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Insurance Hassles Killing Off Family Docs
I love being a family physician. I love the history rooted in the country doc who did his best to help comfort and heal his neighbors. I love the broad scope of practice where I am always seeing something different and something challenging. But most of all, I love the long-term relationships with my patients. So it is with a heavy heart I admit that my specialty is dying.
This matters not because of the nostalgic loss of the way things were; it matters because studies have proved the essential foundation of a less expensive and higher quality health-care system is effective primary care.
Specifically, as primary care dies, access becomes limited, waits become longer and costs soar.
With this silent but looming crisis becoming ever more evident, we have to take an open and honest look at the reasons for the demise.
We are dying because of an insane payment system. Primary-care doctors mainly get paid for visits to the office, with each visit having its own particular insurance code. Although this sounds straightforward, every insurance company pays different amounts for different visit codes, and every patient has his own individual deductible and co-payment, so no one knows who owes what or what the final bill will be until the insurance company signs off weeks to months after the visit.
The process of getting paid is so complex it has spawned an entire industry dedicated to medical collections. But getting paid for visits also forces doctors to jump on the treadmill of seeing patients to fill their schedules.
Even one open slot is lost revenue, so patients who have something which could possibly be handled over the phone or through e-mail are forced to come in for a visit.
Schedules become packed and inflexible, leading to physicians who are harried and insufficiently empathetic and patients who are frustrated from hours wasted waiting for a five-minute appointment. The resulting chaos, due directly to the payment system, is unhealthy for everyone.
We are dying under the weight of useless administrative paperwork. To try to save money, insurance companies have begun to request prior authorizations on everything from medications to radiological procedures to seeing specialists.
This shifts additional administrative costs to the doctor's office, making the treadmill of patients run even faster.
But perhaps more insidious is that it makes doctors think twice before ordering a test or a consultation. After all, that is the only way these impediments can save money.
This creates a scary scenario where a necessary test may not be ordered simply due to the enormous hassle involved in getting it approved. Administrative trivia is not just annoying, it is potentially dangerous.
We are dying because reimbursement is not keeping up with costs. Payment for medical services is socialized, with most insurance companies basing their reimbursement on the Medicare fee schedule.
Since 2001, reimbursement has generally remained unchanged, even though the cost of practicing medicine has gone up 20 percent. If the Medicare Economic Index holds true, between 2001 and 2015 primary care will see an 81 percent net loss of revenue, making practicing medicine financially impossible.
Medical students are seeing this trend and are choosing the financial security of specialties that get paid three to 10 times more a year. Over the past 10 years, this has resulted in a 54 percent drop in the number of U.S. medical graduates entering family medicine - a patient's first step, and medicine's least expensive.
The current system pushes volume over quality and enhances short-term profits for insurance companies at the expense of the primary care office. These policies are killing primary care by eroding the doctor-patient relationship.
Recently, Family Practice Management journal stated that 60 percent of practicing family physicians would not choose the specialty again if they could go back in time. The main reason for their dissatisfaction is a lack of autonomy - a feeling of no longer being able to take care of patients without outside interference.
The tragedy is that in a time when we are searching for answers to our health care crisis, we are losing the one group who intrinsically understands the solution lies in the doctor-patient relationship. As that relationship withers and dies from outside abuse, so will primary care. Unfortunately, so will the health of our nation.
- Posted in
31 Comments so far
Show AllA good look into the insanity of for-profit health insurance.
This is a very well-written article that covers just about everything wrong. The only way to save the system is to eliminate the corporate money-takers. They are always looking at the bottom line instead of how to serve the patient.
My suggestion is for primary care physicians to eliminate taking insurance for their office procedures. The typical insurance company probably only reimburses $50 or so for an office visit, but the physician has to pay for the administrative help to establish eligibility, submit claims, and follow up on payments (or lack thereof). My copay is already $25 for that visit - I would just as soon pay the $50 in cash and eliminate all the administrative hassle, as well as complying with all the "benchmarks for care" or whatever that each insurance company sets up to tell you what to do.
Has anyone considered this?
JaneM
I too am tired of complying with standards of care that seem to only serve the professional's need to get paid. A colonoscopy (colon rectal screening for cancer) is routinely done on men at age 50-whether or not patient history shows a proclivity for colon cancer. The medical field offers closed ranks on this subject-" You must have it done."
