© 2007 Dr. Dale Peterson & drdalepeterson.com

One of the saddest commentaries on the state of what is euphemistically referred to as “health care” in the United States today is the frequency with which the above question is asked. It is asked by approximately three out of four people who are considering consulting me about a personal health challenge. That insurance coverage should be the primary consideration for anyone is shocking. That it is the primary consideration of 75 % of the sick population is appalling.

I am well aware of the fact that most people live paycheck to paycheck and stick to tight budgets. I am also aware that people generally obtain items they value within their budgetary constraints. It is rare to speak to an individual at any income level that does not subscribe to cable or satellite television service, for example. Many people consider a cup of coffee from Starbucks or Java Dave’s a daily necessity. One need only watch the checkout line at a convenience store or supermarket and observe the items being purchased to recognize that nearly everyone does some discretionary spending.

It is therefore quite remarkable that insurance coverage is of primary importance when it comes to restoring and maintaining one’s health. After all, an old adage states, “If you haven’t got your health, you haven’t got anything.”

In a sane society other questions would be at the forefront. Questions such as, “Will the doctor listen to me?” “Will the doctor take time to seriously consider my health challenges and develop a step-by-step plan that will help me get well?” “Will I experience a long wait before being seen?” “Does the doctor usually prescribe drugs with potentially serious side effects, or will he or she attempt to address my health issues with measures that are less toxic.” “Will the doctor work to identify and correct the root cause of my illness, or will he or she just treat the symptoms?” “Does the doctor generally request a lot of lab tests that will significantly increase the cost of my visit?” or “Do most people who see the physician get better after a few visits or do most of his or her patients continue to be seen every month or two for prescription renewals?”

The bottom line for anyone experiencing a health challenge should be, “Will I get well?” not “Will my insurance pay for the cost of the treatment?” That people are willing and eager to pay exorbitant prices for risky procedures simply because they are covered by their insurance is a travesty.

The degree to which health insurance has come to be viewed as a necessity – even as a right – is quite amazing, considering that forty years ago less than half of the people in the United States had any form of medical coverage. The passage of Medicare and Medicaid by Congress in 1965 changed medical care from an option to a necessity and from a privilege to a right. It also set the stage for a rapid escalation of medical costs, a condition that continues to this day.

In 1965, the year governmental health insurance was introduced the total costs were $40 billion and made up 6 % of the GNP. In 2004 total health care costs were $1.9 trillion and 16% of the United States’ GNP. No end to the cost escalation is in sight; it is predicted that by 2012 health care costs will comprise 20 % of our GNP!

To a great extent rising health care costs can be blamed on a system under which individuals do not perceive themselves as paying for the services they are receiving. Medicaid and Medicare recipients do not generally care how much a medical procedure costs – as long as it is a covered benefit. Individuals with employer provided health insurance do not question the cost of an office visit or a prescription drug, only the amount of their co-pay.

Very few employees today view the cost of health insurance as a part of their salary. It is simply something that their employer is “required” to provide. This was not always the case. Employer-provided health insurance coverage is, for the most part, a by-product of governmental wage-and-price controls, which were instituted in the 1950s to control inflation. Since employers were forbidden to increase wages they sought innovative ways to attract and retain quality employees. One method was to provide the employee with “free” health insurance, which did not fall under the wage controls.

While the employees who were caught in a wage freeze recognized that their employer-provided health insurance was a part of their salary, today health insurance is something every employer is expected to provide. It isn’t viewed as income. When it comes to compensation the average worker looks at one thing and one thing only, his or her take-home pay. Income taxes don’t exist and health insurance is free.

The irrelevance of the price of a medical service to the individual receiving that service has a high price tag, however. The cost for businesses to provide health insurance to their employees has risen 87 % since 2000. The average employee contribution to health insurance costs has jumped 143 % over that same period, during which the cumulative rate of inflation was only 18 %. It is predicted that health insurance costs will exceed profits for many companies next year, placing them at risk for bankruptcy.

It is a little known fact that the average retiree in 2007 pays a greater amount in out-of-pocket medical expenses, adjusted for inflation, than someone over the age of 65 paid prior to the passage of Medicare in 1965. Fidelity Investments estimates that a couple retiring today will need $215,000 in savings just to cover the cost of their Medicare premiums, co-payments, co-insurance, deductibles, excluded benefits, and out-of-pocket prescription drug costs. The estimate does not cover the cost of over-the-counter medications, dental services, or long-term care. Someone relying upon Social Security will spend 50 % of his or her income on health care.

