Scott Shreeve, an MD and progressive Health 2.0 thinker over at Crossover Healthcare , pinged me on this discussion yesterday. He's trying to help people understand and see the difference between Health Insurance and Health Care. "People need both, but it blurs to the point of confusion when you try to mix the two in a single financial instrument. Most insurance provides for catastrophic coverage of health related risk, however, it does not function well as a financial instrument for ongoing maintenance," he writes.

Absolutely. Thus, the idea of applying the car insurance paradigm here is afloat. Check out this great article onHappy_car putting principles of auto insurance to work for health insurance. The idea is that auto maintenance and auto insurance for catastrophic events are two different things, and the same should go for health care vs. health insurance.

"Consider your car," Shreeve explains. "You have auto insurance which is primarily for major crashes, and then you might purchase a separate from ongoing auto care (typically a warranty services) for ongoing or routine maintenance. Some high-end cars, like Mercedes and BMW, actually build in the ongoing warranty and preventative services into the prices of their cars and offer it as 'free' to the consumer. The point is, the ongoing maintenance is viewed as something different than the car insurance."

The Contingencies article talks at length about people with chronic illness, who obviously need health service most. One angle the author presents is the (somewhat unfortunate) example of a single mother, whose uncontrolled Type 2 diabetes and obesity lead her to multiple ER visits and a "long list of health care [needs]." The point being that with automobiles, "access to low-priced insurance that takes care of every possible repair, including damage already done, ... [and] regardless of whether she changes the oil (takes care of herself) in the interim" is unthinkable -- because it makes no financial sense, and is therefore simply unsustainable. Using a car insurance model, on the other hand, the insured would receive discounted rates and perhaps more extensive coverage as incentives to "change the oil."

OK, but what about all of us PWDs who take meticulous care of ourselves -- but are nevertheless "sick" for life? We kind of constitute a gray area here, I think.

"Routine care and ongoing treatments of chronic conditions can be pre-funded, can even be subsidized, but they don't constitute 'insurable events,'" the article notes. Some of this is semantics, I suppose, as long as ill people can afford the care they need over the long-term.

"Yes, health insurance involves the sacredness of human life, and is therefore different from auto insurance," the author notes. "[But] as sacred as health insurance is, it's still an economic transaction that has to be balanced by individuals and societies, against other economic choices."

So Scott Shreeve's question to me, as someone who lives "in the trenches and with the expenses of ongoing health care" was: What are your thoughts about a new type of dual-product system that provides you the security of Health Insurance, but also offers separate access to affordable, high-quality, ongoing Health Care at reasonable rates? The additional "service pack" would include the ongoing provision of patient support, advocacy, care coordination between the myriad specialists, and other related "value-added services."

All I could say was yes, yes, yes! Of course we could use a new model for service that helps deliver the best value/best outcomes for people with our specific condition at the best price. But how exactly would this be accomplished? TBD. Many talks between many bright minds are taking place behind the scenes at this very moment. Shreeve would love to hear thoughts from our community.

"Are your needs being met by your current insurer?" Shreeve asks me at the end of his initial email. Well now, considering I've had three different health plans in the last four years, that's a whole 'nother story...

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