Health Care Reform: Giving Chemo and Leaving the Tumor

 

child_vaccinesPhone calls to defensive health insurance officials can be nerve racking, as can opening those statements to determine which visits or interventions were covered and what percentage the turkeys decided to pay. It shouldn’t be arbitrary, but often times, it is.

 But I thought this procedure was covered completely with just a co-pay…My doctor was ‘in-network’. Or, what about when they ask you if your procedure or expense was ‘medically necessary’? Yeah, I thought about keeping that dysfunctional prostate a couple more years before deciding to just let ‘em fix it.

Haggling, arguing, pleading and sacrificing have become much too common in the lives of everyday Americans, regardless of whether they carry insurance, and some 46 million don’t, although many of them can afford it but choose not to purchase it. Excluding those making $50,000 per year or more, only 20 million, or less than seven percent of the population is left.

According to a recent survey, most Americans consider health care a “threat to their security,” and some 80 percent believe it isn’t functioning properly.

Obama’s health care plan may cost upwards of $1.5 trillion over the next decade. And largely overlooked in the ‘who is going to pay for what’ debate, is the reason why we’re here—cost. Our system is overpriced. Our drugs, doctors, hospitals and health coverage cost too much for a variety of reasons.

It’s not about who is paying the bill. It’s about the bill.

New Hampshire Senator Judd Gregg echoes that belief. “We shouldn’t just be throwing more money on top of the present system, because the present system is so wasteful.”

Over the years, the AMA has vociferously lobbied to limit the number of doctors. As a result, qualified students like my friend Karen, a University of Florida graduate in microbiology, zoology and a minor in chemistry carrying a GPA of over 3.5, didn’t qualify for medical school after graduation. Rejected but determined, she entered graduate school in microbiology and received her master’s degree with a 3.8 grade point average. Still not good enough. Oh, and her MCAT (med-school entrance) score was above average. She also had extracurricular qualifications on her resume—she was the university’s mascot for several years, the same years she spent breaking her back to qualify for Med School. 

While the AMA lobbied to limit doctors, the ABA campaigned against malpractice caps. That guy who went in for an appendectomy and left without an arm couldn’t pay his bills or retire on just $2 million. The least that the hospital, doctor, and ultimately, insurance company could do is give him $10 mil.

Doctors. These days, it’s difficult to sympathize with those who run their offices like an assembly line of “get them in and out inside of five minutes,” because the HMOs, Medicare and Medicaid have destroyed their dreams by sapping the automatic riches owed them by their choice of profession. For many of them, it’s a business. You want a refill? Leave a message and give them a couple of days. You want test results? You might have to wait and take an e-mail. You want them explained? Talk to the nurse.

And honestly, spare me the woe is me argument. I was recently introduced to a doctor, born in raised in Milan, Italy who is now working in Orlando, Florida as a cardiothoracic surgeon. We exchanged pleasantries, and I explained that I was moving back to Como, which is a forty-five minute drive, well, Italian drive, from Milan. “I’ve thought about going back,” he told me, “but I wouldn’t make the kind of money I make here. Now that Obama has been elected, though, I might go back because the system will look more like Europe’s.” 

While every industry is getting hammered in the market, pharmaceuticals have dipped but they certainly haven’t cratered like other Dow stocks. It’s enough to do a chart comparison between Roche and Pfizer against the Dow’s performance. Despite spending millions in commercials of couples in bathtubs (Cialis) and in print advertising advising patients which medications they should be requesting from their doctors, these pharmas just keep raking it in. Never mind that Canadians and Europeans pay a fraction of what Americans pay…

Their argument? They need their R&D.

Simple question. How do other companies manage to create new products without price-gouging? Does Microsoft charge $4,000 for the new Windows application? Do Airlines attach an $800 surcharge to passengers for flying in the new Boeing 777?

Memo to pharmas: We don’t need to pay several hundred bucks for a prescription of Nexium to ease heartburn, we can take Prilocec.

I’ve neglected to mention hospitals for a reason. Despite their cumbersome bureaucracy and $50 aspirins, they are forced to deal with all of the above, plus two—the illegal immigrant patient who has 911 on his or her speed dial and the uninsured patient who might declare medical bankruptcy to avoid the ridiculous bill presented by the hospital.

Every industry and every professional involved in the United States health care is culpable in accelerating its demise, yet integral to its possible turnaround. For years, the American people have been doing the sacrificing, and now is the time for those in the industry to do the same.

It doesn’t matter who picks up the tab. The problem is the tab itself.

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