Wednesday, August 19, 2009

Health Cooperatives

Ontogeny Recapitulates Phylogeny

Blue Cross and Blue Shield regional health plans were begun in the 1920’s in Texas as not for profit efforts to provide health insurance that protected individuals and families from unacceptable cost of hospital and doctor care. These regional cooperative efforts between doctors, patients, and labor were very successful because their rates were the same for everyone. Not until employers set up their own plans and spirited away the lowest risk groups from the cooperatives did the cost of the Blue Cross plans begin their long ascent to not being affordable for anyone.

Medicare then guaranteed that the government would have the highest premium based on age adjusted risk. Medicare also relieved private insurers of high risk liability. And finally, HMOs appealing to young families with little risk continued to fragment the American health risk pool. As HMOs gained in popularity and their membership aged they could not deliver the same benefits at lower cost as promised.

In the evolution of health care as in the development of embryos of all kinds, ontogeny recapitulates phylogeny. We learn form this axiom of science that nature will not allow us to evolve to the past. This is especially true when it comes to health care reform. Any new system of health will now require reduction of high cost outlier care by improving the health status of everyone. Any new system will have to be all inclusive to succeed. The goal of health care today today is to reduce the number of people in our whole population that require care for catastrophic illness. Any one left out of the process costs us all more.

No alternative administrative change to health cooperatives or budget reductions for insurers and third party administrators can succeed to stabilize health expense unless we use existing high quality readily information for each of us to guide change to better health. By focusing the debate on improving health and avoiding risk for unnecessary, avoidable and expensive medical care, lower medical expense will be achieved, wastfull spending eliminated and unwanted unpopular government fiat avoided.

New methods of budgeting disguised as health cooperatives is the ostrich head-in-the-sand approach to dealing with our personal and national health need. Preventive proactive health is the responsibility of each person and his physician. Until this behavior change to practive health care occurs there will be no opportunity to reduce medical expense trend in America.

The Health Gadfly

No comments:

Post a Comment