The Nuances of Healthcare Coverage

Dr. Adam Tabriz

Health is a Right, personal, and Quintessential to Sustaining Life's Quality from nativity to departure. It is comparable to other Individual Rights, such as the food we ingest and the air we inhale. Still, some of us confuse 'Health' with 'Healthcare.'

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Health is fundamental and the most precious asset of every human being. On the same scale, it is also the most abused and costly thing to maintain in the modern sense. Healthcare is the most common empirical theme of human life for which one has to prepare perpetually; thus, from a business perspective, it makes it one of the most, if not the only, crowded markets in the world.

The healthcare market is desirable to corporations, even to those of non-medical entities. The latter is the upshot of the vacuum created by the misleading semantics, extreme rhetoric, and business-driven intentions around health and healthcare. Of course, realistically speaking, one doesn't need to blame the business of healthcare delivery, as it is nothing but reimbursing for a medical service based on quality, supply, and demand. But it is about the covert tactical and strategic plan embracing the particular service. The alternate mission serves as the driving factor for complexity, the vagueness of definitions, and, ultimately, the high cost of medical care.

Today, healthcare coverage merely refers to the 3rd party payment system for individuals' medical care when it should not be. In contrast, health has become equal to healthcare and the latter equivalent to coverage. Furthermore, healthcare coverage does not begin with health insurance, be it private or government-run systems.

Health is an Individual Right

There are countless health and wellness misconceptions, yet the biggest of all is that there is one way to be healthy. According to the World Health Organization —

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic, or social condition.”

But the question is how to maintain a healthy life?!- just as we need to eat food and breathe air or drink water to stay alive but not many have the privilege of even being able to put food at their table. Even today, with the significant advances humans have made in science and technology; still millions of people worldwide face starvation. That said, right is not something guaranteed for everyone, just as food is not always reachable. We also must keep in mind; the said individual rights are subject to limitations by a group of people or entities' collective actions. For example, air pollution created by industry or a group of citizens would jeopardize every individual's right to breathe.

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Our job and a food market monopoly would limit the accessibility of a particular skill set and employment on the one hand and raise the costs for food products on the other that will ultimately deprive food access to specific individuals.

Healthcare is a Necessity and a Privilege

Healthcare is a necessity and a privilege in today's socioeconomic structure, just like food to eat or under a shelter to live. Individual factors or social determinants drive Ever-growing health risks; we need medical care more than ever. But just like any other vital necessities, healthcare is not accessible, nor is it unconditional. Everyone has to contribute, in one way or another, to their medical care.

Some argue healthcare is a right, which is nothing but the dispute for specificity toward the utility of the phrase "right" in the healthcare arguments. When statements like "everyone has the right to healthcare" and "healthcare is a human right" are used, the usual implication is that healthcare is not currently a right in the U.S.

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Those who believe in healthcare as a fundamental right argues in various forms. For instance, they see it as the right to purchase healthcare or health insurance, just like having the right to buy food or hunt for food. Within the later framework, they see the right to get healthcare if someone is poor. Because in a typical socialized or welfare program in which healthcare Granted through assistance programs are having problems today, and you might have to lose your life savings and go bankrupt to qualify.

There exists the right to walk into a hospital E.R. and demand health care, but you'll get a hefty bill. What doesn't live is the right to health care, which will not put anyone into financial distress.

The irony of all said; is that in a socialized system of governance exists some oligopoly and bureaucracy. It is something that (as mentioned earlier) collective system takes away the opportunity from individuals from entertaining their rights based on their capability with one hand and tries to give it back through redistribution via the same monopolies. In other words, there are too many middlemen involved in the system with no humane and humanistic traits.

Even the U.S.'s original documents underwrite the rights as the one given to us by a Creator or god. Of course- some citizens may not believe in the ultimate creator and base their opinion solely on their personal or collective conscience. Still, the constitution's right to healthcare is not apparent unless it can be considered a part of the charity. Based on what was outlined, there is a significant semantic and perceptive gap between what a right is and if healthcare is a right.

The 1948 article 25 of the United Nations Universal Declaration of Human Rights states that everyone has a right to a standard of living adequate for health and well-being. It explicitly mentions medical care, yet that does not outline that we cannot obtain a "right" at the involuntary cost to others through collective action. Therefore, since medical care depends on working people, then it can't be free. To mention, if healthcare is to be considered as a "right," medical care would be competing with other types of civil rights, such as the "right to education" and "property rights," and will face scrutiny once the question of care fairness arises. For example, should smokers have the right to taxpayer money for lung cancer treatment? — or Do sexually promiscuous people have a right to group resources for HIV treatment?

