Rights and Health Care topics: Health Insurance

For my next medical topic, let’s look at health insurance. If there is any aspect of our health care system that needs a complete overhaul, this is it. There are so many things wrong with our system, that it’s hard to know where to begin.

The biggest part of the problem is that insurance is big money. BIG!!! And in this country, BIG money dictates politics. It is not an exaggeration to say that insurance companies (as well as many other big businesses) regulate the government rather than government regulating the businesses. That certainly needs to change, but that is outside of the scope of what I want to talk about here.

So, if the government WERE regulating the insurance industry, what types of changes need to be made in order for the insurance industry to be a valuable player in securing the medical rights of the people, rather than being one of the main contributors to the loss of those same rights?

There are several changes that need to be made. Because of the sheer number of changes, I’m not going to go into depth on any of them. I have given them a lot of thought, and may expand on some of them later, but for now, I just want to touch on some of the most serious changes needed. In no particular order, here are some of those changes.

1) An insurance company must not be allowed to make exclusive deals with other companies in terms of what policies are available.

I work for a university, and I have very good insurance benefits. Similarly, if I worked for a big corporation, I would have access to some very good insurance.

But unfortunately, these same insurance policies are generally not available to people who do not work for a big business. Someone who is self-employed, or who works for a small company often struggles to get insurance that is comparable to what I can get.

That is unacceptable. Because health insurance is so closely related to the absolutely fundamental right to life (for which medical care is often necessary), it is critical that the ‘all men are equal’ constraint be applied.

Any policy that a health insurance company is willing to sell should be available to everyone who fits the criteria for that policy, regardless of where they work, and the insurance company should not be able to deny someone who meets those criteria.

2) An insurance company must not be allowed to make exclusive deals with medical care providers.

Although health insurance should have some say in how much they will pay for a procedure (and they will serve as an important check on the constantly raising price of health care), they should have no say in who you go to for treatment. All of the ‘networks’ should be immediately abolished.

If you need a medical procedure, you should be able to receive that care at any treatment facility you choose. If it is not an accredited facility (i.e there needs to be an agency that determines that a medical treatment facility has the ability to treat that condition), insurance should not be required to pay for it. Since there may be a limit as to the amount that the insurance company will pay, that may impact what facility you choose. But beyond that, the choice of who treats you should reside solely with the person being treated.

3) An insurance policy should cover health care, not just some carefully worded subset of health care.

Health insurance should not be split up in the huger number of overlapping policies the way it is. Through my employment, I can get various health insurance policies including: standard health insurance, dental, vision, accident, cancer, hospitalization, and intensive care insurance and others. That is ABSURD! Every one of these is health care. Each of these address a vital part of the health care that every single person needs. Having the possibility of having so many different competing policies merely confuses the issue of who should pay what. Competing health care policies, rather than providing additional support for their customers, generally just try to shift the cost to one of the other policies.

Every health insurance policy should cover all valid health care expenses. You might decide to reduce (or even turn down) coverage on certain aspects (for example, you might decline dental coverage), but at the end of it, you should be able to get your insurance without subscribing to a dozen different plans.

4) An insurance company must not be allowed to determine what health care is covered.

Insurance companies should not have any say on whether a procedure is covered provided it is determined to be necessary by a certified medical practitioner. Far too many medical procedures, especially those related to mental health, are not covered, or are covered minimally.

This is not to say that the person who purchases the policy gets to make that call. For example, there are many ‘medical’ procedures that have never been scientifically demonstrated to have medical benefit, despite the fact that providers of these services tout their benefits. Simply because a procedure has been performed for thousands of years, or because some pseudo-science claims that it is effective, does not mean much. A procedure must be demonstrated using reliable medical evidence to be an effective treatment. Once a procedure has been demonstrated effective, and once a certified medical practitioner has verified that a person would benefit from that procedure, insurance should have no say as to whether or not the policy holder can seek that treatment, or whether or not the policy should cover that procedure.

Procedures that are NOT determined to be necessary (for example, the bulk of plastic surgery that is not designed to repair damage from an accident) would not need to be covered.

5) An insurance company must be quite limited in what types of limits they can make.

Currently, most policies have lifetime limits. Insurance is specifically defined to be a means to ensuring reasonable access to health care throughout your life. Your life does not end after a company has paid XXX dollars towards your health care. Nor does it end when you are diagnosed with some condition that will require a high level of medical attention for the remainder of your life.

An insurance company should have no ability to terminate an insurance policy OR insurance coverage for reasons other than non-payment.

6) The definition of preexisting condition needs to be clearly defined.

A preexisting condition must be defined ONLY as a medical condition that existed prior to a person being covered by a health insurance that covered that condition.

This is the primary reason (and motivation) for getting insured when you are young and healthy. That way, there are no preexisting medical conditions.

If you have a medical condition, and you are insured through one company with a policy that covers that condition, and you then move to a new insurance company, and get a new insurance policy, that medical condition is NOT a preexisting condition. If you meet the criteria of the policy, the insurance company should not have the ability to deny you coverage of those medical conditions.

There are many other aspects of the insurance industry that should also be visited, but that’s enough for now.

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