The Flip Medley

First of all, I’m writing this post having never seen “Sicko”, so this is not inspired by Michael Moore.

That said, one of my best friends is an emergency room doctor. So is my brother-in-law. That said, I can not pretend that I am an expert on what it means to be a doctor, because my experience is far more suited to focusing on the issues confronting patients, who outnumber doctors by a ratio of 384:1.

What I’d like to propose are a few things I think merit consideration if we’re going to “fix” healthcare in this country. I don’t presume to know the solutions, but I have a few suggestions, and I’d love to bounce ideas around with other folks who are passionate about this issue.

I’m sure Paulie Walnuts could “fix” healthcare… If he were just given the chance.

First of all, it seems that regardless of whether we continue with a free-market system for healthcare or if we decide to move towards a more regulated, socialized system, we need to fix billing.

The way money flows through the companies responsible for insuring and caring for patients is convoluted, to the point of creating a bureaucratic nightmare that does not accomplish the goal of making the system more agile or profitable. Instead, it creates complexity — which serves only to keep people who thrive on keeping this system in place employed. And enriched.

For example, I went in for a surgery in 2003 which was fairly straightforward with no overnight stay in the hospital. Prior to the surgery, as I went through the requisite paperwork (complicated enough as it is), I made it a point to ask the folks around me if they knew if their services were covered by my health care plan (CareFirst PPO).

The funny thing is, I didn’t get that in writing. I should have — because my anesthesiologist was actually part of a group that was the sole provider of anesthesia services at the hospital where my surgery was performed.

And that group was in the process of “renegotiating” with CareFirst regarding the rates they would accept.

Given that the doctor may not have been privy to all the details in that contract, or may have just assumed that my coverage would take care of it. Regardless, First Colonies Anesthesia, for a brief time, was not doing business with CareFirst.

And of course, they had my signature stating I’d cover whatever my healthcare plan wouldn’t.

Now, to put this in perspective, keep in mind that when you buy a car, there are laws that protect the consumer. The dealer can’t attach riders to your contract. They also can’t cut your jugular and, while you’re bleeding out, ask you if you’d like the undercarriage rust protection. There’s this notion that you can’t sign a legally binding contract under duress.

However, if you go to any emergency room in the United States of America and observe the check-in process, it’s amazing. You’ll see hospital administrators, inured to the bleeding and misery, asking folks to fill out forms (in triplicate!) that people examine with even less scrutiny that those EULAs on packaged software.

When you’re bleeding out your eyeballs, you really just want to click “Next”, “Next”, “Next”, then “Finish”.

Over the next few weeks, paper mills were kept busy — possibly at the expense of spotted owls — cranking out reams and reams of paper for use by the doctor, the anesthesiologist, the hospital, and CareFirst to show me what they were charging and how it was getting paid.

It’s all interesting until you notice that CareFirst PPO thought the First Colonies anesthesiologist did $50 worth of work, but the anesthesiologist thinks the job was worth $900.

Funny how the work costs more when the individual has to pay instead of the big, bad healthcare company. Lucky for me, I found that showing up in court, ready to fight encouraged them to settle for the same amount CareFirst would have paid for the work.

So let me state with three assertions I believe to be true about how we need to approach healthcare:

#1 A completely free-market system will not prioritize the quality of care for the patient over the need to make profit.

As long as we have insurers acting as the intermediary between the patient and the health care provider, business pressures will always seek to maximize profits by balancing the quality of care against costs. If I’m a parent, and my child needs treatment, I don’t want someone to decide, based on the cost, to compromise the quality of their care.

To be quite frank, I find very few people trust that their health insurance really cares about getting them the best quality of care. Most people accept that it is a game of dollars & cents. But it’s ridiculous that we allow people to slip through the cracks.

Case in point, I know a person who has struggled with an eating disorder for several years. She switched jobs, and found that her eating disorder was considered a “pre-existing” condition by the health insurance provided by the new employer. That meant they refused to cover counseling, physical therapy, or any treatment related to the disease.

However, if she were to just stop eating and collapse, they’d pay for the surgeries to prevent complete organ failure.

How generous of them.

#2 We need more doctors, and socializing the entire healthcare system will not help that situation improve

Part of the reason it is so hard to get an appointment with a general practitioner or to find a doctor to cover those patients in the emergency room is because it is simply not an attractive business proposition for someone to spend ten years of their life accruing several hundred thousands of dollars worth of debt only to find that, at about age 30, they could have flipped burgers at McDonald’s since high school and had a higher net worth.

Luckily, doctors are usually considered good credit risks by lenders, making it easier for them to buy a house despite being in the red.

But the negatives of becoming a doctor has led to a “shortage” — Medical miscalculation creates doctor shortage (2005).

While some of the fault for the poor responsiveness of the health care providers falls on the way they do business (see Tired of waiting for a doctor? ‘Same day’ service is catching on (2004)), ultimately we can’t deprive doctors of the right to enjoy the benefits of a market economy unless we’re going to make concessions to keep this (vital) profession thriving.

#3 Government involvement (on some level) is absolutely necessary in order to provide a base quality of care for all Americans.

Oooh, just writing that made me feel like yelling “power to the people” while sporting a new Che Guevara t-shirt from Hot Topic.

Che Guevara t-shirts are a wonderful example of “irony”.

But here’s the fundamental issue at hand — not everyone has a job that provides healthcare. I’m lucky because, quite frankly, I make a good living and I work for a company that even offers healthcare insurance for pets.

Meanwhile, I’ve got friends who are working 1099 jobs to make ends meet who have to put off seeing a doctor because they can’t afford it.

The insurance companies have no motivation to extend coverage to everyone without a mandate from the government.

Employers have no financial incentive to make health care a benefit for their employees…. unless it’s a competitive edge when trying to hire skilled workers. Unfortunately, not every occupation requires skilled labor, and that leaves a lot of people out in the cold.

The fact of the matter is, as much as I hate getting taxed at a rate that could buy a new sports car every year, I also know it’s morally wrong to let the system languish as it is. And since there is no single entity with a vested interest in fixing the problem, it’s (unfortunately) going to require the people to make their voices heard through the government to mandate a solution.

I just hope we get it right.

This entry was posted on Wednesday, July 25th, 2007 at 11:35 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.