Can citizens demand the other community members to pay for the consequences of our behaviors?

Irrespective of personal spirituality, A human right is still a moral one, as applicable to every human being. Many reasons exist as to why healthcare can't be considered an individual right.

The definition of healthcare is subject to significant variation, whereas such variance is perpetually influenced by the culture, era, perception of the individuals in a community. Healthcare encompasses preventive care such as vaccination, public health measures, health promotion, and medical and surgical treatment of established illness in the modern sense. Does the so-called human right to healthcare also pertain to a request for bare necessities like clean drinking water and enough food to eat? Or does everyone in the world have a right to organ transplantation, cosmetic surgery, and infertility treatment?

For something to be labeled a human right, the minimum requirement should surely be that the right in question can be defined; however, it is not!

The cogitative basis of all individual rights has been eternally unsettled. Most people observe some good in maintaining the idea of civil and political rights. Still, it isn't easy to find any rational or practical basis for viewing healthcare within that framework.

Any rights held by an individual that indicate a duty on others can't be expected to be considered a right. Is it a duty on individual doctors, hospital authorities, governments, or only rich governments?

It is difficult to see how any outline of benefits can be termed a human right instead of legal entitlement when meeting such a requirement would impose an extreme burden on others.

To propose that healthcare as a human right is wrong-headed, but it is also burdensome to society, for the reasons that a mature dispute on the rationing and sharing of limited resources can hardly occur when voters start from the premise that healthcare is their right.

Healthcare and Misconceptions around its Definition

Healthcare is just the means we use to fulfill our right to stay healthy. The truth is that there are many ways to 'arrive' at health, and making the right decisions based on your value system is critical. The word "right" is often used in almost every healthcare argument; because the concept of a right is persuasive, passionate, appears naive, and presupposes a guaranteed win against any dispute. But as mentioned before, the right to healthcare can indicate many different circumstances.

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Providing healthcare rights requires the violation of other rights, moral reasoning, and complex allocation of resources.

Simple throw declarations such as "everyone has a right to healthcare" are trivial, and Arguing over such a statement is counterproductive. Instead, the most relevant quarrels such as precisely what will compose improving the path to satisfy health rights ultimately and how we will develop adequate resources to accommodate them are something on which legislatures and people need to focus.

A Few Blunders about Healthcare Delivery Conflicting with the notion of Individual Right

Even those who believe in healthcare as being a right one can observe conflicting policies and attitudes. For instance:

  1. Political leaders have a significant influence on the healthcare industry and vice versa, representing excessive meddling in how healthcare is appropriated to citizens.
  2. The connection between quality and cost in healthcare is counterintuitive, even though higher-quality care may lead to lower healthcare costs for the populace. But it doesn't reduce the value delivery system's value, indicating the healthcare industry is riddled with monopoly and unilateral legal kickback practices.
  3. High-tech tools lead to better care, as technology can provide real advantages to patients. Still, in many cases, new devices only increase costs without providing health benefits for the same reasons as the previous argument. The quality of care is not determined based on direct patient encounter in an open competitive environment. For instance, the price of medical devices is maintained high through various red tapes and intermediaries.
  4. Every patient craves all treatments that could help them. But High-deductible health insurance and the developing significance of patient education mean fewer patients want every treatment accessible, which that Means; educated patients are more likely to agree with their physicians if convincing evidence is provided. Although the latter argument is valid nonetheless, in practice, it would only prevail if patients and physicians are also engaged in determining the quality and value of care, including deductibles. But in real life, that is not the case. In many scenarios, especially in managed care systems, even the most educated patient is deprived of services recommended by their doctors simply because the payer disapproves of such use.
  5. Physicians shouldn't be disturbed with the cost of medical treatment or that worrying about costs is immoral. However, that isn't the case today, as Protecting patient's resources is part of every physician's responsibility in taking care of them. The idea that physicians must pick up the burden of increasing costs that have been created by the bureaucrats, mediators, and 3rd party payers is nothing short of absurdity, hence more counterintuitive to consider healthcare as a right.
  6. Population health management is equivalent to rationing. Population health management and value-based care pertain to making vigilant choices. Physicians are not in the business of rationing but should eliminate high-cost treatments that don't improve patient outcomes. The said notion is arguable because population health is about the most feasible remedy for the majority within a given community. Then again, is against the concept of individual autonomy and human right.
  7. It's unlikely to get patients to change their behavior unless there's a societal connection they can identify with; they will be more willing to change. But the problem with this theory is that we would be sacrificing the individual right to the collective thinking of the others. That is not an individual or human right unless the concept's proponent has a different impression of what is right.
  8. Physicians exist to produce health and fix ailments; Doctors should not just be focused on healing the sick, as some scholars and bureaucrats believe. They need to work on prevention and align their efforts with population health management and value-based care goals. It would only be valid if healthcare quality and value were determined by doctor-patient encounters instead of the insurance administrative and government offices.
  9. Doing financially well means doing more, they say. And Now that Healthcare has commenced shifting away from fee-for-service, "doing well financially as a society means providing better service to patients. Those also believe in doing better outcomes and preventing illness wherever we can (of course, based on social factors). Yet again, it would be true if doing more would be based on individual circumstances rather than covertly determined fictitious criteria by the administrations.
  10. The future of healthcare is harsh. Despite challenging times, the healthcare industry is poised for success, which deserves asking the question- Whose success? -and what is the definition of success?