I am not going to any more providers sponsored by my health care plan until I am actually screaming in agony-which I was one fine day about 16 months ago. I hope and pray I never need to see another medical provider before I die.
Yet another sane reason for a single-payer, federally funded health care system. After WWII the Europeans decided that no one should be allowed to profit from another's misery and universal health care was born. Profits being the raison d'etre of America, we somehow don't understand the humanity of that decision. It's way past time for us to take care of each other in that same way. That we don't makes me so very sad.
Lynn
Just how would a single payer system address the issue of an overly complicated, poorly understood, Byzantine billing system? In fact is not the idea of government bureaucracy itself the very epitome of the word Byzantine?
You'll be amazed at the number of family doctors in my state who keep blaming only the "trial lawyers" all the while ignoring the fact that they have been robbed big time by the big insurance fraudsters. I hate to say this but both parties are deeply entrenched in the monetary hands of Big Insurance and I don't see that changing any time soon.
Medicine and healthcare in general is turning into a nightmare for most heathcare practitioners. There is too much red tape, too make regulations, esp. in long term care and dialysis, too little reimbursement for all the work, too many headaches, too many surveys by the government, too many patients to see in a day and too little time to really address their concerns effectively. Insane government demands for "care plans" and other paperwork that just waste trees and paper, not to mention the practitioner's time. Then there is all the meetings for daily info, planning care, family meetings, employees meeting, inservice meetings, quality mgt mtg, brainstorming mtg - all to meet some regulator's demands since they believe we don't already have enough to do; as if trying to fit a very stressful 60 hour work week into 50 or less hours/week is really possible! The patients see less and less of their caregivers courtsey of regulation and the all-consuming profit motive!
When I started in healthcare in 1975, I loved it! And eventually made the industry my profession. I now find myself waiting for retirement age, so I can escape the insanity. We need a universial sytem of healthcare with 1-2 payors, mainly one set of rules [that do not change every year or monthly, etc], a reasonable and sensible drug coverage for everyone and nothing should be dependent on being employed or independently wealthy. Unless the system changes, getting new doctors, nurses, RD, PT, SLP, RT, etc will be difficult if not impossible.
I wish Dr. Brady the best; he has earned a better work life.
"We are dying because reimbursement is not keeping up with costs"
A for-profit healthcare insurance system will never keep up with costs.
Denis Duncan is right. We have to stop blaming the trial lawyers. It is the insurance companies that have destroyed health care in the US.
Even after a major medical error, it is nearly impossible to bring forth and win a law suit. The side with the most money wins in any legal battle. Expert witnesses and their testimony is bought and paid for and often the jury does not know the testimony was purchased. (I am not a fan of lawyers either. It is lawyers who have destroyed the judicial system.)
The bottom line is this. All systems in the USofA are failing. People better learn to pull their own teeth, do their own emergency medical care, and protect their legal rights on their own (I don't know how). Welcome to the New and not improved USofA. Machiavelli would be proud.
"We are dying because reimbursement is not keeping up with costs. Payment for medical services is socialized, with most insurance companies basing their reimbursement on the Medicare fee schedule."
the standard propaganda raised by free-market ideologues is the opposite - that rising medical costs are caused by incentives to create phony procedures to bill the Medicare fee schedule
now that "reimbursement is not keeping up with costs", the driver of rising cost is clearly the private sector from a supply-push perspective combined with monopoly pricing - not a demand-pull effect from the government sector
the private insurance companies are exploiting their market power and engaging in manipulation, bureaucracy and fraud on a scale easily equivalent in economic damage to the fraudulent practices uncovered in Medicare via crooked billing
the unstoppable increase in medical cost has run up against the immovable market power of private insurance, and both entities intend to get their cut of the take, at the expense of patients
this is not socialization at work - it's monopoly captalism run amuck by free-market ideologue hypocrites who thrive in cherry-picking government - such as using a Medicare fee schedule to underrate their private insurance payout - instead of a competitive insurance market, while also exploiting an insurmountable and ever changing complexity of terms and conditions designed to cherry pick what is covered at all
"We are dying because of an insane payment system"
You can say it that way but you can also say it another way: Primary care is dying because of the elite's relentless upward wealth redistribution racket which manifests in all the various industrial sectors as problems such as the insane payment system that is killing primary care. Putting it this way illuminates the cause and the effect. It is the elite who must be controlled if you want to limit all of the variety of destructive symptoms of their bloodsucking on the backs of the people.
