Health Insurance, the Surveillance State, and the Incentivization of Chronic Illness

I recently stopped accepting health insurance as a form of reimbursement in my healthcare practice. I agonized about this decision, knowing it would cause financial hardship to many of my patients who might not be able to pay me out of pocket. I also worried about my own financial survival as a small independent primary care provider not taking insurance payments. Many people in my community have asked me why I made this shift. So let me tell you.

Most Americans are unaware that they are being surveilled by their health insurance providers. Every time you go to a medical provider and use your insurance as a form of payment, your health insurance company is notified. This seems obvious, but few people think about the implications.

When you visit your health care provider, she or he takes detailed notes about the reason for your visit, your health history, your habits and vices, your mental and emotional status. All of this information is important in assessing your needs and developing a treatment plan. All of this information is recorded in your health record. All of this seems reasonable. And all of this information is available to your insurance company whenever they want to access it.

That's right. If you pay for your healthcare with insurance, your insurance company knows everything you tell your care provider. Your insurance can, and does, request your records from your provider and procedes to review them in detail. Your insurance company knows your smoking history, how much alcohol you drink, how many sexual partners you have had, whether or not you have had an abortion, and if you have ever struggled with suicidal thoughts.

Of course all of this information is “confidential,” meaning your provider and the insurance company cannot share it with outside sources without your permission. But your insurance company is using this information to create a data profile about you and that data profile becomes part of your permanent digital medical record.

If you want to keep a specific health concern truly private between you and your health care provider, I would recommend not using your insurance as a form of payment when addressing that issue. You can further insure your medical privacy by asking your provider to use an old-fashioned paper chart for recording your visits.

Insurance companies watch which medications you have been prescribed, and they closely monitor your adherence to those medications. When I was accepting insurance, I got weekly notices from insurance companies about my patients’ “non-compliance” with prescribed medications. If a patient has not filled a prescribed medication, the insurance company notices, sends notice to the patient’s health care provider, and sometimes financially penalizes the health care provider for not pressuring patients into compliance. If my patient was successfully healing from a chronic health condition and no longer needed medication, the health insurance companies recorded this as “non-compliance” in the patient’s record as well as my record as the provider.

Health insurance companies incentivize chronic illness and daily pharmaceutical drugs by financially penalizing providers when our patients aren’t taking medication. In addition to the patient non-compliance notices, I received frequent letters chastising me for not prescribing enough medications to my patients. The letters would say something like, “you billed a code indicating your patient has [anxiety, high blood pressure, diabetes, asthma], yet your patient is not receiving a prescribed medication for this condition. This is in violation of the medical standard of care.”

My practice centers around healing through diet, lifestyle modification, and non-pharmaceutical methods of treating illness. If my patients want pharmaceutical drugs to manage their conditions, I am happy to provide that for them. But many people who choose me as a provider come to see me because they don’t want to be on drugs. For these patients I will do everything in my power to keep them off drugs. And the insurance companies don’t like that.

Primary care providers who accept insurance make more money the sicker and more medicated our patients are. A federal program called CMS National Quality Strategy purports to improve US health outcomes through surveillance and financial incentives, but true to these upside-down Clown World times, the program actually punishes providers whose patients get well through diet and lifestyle instead of daily drugs. If you are skeptical (a trait I admire) and don’t want to take my word for it, you can read about this perverse phenomenon on Medscape, a very mainstream source of information on the medical industry.

As a strong believer in health sovereignty, medical freedom, and privacy, I could no longer in good conscience continue to participate in the medical insurance system.

Here’s to your health!