The film John Q, starring Denzel Washington, was a compelling story that raised awareness over the cracks in the US healthcare system when it came out 20 years ago. Sadly, in this case life really does imitate art. As we all know, most medical procedures are dictated by what the patient’s insurance will actually cover. This mandate for parsimony was highly publicized during the healthcare maintenance organization (HMO) craze of the late 80s and 90s, where people were purportedly dying while waiting on insurance companies to decide whether to pay for a lifesaving procedure.
In any other field, the client would simply opt out of their insurance – but healthcare is about social culture as much as culture of practice. There is an obvious problem when the first question asked by a provider of a health service is: “What insurance do you have?” If your answer is “I don’t have insurance, I’m going to pay,” be prepared to be looked upon as a vagrant with no identity. The damaging reality is that it is seen as taboo to not have insurance and that many medical providers simply have no idea of how to handle a self-pay. But, if we are going to encourage a market in this space then we need to embrace the opportunity provided by that self-pay option and that will mean breaking the stigma around going ‘uninsured’.
The industry view of the ‘insured insider’ versus the ‘uninsured outsider’ is a destructive binary that has only emphasized the monopolistic narrative insurers have over healthcare. The millions of real life experiences that echo the John Q story show how deadly that can be. We’re now in a position where technological advancement can endorse the ‘uninsured’ option and make pay-as-you-use healthcare a valid and effective alternative option.
A huge factor in realizing this will be meditech, or, more accurately, what healthcare can learn from use of technology in other sectors. Over the last few years I have worked to make better medical media, whereby patients are able to better understand and work with the diagnosis and medicines they are given. This is key, as is other technology – from monitoring apps, to non-proxy appointments via skype – all will lower the barrier to entry while making healthcare safer and better for all.
The advent of digital technology when it comes to monitoring and gauging your health and how that can inform your financial data and expenditure will also inform the types of healthcare people can access as and when needed, replacing the need for constant coverage. We’ve already seen how fintech has transformed personal finance – the fundamental provisions are nothing new, what’s revolutionary is that the barrier to accessing bespoke products has been removed: individuals can now tailor their finances without having to buy into one-size-fits-all programs.
Already we’re replicating this in Medicare. For example, by replicating personal premiums for unique travel events in our day to day lives, or by designing healthcare programs for small businesses that deal with very specific hazards on a regular basis. I don’t doubt for a second that blanket health insurance will always be attractive, especially for families, but for those nearer the margins of our healthcare coverage a ‘Netflix’ approach could help lift millions into better care; making them more able to contribute to society and pay back the coverage the state has had to provide previously.
The current ‘insurance’ method cuts too many people out of the system – creating a limbo of those perennially required to pay back their healthcare at crippling rates. While, for those outside of healthcare coverage, illness has become more likely as they are unable to secure preventative care. By getting rid of the stigma of not having insurance and by creating viable alternatives that give people the freedom to pay as they go, we will not only make the sector more efficient, we’ll create a fairer and more responsive service without compromising quality of delivery. The right to be recognized and served as an uninsured patient will go hand in hand with the bespoke technical capabilities of medicine: Then we may finally find some constructive solutions to America’s healthcare crisis.