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The Match Game of Healthcare That Works: Understanding Insurance

Published on March 4, 2015

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Understand What Insurance Is and Is Not

Finding healthcare resources – people, treatments, care – is a match game. Your quest is to find resources to partner with you to feel better, heal and experience the life you want to live.

Reading “match game,” the vision that probably came to mind involves perusing a list of “providers” your insurance company included in a thick volume of paperwork. Or maybe you wish you at least had an opportunity to have access to such a list. You see lists organized by “specialty” (which you may or may not understand) and geography; and you hope you can find someone with solutions for your needs – someone to help you feel better – from this paltry information.

The Traditional Match Game: The Insurance Company Sets the Playing Field For “Health”

Health insurance is not healthcare. Insurance is business. Health insurance is a payment system.

In the framework of the traditional match game, the insurance company sets the rules with four basic things: 1) a list of “providers” – people who meet the company’s contractual requirements; 2) a list of acceptable services (your “benefits”) the providers can offer for certain ailments; 3) acceptable fees for such services; and finally 4) a means to parse the payment/cost burden. This is so familiar that perhaps we didn’t even question this until prices sky rocketed and services diminished.

Playing the well-being match game within this familiar framework puts the insurance corporation in a position of power. Playing the match game this way immediately puts a corporation, a payment system, in control of your well-being. Through their contractual relationships they determine what constitutes health, who is allowed to serve your needs, and what treatments or medications are acceptable. Insurance companies narrow the field of possibilities and choices for your path to well-being.

By engaging in this match game we’ve been attempting to attain well-being from a system in which the rules have been set by companies that are focused on payment and profit. Pause and think about that for a moment. We have been lulled into looking to a payment system as a means to experience vitality.

You may have had very good success with this structure. While this may work well for some, and may work some times; for many it is a challenge to find care that works. That challenge can take a further toll on health.

In this traditional match game it is very difficult to insert your personal needs, values, and beliefs about health and well-being into the framework of a payment system. It can be a challenge to find the right partner in healing, the right practitioner, who supports your personal journey to live your best life.

Time To Shift the Paradigm

If it doesn’t work for many, if not most, people to look to a payment system as a means to experience well-being, what do we do? It requires a change in the fundamental nature of the match game. In the next article we’ll explore this shift. It begins with identifying your personal concept of the essence of health, well-being and healing. This will vary for each person, and can vary over time. This shift puts each person back into control of their health.

About the author: Deb is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to well-being inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal and self-caring as a way of organizational being. www.experienceinmotion.net.

Note: This is part of an ongoing series to equip you with a process, a path, to identify and experience healthcare that works for you. Other articles in this series are:

The heart of healthcare that works: know your personal worldview of health

Find your Inner Chris Columbus

Women Are Less Satisfied with Health Care Than Men – Why?

by Elena Perez

Published on January 29, 2015

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The New York Times reported that women are less satisfied with their health care than men, citing a study from Health Services Research.

Researchers could see an overall difference between men’s and women’s views, but these differences were even more prominent for particular questions. One question asked patients if they felt they received sufficient information for the medications they were prescribed, and the other question asked whether patients were satisfied with the cleanliness of the hospital.

In both cases, women were less satisfied with health care than men – significantly so. Now the question is, Why?

Perhaps women have just been paying attention to the news. Dr. Mark Hyman explains in the Huffington Post that postmenopausal women are being prescribed cholesterol-lowering medication that increases their chances of getting diabetes – by 71%.

This isn’t the only instance in which women’s health needs were overlooked:

Premarin was prescribed to postmenopausal women to prevent heart disease, but it increased their chances of having a heart attack.
Studies have found increased osteoporosis in postmenopausal women prescribed osteoporosis medication.
Women are prescribed medicine as though they’re men, yet they are more likely than men to have irregular heartbeats due to prescription cocktails.
Many doctors don’t realize that pain medication does not have the same impact on women as it does on men. Experiments show Ibuprofen did not reduce pain for women.
In fact, the Society for Women’s Health Research and Medco Health Solutions, Inc. presented a study that showed women are prescribed more medication than men, yet they are less likely than men to get the appropriate drug for their needs.
The Center for the Study of Sex Differences at Georgetown University in Washington, D.C. explains that your gender can significantly impact how your disease should be diagnosed and treated. Yet the FDA only required that women be included in drug research since 1993.

No wonder women are less satisfied with their health care than men.

Women Are Less Satisfied with Health Care Provider’s Cleanliness

As it turns out, women’s immune systems are more resilient than men’s. Even so, women are more susceptible to certain illnesses and diseases than men are. Some experts suggest a woman’s stronger immune system is the cause for her susceptibility to autoimmune disorders, but the reasons remain unclear.

