Last summer my father died. Since then I’ve had a lot of thoughts on the state of healthcare in the United States. I’ve been working in the industry for going on eight years now also, and some things have become obvious to me over time. There are many scenes in the healthcare industry that are unpleasant to watch for various reasons. This is medicine and it’s not always pretty. But, the most disgusting part of healthcare is not the emptying of bedpans or changing bandages on bedsores or surgically removing diseased tissue. It’s what goes on far away from the doctor’s offices and operating rooms. The stomach churning part of healthcare is on the business end.
Make no mistake, the American healthcare system is all about money. No, I’m not saying that everyone who embarks on a career in healthcare is a greedy capitalist pig. What I’m saying is that medical systems are huge, complicated corporate enterprises that are designed to maximize profits, even if they are nonprofits. In fact, I would venture to say that there is no such thing as a nonprofit because someone is always there for profit. These are multi-billion dollar businesses run by a number of wealthy people who intend to stay wealthy and increase their wealth through running their business at maximum efficiency and profit potential.
Let me ask some questions.
Why do primary care physicians see 25 – 30 patients per day, spending barely ten minutes with each one before writing a prescription and hurrying off to the next appointment? Why is every physician’s office filled with drug company swag? Why are there giant billboards and expensive, professionally produced radio and television spots for healthcare systems and services? Why do old people end up on ten prescriptions and numerous expensive procedures in their final years of life?
All of these questions can be answered with one word: money. All this is done to make the most money.
Again, I have to state that I have no problem at all with people making money. It’s completely natural for all of us to want to prosper in life. In fact, it would be unnatural if a person was not at all interested in increasing wellbeing in some way. Making more money is the most common way to do this in our modern society.
Money is a problem in the American healthcare system because the whole idea of healthcare has been conflated with paying for healthcare, namely with health insurance. If you’re paying attention to all of the discussions about healthcare over the last few years, you’ll note that almost all of the talk has been in terms of insurance coverage. Everyone has to be covered by insurance or some terrible catastrophe will destroy us all. Think about that for a moment.
In almost every other case, insurance is used to protect the consumer against financial cost to recover from damages caused by unforeseen and usually accidental adverse events. It’s not typically used or even needed to protect us from the cost of anticipated, expected, normal occurrences in our everyday life. For example, your car insurance plan will reimburse you if another driver slides and hits you on an icy road, right? But, does it cover your regular oil changes? How about getting your car detailed? New tires? No?
Does your life insurance company send you a payment every year on your birthday because you’re one year closer to death? Does your home owner’s insurance pay for new paint every 5 or 10 years? I didn’t think so.
So, why does your health insurance plan pay for a regular checkup? An annual physical or breast exam? Dental cleaning? Vision test?
Well, you say, it’s because these things are all so expensive now!
Yes, they are expensive now and the reason they are so expensive is because there are so many middle men and so much money in this system. We are experiencing a gigantic medical industry bubble due to all of the money injected into this already huge system.
Unless you are deeply involved in the business end of the healthcare industry, you truly have no idea how many people have their hands in your medical business. Not just your doctor, nurse, or x-ray tech, but the registrar, the scheduler, the biller, the claims editor, the insurance company claims filer, the hospital administrators, the database and systems analysts, the billing companies, the regional health exchanges, the state and county health information registries, third party system administration staff, and the list goes on. There are typically hundreds of entities who handle your medical information and each one of them makes money doing it.
The ultimate reason for the quickly climbing costs of healthcare are that there are way too many hands in the pot and each one of these hands is reaching for a fistful of your cash, either from your out of pocket costs, your insurance premium payments, or your tax dollars. It all comes out of your wallet.
Don’t tell me it comes from the government. Where do you think the government gets it’s money? Governments have no money unless they take it from YOU. It all comes from the taxes and fees and penalties you pay.
Let’s go back to the topic of what you’re paying for medical care. Most of the money you’re paying is NOT going towards medical care. Kind of like that United Way donation you so generously made where about 10 – 20% really goes to help the needy and the rest supports the massive bureaucracy of the charity. The vast majority of your healthcare dollars are going toward supporting all of the bureaucracy and middle men now involved in delivering your healthcare to you.
It sounds hopeless, doesn’t it? There are all these nasty people out there greedily taking your money and returning only the little bit of mostly crappy medical service that you pay so dearly for. But, all these middle men aren’t really the problem…
The problem with healthcare these days isn’t with doctors or nurses or administrators or even greedy insurance executives. The problem lies with those of us who are consumers of healthcare in the United States. YOU are the problem. And so am I.
We’ve all allowed our dollars to be sucked up into this giant hoovering system because it’s been easier to just allow it to happen. They’ve convinced us that they will take care of everything. We won’t have to worry about paying for a thing. For one low monthly payment (or, more likely, another chunk of our paycheck that disappears before we even get to see it) they will pay all of the bills for us. And that seemed to work for a while. Ten or even twenty years ago, insurance paid for much of the costs of medical care out of our premiums and our out of pocket cost for most non-catastrophic items wasn’t a lot.
All that has changed now. With all of the profit potential and all of the media and political attention, more and more money has been injected into this system and multitudes of new entities have been placed between you, the consumer, and the providers of your medical care. More and more money out of your pocket is required to pay all of them in addition to your medical treatment. You are no longer in a direct fiduciary relationship with the people you are supposedly paying for a service. They are no longer beholden to you as their customer, but to the vast apparatus designed to soak up all that extra money in the system.
So, what’s the answer?
The only way this will ever work out is for people to begin opting out of the current system. You must starve the beast and it will ultimately collapse under it’s own weight. This has been made more difficult now in the day of mandatory health insurance, but you can make choices that take control of how your medical dollars are spent. You can be choosey about your medical professionals and the services they provide. You can say “no” and get second opinions. You can contact your elected representatives and tell them that you want to decide where your healthcare money goes and how it’s spent.
The bottom line is that YOU are the one who is responsible for your own health and that of your dependents. It’s not the doctors or insurance companies. They are people you pay for services. You owe it to yourself and the people who depend on you to be an informed consumer and take an active role in determining your health needs and how they are paid for. Next time you find yourself in a doctor’s office, ask questions and then do your own research. Find out what the alternatives are and what the actual cost is before you lay down your hard earned money.