As the recession deepens, practices are finding many patients no longer have insurance, are trying to get diagnoses and prescriptions over the phone, or can no longer afford the drugs they need. These folks will soon be using hospital Emergency Departments for primary care.
Its ironic how the neocon types working for my employer, as we hang on by a thread, grumble about being seen for only a few minutes by CRNPs or PAs, and then relate cherry picked "horror stories" of long waits in Canada.
The blue collar middle class has largely been destroyed by fast buck off-shoring, and now the (feedback) recession. Its starting to drag down the management, engineering, financial and professional middle class. Sooner or later, that means the medical establishment, too, as we head for third world status.
Some doctors have established "boutique" practices. For $1500/year up front, and no insurance accepted, they will take care of trying to keep you out of the hospital (preventive medicine), and they limit the total number of patients they see. You still need insurance for drugs, specialists and the hospital.
"a 54 percent drop in the number of U.S. medical graduates entering family medicine - a patient's first step, and medicine's least expensive"
The elites need to push medical students into specialties because this structure perpetuates economic growth. The elites teach in their ivy league business schools that we must find ways to perpetually grow the economy else we will face undue economic hardship, job insecurity, lifestyle stagnation. But we don't need to grow the economy. Progressive policies maintain a highly stable economy that slowly contracts with industrialization. Of course there is a limit on beneficial industrialization but that's a different topic. The elites' real motive for perpetual economic growth has nothing to do with public prosperity and everything to do with maintaining and expanding the empire, the capitalist, militarist, imperialist, zionist empire and establishment, i.e. elite interests. Elite interests are served at the expense of the people. Thus we work 50 hour weeks when our level of industrialization requires us to work only ten hours per week to serve our better interests. The better approach for the people to take for physical health is to learn about and understand biology, health and nutrition, and adopt healthy lifestyles and diets. This is easiest to accompish by getting closer to nature. Disengage from the elite establishment if you want to maintain your health and well-being. And when it's time for you to die, please don't allow the elite establishment to become involved.
"a feeling of no longer being able to take care of patients without outside interference"
This is the invasion of the elite establishment into the doctor-patient relationship. To the elites, human health, physical, mental, spiritual, are all means to an end: Expansion of the economy and thereby the elites' property, power, and control over societies worldwide. You can do your part to help build a world without elites by shifting all of your exchange/association away from the elites, i.e. power centers, and toward your local economy. So for example you get yourself a primary physician, a family doc. Get one who does housecalls. He/she will inspect your yard and if it lacks enough food bearing plants he/she will write a prescription: Apple tree, for example.
What "they" are doing to medical practice, "they" are doing to public education and for the same reason. Unhealthy and ignorant people are so much easier to dominate and control. "Let them eat cake", has been replaced by "let them veg out on high def. TV and have to go to the emergency room for medical treatment".
Poet
A radically different perspective is need here...
John Brady, M.D., wrote an article attempting to delineate the issues destroying Family Practice in the U.S., and most of the responders above ended up studying the details, which I respect but which generally miss the larger point even the author may have missed.
Frank Herbert's "Dune" (later the Dune Trilogy) is perhaps a key metaphor here. In "Dune," in at least one part of the Universe computers are outlawed (by the way, pay no attention to the movie; read the book). This requires sentient beings to use their INTUITION. The aggregational wisdom of the neural net, which some would say that computer programmers today are trying to EMULATE.
My father who later became an immunologist who worked for NASA grew up near a tiny Midwestern town, on a farm where they boiled their linen, not a doctor for miles around, and no cars until much later. During the Great Depression, but they did not know of the Great Depression at that time because they lived in a local-based Distributive Economy and were very nearly economically self-sufficient. The only really active "intermediary" was the RLDS Church. OTOH, they also went to town on occasion to sell eggs. Trade and barter.
Back then, if you got sick your illness was a part of everything around you. And you were a part of it.
To return to the newer computer model here, as Frank Herbert recognized, the ability to create complexity creates complexity, and thus is born ACTUARIAL CHAOS. No single node can keep up with the permutations and thus the system cannot but collapse under the weight of ever-more-advanced mathematical models built on ever-more-sophisticated COMPUTER MEMORY. As opposed to the wise application of intuition, which is organic.
