An healthcare insider’s look at the healthcare debate from a money point of view.

Someone recently asked me what I think about the national healthcare debate. I don’t usually talk politics but I have decided to voice my opinion and to give you a healthcare insider’s view of the issue.

Part 1:
I am very angry about the death panel comments. Finally, Medicare was going to pay doctors to spend time listening to and respecting the patient’s end-of-life wishes. (Not telling seniors what to do, but listening and respecting.) These conversations already take place, but the doctor hasn’t been able to get paid for that longer appointment time. If a plumber spends 1 hour or 5 hours at your house, they can charge you appropriately. But the doctor can’t because if there isn’t a billing code for the service, the service can’t be billed. Now the doctors will continue to not be paid to listen to your wishes while they already are sacrificing not going home to their own family on time. This will be one more reason that doctors will leave the practice of medicine. You can only mess with someone so long before they say, “I am out of here.”

The idea of a death panel goes against everything in medicine. The last thing doctors want to do is to kill people. They went into medicine to heal and save. Doctors won’t participate in making sure the prisoner doesn’t feel any pain with lethal injections because doctors won’t agree to be a participant in a death. Doctors are very opposed to physician assisted suicide, even when the patient is in out of control pain and is begging for help with dying. (About 5% of the time, pain can not be managed no matter what medication is used.) These are the types of things that politicians can’t understand. The rules of medicine are deeply embedded in the culture of medicine.

Here is what I am also angry about. The healthcare debate has become a battle of political posturing and propaganda instead of trying to come up with a really great plan. I am angry that the politicians are designing the national healthcare program. Hospitals, doctors, nurses, economic experts, healthcare and public health experts etc. should be designing the government program. It would be like an electrician trying to teach your child in school. They are not trained to do that job and are not qualified. I am also angry with the politicians because they are forgetting or are ignorant to the rules of medicine. They can’t ask the doctors to jump through these new hoops to provide adequate care and still hold them to the malpractice standards in place. You can’t tie someone’s hands and then punish them when they couldn’t do everything they wanted to do.

Here are a few other insider perspectives.

Part 2:
1. We already have 3 large government run programs: Medicare, Medicaid and the Veterans Administrations. While those aren’t perfect, they are already a form of socialized medicine. If someone is against a government run program, then I suggest they turn in their Medicare card and go buy their own insurance. The doctors are already relying on the government (Medicare and Medicaid) to pay their bills because the other insurance companies are paying the doctors less and less after they provide services. The government part of healthcare is keeping hospitals and doctors in business.

2. The biggest problem is that there are too many stakeholders involved. Your employer buys your insurance, the insurance manages your healthcare dollar while taking a big cut for themselves, the doctors and hospitals take whatever they can get and eventually you get service. You are so separated from your healthcare dollars, that you can’t understand the true cost and value of what you are getting. If you buy a Chevy or a Rolls Royce, you understand why it costs what it costs because you are writing the check. But you don’t know what you are getting or what the actual costs are when you get medical care. Would you be willing to pay for the services if it was coming directly out of your pocket?

Next, if the insurance company wasn’t taking their cut, there would be plenty of money to care for even the uninsured. And if you are paying for healthcare, you need to realize that you are already paying for the uninsured. That cost is added to part of the charges the hospitals and doctors are billing your insurance company. Removing the insurance company as a middle man would really reduce your costs.

3. Doctors are fleeing the profession. I know doctors that can’t cover the costs of staying in business. One group of Ear Nose and Throat doctors haven’t been paid a salary for 6 months. They just cover the cost of running their practice and that is it. Would you be willing to work for 6 months without a paycheck? No. But doctors are so devoted to their work that they are enduring terrible hardships. But this won’t last. They can’t do this forever. We are losing the good doctors in record number. This is not a joke. Eventually we will have to recruit foreign doctors to fill our vacancies.

4. We don’t have enough emergency rooms still open. In Los Angeles, a large number of hospitals are still open but are no longer providing emergency services. Because of EMTALA, which mandates that anybody who comes to the emergency room must be treated, it is a tremendous financial burden to these institutions. The only choice they have is to close the ER or they will have to close the hospital. There is no emergency room near me.

5. You can not expect people to keep businesses open when they are losing money. And healthcare is a business that is bankrupt. The time is now to put a new plan in place that is fiscally responsible and can meet the needs of our growing and aging population. I am not the expert but there are experts out there that should be designing this plan for us. Stop the political bickering and get down to creating a viable healthcare system.

See this article for more discussion about our role in the healthcare debate.

A healthcare insider’s look at the healthcare debate from a social point of view.

Have a kind and respectful day.