For many years I have chosen to forego medical insurance. It is not a course that I recommend to others, but I do so for very specific reasons. Understanding those reasons will hopefully allow you to have your cake (health insurance) and eat it too (actually be healthy).

Reason number one: Health insurance is not health insurance.

What our society calls “health” insurance is actually “disease” insurance. There is a vast difference between the two. Health cannot be insured, it can only be nurtured. I have chosen the latter course. I drink purified water. I eat real food. I exercise my muscles. I take a wide array of nutritional supplements to support my body’s needs. I use electromagnetic protection. I do not engage in activities that carry a high risk of injury. I rest. I practice the presence of God in my daily life.

Few people do those sorts of things. They go about their lives secure in the knowledge that when (not “if”) they become sick their health (disease) insurance will cover the cost of treatment. Joint pain & stiffness, loss of energy, loss of hearing, & declining vision are just the price of growing old. Heart attacks, strokes, cancers, and the like are just the result of having been dealt a bad deck of genetic playing cards or having poor luck of the draw. Adverse effects of medications or poor treatment outcomes are something they “just have to live with”.

Reason number two: Health insurance discourages the use of “non-traditional” treatments

A gentleman who came to see me while I was still engaged in the third-party system of medicine is an excellent example of the absurdity of seeking treatment solely on the basis of what one’s insurance will pay for. The man was in his mid-sixties and had been found to have a relatively minor narrowing of one of the arteries that supplied blood to his heart. He was not in imminent danger of suffering a heart attack, in fact he was an ideal candidate for a non-invasive approach to prevent further narrowing of not only the artery supplying blood to his heart, but to his brain and other body tissues as well.

After I had explained his situation and outlined a regimen of diet, activity, and nutritional supplementation I believed would be highly effective in addressing his condition he asked, “How much is this going to cost?”

“The dietary and activity measures don’t need to cost anything above what you’re already spending,” I replied. “The nutritional supports will cost about $60 each month.”

Without further thought he informed me that he was going to have a coronary bypass operation because his Medicare HMO would cover 100 % of the cost. Nothing I had to say could change his mind.

He underwent coronary artery bypass grafting, a procedure with significant risks and potential complications, to address one narrowed site in one artery. He “saved” $360 in annual out-of-pocket expenses on nutritional supplementation. A year later he suffered a major stroke when a vessel supplying blood to his brain became blocked – a vessel that would have been protected by the regimen I recommended, but was unaffected by his insurance-covered bypass graft.

I, on the other hand, made the decision years ago that I would not subject myself to a coronary artery bypass graft. I did so after evaluating the results of addressing coronary artery disease with diet, activity, and nutritional supplementation and comparing them to the results of coronary artery bypass surgery. I am convinced that the results of the non-surgical approach are superior in nearly all cases, and, since I instituted the lifestyle changes before I had a heart attack I do not expect to ever experience one. If I were to have a heart attack I would intensify my current regimen, not submit to a bypass graft.

Reason number three: Health insurance often drives people to spend money foolishly.

I recently saw a lady who had been advised by an orthopedic specialist to lose weight and improve her muscle tone to address a condition that was causing low back pain. She was going to physical therapy three times a week. The price of each session was $150, but the facility was covered by her insurance - sort of. Because she had a 20 % co-pay she was spending $90 each week – more than double the monthly cost of a health club! Since she did not need the ongoing supervision of a licensed therapist I recommended that she visit women’s fitness centers in her area and join one that could help her meet her goals of muscle development and weight loss.

I elected to purchase a home gym (equivalent to two month’s health insurance premiums) and now work out regularly without the monthly cost of a health club membership. Because the home gym is readily available I use it regularly; if I needed to drive to a spa I would be less likely to do so.

Reason number four: Health insurance encourages people to pursue therapies that offer little hope for improvement

Many analyses have shown that insurance payments are highly concentrated among a small group of individuals who have multiple chronic illnesses and consequently extremely high medical expenses. This should not be surprising, for while medical services in the United States are highly effective at dealing with acute illnesses or injuries they are appallingly ineffective in dealing with chronic conditions. An acute illness or injury is something that came on suddenly, requires immediate intervention, and has a high chance of cure. An example would be a heart attack or a broken arm. While the cost of treating an acute illness or injury may be high, it is finite; it has a limit. A chronic illness is a condition that has no known “cure”. Diabetes, osteoarthritis, and congestive heart failure are examples of chronic illnesses. Because medical services in the United States are ineffective in dealing with chronic conditions, their cost of treatment is infinite.

