America's Healthcare Mess - September 2006

The healthcare system in the United States is spiraling out of control. Who should we blame? Insurance companies? Doctors? Lawyers? Government agencies? The Democrats? The Republicans? Or we consumers?

There is enough blame to go around for everyone. It seemed so much simpler when I was a young child. The doctor came to our house, his office sent my parents a reasonable bill, and then my parents sent him a check.

Then everything changed in 1965 when President Lyndon Johnson created Medicare from which Uncle Sam would pay most of the bills for our elderly. Since those consumers no longer had to worry as much about the cost, the medical community was able to raise their rates with little scrutiny. Soon self-pay patients were billed similarly higher rates as were the employed whose employers offered either self-funded health benefits or health insurance coverage.

Thanks to those runaway costs, diagnostic payment codes, health maintenance organizations and preferred provider organizations became the darlings of government and private industry. With today’s new Medicare prescription drug plan adding to the healthcare mess, it is no wonder that our healthcare system is being heatedly discussed in the halls of Congress and elsewhere.

This issue is also starting to get personal to me. The practice of medicine and the processing of insurance claims have become cold and impersonal. It is now only about the money and not about the patient. Only a small percentage of staff even smile any more.

My well-liked general physician dropped my original insurance carrier several years ago forcing me to seek a new doctor. I read that he recently became one of those “boutique” upscale doctors who charges $ 2,500 per year just to be his patient. You still have to make your copayments for his insurance claims.

My wife and I have been told by numerous specialists that they don’t accept the plan we have from our insurance carrier but they do accept that carrier’s other plans. In one situation, she was given clearance over the phone by the doctor’s office only to be rejected when she showed up in pain for her appointment.

Because of such frustrations, my company finally dropped that carrier only to find the same problem with our new carrier and its variety of plans. Frankly, I feel sorry for doctors and hospitals having to deal with so many insurance carriers each with a variety of plans with different specifications.

But doctors are not without guilt in today’s healthcare crisis. One of my doctors – at my request – sent me for a basic diagnostic test but would not explain the results unless I paid him for another office visit. Instead he just gave me the printout to interpret myself which, fortunately, I was easily able to do. Most doctors now want to be paid upfront for copayments or procedures not covered by insurance.

My wife was almost charged for a last minute appointment cancellation because of a family emergency. Yet that same healthcare professional had no qualms about canceling a previous appointment at the last moment because of her own emergency with no regret for affecting my wife’s work schedule.

If you have the misfortune of needing to go to the emergency room at one of our local public hospitals, you need to pitch a tent while either waiting to be seen or to be given a room if overnight observation is needed thanks to the high number of uninsured who turn to the ER for routine medical care.

Understanding the paperwork blitz from doctors, hospitals, and insurance companies has become more challenging than were my graduate studies in business. I see the look of puzzlement on my in-laws when they receive their Medicare statements.

And then there are the questionable number of tests and screenings prescribed by doctors who are afraid of being sued by the unnecessarily large number of medical malpractice law firms. Proactive medicine has unfortunately become expensive defensive medicine.

Maybe HillaryCare is the best solution to our deteriorating healthcare system with the high federal taxes to fund it. Or maybe requiring all employers to at least provide catastrophic coverage and access to health savings accounts to all of their employees is the best way to bring logic back to the medical industry.

Maybe our public hospitals will devise a new system for less expensive non-emergent medical care for those uninsured non-American citizens who clog up our emergency rooms at taxpayer expense. And our country will also need to have a serious debate about whether our tax dollars should be spent providing expensive emergency care to uninsured non-Americans.

Sooner than later, our politicians will have to bring order to our chaotic healthcare marketplace and the American public will have to swallow the bitter pill necessary to bring logic and fairness to this growing problem.

I predict the ultimate solution will be single payer national healthcare, with income-based and behavior-based copays, provided by the most cost-efficient private industry and public providers. Healthier Americans will pay lower rates than those who choose to smoke, eat poorly, and not exercise just as they do for life insurance. An annual preventive care physical will help determine those rates.

All bills will be processed with consistent prices and guidelines so doctors can focus on medicine rather than needing a large staff just to process and contest insurance claims. Private industry will compete to be among the firms which process the claims under a central administration.

If all Americans are covered by the same plan, there will be tremendous economies of scale because the risk of care will be spread amongst everybody. Insurance rates will be reduced and there will be lower taxes since the cost of today’s uninsured care will no longer be a burden on all taxpayers.

Certainly there is much more to discuss and debate about a single payer solution but if we do not start that difficult discussion soon, the cost of fixing it will only increase.