Let us not forget that we can never bring a right at the expense of others, their rights, or other human endeavors, especially regarding healthcare coverage.

Health Coverage is not Healthcare.

Healthcare coverage is one of the multiple instruments one can wield in the healthcare environment while accessing medical services. Some think healthcare coverage equates to healthcare, and in turn, represents health. That is a big mistake!

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One clear example is the affordable care act (ACA), which theoretically provided healthcare coverage for everyone but not equivocal healthcare.

For most people in the health policy world, the word "coverage" carries distinct emotional leverage. People without health insurance coverage, some believe that, is one terrible crack in disability and poverty. Accordingly, most politicians, scholars, and activists wrongfully speculate that promoting healthcare coverage is more important than any other policy objective. But health insurance is numerous and different. Millions of Americans think they have "health insurance" yet don't have access to health care when they need it. If Obamacare stays as the central healthcare policy, the problem will get worse. Private healthcare companies looking to maximize revenues at any cost — just like mainstream companies like Apple

Health Coverage Comes in many shapes and forms but is divided into three significant categories.

Healthcare coverage primarily refers to how a patient can pay for the necessary medical services. It is not merely about 3rd party payers, nor is it about how they come up with making that medical service affordable. Insurance companies are receiving too much credit for their participation in public health when, in reality, they deserve none because all are just another for-profit business entity. The one enjoys legal protection for the monopoly and extorting the public, particularly when they partner up with the Government.

One can obtain Healthcare coverage in cash or direct pay model through payment to the private insurance premium, whether the Government subsidizes it or not, or only via one hundred percent taxpayer government-run insurance program. The three major categories are simplistic. We can find the various hybrid variations of healthcare coverage across those spectrums in many countries. All latter can only work in one way or another, under transparency, free-market economy, and compatible Constitutional framework. But unfortunately, one can scarcely see that happening given current bipartisan political motives.

Healthcare Coverage doesn't have to be expensive.

The high cost of healthcare involves everyone, irrespective of being sick or well. Increased healthcare costs have wounded individual spending capability over the past few decades. Salaries for American workers have risen, but the medical expenses have gone up by more immense proportions, primarily because of bolstering tolls for health insurance.

Some blame increasing costs on Multiple Systems' nature of healthcare like the Administrative costs, medications, physicians, nurse's salaries, and for-profit hospital schemes. Others castigate high costs on defensive medicine and variation on prices in the United States. Although these are relevant arguments, they are the symptoms of a faulty system rather than the cause. They all share one common denominator: lack of transparency and universal accountability within the system, along with the corporate legislative privilege of being carried weight as a person but holding the financial, political, and administrative power of many people. Most of all, within such personification, we must blame the unfair lobbying power.

Direct Primary Care and its emergence amid increasing Healthcare Costs

In the recent decade, a new cash system for service has become prevalent mainly to pay the physicians for the care received directly, primarily based on a free market criterion called Direct Primary Care (DPC).

