27, 2017 at 7:25 am

    Loved reading this post. It is sad that the insurance conglomerates (and politicians) have captured and perverted healthcare to such an extent. It’s even sadder that many do not understand the concept / reason behind the use of the dollars they send to insurance conglomerates. Prevention mind-set is sorely lacking. In NY, I can’t get decent / more definitive blood testing on my own volition – and the difficulty in finding a physician willing to understand why I would want to is equally sad. Truly ridiculous. The systems are set up to be contradictory to the real purpose – pursuit of health.

  2. Ann
    February 21, 2018 at 8:26 am

    I agree with Jim’s comment. I had a policy with one insurance provider, then changed jobs and now have another. The old company covered all of the blood tests every 3 months. First time out, the new company refuses to pay for testing iron, ferritin, insulin, hemoglobin and homocystine calling this lab work “experimental or investigational.” I suspect they will refuse the rest of the items in the QM list once they are repeated. Apparently you have to be well-diseased before insurance covers “preventive” testing.

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