Sharyn Clough, a philosopher of science at Oregon State University, explained on NPR how society’s emphasis on a girl’s cleanliness could impact her susceptibility to diseases when she gets older, since she may not be exposed to the same bacteria as young boys.

While this may, or may not, be the case, it makes sense for a woman to be more aware of the cleanliness of her environment if she was raised to do so. It is even more reasonable for a woman to consider the cleanliness of her surroundings if she is more susceptible to disease – especially when she is in an institution that treats the sick.

It’s important that health care providers know that women are less satisfied with their health care than men. Voicing our opinions raises awareness, and these industries don’t want to lose half of their market.

It’s entirely possible that women are less satisfied with health care than men because women pay more for health insurance than men – health care that seems to be specifically geared toward the needs of men, not women.

This post was published previously in April 2012.

Put Treatment to the Test

by Elena Perez

Published on August 21, 2012

1774 views

Researchers found hormone replacement therapy caused breast cancer and heart disease; yet this form of preventative treatment was recommended to healthy women for more than ten years, up until testing proved that HRT caused more harm than good.

H. Gilbert Welch, a medical researcher from Dartmouth, recommends putting more money into testing the medical practices and treatment we push onto patients, so that Americans can benefit from healthcare that is tested to be effective.

Currently, only .03% of health care costs go towards researching our health care practices and treatment; Welch recommends increasing it to 1%. We spend so much money on healthcare nowadays that it only seems sensible to make sure our money is going towards medicine that works.

His entire opinion can be read in The New York Times.

Can Your Health Problems Be Solved in 400 Characters or Fewer?

by Denise Amrich

Published on August 20, 2012

1497 views

This article was originally posted at ZDNet.com.

A Palo Alto-based startup called HealthTap is attempting to bring health care into the age of texting. Yes, that’s as bizarre as it sounds. Keep Reading

The Poor Spend More on Health Care

by Elena Perez

Published on August 14, 2012

2038 views

NPR recently reported How the Poor, the Middle Class and the Rich Spend Their Money in America, and there are notable spending differences when it comes to education, retirement, utilities, and health care.

While the rich and poor seem to spend the same amount of money on eating out and clothing, the rich are in a position to invest a larger portion of their income towards education and retirement, which, naturally, sets them up for a brighter future.

The poor, on the other hand, are paying significantly more for basic living costs, such as utilities, food at home, and health care, which can make it difficult to prepare for the future when a majority of one’s income is going towards essential living needs. In fact, the poor contribute almost twice as much of their income towards the costs of health care and health insurance as the rich.

Whether the larger proportion spent towards health costs is due to living environments, work environments, health lifestyles, or just due to the fact that health costs take up more of a small income is uncertain, but clearly, the unproportionate amount of spending for health care impacts the poor, potentially deterring them from investing in their futures, which only widens the wealth gap.

Health Costs Impact American Women

by Elena Perez

Published on July 30, 2012

1862 views

In America, 43% of women between the ages of 19 and 64 refrained from going to the doctor or taking medicine due to medical costs, according to a survey by the Commonwealth Fund. Health costs don’t just impact those without insurance: 32% of women with health insurance avoided treatment due to high costs as well.

These statistics are worrisome, especially since women use health care so much – especially as pregnant women or mothers that visit pediatricians with children in tow. Even when these particular visits are not taken into consideration, the Centers for Disease Control and Prevention found that women are still 33% more likely than men to visit a doctor.

Is Gardasil Mandated in Your State?

by Lisbeth Prifogle, MFA

Published on July 30, 2012

4650 views

Last week I reported on the controversy of the Gardasil Vaccine produced by Merck (it is important to note that GlaxoSmithKline also makes an HPV vaccine called Cervarix). Many women left comments which confirmed my statements and research with personal stories of their once healthy daughters who are now sick and disabled from this vaccine. This week I will look at which states are mandating that school children get the vaccine and one state that passed legislation for the vaccine to be given to children as young as 12 years old without parental consent.

As I stated in my op-ed piece on the Affordable Health Care Act, I am a libertarian. One of my main concerns about the government controlling our health care is mandated vaccines. To those who think that this could never happen, the simple fact is it’s already happening in our schools and in our military. While I’m a proud Marine, I’m ashamed of the fact that the government has been known to conduct ethically questionable experiments on our troops. In my opinion, vaccines are one of those experiments and rather than do they protect the patient, they ask will the people blindly take them?

While in the Marine Corps, I was vaccinated against every possible disease that there is a vaccine for not once, but twice, sometimes even three times (somehow my shot records never made it to my medical records, which I understand is common in the service). This includes the HPV vaccine, Gardasil. When I say it was mandated, I do in fact mean that I was forced to get these vaccines. Per the Uniform Code of Military Justice (UCMJ) my body was property of the US Government when I was in the service. You probably think I’m kidding; I’m not. During safety briefs before summer holiday weekends we were told to wear sunscreen (check out the dangers of sunscreen here) because if we got a sunburn while off-duty we could be charged with destruction to government property. Now, that was a little extreme and I don’t know anyone who was actually charged over a sunburn (although it wouldn’t surprise me), it was still true – we were government property. I tried to avoid the Smallpox vaccine and successfully did until we were at the airport terminal boarding the plane for Iraq, I was informed by our unit’s corpsman administering it, “If you don’t get this shot you can’t deploy.”