The prototype has revolutionized healthcare by permitting patients to pay the physicians for the care received directly. Hence, they eliminate insurance from the billing process. The term DPC encompasses various healthcare delivery systems based on financial relationships between the patient and the doctor.

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The Direct Primary Care model is more than just reimbursement. It's an indication that physicians are beginning to step out of the woods to find ways to satisfy patients' criteria while maintaining personalized care. Later is the most important and valuable aspect of this model.

Third-Party Payers of Healthcare Coverage are for-Profiteering

The corporations take over the U.S. health system that includes the insurance industry. Today they are the epitome of the ancient great European monarchies holding power to control the rules under which they operate and to funnel public resources in any way they wish. The latter statement is not a prediction of what will transpire in the future, as it is a statement in the current state of dealings. Corporations have effectually apprehended the United States. They have taken over its judiciary, political system, and national wealth without assuming any of the responsibilities of dominion. Evidence starts with the insurance industry CEO pay. Executive compensation is an exposition of the unadulterated power of enterprise embodied in the chief executive officer and state power. The latter's influence, in turn, is represented in corporations. As of 2020, The Net Worth of UnitedHealth Chief executive officer Stephen J Hemsley is estimated at $324 Million. He owns over 229,012 units of UnitedHealth (UNH) stock worth over $233,099,209, and over the past 17 years, he traded UNH stock worth over $83,629,044.

Corporatocracy is the country's economic and political system, and today, the world is controlled by corporations or corporate interests. It is, indeed, a form of Plutocracy, commonly placing them in influential critical positions in the political system for explanations of bank bailouts, excessive Executive pay, and complaints such as the exploitation of national treasuries, people, and natural resources. Such an advantageous position of corporations ensures their power to manipulate the market and socioeconomic milieu to their benefit, turning benign profit-making healthcare into a realm of profiteering and extortion.

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Unfortunately, the U.S. healthcare system is established on a third-party payer scheme run by the same insurance industry, causing healthcare spending to soar at the sole discretion of the corporations. For instance, when patients are isolated from the premium costs through non-disclosure, they won't be able to take the coverage price into account when considering whether or not to purchase that coverage. That meaning; the standard supply-demand price mechanism isn't going to function; therefore, in the long term, prices will escalate, something in line with every insurance industry's financial strategy.

Government-run Health Programs are Corrupt

Bureaucracy invites corruption, something which is the way almost every Government functions — the more effective the government administration, the more prevalent and expansive the corruptness of the system. With today's healthcare complexity, big Government is inevitable. That deserves particular attention when a community is seeking a single-payer system of healthcare. Naturally, those who are pro- single-payer systems would argue how the Europeans have succeeded with the government-run health programs. We can offer the answer in three parts: Since the United States has always been a consumer-driven market, expectations are much higher regarding the quality of care and timeliness of delivery. That is something government-run programs will never be able to guarantee. Two- European or Nordic systems are constitutionally prepared to impose strict price control and fixing without being vulnerable to being meddled by the corporate lobbyist's scheme as it happens in the United States. Three- let us not forget again; healthcare coverage is not equal to Quality healthcare for all. Eliminating bureaucracy, corporate entities' personification, legal kickback exemptions from corporations, intermediaries, and proper establishment of complete transparency and accountability are the best initial initiatives towards better quality, lower-cost medical care.

Health Insurance Companies are Middlemen who, in turn, promote Corruption.

Undoubtedly, healthcare is laden with high-risk hypotheses with unpalatable results. What makes it complex is the business-driven initiatives of the corporate lobbyists and policy-makers who utter the Government's decisions. With copious, financially inspired multitudes in the healthcare industry, certain prejudices and conflicts of interest endure. Health insurance companies collectively fill the role of moderating healthcare costs between the businesses and the patients at the expense of premiums, deductibles, and copays. Hence incentivizing them to maximize profits; minimize expenditures as much as possible when deciding how much to charge a patient, and reimburse a physician.

Logically, selling directly-to-consumer, whatever that may be, by way of direct payments to selecting premiums, allows for the cheapest pricing and makes it available to the most significant number of people. It merely eliminates "the middleman" who happens to profit off of the downstream patient. The latter is a scenario where results in a more expensive product due to multiple middle persons making money at various stages of the source to consumer. The simple direct-to-consumer model leads to consequences of middle-persons, products, and services being sold at a lower cost to purchasers with higher profits for the seller and benefiting the patients.

