HEALTHCARE PART 2

Yesterday’s article appeared to lay the blame for our malfunctioning healthcare system squarely on the shoulders of the patient. While a portion of the blame belongs to the patient, the bulk of the problem lies elsewhere.  Today, we’ll look at the physician’s role.

In 1984, I opened my office. I was a self-employed physician, as were most physicians.  I employed 2 nurses, an x-ray tech/receptionist, and my wife was my billing department/manager.  I didn’t know it at the time, but I was living in the golden age of medicine, 

The patient/physician relationship was fairly simple.  You registered on paper, no computer.  I took a history and examined you, then scribbled my findings on paper.  I ordered whichever test you needed, performing almost everything in the office.  I explained what I had found and wanted to do, then I gave you a paper bill and sent you to the front desk to be discharged. Most of you actually paid the bill and then received a receipt that YOU could send to YOUR insurance company if you had insurance.

Because our relationship was limited to you and me, I could tell you exactly what everything was going to cost in advance.  Believe it or not, a school physical was $5.00. An office visit cost between $15-20.  A lab culture was around $8.00.  X-rays were expensive at $25.00.  Life was great.  In retrospect, we lived in the Garden of Eden. I had the tools needed to care for you and your family without outside interference.  Then it went to shit!

You, the patient, and I, the physician, share the blame for what came next. There was a serpent in the garden and we listened to it!  Even though the cost of your medical was the cheapest you would ever see, you had other expenses and did not want to pay the bill at the time of service. The great serpent, the insurance company, promised that they would take on your burden and negotiate a better deal for you.  All you had to do is pay them quarterly and turn over all of your healthcare rights to them.  You bought in!

Your physician felt cornered and defenseless.  One day, two suits came in to my office with a business proposition.  They sat at my desk and explained to me that they were going to take all of my patients away if I did not sign on the dotted line.  They explained that their company was the largest healthcare insurance company in the US and that they were actively signing up my patients as we spoke. They would pay a discounted fee schedule which they would create and I would bill them, not the patient. I threw them out.  They kept their promise, and I came crawling back.

Eden vanished and here we are today, living under the rule of the serpent. In the end, I still had 2 nurses but I had 5 people in my billing staff.  Not only did we have to bill the insurance company, but we had to “code” every charge and diagnosis and then be prepared to fight for our rightful money.  No longer was I paid for my services.  I was reimbursed by the serpent at a time and rate dictated by that very serpent.

You screwed up by inviting him into our garden. I screwed up by allowing him to stay. Whereas, in the beginning, I knew what everything I did for you cost and could price accordingly; in the end, I couldn’t tell you what anything cost.  A strep test might be reimbursed at $7 on one fee schedule or might be reimbursed at $20 depending on which version of your insurance you bought. 

Oh yes, while the serpent initially promised to take on your financial obligations, as it grew bigger and fatter, it turned on you, demanding more money upfront and later in co-pays. Prices skyrocketed. To get paid a dollar, I had to charge five.  In the end, the cash price was unaffordable, making it a necessity that you have insurance, further strengthening the serpent.

And in the end, the serpent took away my title of DOCTOR, a once trusted member of your family, and branded me PROVIDER, along with a host of newly minted provider extenders (nurse practitioners and physician assistants).

At this point, I can promise you that, in order to revamp our healthcare system, the serpent must go.  As long as the insurance industry remains in control of each healthcare dollar, they will suck us dry.  (The CEO of Anthem is paid $14,000,000 plus benefits a year.  Where does that money come from? Physicians and patients!)

Tomorrow, we’ll go further into the worm hole.

Here’s your music and a joke.

Life insurance agent to would-be client: “Don’t let me frighten you into a hasty decision. Sleep on it tonight. If you wake in the morning, give me a call then and let me know.”

This drunk wanders into a hotel lounge where an insurance convention just happens to be taking place. The drunk is hell-bent on causing trouble and he yells, “I think all insurance agents are crooks, and if anyone doesn’t like it, come up and do something about it.”

Straight away, this guy runs up to him and says angrily, “Hey! You take that back right now!”

The drunk sneers and asks, “Why, are you an agent?”

The man replies, “No, I’m a crook.”

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3 Replies to “HEALTHCARE PART 2”

  1. Gosh I must be getting old! I remember those starting years as I was a patient.
    I did not like when I did not get my bill handed to me by YOU. I liked knowing what I was being charged and at that time did know what my insurance would pay. I was a lucky patient at that time my insurance was good and paid well with very little argument. Only debate I had at times was with your staff saying my insurance would not pay what it paid. Now I never know my charges and can not figure out how it is paid, because of contracts. BUT even with being on Medicare my secondary insurance plan pays well including pharmacy coverage.
    Best way to explain had cancer charges totaled over $500,000 dollars. My cost was my deductible for two years as treatment went into two yr period.
    So I understand insurance issue but I have been lucky as have most of my doctors as they got paid quickly and with out much fight.
    But Stu I like the old days when you were my doctor and we knew exactly where we stood and were there for me as a patient. You were good at keeping your care and concern for your patients and I always felt you listened to me.
    Thanks for your years of care!

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