Competition: Healthcare Insurance, Crossing State Lines etc., etc.

To clarify the situation for political commentators like Bill O’Reilly, former presidents like Bill Clinton, all politicians at county, state, and federal levels including those ever-hopeful few running in the GOP race for Republican nominee in the upcoming presidential election, and anyone else dim enough to believe their rhetoric, COMPETITION DOES NOT WORK IN THE HEALTHCARE ARENA BECAUSE, BY DEFINITION, COMPETITION CANNOT LEAD TO BETTER HEALTH CARE.

This is so because the competition these bright lights are talking about is FOR DOLLARS. It’s not a competition FOR HEALTH CARE.Thus, it can only lead to the same health care, or perhaps worse health care, and to the 3rd party payer controlling individual patient’s health care, whether that 3rd party payer is private or public.

In the phrase, “let the insurance companies compete nationwide,” what are they competing for? They are competing for business, i.e., more people to buy insurance in their programs at their prices. How will they make any money through competition with other companies? By standard reasoning, those with the lower prices for “comparable services and product,” will attract more customers. Well, if insurance companies keep lowering and lowering their prices, how will they be able to keep up their MEGA-PROFITS? They won’t be able to keep it up. Thus, they will institute old and new dollar-garnering mechanisms, the ultimate effect of which is to directly interfere with clinical decision making within the doctorpatient relationship. Some of these are:

1. Increased premiums, just less of an increase than prior years, and thus realities like bronze, silver, gold, platinum plans. Perhaps O’Reilly and Clinton have crystal balls, which tell them just how much health insurance they need. Those of us, who are unable to breathe in the rarefied air of their stratosphere of spin, just don’t have the advantage of that future knowledge. Terms like the NO SPIN ZONE and WE’RE LOOKING OUT FOR THE FOLKS are sounding hollow and empty to me.

2. Increased deductibles. Gosh! Insurance companies can’t be expected to pay for everything! The patient has to accept some financial responsibility. Thus, deductibles thwart the patient’s instinct to go to the doctor via this financial obstruction. That qualifies as interfering with clinical decision making within the doctorpatient relationship! The patient’s financial responsibility should be satisfied by the premium payment.

3. Increased and more varieties of co-pays,
4. Spurious rhetoric like “cost-effectiveness” and “evidenced-based medicine,”
5. Shared decision making,
6. Medical homes,
7. Accountable Care Organizations,
8. Pre-existing conditions,
9. And on and on.

Much, if not all, of what health insurance companies do, whether it is called competition or not, including interaction with our beloved politicians, is designed to interfere with clinical decision making within the doctorpatient relationship. How can I say this? Because the doctorpatient relationship is the proximate cause of dollar spending in our healthcare system. If you control that, you control a yearly 2 trillion dollar gold mine. So, the doctorpatient relationship is corrupted by the 3rd party payer. This is my definition of socialized medicine whether the 3rd party payer is private health insurance or government.

The current American ethos is that the doctorpatient relationship exists for the insurance companies and other healthcare corporations to earn huge profits. That’s because in our system, the competition is over dollars.

If the competition were over actual health care, i.e., the existence of sound, ongoing, non-conflicted doctorpatient relationships for everyone living in America at a price, which by commonsense reasoning and correct knowledge of actual cost, is known to be fair, then we could achieve true healthcare reform in this country. Under this ethos, health care is the primary goal to be supported by the dollar bill as opposed to the reverse. Thus, with this new understanding, doctors and hospitals would make great efforts to assure that everyone living in their area, regardless of financial status, would have clear and equal access to sound, ongoing, non-conflicted doctorpatient relationships, as opposed to the current practice of shunning those financially strapped individuals with weak or no 3rd party payer support.

Moreover, a truly courageous leader could develop this system in which capitalism remains and greed is removed.

Although Obamacare is a farce, which needs to be repealed, the high-deductible health insurance plans with health savings accounts, which Republicans champion, are just as destructive.

NONE OF THESE POLITICIANS HAVE IT RIGHT. I DOUBT THEY WILL GET IT RIGHT! That would take true courage and leadership and a rejection of the process of bowing to the status quo, a rejection of the ridiculous rhetoric of healthcare consumerism, and a rejection of the notion that political commentators, politicians, insurance companies, or hospital administrators place the interest of the individual patient above his/her own interests and/or ideology or that of their business. If one of the GOP candidates were to adopt this new ethos, i.e., really believe it, accept it, and explain to the American people his plan of enacting it, I think he could be the next President of the USA.


1. a primary goal of health care: sound, ongoing, non-conflicted doctorpatient relationships for everyone,

2. funded by everyone contributing to a central payer: yes, an individual mandate– but it doesn’t have to be a law; it can be that each individual is solely responsible for the complete payment of any healthcare bill he/she creates– so, it is quite advisable to contribute to a payer, who controls pricing and administers total payment,

3. a central payer, which functions as a clerk for paying the bill; which has NO INTERACTION with the clinical decision making within the doctorpatient relationship; and which controls pricing by transparent and fair negotiation designed to achieve good profit for hospitals, drug companies, and other healthcare businesses but eliminates GREED, outrageous CEO salaries, and other unscrupulousness forced upon the American people by the business of medicine,

4. a change in malpractice litigation from a greed-driven assault on doctors and hospitals to justified investigations of individual cases,

5. removal of the rhetoric and manipulation of primary care doctors as gatekeepers, indeed suggesting that specialists replace primary care doctors for both “primary care” and that specialty care,

6. firm standards of nursing care within hospitals, including reasonable patient to nurse ratios; dramatic decrease in nonsense paperwork that nurses are required to do; and degree level of nurses, who will function as primary care nurse for hospitalized patients,

7. complete removal of employer contribution to healthcare benefits,

8. complete removal of the nonsense called generic medicines,

9. requirement for Advance Care Directives from everyone, which can include the directive, “Do Everything,” if that’s what the patient truly wants, after an honest explanation of how stupid and blind this directive is has been given to the patient,

10.  certificate of need for healthcare construction,

11. payment mechanisms and amounts for doctors, which are not only fair but which also remove any financial conflict of interest from his/her practice,


But no politicians and not many other people for that matter have bothered to learn about it. Why?

Because it would mean changing the status quo, removing greed, and accomplishing personal responsibility. We can’t have that! Not in America! So, we continue to elect politicians that say what we want to hear (something which we interpret as an advantage for ourselves) and then go about padding their own nests and making a career of sucking off the government teat.

Regarding health care, we have serious difficulties. Our medical care is very good, if you can afford it. But the increasing financial pressure on the American people to maintain the mega- profits of health insurance companies, drug companies, hospitals, and other healthcare businesses and, as well, to pay the burden for an expanding entitlement population cannot continue. The ridiculous sham, which is Obamacare, will greatly worsen this financial pressure for those who pay taxes and who buy their own health insurance because both payments are going to increase. And the answer from the equally ludicrous Republicans is high deductible health insurance plans with attached health savings accounts.

All the politicians want the same thing: The 3rd party payers to control health care, except of course for their own individual health care. If they get sick, they’ll be on the phone in a New York second getting a consultation from the best specialist available, while the goal of 3rd party payers, whether private or public, is to limit our access to the same.

No one is offering a solution because doing the right thing is too costly for them!

R. Garth Kirkwood, MD