Are You a Part of the Herd?

by | Mar 20, 2017 | Healthcare, Humor, Musings

If you participate as a patient in Managed Care or Medicare systems of health insurance, then you ARE a member of “The Herd.”

Let me explain.

All “insurance” is based upon population statistics. These statistics are used to calculate the cost of caring for “The Herd”. Whether it’s for health, life, auto, home, property, or quarterbacks’ arms, all insurance is just a big bet. It’s a wager by the private or government insurer. The wager is that the money they may soon dish out for an event that has not yet occurred (the quarterbacks who will actually break their arms this season or the patients who will actually have heart attacks this year) will be less than the money they receive this year in premium payments.

For the private insurer (Aetna, Blue, United, etc.) their ability to stay in business (profitability and stock value) depends upon consistently winning the wager.

The government is a bit different. It doesn’t have to follow sound business principles to stay around…  They just print more money, or raise taxes, or make promises…. whatever gets votes.

In the case of Obamacare, in order to provide health insurance coverage to those who couldn’t afford it, they merely took the health care blanket… cut off one end… sewed it to the other end… and raised the price of the whole blanket… The net effect was that for every person that got warmer with the new more expensive blanket, a bunch more got colder.

But I digress….

The complicated system for determining the price of healthcare premiums (as well as how much will be paid and which services will get paid for) is at the heart of what we call “Managed Care”. Because payments for services to providers are contracted in advance (and differ from one plan to another), patients and individual providers have little or no say in the process. There is no free market for patients (consumers) and doctors (service providers).  And the whole thing makes no common sense to anyone except the actuaries.

Now, all money that might potentially get paid out for broken quarterbacks’ arms or burned-down houses is considered “risk” on the part on the part of the payer. “Risk Management”, from the perspective of the payer, looks not at individuals, but at the cost of covering certain “populations” as a whole. Populations of professional quarterbacks. Populations of middle class housing. Populations of patients over sixty with high blood pressure.

These are the “herds”. (Insurance companies call them “silos”). Your own individual coverage and prices for services and medical goods (prescriptions, procedures, equipment, office visits, consultations, etc.) are based upon which herd you belong to.

Do you wonder why you as a patient are being asked so many questions about what immunizations you have had, or what preventive procedures you need, like mammograms, colonoscopies, etc.? And why is there a question about guns in your home? Or have you traveled to an Ebola-infested region of the world?

It’s because insurers have determined that, statistically, certain factors will impact the cost of herd care.  And under the current Medicare/Managed Care scenario, in the near future, doctors such as myself will increasingly be rewarded (or penalized) according to how our charts reflect this type of “risk management”.

It doesn’t matter how much we might care for you personally or how competently we diagnose and treat you in specific situations. It’s about how our little flock in the big herd is managed.

It’s about how many of you have had your cowpox vaccine or hoof-and-mouth treatment, or your flea dip.

So give it up, folks. And just say, “MOOO”.