Suppose you had a doctor who told you, "I refuse to prescribe anything from Big Pharma. Turn off your TV." The system of reimbursement to primary physicians is corrupt beyond redemption. My maternal grandfather was a General Practitioner who spoke two and wrote at least four languages, and I suspect that he would today say, Pol Pot had a point. (Makes we want to toss my eyeglasses...) Back in the early 80s I could go to a General Practitioner who had saved my life in the late 40s. We need to seek and perpetuate/create continuity in our personal lives and eschew computer models of who we are. Otherwise, Mother Earth will truly become the Death Star. We are complex enough without computer models trying to selectively simplify/"slice and dice" us for profit.
Happy New Year to all of CD. You've earned it. My thanks to you all. I am humbled.
-30-
Interesting post here, OleManRiver.
While I've not read Herbert's books, I agree with his premise that intuition serves us much better than computer models. It appears as if our natural ability to look after ourselves and one another, and to live in ways that facilitate that, have gone by the wayside. This is too bad because it is our intuition that can get us out of this mess, if we will only trust it again and use it.
Interesting, though. In the early 70's, when so many hippies went "back to the land," they seemed to have the right idea. Yet, so many have left the land, or at least, brought back into their lives what they had originally left, and jumped back on the bandwagon.
Technology is not our enemy, and never has been. What is our enemy is the hubris we take from the belief that we are superior to natural laws. That hubris is coming home to roost. We can use technology to help us or to hinder us - smart or stupid. Right now, it's pretty stupid.
My wish for the new year, and the years to come, is that the lesson that we are about to learn will not be in vain...or too late.
Oh, and for-profit medical care stinks!
"All Nature's difference keeps all Nature's peace." Alexander Pope
Sioux Rose
Ole man River: I like what you had to say about intuition. We hear today that some remedies of modern medical practice derive from what Indigenous healers and Shaman previously utilized. How did they know? Perhaps intuition, a rapport with the natural world that in essence "spoke" to them.
This article and the power of insurers reminds me of the "sentencing guidelines" acting as intermediaries of how laws will be affected against accused citizens, and the way teachers must teach for tests, not to inspire genuine learning. Things are being moved off their relative axes to allot power to centralized forces, and of course this model favors the authoritarians and their rigid mindsets, their wish to control how the rest of us act, think and behave. Nature is a master of diversity, but the manmade world seeks to replicate, ad nausuem, whatever its product or protocol du jour.
"health care providers" - provide zero "health care" - doctors - nurses - hospitals - clincs - and patients who take care of themselves - "provide" healthcare...
"health care providers" have inserted themselves between the patients and the doctors - nurses - hospitals - clincs...
to extract "their cut" -
the "banks" and "investment houses" inserted themselves between our earnings and savings...
to extract "their cut" -
they can only continue as "for profit" if they make a profit - and they can only make a profit by collecting more and more premiums and denying more and more treatment - collecting more and more wages (savings) and charging more fees...
but since so many wage earners were sold the bill of goods of 401(k)'s, IRA's, mutual funds, etc., they are directly at odds with themselves...
a typical wage earner with a healthy sized "retirement" account can only hope their investment increases over time... and that investment can only increase over time if the companies it is invested in earns more profits... and in the case of "healthcare providers"... that means more and more revenues but less and less expenses... you lose either way... higher earnings means lower coverage...
until enough individuals begin to decouple from the corporate house of mirrors and treadmills... will anything change... how high a premium can a "healthcare provider" charge if it has no subscribers?
how high and how many fees can a bank charge if it has no depositors?
sounds impossible? naeive? idealistic?
let's take the ATM machine. when first introduced - it would SAVE money, SAVE time, LOWER costs... passing INCREDIBLE BENEFITS along to the retail banking customer... now you can't get within 10 feet of an ATM withour being charged... not to mention the "complete relationship" you need to "establish" just to get one of the damn things without fees. ANSWER - move to a credit union.
let's take CABLE TV... you'll pay a monthly fee and get higher quality programming and less interruptions... started out ok... now what? 20 minutes of commercials per hour... reruns... and shout shows... ANSWER use a simple DSL internet account and READ the news yourself. WHY PAY FUCKUP GIBBONS to spend 4 minutes telling you jay leno is on at 10pm.. as part of the "news"...
there's countless examples of disgorging at the everyday level... we're just too lazy...
