Disease perception+Invasive treatment+Triangle relationship

The bill requires the insurers to maintain 85% or more loss ratio seems to be a good idea at the first glance. However, this idealistic proposal without the consideration of American medical reality simply won't fly high. It will fail once this is put into the litmus test. First, American perceive health care as "disease combat" and rarely entertain the thought of preventive medicine or self care. This is just in the stage of opening up the mind and not yet mobilize into actual practice. Once the perception is shifted, it takes the commitment to build up a preventive care routine which is NOT registered in general American psyche yet. The preventive care or lifestyle make-over is a foreign concept in America until recent years. In general, Americans give too much power to medical providers. That might be translated into giving too much money to medical authority. First and foremost, this deep seated belief is challenged and in the process of being transformed. No wonder the medical community is uneasy of new trend and the public is lost. Because the old is gone and the new is not in place yet. The root of high cost and low performance is embedded in the metaphysical level regarding US health care system. We can not measure it scientifically but many are aware of its power now.

More invasive treatment per person in US than other nations: America is famous for its most advanced medical technology. There is nothing wrong in applying it to save lives. But under the current pay schedules, providers compete shares of the pie from larger fees. In US, medicare spend out proportionally in the last six months care for dying elderly than other necessary medical procedures. We need to discern that these invasive treatments are necessary or not, some of them are not applied in the adequate setting and drive the cost skyrocket. To provide the invasive and costly procedures to the dying patient without proper cause is debatable. Do the patients truly receive the benefit is questionable. Meanwhile, the health care cost is rising.

Then there is this triangle relationship between patients and care: Americans are conditioned to believe that gatekeepers are necessary entity. Without "middleman", some feel insecure. We as human beings do have the instinct of seeking the necessary remedy for our dis-eased condition. Do we need a middleman to keep us more healthy? Not so. I have lived in US for decades and encountered numerous primary care physicians ranging from OK to incompetent or worse biased. Mathematically speaking a straight line is the most economic way to solution. Why do we complicate ourselves with triangle approach? Quite a lot of middlemen get the kickback from referrals. One referral to the preferred specialist means more financial gains or favors. The gatekeepers become gatetakers. Sometimes, in the worse scenarios, the patients are deprived of their best cares because of their gatetakers. The unspoken code and hidden costs contribute to the higher specialist fees. In conclusion, administrative cost and margins of profit do deserve our attention. They need to be kept low and functioning. However, the insurers also need to make the healthy profit without greediness to keep the system going. Control of administrative cost and profit alone does not adequately address the high care cost and poor performance.