Starting with the team I know best, the doctors. It is then hard to generalize us as a group, but for greater understanding of the physician it is needed. We went into medicine with the idea of studying science diligently, memorizing a million details about a million diseases. No where in there were we taught about insurance companies, personal finance, business management and legal pitfalls. In a jam packed med school curriculum it seems almost unethical to focus on these things, for it would detract from our greater purpose: to understand medicine in the most thorough, holistic manner. Those who learn about finance and legality of medicine get another degree, an MBA or JD.
As any doctor will agree, the world changes once stepping outside those intense, yet protective gates of medical school. Hopping onto the professional circuitry of the medicine reveals a disturbing reality of medicine in America: it’s a business. Conferences give lecture options: “billing for sports medicine” or “emerging epidemiology of influenza.” Only one of those is going to keep you in business.
I practice medicine with one eye on diagnosis and treatment and another on signing forms, keeping my patients satisfied, write down enough information to prevent me from getting sued and allow adequate billing from insurance companies and do it all very fast.
Which brings me to the partner in the co-dependant relationship of the medical profession: the insurance companies. Granted, in the past, the physician’s held the reigns. I can’t back it scientifically, but all you have to do is talk to my parents or any “old-time doc” and you will here: “It’s just not worth it. Medicine isn’t what it used to be.” Reigns were taken from them because of capitalizing on the medical system for their own financial gains.
As we blame the banks for not baring “financial ethics” in mind, we ask doctors to do the same. They should not overbill, do too many procedures or order too many tests just because they can. Without oversight in place, physicians didn’t prove ethically responsible. Putting in some checks and balances was more than appropriate and was attempted by Hillary Clinton in the early 1990’s.
However power transferred laterally instead of redistributing. Insurance companies were granted the power of curbing spending by mandating what labs, procedures, specialist and the like are necessary for the patient. Too many antibiotics prescribed, the physician is dinged. Too many labs ordered, the physician is dropped from that insurance panel. Not seeing enough patients, means not earning the clinic enough money to justify overhead costs, the doctor is dropped from the clinic.
Medicine not deemed necessary per insurance companies is simply not covered. After three days in the hospital insurance companies claim tuberculosis is all-better or that the patient is no longer suicidal, then no more days covered. Patients are a commodity on which to maximize profits and minimize costs.
And so we find ourselves trapped in an abyss: a space to which the money pours in but very little makes it out. Once again, we find ourselves blaming insurance companies for not having “financial ethics” when dictating a patient’s reimbursement.
Capitalism, arguably, provides the “healthy competition” needed for advancing health care. At Kaiser there are hypertension clinics run by pharmacists, self-referral to nutritionists and incentives for staying fit. Kaiser knows that keeping its patients healthy keeps them out of the hospital, hence keeps their bills down.
Kaiser also maximizes its physician’s, nurse’s and ancillary staff’s capacity as to be the most financially efficient as possible. Speed & service with a smile will get you the good pay and a stable job. The focus redirects to meeting the company’s criteria, aiming to get positive survey responses from patients and seeing a lot of patients. Pay is the incentive, not care.
For a limited time a year Kaiser will have open enrollment for our children without insurance or who are on medical. All of us will try with concerted effort to enlist them. We all recognize that it is a privilege to have all resources available to you in one system. It is for the privileged whom are accepted in.
Another, often overseen, player is the pharmaceutical company. Medicine abroad will run people 10-50 times cheaper. The price differential extends beyond our extensive research of American companies. Money directed towards marketing and lobbying are often incomprehensible. Pharmaceutical companies spent a reported $40 million lobbying Congress in April, May & June of this year. ( http://www.npr.org/templates/story/story.php?storyId=106899074 ) Does the lay person need to see ads about Plavix, a medication prescribed to patient’s at risk for stroke? Is it appropriate for pharm reps to be constantly present in clinics to promote their product over another? Is it appropriate for physicians to spend time with pharm reps in clinic while patients are waiting?
After looking at all these groups we see one commonality. Their services and products generate money. We in the United States have decided that the best way to take care of our health is by letting money run it. Unfortunately, it is at the expense of our health. Here lies the crux of how Kaiser differs from France: they diverge at the dollar. Kaiser will decide who is accepted. Once in you will feel the penny pinching from the patient's complaining about copay to the physician's eluding to the "golden handcuffs."
The bottom line for socialized medicine is the health care, even if moderate, for everyone. Until that goal is redefined the conglomerate of hairy wire mesh chasing the dollar will run rampant, abandoning the citizens it’s to care for, leaving many to fend for themselves on the side line.
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