Let's look at all the things carriers and employers have doneover the last 40 years to try to curb the increase in both healthcare costs and utilization. They include (but are not limitedto):

1) The creation of networks

2) Implementing deductibles

3) Various forms and severity of medical management

4) Wellness programs

And when those didn't work, the carriers and employers (andtheir consultants) had the following bright ideas:

1) Narrower networks

2) Higher deductibles

3) Increased medical management and intervention

4) More wellness

And these continue to be the same strategies implemented today,some at an even more rapid pace.

Einstein once said "We cannot solve our problems with the samethinking we used when we created them.” Nowhere is this moretrue than in health care and health insurance.

So if what we have done isn't working, wouldn't it hold truethat we must either do something different? I propose thatall of these strategies were put in place with (mostly) goodintentions, but a very important step was missed that would makeall these strategies more effective.

We often talk about "consumerism" and "consumer drivenhealth plans," but the only thing the consumer is driving iscontinued cost and volume increases. Before any of these can ideaschange behavior, I believe there needs to be a fundamental shift inhow we think about health care and healthinsurance.

First, we need to understand that those two terms describe veryseparate and distinct things. The first is how we consume andinteract with the health care system; the second issimply how we pay for it. And we think about the latter completelydifferent than we do any other kind of insurance.

Allow me to provide a few examples. Have you ever been in asmall fender bender where you were at fault? Let's say youhave $1,000 worth of damage and your deductible is $500. Would youever consider just paying the full repair instead of making a claimon your auto insurance for fear of your rates going up or thecarrier possibly dropping you? Most would at least consider theoption. But how many of you have ever said, "It's just acardiologist appointment. I'll pay the $250 instead of making aclaim because I don't want my health insurance company knowing Imay have heart disease"?

Another example is when we have employees from our employerpartners call our office to complain. After happily paying a$10-$15 copay for a generic drug, one day they realize it has beenon the Walmart $4 list all along and, had they paid cash, theywould have paid less. Yes, they get mad at their insurance company,because the pharmacy charges more when using insurance. Where elsedo we get mad at someone paying the bill for us because the vendorcharged us more, simply because they know someone else is footingthe bill?

In the same line of thinking, patients also direct frustrationat the insurance company when their prescription copay goes up,failing to realize that this is usually in response to what isoften a doubling or even tripling of the drug price by themanufacturer and, in most cases, the insurance is picking up alarger percentage of the cost even at the higher copay.

The American patient wants to do whatever their doctor suggests,and feels that cost (and quality) shouldn’t be an obstacle orconsideration. And I wish it weren’t. But now that wehave the most expensive health care system in the world, and onethat is ranked last among industrializednations (and some third world nations too), isn’t ittime we considered this?

The strategies listed above have had other negative impacts, aswell. The leading cause of bankruptcy in the U.S. is medicalbills, and nearly two-thirds of those filing for bankruptcy hadhealth insurance. If insurance doesn’t protect us frombankruptcy, what good is it? It is still necessary becausewithout it, we would never get treatment for many conditions likecancer, or heart disease (a heart attack, yes, but not ongoingtreatment and care). Further, the deterioration of benefitshas led many covered Americans to delay care, thereby increasingthe likelihood of major diagnostics or procedures beingrequired.

The most common reaction to the rising costs (both premiums andout of pockets) or the worsening of benefits, or the increase inthe insurance company meddling with the care we receive, is to getangry at the insurance company, or in some cases, ouremployer. But rarely do we ever look to the health caresystem, and even less frequently, to ourselves.

I think a major shift in thinking has to occur before we can getto the root of the problem. And if we don’t do it soon, thegovernment will have no choice but to step in in a way thatmakes Obamacare look like child’splay. I believe our current system is the rightone. I believe in the employer-employee relationship forhealth insurance. I think this type of market provides forthe greatest opportunity for advancement, innovation, quality andefficiency. So why are none of these things occurringnow? Simple: The consumer (in this case, the patient) is notmaking demands before allowing any money to be spent (either bythem or their health insurance company). Conventional wisdomwas that the creation of networks would reward the providers thatmet these metrics, but here is the problem with that thinking: Thepatient did not stop using those providers, and if their carrierdidn’t have the provider they wanted in the plan, they would switchto another carrier that did. And if the carrier tried to dropthe provider after members were enrolled, the members yelled andscreamed at the carrier and threatened to switch.

Please do not take my message as a defense of the insurancecompanies. Our health insurance system is also of relativelylow quality and very high cost, which is simply reflective of whatit is paying for. My theory is that the health insurance weall deal with is a result of the problem, not the cause of theproblem. I propose we need to fix the health care systemfirst, then we can fix the health insurance system. Most ofwhat the government, the employers and the country has done hasbeen the opposite.

Let’s start a revolution. Let’s put even half of theeffort into determining total cost and quality of a hospital,surgery, or MRI that we put into buying a new refrigerator, orfinding a new restaurant on Yelp. Admittedly, doing this inthe current environment isn’t easy. And it won’t be until theinformation required to do so becomes more readily accessible; butthat information will not become more readily accessible until wedemand it, and refuse to have money spent at providers that do notshare that info. But once we demand and reward providers fornot only sharing it, but excelling at raising quality and loweringcosts, this can have a profound impact on our healthcaresystem. A recent article by Leah Binder, CEO ofLeapfrog Group, that publishes data for free on quality ofhospitals, highlighted a hospital in Seattle that’s already doingthis. And the data shows that this hospital excels in bothquality and efficiency.

I know that when a health event occurs, we are vulnerable, andsusceptible. And when this happens, we have the most on theline, both financially and physically. I say it’s time wetake responsibility for that and make better, more informed choicesbefore the ability, and the benefits of doing so, are completelyremoved from us.