The best defense to for-profit health insurance? Staying healthy.

There are many reasons why the United States has comparatively poor quality health outcomes while having the most expensive health care system in the world. A plethora of for-profit entities siphon away health care dollars while not providing one iota of health care.

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The most obvious is the health insurance companies. These for-profit publicly traded entities have a fiduciary responsibility to their shareholders. This is incompatible with the practice of medicine, which should be 100% concerned with the welfare of the patient. The conflict of interest is glaring. Furthermore, to maintain this unethical system, health insurers hire lobbyists. And you pay for them! Think about it. Your health care premiums go to pay lobbyists who keep an unethical system in place that is contrary to your interests.

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We have medical malpractice attorneys and their lobbyists who block tort reform. This drives up malpractice premiums. You ultimately pay for all of this. Consider the tragic situation of a child born with cerebral palsy due to cerebral anoxia. The young parents will have an emotional and financial burden that will continue for the life of their child. They need help. Instead of a bad outcome fund to help them (with a separate board to examine the conduct of the obstetrician) everything is bundled into medical malpractice. So if the obstetrician is found not guilty of malpractice these young parents get no financial help. This biases jurors to blame obstetricians who may have provided appropriate medical care, which thus results in large out-of-court settlements.

Another byproduct of our medical malpractice system is that physicians practice defensive medicine, which drives up costs by ordering more tests than indicated. There should absolutely be a system to hold physicians accountable for incompetent care. The current system, however, is more designed to enrich attorneys than objectively root out incompetent physicians.

You pay for all those advertisements for pharmaceuticals on television, too. Thus advertisers and media companies get their cut of your health care dollars. And there are more lobbyists for the pharmaceutical industry too. These lobbyists work to keep our drug prices the highest in the world.

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When private equity companies purchase health care systems, they prioritize profits over patient care. This leads to poor health outcomes for patients and even eventual closure of hospitals as the vultures take the money and run. This leaves communities without accessible health care.

There are other reasons for our comparatively poor health outcomes that have little to do with our health care system. For example, improving early childhood education would pay huge dividends by empowering our youth to embrace a healthier lifestyle from an early age. Obesity, cigarette smoking, alcoholism and illicit drug use eventually raise health costs in a myriad of ways. Better financial literacy would reduce stress on families and lead to better health outcomes. Sensible gun control would prevent tragic suffering and lower health costs.

As a society, we could reduce health care costs by embracing prevention of illness. Our health care system is largely reactive with a reimbursement system that prioritizes high-tech procedures and devices instead of preventive health care. We should invest in quality primary care that would help prevent advanced disease. This would not only reduce future suffering but would reduce the need for more expensive specialty care.

Finally, we spend far too much money on end-of-life care. As a physician, I observed many instances where instead of saving a life we were prolonging suffering at great expense. This can often be prevented by having difficult but necessary proactive discussions with those who will be making decisions for us if we are unable. If necessary, put them in writing to prevent conflict among your descendants who may have differing opinions. Such foresight will be a significant parting gift to your descendants by heading off future conflict.

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