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Our Unhealthy Addiction to Health Insurance

Welcome to AHIAA (American Health Insurance Addicts Anonymous)

Whenever I give a talk about healthcare, I ask the audience, “What is the worst addiction problem we have in the United States?”

The answers are typically the same and all are good guesses – alcohol, tobacco, opiates, and sugar are most frequently cited. I agree these are all terrible addictions that need to be addressed but, in my opinion, the worst addiction in America right now is to health insurance.

That answer usually draws a stunned or shocked silence from the audience but the numbers bear it out. The chart below shows the staggering costs American spent on healthcare in 2017. Please remember, these figures are in billions of dollars, so $2,961 spent on “personal health care” represents $2.9 trillion(!).

What is most shocking about these numbers is not just the high spend but the lack of value delivered in return. As a primary care physician who has practiced within the insurance-based system and now outside of it, I can tell you Americans are paying Porsche prices for Yugo performance.

The typical American experience in seeking healthcare is not good. There are often long waiting times for appointments (usually which could have been cleared up in an email or phone call), brief interactions with an actual doctor, high co-pays and deductibles, long waits at the office, a crushing amount of paperwork, and a stunning lack of communication. Does this fit into a description of “Porsche value”— especially when one gets the mystery, indecipherable bill for services weeks later?

The main mistake that we have succumbed to as a society is that we have deviated from the original intent of health insurance. The true purpose of health insurance was to protect people against financial ruin in the event of an unexpected, major occurrence – just like car insurance, life insurance, and homeowner’s insurance. But things got murky when people were indoctrinated into the belief that good health insurance should “cover everything” because “everything in healthcare is expensive.” 

The irony is that, because of this mistake the “insurance” has become more expensive to the point it is unaffordable to many, and even those that can afford the premiums struggle to put money aside to cover the huge deductibles and coinsurance. Read yesterday’s article from Bloomberg Employer Based Health Insurance Costs over $20,000

The system got messed up when health insurance stopped being a form of insurance and instead became a default payment system. The dialogue below is an actual discussion I had this past year with a patient about lab tests.

Me: “Those lab tests will be 20 dollars cash through our pricing.”

Patient: “What will it be if I bill through insurance?”

Me: “We can send it to a hospital who will bill insurance but if you are on a high deductible plan I have no idea what your out of pocket will be, but I can guarantee it will be more than 20 dollars.”

Patient: “Ok, well let’s use insurance.”

Me: “You do understand part of the reason insurance is so expensive is because we use it as a payment model rather than insurance?”

Patient: “Well I pay a lot for my insurance so I want to use it.”


(FYI- labs ended up being around 400 through insurance due to deductible)

The definition of addiction is “a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.” It’s discussions like these that make me assert that we are addicted to health insurance. This patient simply could not imagine not using their insurance for a simple procedure and, in so doing, drove up the prices unnecessarily for everyone. By doing this, we as a society, have let this addiction consume us, our paychecks, and our savings for our children and grandchildren. And we keep doing it because our brains tell us there is no other way.

The chart below illustrates the spiraling costs of our health insurance as payment system addiction:

One of the health insurance benefits experts I work with is correct when he says “Today’s claim is tomorrow’s premium, copay or deductible.”

Unfortunately, the hardest part of treating addiction to any substance or belief is that denial is a major part of the disease. In order to fully treat addiction successfully, the addict has to accept that they are an addict and want to get better. Once that happens you just have to ask for help and there are resources available.

This country needs help as 20% of our GDP is on health insurance and the costs of care. It is up to us as a society to fix this as we are all patients and deserve better. We deserve high quality care when we are suffering from an insurable event and should be protected from financial ruin in such cases. We also deserve transparent pricing and quality assurance.

Above all, we deserve a system with a working payment system and to stop using insurance beyond its intended purpose. Simply stated, we must break our unhealthy addiction to health insurance. I am starting a support group called AHIAA- American Health Insurance Addicts Anonymous (ironically HIAA is already being used by you guessed it….Health Insurers Association of America). As the founding member, I am willing to admit that I too am a health insurance addict, but am now in recovery. The process of recovery has not been easy, but it has been the most rewarding process of my life. This group is established to help you through this process so please join me so we can let the healing begin.


