Thread by @tjwebbmd

There's this theory that "capitalism breeds innovation," so our healthcare system must be improved and advanced by the competition of private insurers.

It fails because it doesn't account for the fact that all innovation of insurance companies is directed at increasing profits.

https://twitter.com/pjputh/status/1490119504625553408

2/ Under our current model, there is no incentive- none at all- for insurance companies to innovate in the direction of improving peoples' health; not the health of their clients, and certainly not the health of others in our society.

3/ In most industries, if you get poor service or have deeply negative experiences with one company, you try a competitor. You can typically do it right away, even with other forms of insurance; I can switch from Geico to Allstate tomorrow if I want to.

4/ We all know health insurance doesn't work that way. Most people who have insurance get it through their job; if multiple plans are available, they are usually equivalent (no innovation to distinguish one from the other) and you have to wait until the new fiscal year switch.

5/ I've had many different insurance providers and I can't think of a single thing one of them did differently to try to improve my health; that's just not where they innovate.

But I also can't think of anything they did to try to keep or earn my business over their competitors.

6/ Some advertise, and some have unique client-facing services; but for the most part their market share depends on appealing to employers, not to individual patients.

So their first direction of innovation, "how to bring in more money," is all about corporate relationships.

7/ But their second area of innovation is the really insidious one.

Profit = Money Taken In - Money Spent.

In most industries I guess this means finding the right price points, then keeping things like supplies, payroll, and physical plant costs as low as possible.

8/ But in health insurance, the way to keep as much money as possible- and thus to maximize profits- is to deny services; to refuse to let go of the money you've gained in the form of premiums.

So the area insurance companies really innovate in is how to neglect their clients.

9/ Whenever single-payer health coverage is brought up, people raise legitimate concerns about bureaucratic inefficiency and incompetence leading to patient harm.

But in our current system, the inefficiency is deliberate; the harm is intentional, and devastatingly competent.

10/ And in this area, insurance companies are incredibly innovative. Ask any PCP; they can tell you really impressive ways insurance companies find to deny services, prescriptions, referrals; and to make it so difficult to get those things that many people just do without.

11/ Our system harms the poor and vulnerable by making healthcare a commodity; but it also deliberately harms those with coverage, because every dollar they spend on your health is a dollar they don't get to keep. And their whole business model is "keep every dollar possible."

12/ People worry about waiting months for an MRI if everyone has equal, fair access. My insured patients already wait months for an MRI due to deliberate and medically unnecessary barriers meant to save their insurer money.

My uninsured patients can't get an MRI at all.

13/ We spend more money on healthcare per person than any country in the world; it has never been about limited resources. Your doctors are waging a war on your behalf with insurance companies that see all of that money and want to keep all of it. A war with very real casualties.

14/ I don't mind waiting a few months for an MRI or a surgery because my neighbor is sicker than I am and needs those services first.

I do mind waiting because of someone else's greed, while my neighbor gets sicker and dies waiting. I mind that very much.

You should too.