Saturday, September 27, 2008

From Mangled Care to Direct Health CarING©

The process of health carING© is almost insurmountable in its multifaceted complexity, thus according to the rules of non-linear dynamics it simply can not be “managed”.

What can be managed, meaning rationed, are the ever-rising costs of such carING©.

“Managed care” is a primary oxymoron by default; in its present form is best described as
mangled care.

When originally introduced to our naive country and promoted by then ,and still, misguided and ill qualified Mrs. Clinton and her Jackson Hole Task Force, mangled care was, defined as:

" A prepaid risk-based system of integrated health care delivery, having appropriate capabilities to improve quality of care and manage utilization and cost of a given population.” (Thomas Morrow, MD., at NMHCC/IT Fall 1998, Los Angeles, CA)

These for-profit extremely profitable mangled care companies have embraced, and function under
divergent and practically mutually exclusive core values.

On one hand, these companies are obligated to provide rather than ration health care services.

On the other, their entire existence hinges on their
obligation and ability to generate consistent profits for their executives and shareholders.

More often than not, provision of appropriate health carING© and profit margins of mangled care companies come into direct conflict.

This conflict fuels a “double explosion” of the system: while availability and quality of health services goes down; costs of services to purchasers and profits of mangled care companies go up.

This abominable situation creates significant financial “counter-incentives” to provision of appropriate, accessible, affordable health carING© which can be gauged by the
divergence coefficient.

Such counter-incentives further negatively effect already financially squeezed powerless and frequently frustrated health providers.

In addition to divergent and conflicting core values, double explosion, financial counter-incentives and overall patient and provider frustration there is, what I coined, business disconnect.

Entire purpose for insurance, companies, HMOs and other "mangled" health care organizations existence is to grab as many pennies from consumer’s health care dollar as they are allowed to by the workers.

Business disconnects exist due to interlined logistical, financial, physical and ethical aspects of mangled health care:

•The recipient usually does not request, does not order, or pay for the service.

•The payor never requests, does not receive, nor order the service.

•The orderer does not pay, nor receive the service.

In order to achieve their business objectives, here are some of the strategies used:

•If someone is already paying a lot, let him or her continue.

•Even if a lot of people complain about managed care quality, it won’t contain cost.

•Never provide coverage unless the treatment is unpleasant.

•Quality is being in a waiting room with people who earn more money than you do.

Please visit
maintained by AFL-CIO for real life stories.

Despite such an unorthodox business model, they do grab a sizable chunk: 17 cents out of every healthcare dollar without actually working, being sick, or providing services.

Here are three of many “secrets” in health carING © that health insurance companies do not want health consumers to know:

• Health consumers can request and receive health carING© from doctors, nurses,
pharmacists, hospitals, labs, pharmaceutical companies, and others without mangled care.

• Doctors, nurses, pharmacists, hospitals, labs, pharmaceutical companies, and others can
provide health carING© without mangled care.

• Healthcare consumers can pay for health carING© without mangled care companies.

Only complete elimination of mangled care as the middle man, can generate enough money to provide appropriate, accessible and affordable health carING©.

Patient-driven health care model promoted by mangled care must give way to
direct health consumer-administered health carING ©.

I, for one, am willing to make a difference and show the way.
We are making a difference (MAD), you decide!

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