LEASING cars... why not BUY a car... pay it off... and keep it 5 more years... because the leasing company will take care of everything... and take it back to LEASE you another in 2-3-4 years... PERPETUAL INTEREST payments...
yeah... i veered off healthcare... but sometimes all the solutions are quite simple...
anyone out there know anybody who dies for lack of air conditioning? not having a cell phone? etc., etc., all these things started off well meaning... once accustomed... the providers just milked it for all they can get...
ya can't get fleeced if you take away the sheers...
Rockerbabe1 expresses the frustration of health care workers very well. In my experience, nurses and doctors who think clearly and who really care about patients are the most frustrated and angry. Olemanriver and Siouxrose make a good point about "intuition" as well. Experienced and sensitive practitioners can sense things from small clues that may not match a check box or a diagnosis code on a form. They need sufficient time and professional respect to follow up on their intuitions rather than being tied into insurance company designed protocols. Of course you need protocols, but the motivation should be proper delivery of health care, not only cost cutting and tight control.
Right now decisions have been taken out of the hands of those with medical training and committment to patient care. Like education, medicine has been hijacked by profit-driven organizaitons and ham-fisted, overstaffed bureaucratic layers.
There was an elderly doctor in my extended family who stopped taking Medicaid because of the insurance hassles, denial rate and low reimbursement. He showed me examples of extensive paperwork that resulted in like $28 for treating 10 patients and submitting mounds of forms. He just went back in time and considered treating those who could not pay "community service" and treated them for no charge.
Young doctors with family obligations, huge student loans and years of underpaid exhausting exploitation as interns and residents do not have that option.
We need single payer, free medical education in return for service, stability of care, and cost benefit analysis based on public health considerations, not insurance company profits.
Joe
oldcreditiste says; Dr. Brady is right on the mark. I graduated 55 years ago and still practice surgery. My father was the family doctor of the politician in Saskatchewan who started 'medicare'. He predicted all that has come true. The single payor is not the answer. The government does not provide enough money,and in Canada has contrived a shortage of nurses, which makes the shortage of doctors worse. Until doctors are again paid as well as professional hockey players and nurses as well as school teachers, I do not expect improvement.
Patients should demand to pay their doctor directly and to deal themselves with the insurance company, or demand that taxes be raised to pay for the things that the government has promised. I have little hope that the people will do that.
I never believed the stories about patients being untreated because of lack of ability to pay, except that I know that hospitals in Canada have been very 'strong' in collecting where there was a chance to do so. Good Luck to all who are trying for a better system. I hope that you do not make matters worse.
Start by avoiding any and all euphemisms. A hospital 'bed shortage' is not a bed shortage but a nurse shortage. If it were a bed shortage you could go and get a bed and mattress. It is a situation where the politicians lack the guts to tax the people to get the money to pay the nurses. Start there. Good luck
Profit Care comes ahead of Patient Care in East Tennessee. We need a cure for health care. http://www.wisecountyissues.com
US health costs are between 30% and 50% more than those of the other advanced capitalist countries. Why? Insurance companies and the amount of paper-pushing and shuffling they require and the hours of work their employees do to try and find ways to deny coverage which their subscribers are paying them to endorse.
In other words, a huge component of the U.S. "healthcare cost"
exists not to provide healthcare--or anything else--but to stand as intermediary between patient and doctor, doing nothing but pocketing a bribe (or a tip if you prefer) in order to allow the patient to see the doctor.
In a sane world this would be called what it is: extortion.
I wonder if this physician's complaint means that, unlike the last time (the early '70s) that "socialized medicine" was raised in Congress, the AMA will not stamp it into the ground. And if so, will the AMA be performing a public mea culpa for killing it the last time?
Rainborowe
Peace
It is not the money factor that is killing primary care. It is stress, fatigue, anger, never ending daily frustrations. It is a loss of the pleasure factor of doing for others.
We have a system failure. Hard working people doing their best to survive, paying taxes and supporting their community and country, and still not able to afford health insurance or provide for themselves in old age or sickness. One illness may be bankrupting.
We have a people failure. Falling into the clutches of consumerism. Not understanding when enough is enough. Looking forward to a better life after death, instead of a wonderful life here on earth in sync with nature.
It is a life too complex.
