Harver Health Insurance Counter Fraud Group

Fundamental Principles

The issue on health insurance recently hugged the headlines not just in the US but also in
some countries which recognized the need to address the health services that their populace
need and expect from their employers and the government.

Previously, health insurance was practically non-existent. Pension funds and provident funds
were already in the consciousness of people as well as in the administration of institutions,
whether private or public, for many decades. And yet, health is as important as ones future
retirement fund and present financial needs and is, in fact, closely related to both essential
requirements for a healthy and productive working population. Hence, the rush to enact laws
requiring all workers to acquire health insurance of some form has become a crucial issue.

For us to understand what health insurance is all about and its foundational principles,
consider some pointers to guide you decide whether having health insurance is really essential
or not:

1. Ideally, health insurance is not state-sponsored medicine

We hear activists declare that health insurance is a form of taxation or revenue- generating
scheme of the state. Well, if some corrupt officials were to be given the hand, that would be
true as news of government funds being carted away by top-level officials flood the news daily
today.

However, as conceived and its ideal form, health insurance is a plan whereby money is
collected usually from the employer, the employee and the state and set aside as a fund out of
which those who render services (health practitioners) to the insured population (the
employees, that is) are paid. It is not state medicine which is a technical phrase define by
the American Medical Association as a form of medical treatment provided, conducted,
controlled or subsidized by the federal or any State (provincial) Government or municipality
and has certain exceptions.

2. The end beneficiary of health insurance is the insured

Again, this is the ideal case. At any time an employee or member of the fund requires medical
attention, the fund is obligated to answer the immediate need without the insured having to
pay anything above the premium already being collected. Of course, we hear of cases where
hospitals or doctors turn away patients who could not put up a deposit or, perhaps, certain
technical requirements such as a missing ID or other reasons; but these are exceptional cases.
In general, the fund is meant to serve the beneficiary for the state sees the fund as a means to
promote health.

3. The other beneficiary of the health insurance is the medical practitioner.

The health insurance may appear as if it puts the health service providers as the masters and
not as the public servants that they are. We all have those people in every place those who
look at their work not as a way of alleviating suffering but aggravating it among those who
sustain their livelihood. Yet, it is through the health insurance fund that health practice is
enlivened and made more accessible to more people with the proper implementation of the
program.

4. No monetary benefits.

The only benefit the insured gets from the fund is medical service, not cash benefits. In some
cases, the insured may receive free medicine, diagnosis or medical surgery for free, depending
on the coverage and the type of services that a particular state provides for it populace.
However, in general, only medical service is given to the insured and not cash as it is often
done in other insurance policies.

5. Preventive and curative medicine are given equal attention in health insurance.

This is one of the ideal principles in the program; but it is one that is easily forgotten or abused
by practitioners and even by politicians who manage or control how the funds coming from
the State should be used.

We know that medical practice has become a big moneymaking venture, especially among
those who support the industry with pharmaceutical drugs, equipment and assorted medical
supplies. The end-user in terms of medical care has to be knowledgeable enough to know
what he or she needs for any particular health issue in order not to be taken advantage of by
unlawful medical-service providers.

With these basic facts about health insurance, you can determine what you can expect to
derive from having a health insurance. Ultimately, sustaining an active and healthy life will not
depend on having the protection of a health insurance but having a healthful and wholesome
lifestyle. Doctors and the medicine they use to cure people, ultimately, do not heal us. The
body has the built-in immune system to do that. Medicines and other therapies and methods
only enhance the immune systems ability to bring back the body to its optimum condition.

Hence, a health insurance is more a temporary fall-back position than a real solution to having
a reasonably healthful and fulfilling life. Leading a consciously active and healthful way of life is
much better than depending on a supposedly a fail-safe crutch while living a carelessly
unhealthful lifestyle.

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1827466/pdf/canmedaj01695-
0147.pdf