Thanks to Health Insurance Health Care Is Getting Worse.

In the United States, we already pay more than any other developed nation for health care, but have poorer outcomes in major categories of care, such as infant mortality, life expectancy, obesity levels and rate of suicide, just to name a few.  Of course, there is one significant difference between us and the rest of the developed world; we are the only ones without universal health care.  This has two important consequences, which will continue to plague us and which will likely lead to a continuing decline in our quality of care.  First, many of our citizens do not have access to health care, until they are desperately ill and hospitals are required by law to accept and treat them.  Second, health insurance companies take a huge chunk out of our health care spending as their cost of doing business and profit; money that could be better spent providing care.

Daring Women Doctors: Physicians in the 19th Century | PBS

If you have health insurance and think that the plight of the uninsured is no concern of yours, you are sadly mistaken.  Adults and children without health care cost society a lot of money.  Preventable illnesses or medical conditions may keep lower wage workers off the job and injure productivity or put them on government-paid disability.  Preventable illnesses may keep children out of school or they may go to school and infect other children.  As noted above, when people get sick enough, hospitals must accept them as patients and treat them until their medical emergency is over.  Someone must pay for that treatment and it is not likely to be the uninsured patient.  The cost of their care is added to your hospital bill and mine.  Since we are going to pay for it anyway, we should be looking for ways to keep people healthy as it will cost us the least in the long run.

The profit motive does not belong in health care and yet it is front and center.  Under our health insurance system, doctors treat patients and then send bills to the insurance company.  Each treatment and condition must be coded for billing purposes.  Doctors offices employ teams of people, not to treat patients, but to handle coding, send bills, and resolve billing disputes with the health insurers.  The bureaucratic paperwork necessary to run our health system takes up billions of dollars each year, even before the health insurers take their profit.

The health insurance companies are in business to make money and, according to Wall Street, they are very good at it.  One of the ways they make money is by controlling the care doctors provide their insured patients.  If the health insurer does not think the treatment was medically necessary, it refuses to pay.  If it thinks the doctor spent too much time with the patient, it refuses to pay.  If it thinks that the treatment was not covered by the mish mash of provisions in its insurance policy, it refuses to pay.  Doctors should not be forced to make treatment decisions based on whether the health insurance company is going to agree that the patient needed that care.  Doctors should not be forced to deny or limit needed care for fear of not being paid.

The corrosive effects of our health insurance system are all around us and getting worse.  Doctors spend less and less time with patients because health insurers limit the amount they pay for an office visit.  Everyone in medicine knows that listening to the patient is the best way to figure out what is going on.  It is the very foundation of diagnosis.  If the doctor has no time to listen to the patient, misdiagnosis, the most common form of medical malpractice, is more likely to occur.  Patients do not receive the treatment they need when the doctor cannot take time to listen to the patient.

Another key to good care is the quality of the physician/patient relationship.  The more trust the patient has in the doctor the better.  The better the doctor knows the patient and her medical history, the better care the doctor can deliver.  Health insurance cares nothing for the physician/patient relationship.  If your employer or you change your health insurance company, you can probably say goodbye to your doctor as you will be forced to use a doctor in the new insurance company’s plan and your doctor may not be among those on the list.  If you choose to remain with your doctor, you can count on paying extra for out of network treatment.

The corrosion raises ethical questions for doctors.  Faced with the risk of underpayment or no payment, the doctor is tempted to fudge the coding in billings to increase the chances the insurance company will pay for a treatment the patient needs but for which the insurer would not pay, if it knew the true story.  Forcing doctors into this ethical dilemma is bad for the doctors and for their patients.

As long as our health insurance system remains in its present form, health care is going to deteriorate.  Costs will go up.  Co-pays and deductibles will increase.  Doctors will be squeezed more and more.

Our health insurance system is virtually immune from meaningful change or regulation.  The problem is national in scope and requires a national solution.  We have a Senate in which nothing gets done without 60 votes.  Health insurers are veterans of the lobbying wars.  They have lots of money and know how to spend it to make sure they have the votes to prevent any threats to their profits.  You might as well get used to health care that gets worse each year while at the same time costing more each year.




Posted in Doctors, Fee for Service, health, Health Care Costs, Health Insurers, Hospitals, Medical Costs, medical ethics, Misdiagnosis |