Much confusion about health care, regarding the individual art of practicing medicine and the societal environment needed to keep health care going, has been generated by the partiality of the writer. In conjunction with commentary maligning the health care companies and technology (should we all become Luddites?)as the big bad evils that they are not, we are quickly arriving at a worse understanding of the overall situation. The fact that health care and health care insurance as topics of discussion in today's world create situations like this and the fact that these kinds of confused discussions happen so often, is greatly disturbing.
1. Insurance is necessary in a risk filled world - traders, merchants and builders of the 15th century took out insurance on their ships, businesses and homes. Ever since then the idea has been the same; people gather together to pool money and spread risk as thinly as possible. Insurance companies do not 'stand in the way'-they are the administrators for large pools of money. All insurance administrators have to make tough decisions-would any one of the gentle readers willingly be in charge of say, $900 million dollars, and make decisions to pay for other folks' health care and decide how, where, when and for whom it should be spent? For those who think insurance companies can be obliterated-would you want to pay medical costs on your own income? Perhaps not, unless you have a steady $50,000/month coming in the door.
For those who plead the panacea of a single payer-let me hear how you would ask your congressman for a decrease in your monthly premiums or increases in your coverage. Medicare does not cover yearly physical exams! Soaking taxpayers makes sense perhaps if a system that takes care of people can be arrived at, Medicare actually has a bad track record of slashing salaries for professionals and forcing hospitals into oblivion. The image of a remote government administrator or congressional staff member as a team player in my health care is not any more comforting to me than the picture of a remote corporately run insurance administrator.
2. Medical billing is complicated because medical procedures can be complicated and again, let the gentle reader decide; imagine tracing an ER visit, a mangled person barely breathing- whose life will eventually be saved by the actions of 5 or 11 or 20 people and the associated support staff. Again- go ahead an sit down and decide how YOU would:
set up the facility
staff it , keep it open 24/7, clean it
maintain it
publicize its whereabouts, etc.
I grow increasingly weary of listening and processing comments from those who merely complain about the high costs of health care yet have no solutions.
3. Medical billing has been made more complicated than it might be in a better world because of the numerous ways in which procedures can be billed. This complication has been brought on to a very large extent, by the organized efforts (the AMA leaps into my mind) of practitioners in the medical field. They, and to some extent, in conjunction with the tacit approval of the insurance companies, despite the author's implied suggestions to the contrary, have created the Byzantine world of medical billing. Professional bakers would not be allowed to bill customers for getting out the pan and ingredients, mixing the batter, pouring the batter in the pan and placing the pan in the oven. Professional medical billing now involves over 5,000 different procedures. The author of the article would be well served if he were to conduct some background research concerning the historical nature of the medical billing field. He might then begin to see how the business of medical billing came to its present state; practitioners, particularly specialists, have had much influence over the years in creating the complications of the current system of billing.
4. The family practice, like the cottage industry in 18th century England that at one time generated a lot of cloth, is obsolete. The family practice, like buggy whip makers, is being narrowed down to a few curious museum pieces because it deserves to be set aside. Medical practice should be done as a team effort in a clinical setting where diagnosis and treatment can be open to checks and balances. No one person has enough knowledge in today's world to treat even the common cold working underneath the thatched roofs of a cottage. At the same time, maybe some kinds of general treatment could be done by someone with less than an MD's degree or level of skill. Or maybe the treatment of a particular patient requires more skill that a General Practitioner; however a medical practitioner working in an isolated cottage, I can hazard a guess, would perhaps never know whether or not she or he had misdiagnosed or mistreated.
5. We could all go back to inscribing wedge shaped cuneiform on clay tablets, however, would our intuitive skills increase because we did so?
Technological change is not a root cause of our confused state of affairs in figuring out how to get a sick person to the right care provider; the business of delivering medical care to folks is a fractured state of affairs forcing people to go from cottage to cottage (figuratively speaking) to find care.
Technological advancement in the arena of delivering health care did not break the system and is not a root cause that is forcing costs to go up. If some medical procedures can be made more efficient with better tools (delivered quicker, faster, with better results, resulting in larger numbers of healthy people) is there a single one of my most illustrious readers who would not like to have those better tools in place? How can a better (faster, quicker, more efficacious, less cost in the long run) way of doing something be a problem?
As a former programmer and IT person in the hospital system, I can say that technology alone cannot resolve an underlying chaos. We need single payer and a medical system where cost-benefit is based on public health concerns, not insurance company profits and executive bonuses or barrages of pharmaceutical company marketing.
