The Big Picture-The Current American Healthcare in Transition Model


“Hi. I am Poppy and I am a Cockatoo. My human has asked me to introduce the subject.”

The Big Picture

Today, the for-profit health insurance model drives american healthcare in transition (non-profits make money, they just don’t share it with stockholders). This model is broken!

What does the model look like? It is a three- party system.

There’s one party — the provider who provides the service

  • Have their own master list of charges for different services
  • Different from provider to provider

There’s a second party — the patient, who receives the service.

  • In the three party system the patient is no longer the primary decision maker

And there’s a third party —the insurance company, or whoever pays for the service.

  • Will not pay those listed charges
  • Negotiates for lower prices with each hospital and doctor on every plan.
  • Negotiated prices even can vary within an insurance company depending on which plan a patient has.

This model is much like a baseball park

Where you sit is dependent upon the seats you can afford to purchase (or have purchased for you as the case might be)

  • The seat is determined by the type of healthcare insurance you have (or don’t have)
  • The amount of actual healthcare coverage you enjoy and the amount of money you pay for healthcare is related to where you sit in that ballpark.

basball park - where is your healthcare seat

Important issue: Tectonic Plates!
“And make no mistake about it, there be earthquakes here!”

Added to the preferred hierarchy of seating arrangements is the X-factor.

  • Out-of-your-control occurrences
  • These are the tectonic plates
  • Caprice ebbing and flowing (the ground moving under our feet) = earthquakes
  • Which disrupt American Healthcare and keeps it in ‘transition.’

tectonic plates in baseball stadiumLosing the Benefits of Medicare and Medicaid

  • Seeing the Doctor of Your Choice
  • Health Care Costs
  • -Procedures
  • -Medical Devices
  • -Patient Compliance
  • -Prescription Drugs (Pharmacy)
  • The ACA Marketplace
  • -Underinsured
  • -Pre-existing Conditions
  • -Subsidies
  • -Coverage Mandates
  • -Benefit Coverage
  • Hospitalization versus Observation
  • Mental Illness
  • Addiction
  • Uninsured
  • Coverage Denial
  • Other

“Next time I will tweet about what you humans consider your top tectonic plates masquerading as health care issues.”

By | 2018-11-05T14:54:44+00:00 November 7th, 2018|Categories: Healthcare|0 Comments

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