Wednesday, March 11, 2009

Required Reading on Health Care Reform

As a physician, there are many out there who would assume that I want to keep our current US health care "system." They couldn't be more wrong. Daily I experience the waste and inequities of our state of affairs, and I am appalled.

Required reading is this week's cover story from Time Magazine. A health care reporter, Karen Tumulty, describes the hell her brother went through when he was diagnosed with chronic kidney disease, even with an experienced medical reporter in the family to work through the system (or lack thereof). This story is not an isolated incident; this happens to thousand of working Americans every day! It is especially tragic to me when a parent has to change jobs and their children with pre-existing conditions cannot be covered by a new policy.

From my professional perspective, the waste involved with multiple payors is incredible. At our institution we have many people whose job is to figure out what is covered for each patient and to what level. Some patients have multiple sources of coverage. While this sounds like a good thing, what usually happens is that no payor wants to cover anything. When I see the number of people employed just to figure out this transaction, I can't help thinking about how many people could be covered with the funding for these bureaucratic expenses.

Another frustration is the nit-picking that goes on for trivial expenses. One recently discharged patient needed a medication she had previously taken as a pill in patch form. She had been admitted several times because she would vomit the pill and her health issues would decompensate. I had to spend 45 minutes in voice mail hell to get the switch approved. The cost of one admission would cover the difference between pill and patch forms for a long, long time. I can't imaging being a patient, someone not familiar with the system, and trying to jump through these hoops. I'm afraid I would just give up - and many patients do, to the detriment of their health.

The job of the insurance companies is to make money for investors, just like any publicly traded corporation. Spending money on healthcare reduces profits, even if it makes you, the insured person, better. If patients truly had choice, they would pick companies that covered them better over time and others would go out of business. The choice is not in the hands of patients but their employers who are looking at the needs of the group and the business, not the individuals. We need a drastially different approach to healthcare in this country. It's time, America.

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