The 5000 billing codes, the hundreds of procedure codes, the different rules from each carrier that coordinate and control the codes and their relationships, the determinative role of profitability when prescribing treatments, the gaming that goes on back and forth, are the result of a constant tug of war for revenue and reimbursement between hospitals and doctors on the one hand and insurance carriers on the other.
It is partly doctors' fault because in the past they resisted national health. Now they are living with a health system run by different schools of MBA sharks. Technology can hardly keep up with the shifting rules and variables, no less solve the problem. It keeps a lot of programmers and IT people employed, but not doing the good stuff related to diagnosis and care.
Joe
"Your money, or your life" - it is as simple as that. The insurance companies, in collusion with the Congress, are extortionists. Worse than that they are killers. In the US 18,000 die every year because of lack of access to health care. That is like having a 9/11 every 2 months. I guess we can figure out who the real terrorists are. Instead of looking for BinLaden, arrest the CEOs.
Let me raise these points-
Insurance is necessary for everyone to have and to pay for medical bills. 98.9% of the population can not afford to pay for a lifetime of care without insurance.
The questions regarding costs are of course paramount. The problem of high costs is not something that came into existence merely because insurance companies sit around devising ways to drive up costs. They may contribute, however another hidden iceberg that is sinking the health care in this country is yet lurking in the waters ahead:
1. Visit the web site of an incisive study of health care "To Err is Human"
http://www.nap.edu/catalog.php?record_id=9728. Discover, and why this should surprise anyone I'm not sure, that the number one cost factor in raising medical care is quality of care. Professionals-in hospitals, clinics, offices, kill between 100,000 and 284,000 people a year-according to the study found here >>>> http://silver.neep.wisc.edu/~lakes/iatrogenic.pdf
The article is entitled "Is us health really the best in the world?"
Until we all face this issue we will be talking of ghosts and shadows; the ghosts of lost individuals who met an untimely death at the hands of those who were supposed to help. This is not to blame individual professionals, it is to blame the larger system they are part of and that we are all part of. And that we all contribute to in our own small way.
2. The Institute of Medicine, that sponsored the study "To Err is Human" is sponsoring a larger study 'Crossing the Quality Chasm: The IOM Health Care Quality Initiative' This shows that besides the quality issue or health care industry is fractured-no real competitive drives exist and consumers are awash in 'choices' that are non productive. Simply choosing a family doctor is a hit or miss proposition that seldom yields the best choice or gives any reason for choosing. The whole medical field confronts consumers with a plethora of similar 'non choices.'
3.Costs are also driven up by these factors in this order.
Overuse of health care-services are given to people who are not sick and do not need a doctor or a surgeon.
Under-utilization: people do not seek a doctor when they need one for various reasons-they can't find one, can't afford one or don't know they need one 'cause they have not seen one in two decades or any combination of these reasons. They then become involved in an untreated medical condition that thrusts them into the system on an emergency basis. And yes, the lack of health care for everyone is a tremendous factor. And yes, we need government sponsored subsides for those who are unable to pay. And yes, we need to force employers, who are not already doing so, to hold up their end of the stick. And no, we do not need a one payer system. We do need some real competition in the health care industry based on sharing knowledge about the hospitals, doctors, clinics and other providers who are already giving the best care so more people can find there way to them. And then yes, we need to put out of business the hospitals, doctors, clinics and other providers who are already giving the worst care.
4. A government bureaucrat would have no reason to be better at designing, deciding or choosing my care for me than a privately sponsored bureaucrat.
Period.
Let me place another period at the end of that statement
.
Why would a remote administrator in DC or a staff member of a Congressional place hold be able to do any better than the private administrator in deciding what I should have for a health care plan?
"Why would a remote administrator in DC or a staff member of a Congressional place hold be able to do any better than the private administrator in deciding what I should have for a health care plan?"
Same reason I am damn glad that moves to privatize Social Security failed. The private sector is a lawless bunch at the moment.
If we had stable delivery of routine primary health care in neighborhood family clinics, many of the overuse and underuse problems you raise could be alleviated.
Joe
Uhh don;t forget, insurance only pays for a part (in many cases, a small part) of any given healthcare cost.
From what I remember in the movie Sicko, in the UK system the medical personnel are government employees who make a salary right? Do they bill the government per item and per procedure like they do here in America? If we can get beyond that crap, then single payer healthcare would be much much simpler.