My experience with the healthcare industry has been, for the better part of my life, consumer focused. In fact, as a child and then as a single adult, I clipped along quite well taking care of the common ailments likes colds and gastrointestinal disorders with the simple and tried and true remedies like rest and fluids. Growing up, we only visited our family doctor when the medical problem grew beyond the scope of common sense practices: when we needed stitches or clearance to play some organized sport or other. When we needed to use the system, we paid for the services at the time, much as we pay a mechanic for car repairs, or a landscaper for landscaping services and the like. The concept of medical insurance was, as all insurance used to be, something you bought or not bought depending on your perspective. For the greater part of the population, catastrophic insurance or what used to be called "major medical" was plenty. It was inexpensive but gave peace of mind.
Big business became a player in healthcare when businesses and corporations offered coverage to employees as a perk of employment. Unions have used health benefits as a bargaining chip when negotiating contracts. Insurance companies responded gleefully by offering more and more benefit plans with varying degrees of benefits and costs. As consumers relied more on their employers to provide medical insurance, they became less involved in what they actually were receiving. The result is that through the years, insurance companies, with no vested interest in anything other than a larger profit margin, began paying out fewer dollars for medical services, requiring the medical provider (whether a physician or a service entity like an imaging center or lab) to write off some of their service as a contractual obligation, or charge more for the service to cover the loss. Many people, myself included, opted out of insurance coverage, choosing to put those dollars away in a "just in case" jar and pay for medical treatment as needed. That did not last long.....
The nail in the coffin of health insurance sanity came when insurance -- not just medical insurance --became not a choice, but a legal mandate. Want a car? The law requires car insurance. Rent? Renters' insurance. Want a home? Can't be cleared for a mortgage unless you have mortgage insurance. Are you a professional of some sort? Those in trade professions are required to be licensed and bonded. Goodness knows that those persons who decide to make medicine their life and career have been required to shell out thousands and thousands of dollars each year in ever increasing increments just in case an adverse event happened to a patient, whether there was "gross negligence" or not. (This is the subject of another blog). The point is that we as consumers, and those who have chosen to help people manage their health, are being bilked out of thousands of dollars each year to the benefit of insurance CEOs, and our government (both state and federal) is complicit. This situation has greater ramifications than just the loss of consumer dollars.
I have the non-enviable position of being both a consumer of, and an employer in, a healthcare-related business. I know from experience on both sides of the sliding window (as it were) the horrors of our current healthcare situation. We see patients everyday who complain about their insurance premiums (despite their "employer paid" portion), their high deductibles (despite low premiums), their high copays (despite low premiums), and in the post-Affordable Care Act age, the lack of benefit coverage in spite of the plethora of plans. I have heard (and as an employer have seen) about plans being discontinued, to be replaced by a "comparable plan" that is (not surprising) not only at least 50% more expensive, but also offers fewer benefits. In many plans, the "insured" has to meet their deductible before the insurance will pay a dime on a claim. So the consumer not only has to pay higher and higher premiums (or portion thereof), but has to fork out even more dollars before their insurance will pay....but only if the claim is for a covered benefit. It gets worse.....
What is really so diabolical is that insurance companies have replaced trained physicians and mid-level providers in diagnosing patient medical problems. Our office sometimes spends days processing the forms and sending medical records to some insurance processor to get "approval" for medical services for our patients. If we are stonewalled, the process moves to a "nurse reviewer" and finally a "physician reviewer" who requires our providers to get on the phone (taking time away from clinic patients) in order to justify getting a heart study or a CT or a Doppler study. In the interim, the unlucky patient waits and waits, often calling us multiple times a day hoping to hear the OK to schedule the test. It seems that no matter how we try to communicate that we are doing all we can to get approval, we still bear the brunt of their frustration and anger. This is just for medical benefits: the process is even worse to get medicines approved.
The sad fact of the matter is that with all these insurance mandates and the planned confusion that comes with it, the real loser is the physician-patient relationship. Patients don't want to have to pay more on already expensive healthcare. Physicians and other providers don't want to spend their time fighting insurance companies for legitimate medical services needed to diagnose and treat their patients: they want to help their sick patients get better. The result is that most providers spend more and more time on insurance paperwork and in order to have any sort of life away from their job, they either need to see fewer patients (with the result that patients sometimes cannot be seen for several weeks out), or they see more and more patients (with the result that they spend less time with each of them). I believe that the majority of physicians, nurse practitioners and physician assistants chose their profession in order to make a difference in the lives of those who seek their care, but the system has been rigged against developing the kind of human relationship needed to really know, understand and care for people to make that difference.
None of this stands to reason. When I am sick, I expect to be able to seek out medical care and it should not cost an arm and a leg. As a consumer, I expect that my healthcare dollars will be available when I need them and for whatever I legitimately need. As for my provider, I should expect that she should be paid according to her experience, time and skill, and not have to "write off" a significant portion of her fee to be pocketed by some insurance administrator or suit, or to improve an insurance company's bottom line.
So for what it is worth, I will likely continue to shell out thousands of dollars each month for health insurance, continue to commiserate with patients and medical professionals about the sad state of affairs, and will continue to wonder how it ever happened that health insurance became a "right" when it is not specifically mentioned in any constitution, whether state or federal. I will also keep praying that consumers wake up and push back against this travesty, or that the whole system will implode and we can begin again with more sane minds managing the system.
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