If an individual experiences the symptoms of a heart attack, health insurance covered medical treatment offers the best chance for survival. If, however, that individual develops congestive heart failure, a condition in which the heart is not pumping efficiently, treatments covered by medical insurance offer little chance of survival. Individuals who come to me after being diagnosed as having congestive heart failure commonly report that they have been told that they will be dead within six to twelve months.

Health insurance will pay for prescription drugs that ironically typically worsen the quality of life individuals with congestive heart failure experience. It will often pay for a heart transplant, which is said to cost over $300,000 the first year and $40,000 each year thereafter. Thirty percent of individuals die within five years of receiving a heart transplant and, while there are some long-term survivors, few live longer than 10 years. In many cases health insurance will cover the $250,000 cost of an artificial heart pump, even though the life expectancy of someone with an artificial heart pump is less than nine months.

Health insurance will not pay for exercise equipment, a gym membership, or supplements such as coenzyme Q10 or L-carnitine. About ten years ago I stood at the bedside of an individual who had been hospitalized with congestive heart failure and listened as a cardiologist (heart specialist) and pulmonologist (lung specialist) told him that his only hope was a heart transplant. If one was unavailable, he was told, he would be dead within a matter of weeks. Since the wait for a heart transplant is typically from 2 months to 2 years he had been given a death sentence.

Rather than accept their conclusion, the man elected to take coenzyme Q10 and increase his level of physical activity. He is still alive today and the quality of his life has been high. He continues to work full time. His annual cost of treatment has been approximately $1200, and he has not faced the risks of and adverse effects associated with immune-suppressing anti-rejection drugs. He has gained a great deal and he has given up nothing. Should his condition decline, heart transplantation remains an option.

Reason number five: Health insurance promotes an attitude of immortality.

I have observed that people who have health insurance do not expect to die. Health insurance, after all, is there to pay whatever it costs to fix whatever health challenge is present. This is evident from the fact that over a third of all Medicare expenditures in any given year are for services given to individuals who are in the process of dying. Do not get me wrong here. I am by no means advocating abandonment of people who are in their closing days, weeks, or months of life. I am not recommending that laws be passed to allow for “physician-assisted suicide” or euthanasia by any other name. I do, however, believe in allowing people to die outside of the confines of a hospital intensive care unit.

Death in the United States has become highly medicalized. It is, I believe, more unthinkable for a person to die at home than to be born there. Home deliveries, while frowned upon, are more acceptable in our society than home deaths.

Where is it written that no one should be allowed to die in the comfortable surroundings of his or her own home surrounded by family and friends as opposed to a hospital emergency room surrounded by strangers who are prodding every natural orifice and creating others with needles to establish IV lines? Who ordained that an individual’s life savings must be expended in one last desperate effort to stay alive one more day?

I accepted my mortality many years ago. It was thrust upon me in my late twenties as I watched a man my own age die of leukemia, despite the best efforts of modern medicine to bring about a cure. It was solidified a few years later when I buried my father in what should have been one of the prime years of his life.

This life is but a prelude to those glorious times the lie ahead. I have already exceeded my life expectancy, had I relied upon health insurance to save me, by nearly a decade. I don’t plan to stop living; I fully intend to be here to help my grandchildren grow into responsible adults, but I am not afraid to die. If I collapse, am unresponsive, and have no palpable pulse, I sincerely hope that I am in a remote area inaccessible to a rapid response team.

As I said earlier, I do not advocate refusing your employer-provided health insurance. If you have the option, however, I would highly recommend that you obtain a high-deductible catastrophic policy and open a health savings account. This will provide protection from the high cost of unexpected calamities while encouraging you to take measures to protect your health rather than waiting for a disease to appear.

I hope you take my reasons for choosing not to purchase health insurance to heart and begin to look at your policy as “Plan B”, a last resort, rather than your primary means of dealing with the health challenges thrown your way. Recognize that what you have is disease insurance and do your best to put yourself in a position where you never need to use it. Don’t let your health insurance coverage dictate your choice of treatment if a disease appears. Don’t spend money foolishly when options not covered by your policy are less costly than your deductible or co-pay. Pursue therapies that offer the most hope for improvement even if they are not covered by your health insurance. Finally, recognize that death is inevitable and approach it in the way that seems most appropriate to you not that dictated by our medically-conditioned society.