Why Are U.S. Health Care Costs So High?

IN RESPONSE TO TODD HIXON,  FORBES CONTRIBUTOR’S ARTICLE:  Why Are U.S. Health Care Costs So High?

Todd, it is amazing how you can collect numbers to justify nearly anything. I am not saying you did that but I wonder why your numbers add up so poorly from my perspective as a doctor and specialist?  Lets look at it from my perspective.

40 years ago when I started my practice as an eye doctor, I made an income a bit above a PCP but only because my practice offered exceptional services and attracted patients from as far away as Sweden (though not many).  With the advent of “Hillary’s” managed care things changed. Little by little,  year by year my income receded, even though my responsibility grew under the pressure of managed care!  However, the prosperity of insurance companies and the size or their staff grew enormously on the profits sucked out of doctors practices.

Nothing has changed!  Doctors incomes have drastically fallen when measured on PROFITABILITY rather than GROSS.  I suspect you used gross income,  which is, in my opinion, smoke and mirrors!  When I started practice (very competitively priced always, despite the excellence of my care) I used a box with a crank handle and IBM triple copy paper to write a receipt.  Believe it or not, I could do this “high tech task”  by myself!

Today, my office and that of all other doctors is filled with staff who WE MUST PAY but who really work for the insurance companies!! One person spends an entire day on the phone fighting for crumbs off the table of fees,  another is a data entry specialist who deals with the intermediate companies that transfer data from our software to the insurance companies (so that they may deny payments as often as possible).

We have Tech Staff, sometimes full time or part time,   who provide IT support so we can run the computer systems that the INSURANCE companies outsourced to our offices at NO FEE (How nice for their profits!).

 

We do and must practice defensive medicine as Liberal Courts pay millions when we are proved to be less than God (never noted that designation in my degree by the way). Thanks to Obama and congress we now have EMR,  which surveys show slow the doctor down about 30% (how efficient!).  EMR is updated regularly and creates havoc so severe that doctors take home records and must work late into the evening to fix the crap that bad code dumps on them. Surely with yearly bureaucratic recommendations and insurance company demands, there will no lack of bugs crashing and confusing our work.  We have ICD 10 (the world standard we are told)  to add to our current very complicated system.  This should “really”  speed up exams by adding levels of frustration the already formidable task of reporting everything we do to our overseers at the insurance companies.

 

Oh, yes this is America and we have freedom of choice!  We can pick another EMR vendor….. not on your life!  We have devoted hundreds of thousands of dollars and thousands of hours of training to use the EMR we purchased.  It is a marriage made in hell but mandated By Congress!   This is just a little of Reality that your numbers are blind to!

The newest attack on us, other than your words,  are ACOs and PCMHs. These wonderful tools,  to reward Insurance Companies,  take all the risk out of their business and dump it squarely on the shoulders of doctors who are now supposed to become  actuaries in addition to everything else!  In essence it is HMO’s revisited using Capitation to cut services to patients.  Okay,  supposedly the “big difference” is that we will share records (another layer of expense doctors will pay that will “obviously reduce costs”  as it comes out of the doctor’s pocket).  Doctors dropped out of  capitation years ago, as fast as they could.  Why?  They were tied in for a year, lost money and had to deny care to make it work.  Now it is ” improved”,  the government mandates that doctors get tied in for 3 years.  I wonder why this is motivational?   I always thought Russian Roulette, with one bullet was dangerous but are you telling me it is safer with 3 bullets?

If  business really want to control health care costs and was made of conservative businessman rather than someone who gets elected from insurance company coffers, as congressmen just might, you might create a new accountable care model that made sense to doctors not insurance companies and the congress they help elect.   For Example:   NO EMR,  No insurance billing by doctors, No corporate payments for insurance. Re-Create the doctor/patient relationship and get big corporations out of the middle!   Instead put responsibility in the place where it creates  Real Accountability at the doctor patient level, the patients hands!   Go back to the 80% insurance payments with 20% copays.  Let companies rate patients fees based on how fat the patients are, how much they smoke…etc!  If the child throws up after eating a box of candy, they will learn prudence.  A big insurance bill because you like to eat chocolate truffles, smoke Havana Cigars, and have two Brandies every evening might deter some.   Accountable Care as designed today, is a JOKE!  It makes the doctor accountable for the OBESE patients, who eat FAKE FOOD, made by mass food processors.  People are SICK!  One Third of all Americans are projected to be diabetic in the next 20 years! When 15 year olds come into my office with arteriosclerosis, and diabetes that their parents never had,  THIS IS THE COST OF HEALTH CARE  as well as the OUTSOURCING OF INSURANCE COMPANY TASKS to doctors offices for free!   Fix Health Care Costs?   ASK DOCTORS AND STOP SHOVING YOUR ARM CHAIR THEORIES DOWN AMERICAS THROAT!

Janr Ssor