  1. Gayle B on October 2, 2019 at 1:27 am

    What a great blog post!

    I like to also think about it in terms of patient empowerment. We’ve given up our power to handle our health issues because getting care can be so complicated & confusing. But when we break the cycle of addiction & take back our power, we’ll be on our way to better, affordable care.

  2. Batman on October 2, 2019 at 1:33 pm

    This is an excellent piece. What you might want to write about next is where the money goes. In other words, when those lab tests you mentioned cost $400, where does the extra $380 go? You & I know it lines the pockets of Wall Street & healthcare corporate executives. But most people can’t make that deduction on their own. People love a villain to fight against. Uncover the truth, and give them one.

    • Dr. Gold on October 2, 2019 at 2:10 pm

      Thanks Batman (my favorite superhero FYI) for commenting and feedback. This article which just came across my feed this AM does a wonderful job of breaking this down : How Health Insurance Bleeds Employees There are a few very big villains in this “cartel”. For people who really struggle to understand how our system works, I advise them to watch Narcos on Netflix. It really is no different than what Escobar built in Colombia .

  3. Bob G Shupe on October 2, 2019 at 7:21 pm

    Jeffrey, thanks for this break down from a primary care perspective. I and several others concure with your assesment. We all are trying in different ways and from different vocations to become one united voice against billions of dollars spent by all of the elements of healthcare and industry lobbiest. We can no longer just speak for our piece of the pie. You are an important piece of the equation.

    I am an insurance consultant, do not sell insurance, working with public entity accounts in Tenneessee for over 30 years. I just released my third book on healthcare, Behind the Healthcare Cost Curtain… there is an answer! This 400 page, 3 year project speaks to almost every area of healthcare and health care-there is a difference. I ask the same question regarding each; What is their motive to lower the cost of healthcare? I encourage you to read it and spread all of our united observations.

    After reading your article, very well written by the way, I encourage you to write a book. I just don’t think we can fight this battle with 140 character bullets. Let me know if we can talk and how I can help. Thanks for being a part of the real solution.

    Thanks for listening.

    Bob G. Shupe, REBC, CEO
    ESP, LLC
    277 Wilson Pike Circle
    Suite 203
    Brentwood, Tn 37027

    • Dr. Gold on October 3, 2019 at 1:54 pm

      Bob thank you so very much for the kind words and the work you are doing on your end to help change this system for the better and from the ground up which in my opinion is the only way. I would love to chat more as writing is something I am actually very terrified of and self conscious about so to hear someone say I “should write a book” is really appreciated but also scary as heck.

      “You never change things by fighting the existing reality.
      To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller

  4. Amber Beckenhauer on October 3, 2019 at 1:27 am

    Dr. Gold, as always, you are a man wise beyond your years. Fabulous article and thank you for paving the way to healthcare freedom.

    • Dr. Gold on October 3, 2019 at 1:50 pm

      Thank you so much Amber. And I do believe congratulations are in order? 🙂

  5. Brad in MA on October 5, 2019 at 10:57 pm

    Because health insurance has become most often an employer and “Group” plan, there is pressure to join (Be a part of our group! It’s the law! We get a better rate with 80% participation! You must prove why you are refusing to join!)

    PLUS the removal of personal interest in keeping costs down. How many folks have a mindset that: I won’t make this Home/Auto Claim… it’ll probably make my rates go up next year or they might drop me… I’m waiting for a big claim.

    Imagine if Home/Auto was sold using the same group-think as Health. Good chance you’d see premiums skyrocket as claims for every loose shingle and fender-bender start flooding in.

    Thank you for naming this addiction. Now maybe we can get a government program to wean us from it. DARE to be Different. Hah! Good on you for doing your part, thanks!

    • Dr. Gold on October 11, 2019 at 6:35 pm

      Thanks so much for commenting and reading Brad! Share and preach the gospel. Only way this system gets changed is if WE the people do it. I tell people that wait for the government and/or insurers to fix it to pack a really big lunch 🙂

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