The final payer, i.e., the Government and taxpayers, compensates through various subsidies for what profiteering insurance companies are unwilling to pay while "the middlemen" come out on top with mammoth profits.

The Government and patients pay the sum of the most significant percentages of GDP worldwide to ensure the insurance industry's profits. For instance, with Obama care's idea without mandates (to contribute to the middlemen profiteering) to ensure everyone, an insurance company has no incentive to provide better care for a patient since they already know it will be more expensive.

Eliminating the middlemen, one can indeed redirect profits toward making healthcare cheaper.

Government Partnership with Middlemen is a Disaster

The United States has been dealing with Medicare for decades since its implementation. As of today, with intermediaries, we continue having challenges, particularly about medication coverage.

The insurance industry has maintained its stronghold by making Medicare beneficiaries and the Government dependent on their drug programs through Medicare part C or part D programs. They will not let the system cover its medication costs because it is merely a significant profiteering source.

The administration still hasn't implemented a reliable policy of medication coverage without roping in private pharmaceutical companies, FDA, and private insurance provider's monopoly.

Government healthcare programs, irrespective of shape and form, all require one thing: a total appropriation of healthcare by the Government with full authority, something that within the current partisan socio-political arena is close to impossible. In countries with low medication pricing, the Government has the control by the constitution to enforce caps on costs and regulate the market. And Until the administration does the equivalent in the USA, it will be a long-drawn crusade with medication cost and coverage. The outcomes will echo themselves on the legitimacy of Medicare and other government-run programs at the federal tier.

To be safe in the United States, the Government shouldn't entertain itself in negotiations with private profit-seeking parties because it predisposes the negotiating table with double standards and unfair deals that will only place taxpayers in jeopardy. So, we need to eliminate all double standards surrounding human health, Government, and politics.

By the Constitution, the United States' Partnership with Corporations is a Mistake

The corporations of the early era of the United States were very different than what we see today. They were introduced to Americans from Britain, bestowed as a royal privilege on specific organizations, or used to organize municipal governments. However, after the Revolution, the founding fathers had to decide what to do with corporate entities. They could abolish them utterly or find a way to democratize and make them synonymous with the spirit of independence and the federal republic's structure. They elected the concluding. So the first American corporations ended up becoming cities and schools, along with some charitable organizations.

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Accepting the corporations in a free market system by the legislature of the era was a matter of taking it or leaving it.

Post-Civil War, to prevent former Confederate states from infringing on freed slaves' rights, the 14th Amendment encompasses "equal protection" to all American citizens. Section 1 stipulates that this applies to all "persons." In an 1886 Supreme Court case about a railroad, the court's reporter, a former railroad president, declared that the justices agreed that a corporation qualified as a person. That served as the turning point of placing corporations in charge of individual freedom.

It is evident that in the late 19th century, far more equal protection cases were heard by the Supreme Court, where corporations were plaintiffs than freedmen. The court- not the legislatures or the Congress allowed the personhood distinction to slip away. Some legal scholars uphold the granting of personhood to corporations as a helpful creation since it will enable them to enter into contracts,

We cannot expect the administration negotiations to be productive until pharmaceutical and Pharmacy Benefit Management (PBM) becomes transparent with a proper cap on pricing for the citizens' benefit.

For-Profit on the Free Market is Okay, but biased Market Control is Terrible.

It doesn't matter who pays for healthcare coverage or how it is paid. We can use any form, such as cash, insurance, direct pay — all options should be voluntarily accessible through fair and competitive standards. We must eliminate restrictions and red tapes, wipe out bureaucracy, and monopoly in healthcare. The latter can only be through a bottom-up strategy since we can never anticipate obtaining the politicians' help if we don't enable individual citizens.

Empowered patients can demand what is right and just. Public demand will force politicians to align their mission with that of the patients. And finally, the Government can ensure free and fair competition by upholding the constitution and ensuring consumerism in the open market. It also needs to be stringent with public safety and fairness.

#healthcareisright #healthcoverage #healthcare #healthinsurance

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Adam Tabriz is a Physician, Writer, Entrepreneur, and public health policy, expert. He is an advocate for Personal liberty. The combination of his experience and expertise underlines his passion for advocating true “Personalized Healthcare” and “Healthcare without Borders.” His favorite slogan is: “Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

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