An Ounce of Prevention

In 1736, after fires had started on a ship that spread to the wharf in Philadelphia, burning down many warehouses and several residential houses, Benjamin Franklin helped organize the first Fire Department in the City.  Franklin also started an insurance company because of this event named Philadelphia Contributionship.  Through that company, Franklin offered people 7-year policies to cover the cost of damage to burned buildings.

It was during this period that Franklin coined the famous Proverb, “An ounce of prevention is worth a pound of cure”.  And while Franklin used this phrase to remind Philadelphians of the importance of fire prevention, the phrase has long-survived because of it’s broad application in so many other areas of life.

From the time we were kids, we’ve been told by our parents, school teachers, ball coaches, and of course, our doctors that PREVENTING things is better than trying to fix problems after the fact.

If you eat healthy and exercise, you can prevent diabetes.

If you study hard and put in the time in your school work, you won’t fail or make a poor grade.

Yes California, if you clear underbrush, you can prevent wildfires….

We are also reminded, constantly, that prevention costs less than fixing a problem after the fact too.  This is just common sense for the most part.  Keeping up with oil changes is certainly less costly than replacing a thrashed engine.  I could literally use 50 different analogies.

No industry preaches “prevention vs. cure” more than the healthcare industry.  There’s never a missed opportunity for doctors to remind us to “stop smoking”, “drink less alcohol”, “eat less sugar”, “get more exercise”, “get better sleep”….and the list goes on and on.

And they aren’t wrong, and we all know that.

But the healthcare industry is hurting people too, millions of people.  So now it’s my turn to use Franklin’s famous Proverb for a moment.  It’s my turn to talk about prevention in the healthcare industry.

Just a few questions…..

How do we PREVENT predatory billing in healthcare?  How do we PREVENT medical bankruptcies?  How do we PREVENT getting charged $800 for lab work that only costs $5?  How do we PREVENT double digit average rate increases for health insurance?  How do we PREVENT doctors from prescribing unnecessary care?  How do we PREVENT a person from delaying/foregoing necessary medical care because they can’t even afford their Deductible?  How do we PREVENT an opioid crisis?  How do we PREVENT squandering more than $1.3 Trillion per year in healthcare? 

You see, no one seems to be trying to PREVENT the single biggest problem we face in healthcare…..the prices we pay!

Every week I get a call from a client, or someone I know, who tells me a story about going to a hospital, or an Urgent Care, or taking their kid in for care, and then getting slapped with an outrageous medical bill….after the fact.  How can we prevent THAT?

Well, I’ll give you my answer.  I’ll tell you what we’re doing.  We have built a health insurance plan with PREVENTION in mind.  Not only medically, from the clinical standpoint, but financially too.  How can we PREVENT people from delaying/foregoing care because they can’t afford their deductibles?  We eliminate deductibles for starters.

“You can’t eliminate deductibles!  Employees gotta have skin in the game!”

Oh, the outrageous premiums being deducted from their paychecks isn’t “skin enough”? 

Listen, we all know the single largest barrier to good quality healthcare in this country is affordability.  You want people to prevent costly health conditions?  Make care more affordable, not just insurance.  You can’t make insurance affordable unless the care it is insuring is more affordable.

That’s why we are doing what we are doing in these health plans.

We negotiate healthcare pricing directly with many different care providers and facilities.  In exchange, we take the savings and give it back to the people who need it most….employers and their employees through lower premiums, lower deductibles and copays, lower out of pocket costs for patients.

How do you PREVENT a diabetic episode that lands a person in the emergency room?  You make their insulin and testing supplies affordable so he/she will improve their adherence.  The dreamer says, “You get them a wellness program so they’ll lose enough weight to get off insulin….”.

Is that possible?  Of course it is.  But it doesn’t happen overnight, or in 30 days, or even in a year in most cases.  We should absolutely support lifestyle changes, healthier eating, more exercise, but let’s face it, many people are not ready to make the level of commitment it requires to reverse diabetes, lose 100 pounds, or completely change their lifestyles.

An ounce of prevention is worth a pound of cure. 

Through our custom health plans, we are preventing medical events from also becoming financial events.  I have a friend who was uninsured for a period in his life who had to have an emergency gallbladder surgery where the final bill was $48,000.  He’s still paying that bill, and will keep paying it for years to come.  $48,000 for a procedure the hospital where he had the surgery routinely accepts $9,000 for the exact same procedure.  That medical event absolutely became a financial event that is still impacting that family.  Unnecessarily I will add.

We’re working on preventing THAT.  And we are succeeding.  Whether it’s helping a client get an umbilical hernia repaired after ten years of suffering because he simply couldn’t afford the surgery, or helping a woman get a needed medication after she walked away from the pharmacy counter when they told her that her copay was $500….we’re succeeding.  We are effecting the unit price of healthcare and giving the savings back to the covered plan members.

Our plans offer $0 deductibles for thousands of services.  $0 Primary Care visits.  $0 Generic meds.  $0 diagnostic imaging services.  We’re able to do this because of the actual prices we’ve negotiated for the services.

This is how we solve the price issue in healthcare.  We prevent it from happening in the first place.  And if a doctor, or hospital, or pharmacy, or any healthcare-related facility tells us “no”, they won’t offer us fair pricing?  Well, we simply educate people and tell plan members to avoid those locations, those doctors.  Would you continue buying gas from a station that refused to lower their gallon price and continued charging you $12/gallon?  Would you continue buying food from a grocery store that was 5x more expensive, and refused to sell food at a competitive price?

This is what our custom plans do.  The good news is we aren’t the only ones constructing plans and solutions like this.  Plans like what I’ve described are being deployed all over the country, by some of the brightest and most passionate people I’ve ever met.  I am extremely honored to call them friends and colleagues.  We are working to prevent one of the biggest challenges Americans face today….the unaffordability of healthcare in America.

Josh Butler

Josh is the President of Butler Benefits & Consulting. Passionate about healthcare reform and helping employers save money while improving the quality of employee benefits.

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