Commentary on Managed Care
(licensed vs non-licensed de facto practice of medicine)



"Managed care is a social experiment involuntarily imposed upon a group of unconsenting subjects... the physician and his patient." Anon.

Sunday, 16 August 2009

Commentary by
Roger S Case, MD

(Health Officer, Island County & Commissioner, Whidbey General Hospital)


This is the thirteenth  in a series of commentaries addressing the subject of the funding of (y)our medical care, and what we as wage earners (and businesses) can and must do to regain control of his/her/our healthcare dollar.


Friday, 18 April 1997

  Saturday, 26 April 1997

Saturday, 11 April 1998

Friday, February 15, 2002

Friday, 11 July 2003

Saturday, 7 January 2006

Friday, 10 November 2006

Sunday, 18 March 2007

Wednesday, 13 February 2008

Wednesday, 30 April 2008

Tuesday, 30 December 2008

Monday, 29 June 2009

Sunday, 16 August 2009

Monday, 26 April 2010

Monday, 15 November 2010

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Why is medical insurance not run as a non-profit service? Why does this particular insurance activity have to support administration, executives, and stockholders Ė all of whose major interests are in generating the greatest amount of profit with the least amount of claim payout? Shouldn't the "health insurance" industry's moral interest be in providing the greatest amount of distribution of premium dollars to the providers of health care at the least amount of overhead cost in providing that distribution, while offering it to all who seek health insurance? Shouldn't the mantra of the health insurance industry be illness prevention and health care promotion for all? Why do folks who are looking for investment opportunities have a role in healthcare insurance?

Again, this is not to say that medical insurance is not necessary. Quite the opposite ...the insuring function is absolutely necessary. Itís just that insurance should be provided by an entity that is uniform in their payment schedules, offering a series of plans to one and all with premiums based on the individual's age and health, with incentive discounts for those who chose to lead healthy lives. No expensive staffs to pay; no corporate CEO to siphon off unseemly huge salaries; no stockholders looking for "a Return On Investment" ...just premiums in, minimum overhead for administration, and payments out to hospitals and  providers of care.

Consider this: a not-for-profit single-payer type of insurance program ó a form of "self-insurance" at the organizational/county/state level.  All health care premiums presently being paid to insurance companies, Medicare payments, etc., would be collected by the Single Payer Entity and paid out according to the plan level purchased by the individual. The dollars are there, folks. In this dynamic, funds would not be siphoned off as occurs in our current profit-driven private health insurance system. Extra medical benefits could be available by encouraging Health Savings Accounts for the individual so inclined.

Let's consider your current insurance company. Try thinking it as a "single payer" plan, since as far as you are concerned it is a single payer for your health care bills. Now think how much more beneficial it would be if your insurance company didn't have to function in a "for profit" mode ó no large salaries for senior administrators, no investors requiring a stake in profits, etc. And now consider several such insurance companies combining into a single company with that same limited administrative staff and no profit incentive driving premium cost. That is what a "single payer" non-profit health insurance plan would look like. Makes sense to me that eliminating corporate officer and investor pay-outs would result in more of the premium being made available to the providers of care and would permit a lowering of premiums... the way a non-profit agency conducts itself.

Arenít you tired of all this? Itís no way to run the show. By now your interest has been piqued enough by the debacle being proposed by our congress that you surely have some thoughts about how better to organize health care insurance for the masses. Non-profit is the way forward. Tell the profiteers to find some other field of interest ó not health care insurance. Personally, I am repulsed by an activity that seeks profit from the misfortune of others (i.e. illness/ surgery, etc.) while investing nothing of themselves in the mix, having only a pecuniary interest. Insurance programs based on this principle morally have no place in health care, in my opinion.

There is a whole new ball game pending in the delivery and funding of health care in America.  Change is afoot, it is an absolute certainty.  Make sure the change is not for the worse. You have a voice. Use it. Get involved.  Itís your health. Itís your money.  Let's make the most of this opportunity. Talk to your local leadership, your state senators and representatives. Don't let this become a FEDERAL program!!! Governors take notice! State Insurance Commissioners can require an absolutely level playing field. "Managed Care" (i.e. Managed Financing) can indeed be accomplished in far a better manner.

If we allow this become a Federally run program, kiss it all goodbye! Too much authority in the hands of too few, too far from public scrutiny and/or control. Local (i.e. State and/or Regional) non-profit can do it far better!

Roger S Case
, MD, FAAFP, retired Family Practitioner

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