Health Insurance and the Health Care
Crisis
 There is an unmistakable revolution occurring in
Healthcare. As a direct consequence of this, you are losing control of your
health care provider and your money spent on health care insurance. You may not
even be aware of this. The government and insurance companies would like you to
think this problem is due to "greedy doctors." In fact the problems we
are encountering are not new or unique to the United States, but are throughout
the Western World. No country's solution to the problem of providing wide access
to Health Care at a reasonable cost has been adequate. Canada's Health Care
System is on the verge of bankruptcy and physicians leave that country in large
numbers each year because of incredible government rationing of services and
absolute caps on salaries to physicians regardless of the work they perform.
Britain has turned full circle from private fee for service to a purely
government subsidized Health Service back to reinstitution of private care. This
is largely due to inefficiencies in a highly bureaucratic government controlled
system where cost outweighs quality, and the social and personnel impact of
health problems are ignored rather than incorporating them into the complex
equation. Sweden has excellent health care but also a nationalized health care
delivery system contributing to an enormous tax burden on the public. The United
States is currently groping in unexplored territory with a Health Care System
which most would agree is little more than a huge experiment.
History
The history of American Medicine is important in
understanding why we have our current problems. Health Insurance did
not exist prior to 1937. It was created in
response to the Great Depression and the inability for hospitals to survive when
few had money to pay. Health insurance companies were given special antitrust
protection because of this unusual situation, and they
continue to retain this special protection despite a very different world
and healthcare landscape. On the other hand, individual physicians are still
treated as large corporations. They are not allowed to speak about what they
charge, nor act together as a unified group despite the fact that what they
charge is unrelated to what they are paid; if they are paid at all. Large
hospital groups and Insurance Companies on the other hand, use your health care
premiums to advertise on billboards, TV and Newspapers, for care which they don't
provide and pay little or nothing for.
Most patients are happy with their own doctors even when they are unhappy with
their shrinking coverage for care. Despite inflated claims of insurance
companies, they provide less everyday to you, pay less to your providers of
care, and have decreased insurance premiums little or even increased them.
Depending on your carrier, over 20% of your health care dollar is
taken as profit by your insurance company which accepts less and less risk,
while the physicians are forced to accept more.
Nearly all the driving force behind the health care revolution is purely
monetary. There is little or no competition if the only survivors in the new
order are large conglomerate groups of physicians battling over a shrinking
dollar and they are pitted against one another by insurance companies whose
motive is primarily to profit their investors, and not to improve health care to
their patients.
Advocacy
It is important to realize that your only Health Care
advocate is your physician in an increasingly complex health care landscape.
Without your doctor nobody is going to make sure you get what you need.
Some physicians are more dedicated to this than others. This is not related to
practice employment, hospital affiliation, or part of a large multispecialty
organization. Most physicians maintain high ideals and continue to practice the
Hippocratic Oath, placing patient care ahead of all other considerations. You
must realize that these physicians do this at risk to their own professional
survival for your well being.
You are the most powerful advocate for
your own health care. You alone can improve the situation.
Physicians are generally felt to have too
great a financial interest to be unbiased. Because of this we have great
difficulty in influencing legislation. In addition, those who are your strongest
advocates have the least time to direct at political change.
Most physicians practice the best medicine they can, utilizing the highest
standards they know. There is scientific basis in treatment and rational care is
based on personnel experience and training. We are currently attempting to
further validate what we do to show what works best and what should be deleted
from the medical armamentarium. Outcome studies are the new order of highly
sensitive tools to capture what you think about your health care and
what needs improvement. The best person to collect this information is your
physician. He or she is trying to work to improve your health care and learn the
most expedient route to the best result. In the hands of Insurance Companies
this information may be easily misinterpreted without a complete knowledge of
the long-term benefits of treatment. It is unfortunately easy to examine today's
costs without considering tomorrow's related savings. A simple example of this
is the elderly patient with a hip fracture. Without adequate care, this patient
will end up in a Nursing Home for a long time or the rest of their life. When
treated appropriately, this same patient generally is home within one or two
weeks, and continues to function as a valuable member of society at a reduced
overall cost.
Technology
Technology is often cited as the reason for the
inflation spiral in health care costs. Certainly technology needs to be used
judiciously, however, much of what we do now is so much more cost effective than
5 or 10 years ago, that it is absurd to blame technology on medical costs. In
Orthopaedics, only 10 years ago femur fractures were treated with 6 weeks of
traction in the hospital. Now, routine intramedullary internal fixation allows
the patient to be walking the day after surgery and often return home one or two
days after surgery. Not only are the direct cost differences enormous, but the
indirect cost difference to society in a rapid return to work and the
psychological improvements are inestimable. The same is true with ligament
injuries. Ten years ago they were routinely treated with open knee surgery and
required over a week convalescence in the hospital. Now, routine ligament
reconstruction occurs with Arthroscopic techniques. This is more technical, but
the results are more reproducible, and often the patient returns home the same
day as surgery or at most stays overnight in the hospital. These patients are
treated without casts, and may return to light work within a week or two of
surgery. The cost to treat these patients is low in relationship to the
long-term benefit gained. More important are the ethical considerations involved
in medical decision making. Decisions regarding medical or surgical treatment
options are best made with patient, family, and physician together. These
decisions are not always easy, but families and patients generally choose what
is best for themselves, and the physician need only listen. Medical decisions
need to be made by you, not your insurance carrier, government, or
employer.
Choosing
your Insurance
You have power when you decide what
insurance you purchase. Unfortunately, you may not have a choice if your
employer offers only one or two options. In this way, the Insurance Companies
have gained even more power by removing your influence on your health care one
step further. If you can choose between several alternatives, pick whatever
gives you the most freedom to choose your physician. Ask exactly what is
covered, what your co-pay is, and for what. Often patients are not aware that
co-payment is required or that payment is denied for simple things like
crutches, braces, or even surgery. Truly the only thing that Insurance
Companies "insure," are their own profits. Be a savvy consumer and
write your legislature.
Remember that the
future of Health Care in this country is in your hands!
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