Insurance Is Part Of The Problem, It Is Not The Solution

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The Institute of Medicine, a prestigious body, has released a new report building on previous reports issued between 2001-2004 which have all concluded that the lack of health insurance in our society is putting a lot of pressure on our current health care system and leading to skyrocketing costs. The current report concludes that when local rates of people without insurance are relatively high, even people with insurance have difficulty obtaining needed care.

According to the report, the number of people who have health insurance continues to drop, while employment-based coverage - the principle source of insurance for most Americans - is failing. The average amount of money that employees paid for year for family coverage has doubled in the past decade to $3,354 in 2008. The IOM committee concludes that if there is no intervention, the decline in health coverage will continue, costing the health care system more money down the line in terms of delayed diagnoses and poor outcomes.

My take is somewhat different. Here's why_

* I don't assume that increased health coverage automatically leads to improved health outcomes. Our system is currently clogged with insured patients who overuse their coverage precisely because they don't feel the pain in their pocketbooks. Recent studies have shown that it is these folks who unnecessarily fill our ERs, often with minor ailments. * There is a great and growing shortage of doctors, especially primary care doctors. Current medical school graduating classes average only 2 percent going into primary care. So who is going to practice all the preventative medicine that IOM has in mind by extending insurance coverage? * The current system of health care is far too intervention-oriented. This means that we wait until people get sick and then use our insurance coverage to absorb the cost of disease-modeled intervention. Did you know that over $460 billion - that's right BILLION - was spent last year in the U.S. on cardiac and vascular interventions. Until we transition to a real preventative-oriented model, where hospitals are NOT the focus, extending coverage will only extend the problem. * Making the system more prevention oriented is not a function of extending a generic disease model to more people. Instead, it means disruptive innovation, altering the system itself, with a new focus on prevention through the use of genetic technology, biotechnology, personalized medicine, and most importantly, increased development and use of screening tools that lead to catching a cancer or heart disease before it occurs, or at least before expensive chemotherapy or elaborate stenting procedures are required. * With the current managed care/employer-driven health model, there is no way to protect the patient/consumer from shoddy care. Extending that will only extend the shoddy care.

Let me give you an example of how the current system doesn't work - (as if you don't know it already from your own health care difficulties):

A producer here at Fox had an earache - he wanted to see his primary care doctor, but the doctor was all jammed up with patients. So he went to a mini-medicine mart, a doc-in-the-box, and was quickly given an antibiotic, and his ear has started to improve.

But ears are tricky, and are easy to misdiagnose or mistreat. I send many of my patients so afflicted to ear specialists. The producer may not have needed the antibiotic or he may need more care than just an antibiotic. Either way, I am wary of the care he received, and am concerned that in the end he could end up costing the health care system more money, and himself more aggravation, than if his primary doctor had been available. And keep in mind that his doctor WAS not tied up with the uninsured, but with the kind of coverage that IOM thinks should be extended to more people.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of "False Alarm: The Truth About the Epidemic of Fear"and "Bird Flu: Everything You Need to Know About the Next Pandemic." Read more at