'Coverage' Isn't 'Care'.

• Author: Smith, G. Keith
• Position: GUEST OPINION

If you are following health-related topics on social media you have likely encountered "coverage is not care," as a theme or #hashtag. This phrase/quip should be viewed as an opportunity and lens through which the dysfunction of the crony-dominated "healthcare system" in this country can be viewed.

Not only is "coverage" not equivalent to "care," "coverage" can and many times does create a barrier to care.

It might shock you to learn that the "cash" price for many medications at your local pharmacy is less than the co-pay if you are using your "coverage" to buy these same medications. In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals! Why is this? Your "coverage" represents an additional, contracted layer--a toll booth--through which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50% of the purchase price for a large number of medications.

The same goes for the care at many physician offices. Any physician who is contracted with insurance companies labors under their fee schedules, any departure from which risks expulsion from the "network." Physicians who waive all or part of deductibles for patients or treat cash-strapped patients free of charge run the risk of running afoul of these same "network" contracts and may also face legal action. What gives?

Waiving deductibles or co-pays for those short on funds lowers the barrier upon which the insurance carriers rely to protect their own corporate wallets. After all, a patient who cannot muster their deductible represents little or no financial risk to those providing the "coverage," and the higher the deductible--or barrier to care, the greater the likelihood the "insurance" companies will pay nothing at all. The courts have been no friend to those well-intentioned physicians and facilities that have waived deductibles/co-pays in an attempt to help their patients. Once again, if you have "coverage" and are low on funds, you should always ask the "cash" price for a service before revealing that you actually have "coverage."

Do you have "coverage" and have no trouble meeting your deductible? Do you therefore think you can safely access the care that you need? Think again. "Insurance"...