When there is any type of solution out there, there’s a problem that’s been defined and some designer then created a solution to solve that problem. And when people have that problem, they hire the solution to solve that for them. So, what is the job we’re hiring heath insurance to solve for us? What’s the problem to be solved?
I think the problem Americans should hire health insurance for is protection from bankruptcy due to medical bills. That’s it. When you get sick in America and need medical care, absolutely nobody should go bankrupt. It’s literally that simple.
But, there’s a job that health insurance companies have took upon themselves to also solve for you, all fostered by the federal government. It’s one that’s far more complex. It’s micromanaging the delivery of all aspects of healthcare, from a million dollar pneumonia in the ICU to the college student’s annoying $75 strep throat. And insurance companies are absolutely godawful terrible at micromanaging all care. Even worse, they must approve of all innovations in making even basic healthcare more simple and accessible for you. Innovations in healthcare delivery typically take 10 to 20 years to be approved by the insurance companies, so our day-to-day healthcare experience has a bottleneck that doesn’t match up to what we’ve come to expect from services in America. There’s a 3 minute wait for an Uber right now and a 3 week wait to see my PCP. That’s because health insurance companies must have pilots and reams and reams of decades-long data to “prove” that something they’re going to pay for is cost-effective for them. Health insurance companies have a very simple business model: Use data from micro-managing all aspects of your care to get really good at predicting next year’s expenses and adjust your premiums accordingly. Anything that throws a wrench in the status quo disrupts this business model. So, as long as people keep paying their premiums, they’re happy to continue the status quo.
There’s a theory out there for why civilizations fail:
One day you wake up and everything around you is there to maintain complexity, and not add value.
This is the definition of healthcare in America.
If 5% of people spend 50% of costs, 95% of people spend 50% of costs. That 95% of people needs a service revolution. The experience of getting healthcare needs to be made exceptionally convenient and effective. This is goddamn America. We can build Uber, but we can’t make a primary care doctor available in less than 3 weeks?
Making healthcare equitable for people is a deep-seated philosophical belief amongst folks in the government and public health academics. They start with “everyone should have access to healthcare,” hence the focus on the individual mandate in Obamacare. But without a concomitant “health insurance companies should be lazer-focused on quickly getting an uber-like efficiency to making care accessible,” we’re shooting ourselves in the foot. Equity at the expense of innovation is a losing battle. And this means in America “equitable” means everyone should have access to 3 week waits for primary care doctors and $36,000 ER visits. There’s an assumption out there amongst public health academics that if you make healthcare too expensive to access (like make that college student pay $75 for a strep test), people will put off care and then they’ll die. I believe that, especially when you make going to the doctor painfully worse than a trip to the local DMV. But if you make the majority of healthcare simple and accessible and as efficient as getting an uber for 95% of Americans, you can make healthcare far more equitable. That starts with freeing up healthcare deliverers to innovate on their own accord and compete based on price and experience. Fostering service innovation should be far more important than equity. Open up the innovation flood gates and equity will soon follow.