Is Free Ever Free?
Air is free, why would anyone with any common sense want to
pay anything for it?
Changes in our insurance coverage, reimbursements, and especially
their guidelines have had profound effects on the delivery system of
the health care that we know and have come to expect. Medicare,
Obamacare and employer-based dental insurance have significantly
changed how all of our hospitals, our doctors, and our dentists can
and do treat us. Some of those changes are good (cost savings), but
many are not in our best long-term health care interest.
Dentistry started this change over 40 years ago, Medicare started
15-20 years ago and Obamacare started 4 years ago.
They have all dropped coverage in some areas and reduced coverage in other areas, some more some less. But this has had a steady and cumulative downward effect over the years and has had a dramatically quicker effect with Obamacare.
If you are healthy and don't need any health care services there has been no observed change, it is only when you need some service that you though you had that it becomes apparent that the rules have changed. If you are healthy and don't need to use any benefits your coverage hasn't changed at all.
In medicine if you haven't had a sick or dying parent you can't realize how much the system you have lived with your whole life has changed. Coverage for the poor or undocumented has improved, even if it has moved to an almost non-functioning hospital emergency room.
Options for the very wealthy still work with a direct payment in advance to the provider for the best of the best. This concierge care is the fastest growing segment in health care dropping valuable access from the most talented and successful doctors. Most of the best in dentistry have been in a variation of this not accepting insurance in full for decades.
You can't keep paying less and less and restricting through regulations and guidelines and expect to get better and better health care results.
Just lowering insurance cost and insurance reimbursements without a counter balancing way of evaluating the outcomes or the results is a naive expectation.
New guidelines or policy results need to be evaluated in comparison to a reasonable idea of outcomes or high value result. Otherwise we are just lowering treatment outcomes and results to balance the cost to complaints. We are moving to a new Canadian or VA level healthcare system where everything is free, just try to find or get the care.