Almost eleven weeks ago I suffered a "slip-and-fall" accident on ice and broke my ankle in four places when my body weight landed on it. I heard a loud crack as the bones gave way. The layperson’s description is that I broke off both of the knobs on the inside and outside of my right ankle. In other words, the leg bone was not connected to the ankle bone. I have a touch of PTSD from the experience. Four days later I had surgery. My ankle is held together by a stainless steel plate and nine screws. I exercise daily to strengthen the muscles but I still walk with a slight limp and the joint feels stiff. I expect it will be another six weeks until I have my strength and flexibility back. The healthcare I received was excellent and I am fortunate to have good medical insurance, but the system within which the care was delivered is full of waste and inefficiency.
My ankle is heeling fine and I expect to be back to normal in about six weeks. I thought my observations about inefficiencies of the healthcare system were worth a diary.
Over Focus on Payments
It seemed to me that the main focus was to arrange for payment, and a request for my insurance card always preceded questions about what was wrong with me. This is a misplaced priority. Healthcare should be the priority of providers, not collections. In fact, this was illustrated during my ambulance ride when the emergency responders had a sophisticated computer system for obtaining and processing my insurance information but tried to convince me I had an ankle sprain instead of broken bones. Stupid.
Too Many Bills
This was the first time in decades that I had a relatively serious medical issue and I could not believe how many bills I received. The emergency room visit resulted in separate bills for the emergency room services and supplies, the emergency physician, the on-call orthopedic surgeon, and the x-ray. I could not believe that the x-ray service of an emergency room was subcontracted to a separate organization. Each bill represents a wasted expense of its own mini-bureaucracy to process the paperwork and mail out the bill. It’s ridiculous that an emergency room can’t run its own x-ray machine!
I went to an outpatient surgical center for surgery. Again, medically, I was treated well but the excess bureaucracy was depressing. I received bills from the surgeon, anesthesiologist, and the surgical center. In fact, one of the forms I signed listed five entities that might bill me. It seemed that I was being seen by entrepreneurs, not healthcare providers. Each had LLC or PA by the group’s name and was most interested in billing. Each separate bill must add to the costs of the service because the same paperwork is being repeated over and over.
Too Many Interviews
I lost count of the number of times I was interviewed from the time I entered the ambulance to checking out of the surgical center. Each interview seemed to ask the same basic questions with slight variations and was conducted by each of the separate billing entities. Each interview asked for insurance information and health history. There was no central location for the information so it apparently needed to be obtained over and over by an assistant of each service provider. This process added more unnecessary expense. The repetitive interviews are a symptom of the bloated mini-bureaucracies that inflate the costs of our healthcare.
Subrogation
Subrogation is a clause in most medical insurance that requires any money collected as a result of insurance payments by some non-medical entity such as auto insurance or premises liability to go to the medical insurance company first. I discovered that my medical insurance company has an entire bureaucracy in charge of subrogation collections. A simple and law on subrogation could save tons of unnecessary costs. I would recommend that the patient’s out-of-pocket expenses be reimbursed first, and then the medical insurance company be reimbursed, and then any remaining money goes to the patient. A simple law could cut out a major subset of unnecessary medical bureaucracy.
Costs
Everybody is familiar with the discounts that insurance companies can demand from service providers. I received a bill for part of my surgery for $2,516, but the amount "allowed" by my insurance company was $1,174. An x-ray billed at $89 had an "allowed" amount of $49 (with my co-pay being part of the "allowed" amounts). In the first case the discount is 53.4% and the second case, 44.9%. If the costs of an x-ray are met at $49, then why do others pay an extra $40 for the same service? I don’t know the answer to this question, but I do know that someone is making a nice profit from that extra $40.
Credit Card Payment
Every bill I received had a small section allowing the patient to charge their medical bills to a credit card. Some healthcare providers set up their own interest-charging payment systems. When I am in a bad mood, I cross out this section and write some comment over it such as "immoral." In my opinion, we could go a long way towards shrinking the huge number of medical bankruptcies by forbidding medical service providers from charging interest on their bills or accepting credit card payments. If these people want to be millionaires and entrepreneurs from the health problems of their patients, they could at least make their money from services and not interest, and they should not be passing the debt to credit card companies charging usurious interest rates. It’s fine to charge interest for a new car or HDTV but not for health services.
The Entrepreneurial Spirit
There is a place for entrepreneurship, even in the medical field, but is it necessary to turn the entire healthcare field into entrepreneurs? Why can’t the doctors work for decent salaries instead of becoming independent billing entities? Each independent entrepreneur needs to have a staff, a separate interviewer, assistants, and a separate set of paperwork. Although the entrepreneur becomes rich by virtue of being able to bill for their services, the healthcare system and many of those needing healthcare become poorer because of the unnecessary duplication and wasted expense.
Let’s Keep Going with HCR
I cheered passage of the HCR bill. I thought it was a great victory for Obama and accomplished some positive change. However, the bill fails to reign in the abuses of health insurance companies and does not reduce the bloated bureaucracy that accompanies our system. Public corporations are required by law to operate in the best interests of the shareholders and pursue profit at all costs. They will continue to wreck havoc on society until we change the basic laws that govern them. Can we do something about the bloated bureaucracy? I think we can. Here are my suggestions:
- We need to put all insurance company CEOs into a room and not let them out until they produce a uniform and simplified set of policies, rules, and paperwork. Failure to do so within 90 days would result in a fine of $10 million per day per company until they produced an acceptable result. I believe this would save costs and improve competition among insurance providers.
- A simple subrogation law, even if it favored health insurance companies, would cut out another unnecessary layer of bureaucracy.
- I feel it is immoral to charge interest on a medical debt and we need to enact a law that puts this belief into practice.
- We need to consider changing the method of educating healthcare providers, especially doctors, who come out of medical school with huge debts so that they gravitate naturally toward an entrepreneurial approach to healthcare. At the very least, interest free loans should be available to every medical student, provided they agree to work for a salary instead of adding to the bloated bureaucracy. Okay, there are some details to be worked out here, but I think the basic idea is sound. Limiting the debt burden on new doctors could have positive effects that ripple through the healthcare system.
- I was a big fan of "Grey’s Anatomy" for a couple of years until I realized that patients never had to worry about paying for their care. My students say this tradition continues. Perhaps this show is responsible for the opposition to HCR because it represents a fantasy world of "free" but excellent healthcare. Those of us, who now have good healthcare, would probably not pay less even if we had an efficient single-payer system. The savings would probably go to those who now do not have any decent healthcare. Yet the goal of universal healthcare is one I completely support. Let’s keep moving.