What is the solution to insurance? Right now, Maryland is forcing Wal-Mart to offer insurance to it's people or else they will be taxed to make up the Medicaid costs. I'm listening to Rush right now and he's apoplectic. With good reason, I think.
I am not against poor people. When it comes to insurance, I am poor people. We have a high deductible plan $5,500.00/year before one penny of insurance is invoked. Every year we have sidled right up to the $5,000 mark. Every disease-ridden year. Oy.
At our office, we do not accept Medicare/Medicaid. If a patient with that coverage wants us to treat them (because we're the best Alternative Health Care Providers in Houston, of course), they must sign a waiver. They must pay...in cash.
Why don't we provide for the government? Because he is an odious taskmaster, that's why. It is impossible to please him. He pays terrible. We can do nothing right. And when we are wrong, we don't just pay them or people back, we go to Federal Mandated-sentences Jail. Am I being alarmist? Probably. Our office is small potatoes compared to other practices out there, but we must comply to all the crazy rules, too. The regulations stiffle patient care and if you really care about the patient you give lots of services away for free. And why not? This is America--HOME OF THE FREE.
The government is bad enough. The Insurance Companies, the government dressed up in ruffled skirts and stilettos, is equally as bad. Cutting fees like a deranged seamstress, rejecting pleas for payment with callous disregard, limiting patient treatment like sadistic bureaucrats they are all adds up to lots of pain and little gain. Little health gain. Little wealth gain. And the two are connected.
The solution? Go after companies and MAKE them pay their employees health coverage! Yeah, that's the ticket!
Hey, wait a minute. I am an employer, too. Barely able to cover my own health care expenses, we would have to get rid of our two part-time employees if we were forced to pay their insurance coverage, too. It's just to much.
The problem, as always, is the government. Insurance companies now follow Medicaid's lead when it comes to coverage. The government covers the barest minimum for health care survival. So insurance companies have followed their lead. Interestingly, though, fees for one thing are excessive, things for others are obscenely low. Some specialties thrive. Some are dying. General practitioners in stand-alone practices are dying breeds.
What is happening is this: Doctors and patients are turning back to an old standard: CASH. You see, when a patient pays cash, he seems to miraculously get better faster. You might think that it's the doctors sucking up all the coverage and in some cases that is true. But for doctors like us who want our patients to get healthy ASAP, we find that our cash patients consistently follow care recommendations more closely, respond to treatment quicker and generally take charge of life more. They have a BIG incentive to do so--their own pocketbook. While the insurance patients tend to look at their insurance plans as banks from which you can indefinitely withdraw. SOMEONE is paying those bills people. You want taxes to go down? You want your pay at work to go up? Lower your health care usage. Most of it's crap anyway.
Here is what we did for our son because of our lack of health care coverage. Some of you might think that it proves we need universal coverage, but I don't think so. When Little Toot burned his hand, it was an obvious emergency. We knew that we had a $500 payment minimum for what would probably be a one-hour hospital stay, but we had to do it. So we did. At the hospital, the doctor showed us how to treat the burn. We watched closely. He gave us explicit directions for care. We listened attentively. When we got home. We did exactly as told.
Now, the doctor wanted us to follow up with a Hand Surgeon the next day. That would have been at least another $200. For what? So she could look at the hand and tell us what we knew: that the hand was healing nicely and quicker than expected considering the severity of the burns. She would have then asked us to come back in one week--another $200.
Do you see? The care is approaching $1000, actually with the prescription pain medication and hand cream, would have been $1000. Instead, because we are paying the bill ourselves, the bill is around $500. And our son's hand is healing pefectly fine.
Yes, we are doctors ourselves, so feel more confident evaluating the healing process. But that's just the point. For other people it might well be worth their money to get the follow up care because they lack expertise.
For example, when we go to the car dealership, we have to pay for a lot of care that other people might not because they know how to fix it. We don't. Likewise, a lawyer might not have to pay for law advice because she knows it. Or a grocer can skim old produce off the shelf because it will go to waste anyway and he'll save money.