I sarcastically replied, “Okay,” only to turn around and see the Executive Officer (XO) standing behind me.

Not amused by my sarcasm, he said, “If you don’t get the shot I will charge you with disobeying orders Lieutenant.” He was dead serious.

Thankfully, I have not had any major complications (although the more research that I do, I think I have some ongoing side effects from the Gardasil vaccine).

State Mandates

According to the National Conference of State Legislatures (NCSL) school vaccine requirements are determined by individual states, a right which might be revoked now that states are mandated to enforce individuals to purchase insurance per the Federal government.

In 2006, the Michigan Senate was the first to introduce legislation (S.B.1416) requiring girls entering sixth grade to have the vaccine. The bill was not enacted. According to NCSL, “Since 2006, legislators in at least 41 states and D.C. have introduced legislation to require the vaccine, fund or educate the public about the HPV Vaccine and at least 21 states have enacted legislation, including Colorado, Indiana, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Nevada, New Mexico, New York, North Carolina, North Dakota, Rhode Island, South Dakota, Texas, Utah, Virginia and Washington.”

In February 2007, Texas Governor bypassed state legislation and made an executive order that all females going into the sixth grade had to get vaccinated with Gardasil. In May 2007, state legislators introduced and passed the bill H.B. 1098 to override the executive order.

The Virginia legislature also passed a school vaccine requirement for Gardasil in 2007. To see what legislation related to the HPV vaccines and information has been introduced to your state, see NCSL’s chart here.

No Parental Consent Necessary

Can it get worse than mandating parents to give their kids a vaccine that causes severe side effects and does nothing more than an annual pap can do to prevent cervical cancer? Of course it can. On January 1, 2012, California’s Governor Jerry Brown signed the bill AB 499 into law. It states:

“Existing law authorizes a minor who is 12 years of age or older to consent to medical care related to the diagnosis or treatment of an infectious, contagious, or communicable disease if it is related to a sexually transmitted disease. This bill would additionally authorize a minor who is 12 years of age or older to consent to medical care related to the prevention of a sexually transmitted disease. Time-critical preventive services for sexually transmitted diseases include the hepatitis B vaccine, post-exposure prophylactic (PEP) HIV medication (which must be administered within 72 hours of exposure), and the human papillomavirus (HPV) vaccine, which, if given prior to exposure, may significantly reduce the risk of certain cancers.”

How did we get here?

This is the easy part. Look at who is benefiting the most -follow the money. In this case, the makers of the vaccines are obviously going to benefit if their product is mandated by use of all children the age of 12-26 years old. Similar to when Texas Governor Perry passed the law to mandate the HPV shot shortly after Merck contributed $6000 dollars to his campaign (amongst other ties to Merck); in California, Merck donated $39, 500 to legislators voting yea on AB 499 according to Cal Watch Dog.

The cost of one shot is $120 and the vaccine is a series of three given over the course of a year. That’s $360 for every girl and boy who gets the vaccine. In most states insurance is mandated to cover this vaccine and there are numerous state and federal programs for those who do not have insurance. With all the side effects and even deaths from this shot, why wouldn’t politicians put those tax dollars to use providing un/under-insured women access to pap smears, a screening test that can catch HPV before it develops into cancer far enough in advance that fairly simple steps can be taken to stop cancer before it even develops? Why, because Merck and GlaxoKlineSmith can’t profit from preventing cancer that way. And how much has Merck made from the Gardasil vaccine? According to CNN Money, Gardasil grossed over $1.1 billion in the first nine months on the market. Unfortunately for Merck, the initial sales momentum has flattened out and is declining. The American public are obviously not buying this vaccine, so Merck and others are going to legislators and to have it mandated instead.

What can you do?

As I always say, GET INVOLVED. Get educated. Complacency, apathy and ignorance are how we got to this point (and Citizens United). Be wary of a bill that puts a private company’s profits above the safety and well-being of the individual, especially one that involves the health of your child. It is incumbent upon all of us to assess the safety and risks of any medication or vaccine before taking it.

Hormones Matter^TM is conducting research on the side effects and adverse events associated with Gardasil and its counterpart Cervarix. If you or your daughter has had either HPV vaccine, please take this important survey. The Gardasil Cervarix HPV Vaccine Survey.

Further Reading:
Gardasil: Miracle or Deadly Vaccine?
What about the Pap?