Rethinking Health Insurance

Health insurers have certainly been beat up in the past few months by the political candidates. In some cases, I think it's right, when insurers are withholding payments for legitimate operations that might save a life. But in other cases, I don't think health insurers are the only ones to blame.

Here is an article written by Dr. Pam Popper, nutritionist, naturopath and President of the Wellness Forum in Columbus, Ohio.

I think she is right on with some views on how insurance companies could easily become the real innovators in our move to a better healthcare scenario.

There is so much wrong with health care that it is almost impossible to fix the existing system. And, in my opinion, we are focusing on the wrong things and blaming the wrong organizations for some of our problems.

For example, health care reform often involves criticizing insurance companies for not paying for certain types of treatments. For the record, I'll state that insurance companies are guilty of many things and do their part to contribute to the poor state of health care today. But forcing these companies to pay for any treatment offered by drug companies and desired by patients may be causing our problems to worsen, not get better.

For example, I have written before about Avastin, originally approved for colorectal and lung cancers, and recently granted "accelerated approval" by the FDA for metastatic breast cancer. It's actually almost worthless for all cancers. Avastin extends life by a few months for colorectal and lung cancer patients, and about 5.5 months for metastatic breast cancer patients. The side effects, according to an article in The New York Times, include death. Offered by Genentech, the drug costs $92,000 per year. Genentech acknowledged in an editorial that it "does not claim that the drug is cost-effective for advanced breast cancer but believes it will be clearly worth the cost if shown effective in earlier stages of breast cancer."

In spite of this, Avastin has already been prescribed off-label to over 11,000 cancer patients with advanced breast cancer, and the recent FDA approval would increase the number of patients who qualify for it to 43,000. Genentech acknowledges that the drug only extends life for only a few months. Using half of the $92,000 annual cost of the drug (since patients are almost always dead within a few months), the revenues to Genentech for this drug have grown to a potential of close to $2 billion dollars per year. Where does the money to pay for this drug come from? Insurance companies and Medicare/Medicaid. And if some of our political candidates get their way, we will add universal health care coverage, meaning more taxpayer-financed reimbursement, to the pool of available funds.

This is not the only example. Billions of dollars are spent annually on unnecessary back surgeries and other procedures, mammography and other useless diagnostics, as well as drug treatments that are completely ineffective, and often hurt people. Can you blame the insurance companies for refusing to pay for this?

Unfortunately, the insurance companies also deny reimbursement for treatments that do work, such as dietary intervention. They've thrown the baby out with the bath water, attempting to deny coverage for anything different or progressive.

Insurance companies are in a great position to be innovators in the health care field if they decide t do so. They could develop policies for people who choose to practice dietary excellence and optimal habits, and reimburse these people for the counseling and other support needed to learn how to do so. There is evidence that this will work, and can save enormous amounts of money. The average patient who gets bypass surgery spends $86,364 over a 5-year period; the average patient who has angioplasty spends $63,897 during a comparable period of time. A consultation with Dr. Esselstyn (who has an excellent track record reversing cardiovascular disease through dietary intervention) costs $500; a membership to The Wellness Forum, complete with books, CD's and DVD's costs only $221. Reimbursing for these types of services and refusing to pay for bypass surgery and angioplasty unless the need is clearly demonstrated (it rarely is) would result in huge savings for both private carriers and Medicare.

I'm not upset with the insurance companies for saying enough is enough as it pertains to reimbursement for medical services that do not work. And I do not think universal health care, which will result in all of us as taxpayers shouldering more of the burden for useless diagnostics and treatment is the answer either. The answer is to continue to educate people to make different choices, and to target the purveyors of misinformation as the real culprits - our government, national health organizations, medical schools, unenlightened doctors and others who continue to promote ineffective and harmful treatment.