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Welcome to Health Insurance Guide

Florida Health Insurance Providers Article

Is Your Insurance HEALTHY?

Is Your Insurance HEALTHY?

By Irina

The author grants permission to publish this article, in
its entirety, electronically or in print, as long as the
bylines are included. A courtesy copy of your publication
(or, at least, an e-mail notification) sent to will be appreciated.

Five years ago, average health insurance premium was equivalent
of a car payment, now it's more like a mortgage. More and more
people are faced with a tough choice: indefinitely postpone their
next visit to the doctor or start depleting retirement savings in
order to pay medical bills.

There should be a better way to keep our families healthy...

Let's begin with terminology. The generally accepted definition
of an "insurable event" - be it a traffic accident, a house fire,
or an earthquake - is something that
(a) comes without warning;
(b) is very unlikely to happen and
(c) is definitely undesirable.
Now try to apply this definition to any routine health
maintenance event like teeth cleaning or annual physical and you
will discover that the very term HEALTH INSURANCE contains a
built-in contradiction.

From financial considerations, any INSURANCE system works best
when the fewest number of participants actually use it (i.e. make
claims). This way an insurer makes profit and is able to lower
the premium which, in turn, brings more paying participants who
are happy NOT TO USE the insurance, especially if it does not
cost them too much. Remember, we are talking about real insurance
and truly "insurable event" - something that is definitely
undesirable. On the contrary, the HEALTH CARE system works best
when the most people use it (i.e. get checkups, tests and
vaccinations). The financial structure and goals of the two
systems are incompatible.

It was in an attempt to reconcile these differences that the
concept of managed care was developed. Unfortunately, that system
satisfies nobody. It enrages health care practitioners and
consumers alike when it limits or denies payments on the grounds
that the particular treatment or service is not medically
necessary. It also frustrates insurers by mandating payment for
routine services, whether they are really necessary or not.

There's another basic problem with the current system: it's the
assumption that health care is a benefit of employment. So if you
are unemployed, self-employed or employed by someone who lacks
the negotiating power of big businesses - health insurance is not
for you. Even if one has an employer provided coverage, recent
premium hikes can price him/her out of the range of affordable
health insurance. Why? Unlike virtually any other commodity,
contracts for health care services are negotiated not by the
affected parties (physicians, hospitals and consumers) but by
insurers and employers.

The list goes on, but even without considering numerous other
"symptoms" it should be clear by now that the current
fundamentally irrational HEALTH INSURANCE system is designed for
conflicts and lawsuits rather than providing the best health care
at the best prices.

So, is there a common-sense solution to this crisis? The answer
is YES, but it's not universal. The right solution for you and
for me may vary due to the different circumstances, health care
needs and risk tolerance. It is important to realize, though,
that each of us should be able find that optimal balance!

To begin with, we must recognize that we are dealing with two
different levels of health care needs and must cover those needs
with two separate tiers of payment. One level is catastrophic
illness - and for that, insurance is the answer. Policies that
carry a high deductible (say, $5,000 a year) are relatively
inexpensive, even when the coverage is very high ($1 million or
more) or unlimited. That is because most people do not get
catastrophic illnesses or injuries.

The second level comprises health maintenance and routine medical
procedures. For these, insurance is not the answer. Instead,
there are two alternatives. One is for people to pay these costs
out of pocket, the way we now pay for many other routine needs.
There are number of benefits to this approach, including no
managed care and less paperwork. For many people, coming up with
the cash to pay routine medical bills, especially if they know
that any major illness or injury would trigger a backup insurance
plan, would not be difficult.

For others, however, it would. Fortunately, back in the 1980s,
the idea of so-called patient advocacy via health care savings
programs was born. The availability and popularity of these
programs is picking up year after year, as more and more people,
unable to get or afford health insurance, are discovering them
for the first time. These programs negotiate prices with health
care providers on behalf of their members. Since they represent
large groups, the resulting discounts are usually the same that
the hospitals and physicians give to big insurance companies. But
this is where the similarity with old health insurance model

With health care savings program, it's a patient, not an
insurance company, who pays the bill. This seemingly minor
adjustment makes a world of difference. It benefits medical
providers because they get paid "on the spot" without enormous
paperwork and disputes with insurance companies. It also benefits
individual consumers who get access to the discounted "insurance
rates" without having to pay high premiums. Yet most importantly,
the entire system appears to be financially sound and socially

Unlike traditional insurance model, the patient advocacy actually
encourages people to seek medical help as soon as the need arises
thus preventing "little aches" form developing into life-
threatening illnesses and financial disasters. Monthly membership
fee is affordable and no one can be turned down because of a pre-
existing condition. Many of such programs also allow their
members to contribute money to medical savings accounts. Federal
law makes this an attractive option, because medical savings
accounts are tax deductible or not taxable, as long as the funds
are used to pay for health care.

Five years from now, average health insurance premium may well
exceed a car payment and a mortgage payment combined together.
There is, however, a way to keep our families healthy without
jeopardizing financial security. This writing was intended to
assist the reader in finding that right solution by providing a
better understanding of the ever-changing situation and available

Copyright (C) by Irina 2003.

About the Author:
Irina runs home-based business helping people save on health care
and create steady stream of residual income working from home

About the Author

Irina runs home-based business helping people save on health care
and create steady stream of residual income working from home

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