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Why Health Insurance Keeps Getting More Expensive · Doctor Turned Health Coach

• 0:21
  Today, we're going to do a bit of a deeper dive into the cost of health insurance,
• 0:27
  specifically what you can do to protect yourself against a rising cost, and also,
• 0:34
  more importantly, prevent yourself from a financial catastrophe,
• 0:37
  because health insurance is now one of the leading causes of why somebody might
• 0:43
  file bankruptcy or might accrue a major credit card debt.
• 0:49
  So health insurance in the United States, and even in a lot of other countries now,
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  is a private entity, meaning it is something that private health insurance companies
• 1:00
  offer to the individual consumer,
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  and in return, you get medical care from a hospital,
• 1:09
  clinic, lab, or an imaging center like a radiology center.
• 1:14
  So, you know, the thing about health is that it has nothing to do with health insurance.
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  This is something I always tell my patients. Health insurance is not health.
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  And I know that sounds really obvious, but many people always say,
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  well, how am I going to take care of my health if I don't have health insurance?
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  What if I get hit by a truck? What if I have cancer? And these are people who...
• 1:42
  Logical, sane, rational individuals. They are entrepreneurs. They are teachers.
• 1:47
  They are parents. They know how to think through important, critical problems.
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  However, when it comes to health insurance, because the whole thing is so opaque
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  and complicated, they lose that ability to make sense of everything.
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  And they forget that developing cancer, ending up in the hospital,
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  getting hit by a truck, are really, really rare events.
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  And for such rare events to be this expensive in the health insurance model.
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  Unfortunately, that doesn't make sense. And that's why a lot of people are going
• 2:26
  without health insurance.
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  Now, some states are still going to penalize you for not having health insurance.
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  So there is a certain fee you have to pay, tax penalties, if you choose not
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  to have health insurance.
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  And this podcast isn't about foregoing health insurance.
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  Unfortunately, the majority of us are only going to be able to afford high deductible health plans.
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  These are health plans, sometimes labeled as bronze plans.
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  They're not gold, they're not silver.
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  And what you can get from them is a very high out-of-pocket expense,
• 3:00
  a very high monthly premium, and a high deductible.
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  Meaning you have to meet about $5,000, $8,000 for the year until your insurance starts kicking in.
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  And even then, for certain things, you have to meet a total out-of-pocket expense.
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  And now that usually falls somewhere in the $8,000, $7,000, $6,000 a year range. It's a lot of money.
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  And what are you getting in return for that? All you are getting in return for
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  that is somebody else paying for your healthcare.
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  You're not getting a doctor. You're not getting a top-notch psychiatrist.
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  You're not getting a top-notch cardiologist. You're just getting access to the
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  healthcare system, the insurance-based healthcare system.
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  Now, this healthcare entity, this health insurance entity has grown so big, so large, that every,
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  the majority of physicians, the majority of physical therapists and hospitals
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  and imaging centers and lab centers are all under the insurance umbrella. So when you do...
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  Go and search for somebody to pay cash, you have no access. You can't find that
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  person because that person is working for a large medical group who contracts
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  with a large insurance company.
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  So unfortunately, the self-insurance system is also limiting the ability for
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  our patients to get good care.
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  What they're getting instead now is a very short visit, a very fast visit,
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  and oftentimes a very defensive visit.
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  What I mean by defensive is the health insurance system has also created an incentive for people,
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  poor care, bad care, quick care. So instead of me spending 30 minutes with a
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  patient, really getting to the bottom of it and discussing all the options available,
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  I only get seven to 10 minutes because that's how much the insurance company will pay me.
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  And I will meet with this person, give them a few cursory options.
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  They pick one option and there might be a side effect from that option.
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  So of course, as a physician, I'm going to pick the safest option,
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  not always the best option for the patient, because the best option for the
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  patient may expose me to some malpractice risk.
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  So then the patient might sue me, which means I wouldn't be able to practice
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  medicine anymore. I would give up my medical license.
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  And these are all the things that physicians deal with. And it's only her harming patients.
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  And it's certainly not helping doctors. We don't want to practice like this.
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  We don't like this concept.
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  But if you were to open a medical practice as a physician, Generally,
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  the only people that are going to come to you are people who have health insurance.