When it comes to cash, people are more willing to deal, too. No patient who needs care but can't afford care gets overlooked in our practice. Thousands of dollars of care gets given away every year in our practice and in doctor's offices (especially the independent ones--the big hospital-affiliated practices don't give as much away because billing is separated from the one giving the service--the doctor) across the USA. And that is as it's should be. We are in a helping profession. We like to help.
I am loathe, however, to see corporate patients with rich health care benefits while their insurance cuts my fees to nothing. In some cases, we go behind financially with insurance covered patients who could more than pay for their care! That is an uneven exchange. The patients are numbed by their relationship with the Insurance Company. They no longer see themselves as consumers. They see themselves as beneficiaries and get angry when they actually get billed for services not covered by their insurance. Newsflash! Why should doctors be expected to work for free? More than many other professions, we have HUGE costs to operate our business. I don't even like to add up our insurance coverage (doctors are big targets), money we spend on accountants (IRS likes doctors too), and then there are our fat college loans.
Cash, which forces a direct doctor-patient (service provider-consumer) relationship, solves this. Doctors can cut fees at their discretion. Patients have to explain to their service provider directly why they can't pay. Doctors can choose to give extra services. Doctors can give the care they believe the patient needs. Doctors can spend the time they would like to understand the problem.
What about high-cost treatments? Well, you know what, a lot of treatments are bunk, but insurance pays them. Consumers would get smarter. Episiotomies? That $400 procedure has absolutely no medical benefit, but it is done all the time. Caesareans? No, "elective" procedures should ever be covered. There is too much risk. But insurance pays them. Blood thinners with Angioplasty? Actually make outcomes worse. But insurance pays it. Angioplasty itself? Not effective one year out, but insurance pays it. Knee surgery? Back surgery? Bunk and bunk. Done all the time and insurance pays it.
Why does insurance pay this stuff? Heck if I know! Why do patients submit to these ridiculous, painful, unhelpful procedures? Mostly becuase they have the s%#t scared out of them and "Something MUST BE DONE". Bah! So many patients would rather have a sexy surgery, than exercise, change their diet or do the very unsexy work to get back to health--because they wrongly believe the "procedure" will save them time and money (because the hard work stuff isn't paid for by insurance). Which it doesn't.
Our practice is full of post-surgery pain-filled people who are as bad off or worse than before their procedure. That's why we call our office a RESORT--the last resort. Frustrated, embaressed, the patients are willing to try anything to get back to their old way when "standard practices" and "procedures" fail them.
That is not to say Modern Medicine fails everyone. On the contrary, patients need surgeons to cut out bad stuff, emergency medicine in emergencies and high-tech diagnostic procedures to catch bad stuff before it gets really, really bad. That costs money. A lot of money.
The high-deductible insurance is a good choice. Consumers will have to decide if the problem their facing rises to the level of serious monitary investment. No? Maybe they dodge a bullet and the problem goes away. Yes? Maybe they pay money for nothing. Yes? Maybe they catch a life-threatening problem.
Patients know. They might be in denial, but they know, often intuitively, when something is not good. Doctors are notoriously wrong when it comes to knowing how much worry to invest in a patient's symptoms. This is proven as more and more care is dictated by computers because they are less wrong than human doctors! (Heart attack signs are better evaluated by a complex computer algorhythm than people. It's true. The computer ignores all the doctor's biases. Even really good doctors.)
Let the patients decide. They have to live with the results anyway. When costs come down because patients take their health into their own hands, the result may be that more employers pay for the high-deductible plans. It's a nice BENEFIT.
Insurance is not an obligation of the government or big business. It just creates a further class divide. Health care payment is the obligation of individuals. Everyone needs to remember this as their insurance coverage dwindles.
The country will be a better place when insurance companies diminish and the consumers take charge again.
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