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FIXING HEALTH CARE: Defining Health Insurance #2 |
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Submitted by Fritz Scheffel
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Let’s continue our discussion of Health Insurance. The previous article talked about “catastrophic coverage” and the comments I received from subscribers indicate a lack of a clear understanding of “health insurance” per se by most people. To continue our discussion, this article will focus on what I call “co-pay” health insurance which most people have at least some comprehension of. Unfortunately, most people equate “health insurance” with “health care” and this is where our vulnerability to government intrusion takes form and thus becomes the genesis of our health care problems.
As a reminder, I am a firm believer that the United States has the best health care system in the world, but our system is being threatened because the populous does not grasp the overall concept of just what “health care” really is, and politicians are using this vulnerability to grab power for themselves. Nor should we forget the part lawyers play in obfuscating the health care system for their own personal gain. This is especially galling to me because lawyers contribute nothing to health care, yet they are hugely responsible for the inflated costs.
Starting at the beginning, everyone must understand that “health insurance plans” are nothing more than “financial plans” presented by insurance companies as “health insurance” allowing purchasers to pre-pay health care services they may, or may not, need during the year. We must never forget that to the insurance company these insurance plans are all designed to be profitable for the company. It is really not about your health, it is a business and here is how they work.
The insurance companies create a variety of plans for prospective buyers to choose from that will ostensibly pay for health needs spelled out in the plan for the year. The plans will vary in price depending on the illnesses covered in the plan’s fine print, co-pay amounts, and even the drug formulary available to doctors that treat your health needs. The insurance companies have multiple ways to insure the plans will be profitable. Almost always, pre-existing conditions will not be covered and the doctor must call the insurance company prior to treatment or he/she may not receive compensation from the insurance company for the services deemed necessary. There will always be medical needs not authorized by the insurance company and these must be paid out of pocket by the person needing treatment. Have any of you ever wondered why health insurance plans are only good for one year? This little feature helps insurance companies limit their liability or financial exposure for those policy owners who get real sick and need exorbitant financial help during the year¸ and guess what, when you want to renew for another year you find out you now have a “pre-existing” condition. A little known fact is that somewhere in the insurance world is a big computer with everyone’s medical history on it, so moving from one company to another trying to hide conditions will not work for very long.
The bottom line with “co-pay” health insurance is that opportunities are there for people to cheat the system for short periods of time. When I say “people” I am not only talking about policy owners, but doctors, hospitals, and pharmacies as well. I have said for years, there is a better way to do health care that will benefit everyone. These “newsletters” over a period of time will be educational and my desire is that you will stay tuned and invite your network of friends and family to join. I have written two books and numerous articles on health care and all are available through my website TheHealthCareFix.com. Now that the election is over there is hope the government run plan will be totally repealed, then we can truly fix health care the way it should be and everyone needs to be involved. Until next time, have a great and blessed day.
Fritz Scheffel provides regular articles about health care and has books on the subject currently available through Amazon, Amazon Kindle and The Health Care Fix website. You are also invited to sign up and receive Fritz’s Health Care Newsletter. Join through Fritz’s website. Comments welcome.
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