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  And you know you're really not going to make a lot of money.
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  When you see one patient, the insurance company maybe is going to reimburse you $125.
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  That $125, half of that is going to go to your rent.
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  Half of that, and then another maybe 20%, is going to go to your staff.
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  Another 20% is going to go to your malpractice insurance. So it goes on and
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  on and on, and all of a sudden you're left with a very small profit margin,
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  which forces you to see many, many patients, which forces you to practice defensive medicine.
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  So the way we protect ourselves against the rising cost of health insurance
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  is by understanding that health is mostly in our own hands.
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  There are a lot of things that we can do on a day-to-day basis to prevent needing
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  any strong medications, antibiotics, surgeries, hospitalizations,
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  procedures, treatments, and even lab tests, even radiology tests like x-rays and CT scans or MRIs.
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  But this requires us to raise our general knowledge, to educate ourselves,
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  to raise our health literacy. When you raise your health literacy,
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  you realize that you actually don't need a lot of these tests that everybody's doing.
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  You don't need a lot of these medications that everybody's taking.
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  You don't need to go to so many different specialists to figure out what is actually happening.
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  One thing that a lot of people realize eventually is that a really good primary
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  care doctor who knows you,
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  who has the time to speak with you, who has the time to research your condition
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  can be incredible because that person can save you so much headache and time and effort.
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  And so you really wouldn't be having to use your health insurance all that much.
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  It's one thing to have to pay $500, $600 a month.
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  Yes, that's an absurd amount of money to pay every month for health insurance,
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  but it's another thing to have to then go to multiple specialists, take time off,
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  wait in horrible waiting rooms, pay another $8,000 out of pocket for the year,
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  pay more money for medications, then sit endlessly on the phone trying to get
• 8:00
  a certain treatment authorized that the doctor ordered, but the insurance company is denying.
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  Those are the things that we want to avoid.
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  So as health insurance costs go up, and they will continue to go up,
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  the way we can protect ourselves as consumers of healthcare,
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  aka patients, is by relying more on that one single physician,
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  that patient home, we call it, that one primary care doctor,
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  internal medicine doctor,
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  we call them internists, family med doctors,
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  you know, these people who are primary care doctors who really understand the landscape.
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  Now, if this person happens to have enough time for you and is in the insurance
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  model, great, that's still a fantastic person to partner up with.
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  What I've realized, what I've noticed, is that the only way to find a great
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  doctor like this is in the cash-based space. Somebody who is out of network
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  with insurance companies and will charge you out of pocket for their care.
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  An example is my own direct primary care practice.
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  I take on patients, they pay me a monthly fee, what I call a direct primary care practice,
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  and we develop a long-term relationship, and as long as they pay me,
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  that monthly retainer, which is somewhere around $150 to $200 a month,
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  they get unlimited access to me for their primary care needs.
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  Any tests that they need, any x-rays, CT scans, MRIs, lab tests,
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  referrals to specialists.
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  And of course, they can always use their insurance for those things.
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  But I'm a really good curator of resources. I know that if it's not necessary,
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  I'm not going to refer my patient to a specialist. I'm not going to prescribe
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  them a medication that they absolutely don't need.
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  And those are the things that we get to decide together because I have the time
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  to have those deeper discussions.
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  And if you're going to go this route,
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  Remember that you always have to find a physician with whom you connect.
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  There are many people who may come to me and after a brief conversation,
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  both of us kind of realize, yeah, we don't really have the same personality.
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  We don't really have the same way of speaking and talking and we don't have
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  the same priorities when it comes to health.
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  So you want to find a physician who has the same priorities as you.
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  Looking in the direct primary care space, actually searching for that keyword
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  online is going to help you find a lot of such physicians. Now,
• 10:30
  my practice is completely virtual. It's online.
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  And the reason is I just want to make it easy for my patient to connect to me.
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  They don't have to make a big drive to come and see me. But you can also find
• 10:39
  direct primary care doctors locally in your area.
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  So no matter what you choose, remember, health is not the same thing as health insurance.
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  And while you have health insurance, a much more powerful tool is a physician
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  in your corner who's going to know you and make the best decisions on your behalf.