My prescription for better health care for ALL Americans. Part 1/3: Top 5 factors raising premiums

Introduction
​Those of you who follow my blog know the foundation of my leadership philosophy. Empower your team with tools and resources they need to solve problems creatively; ultimately bringing success to the entire group. First step in solving any complex issue is to first understand the problem. And so, we start by looking at the problem in the economics of delivering care by understanding the cause for rising insurance premiums. I hope to raise your awareness in this 3 part series to illustrate the real issues with the Affordable Care Act and propose a solution which I think will propel us to being the most innovative and efficient health care system in the world. 

If you are like most Americans, the open enrollment season is confusing, nerve-wrecking, frustrating, and quite honestly, an overwhelming time. How do you choose which insurance is right for you? All the language and terminology is so confusing that making sense of a single plan is a daunting task. Insurance brokers are there to help, but the industry is changing for individuals at least as the insurance companies are not paying these brokers commission for selling their product; leading to less brokers out there helping individuals and families.

Naturally, we wonder why the premiums are so high and why they keep rising? Here are the top reasons why insurance premiums are rising and will continue to rise until we finally agree to privatize primary care and other outpatient services; keeping health insurance out of these basic services. 

Top 5 factors 

​
1. Increased use of specialty care (hospital care, specialists, ​other advanced services)
2. Rise in chronic illnesses 
3. Growth of administrators and staffing which raise fees
4. ​Consolidation of insurance carriers leading to decrease in networks
5. Rising cost of prescription medications

​How has the rise in insurance premiums compared to median household income or earnings? 

So, to put this in perspective, workers are not earning enough to keep pace with rising insurance premiums. This leads to either the employer spending more on health care coverage, letting go of some employees in order to provide coverage for others, downsize the business, or stay less than 50 employees to prevent having to require health insurance. This de-incentivizes economic growth. How does this make any economic sense? 

Higher premiums mean less out of pocket? Wrong! 

Your analysis is correct: rising premiums and deductibles are outpacing inflation. This is why earnings are not keeping pace with premiums or deductibles, causing Americans to hold onto their wallets even tighter. 

​Rising Chronic Illness leading to higher costs of care 

This is the reason why investing in primary care is so critical to keep costs down. More chronic illnesses does not necessarily mean more specialty care. Primary care is built, conditioned, and positioned to be fully capable of managing these illnesses at a low cost. The problem arises when the system does not allow primary care to do what it is capable of offering. Instead, the system encourages more specialty care. 

Even with value based purchasing and the movement towards rewarding value rather than volume, the cost of doing business in health care favors larger health systems instead of small private practices. Ultimately, making no progress in making the delivery of health less complicated, more personal, accessible, and affordable.  

Will the demand be met with a supply of primary care physicians?

The current health care market is ripe for future primary care physicians. Many may look at the current state of primary care and run away. But the informed and astute medical student will understand the industry and market trends illustrated in this blog and realize this is the best time to be a primary care physician. It is also a wonderful opportunity for investors and innovators to assimilate modern technology with quality primary care. No, not telemedicine by itself. The human touch and relationship must never be obliterated. Imagine the patient experience with modern technology and medicine that focuses on building strong, long lasting, relationships. 

That is the future of primary care. That is the future of the United States Health Care System. 

If you are a investor, innovator, or someone in the community who wants to support my vision, please support our growing practice. Health care will be much different and more efficient for the next generation.

​Dr. Ahmed