This is an interesting Tweet from Dr Shane:
"for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total" David Goldhill #DPCrising
Dr. Shane and David Goldhill blog about the rising costs of health care regulations.
I want to approach the number of insurance positions from a different perspective.
I once worked in insurance. My experience was that insurance employees are wonderful people who really want to help people with health care.
I see 470,000 wonderful people, most of whom are trying to make a positive difference.
The reason I left the insurance world was because I realized that the nature of insurance prevented me from making the positive difference that I imagined insurance offered.
The problem is not with the people, but with the configuration of insurance.
In the current system, our health care dollars sit in enormous pools. The money in this system flows from powerful insurance pools to industrial style hospitals.
A bureaucracy configures itself to the flow of money.
The careers of these 470,000 people end up aligning with the needs of the the insurance pool and not the the needs of the people.
The reform I propose is called: "The Medical Savings and Loan."
This reform starts by giving policyholders a medical savings account. All medical transactions flow through the account.
We replace the insurance pool with a thing called a loan reserve. Policyholders buy a share in a loan reserve. This reserve has about the same amount of money in it as the insurance pool.
When a person needs care, the money comes from their savings account. If there is not enough money, they can get an interest free loan from the pool. People who make enough to repay their loans are expected to repay the loans. Those who cannot receive grants.
The Medical Savings and Loan changes the flow of the money.
As bureaucracies shape to the flow of the money, the flavor of these 470,000 positions will change. The worker's efforts will start aligning to the needs of the people.
To emphasize this re-alignment, I created a new title: "The Health Care Advocate."
The driving mantra of the Medical Savings and Loan is: Those who can self fund their care should. The system redistributes money for those who cannot.
The Health Care Advocates help policyholders set up their savings plan. When people need care, the advocates help people find doctors and help in the negotiation of prices. When needed the advocates will apply for loans and grants.
Because the money flows from personal accounts to health providers, the work of these professional changes.
If we simply changed the structure of our health care system from pools to personal accounts, we could force a complete re-alignment of the insurance industry and all the positions in it.
Our problem isn't that people in insurance are bad and evil. The problem is the flow of the money.
Follow the money. The way the money flows creates an inefficient system.
If the money flowed from personal accounts to providers; then we would see these jobs align with the needs of the people.
Insurance companies have the job of protecting the pool. Health Care Advocates have the job of helping people maximize the return from their health care dollars. These advocates would be like personal financial assistants. Changing the flow of mone changes all the positions in health care and this improves care.
I think it is wonderful that 470,000 have jobs in insurance. I have no desire to make these wonderful jobs go away. I want to see their jobs aligned to the needs of the people and not the needs of an insurance company.