Rethinking Healthplans

Some time ago, I posted some thoughts here on the Healthcare system of the future. My point there was to emphasize that the mind of the patient plays the central role in healing, and that a doctor at best is a midwife in the healing process. The bottom line is that once it is understood that as Albert Einstein put it, we are a non-local being, having a local experience, or in the words of quantum physicist Amit Goswami, our universe is a world of downward causation, then it is obvious that the manifest world, including our body is an effect and not a cause. And therefore the Newtonian model of medicine that was adopted by allopathic medicine is categorically wrong, and is in and of itself the cause of the uncontrollable inflation in healthcare, because we are committing ourselves to solving a problem that is a priori incapable of being solved.

Structural decomposition of Healthplans

  • Level 1 is O&M: operation and maintenance. Like with a car, you cannot buy insurance for your gas (or electric) bills or oil changes. The concept of lifestyle medicine puts the personal responsibility of the patient central, and that first level of healthcare should be treated accordingly: it is the O&M of healthcare. Conceptually, it could be the membership component in a mutual (i.e. member-owned) insurance company, that comprises some expanded definition of primary care with a practice of lifestyle medicine and integrative healthcare, the focus being on what the patient can do for themselves. The primary care physician becomes your subject matter expert on navigating the rest of the healthcare system. Over time, the radical implementation of a Whole Foods, Plant-Based diet is the key to driving down the use of prescription medicine by 80% or more. This component could notionally be a contribution of $200/month, and that should include the administrative and legal end of the mutual society, which would also handle any malpractice cases for the patients, and the remainder of the premium should consist of the true insurance, which is covered by via re-insurance. Tax credits can make subsidize this portion for the indigent, so that everyone can afford it.
  • Level 2 is the actual insurance component: this part should be a zero-deductible insurance for medical interventions and drugs over and above the lifestyle medicine/primary care component. Here is where it is critically important that this is true insurance without deductibles. Deductibles were meant to incentivize patients not to abuse insurance, but in our system the patient already takes responsibility for the first layer, in lieu of a deductible. The key will be to work around the existing tax structure, so this level can be paid for by employers.
  • Level 3 is the problem area of “pre-existing conditions,” and the best way would be for this part to be socialized in some form and managed also with lifestyle medicine, which could probably shrink the pool dramatically, at least by 50% within year one. The example is the 80-year old mother of Brooklyn Borough President Eric Adams, who after being an insulin-dependent diabetic for years, weaned herself off of insulin and all her medicines within 3 months with a whole foods, plant-based diet. In other words, this legacy pool can be managed down, but the residual amount should be a social safety net, a sort of medicaid for all, so we don’t leave people dying in the streets, except if they so prefer.

The Tax and Legal Angle

Finally, there is the reality that healthcare is often paid for by employers, and the tax-code favors this, so it would be beneficial if Level 2/3 could be based on employer contributions, and again, paying for level 1 should be a tradeoff for deductibles. On this basis, it should be entirely possible to keep your insurance going if you are between employers. Under this model the member should be building equity in lower premiums in the future, so it would be of the essence to keep the same insurer for the long run.

There will undoubtedly many wrinkles and tweaks that remain to be worked out, but the above parses the problem into its logical components, where the insured takes responsibility over those things he or she can control and is insured for the things they truly cannot control. One of the many ways the current system fails is that by forcing the issue of deductibles or even denial of coverage to the wrong place in the chain, administrators interfere with proper care. Under the mutual model, the primary care physician helps the members making prudent use of health care services in a medically appropriate way. They are the subject matter expert supporting their patients, and helping them keeping costs low in an appropriate way. Plus they are backed by a legal department that can assist in negotiations.

In all, deconstructing the problem in these layers is the first step towards arriving at a sensible model.

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