Venting on the Healthcare System

Prior to my pregnancy, I hardly ever had to see a doctor, except for the annual physical exam. Therefore, I never realized how awful the healthcare system was in this country – no wonder all the presidential candidates would have “healthcare reform” as an agenda item. Now that I have had some experience with both the providers (doctors and hospitals and diagnostic labs) and the payers (insurance companies), I realize that this system is like a huge tumor on a vital organ – sure, it’s best to surgically remove it, but you will probably die as a result. Therefore, we continue with various forms of healthcare reforms, which are more or less like palliative care that only superficially reduces the worst symptoms.

First of all, why is it that there seems to be a shortage of doctors everywhere? Usually when we see a supply/demand situation that’s continuously off, it is because someone is holding up supply arbitrarily. Since Michael is an MD as well, he knows more about the medical profession than I do. He said that the shortage of doctors is created by the doctors themselves, so that they can charge a lot. – Most medical schools run hospitals and most medical faculty members are practicing physicians themselves. Indeed if they allow more people to enter medical school, there will be more doctors, especially in general medicine and primary care. With doctors paying more attention to their patients, short-term problems will get fixed instead of worsening into long-term problems that would cost the healthcare system millions if not billions. If it’s not that difficult to get an appointment, most people will probably stay healthy for longer. After all, the United States is known for the superior dental health of its population. A simple explanation is that my dentist would call me to schedule the next cleaning, whereas when it comes to doctors, the responsibility is all mine to find a good doctor that has openings.

Second, why is it that while there seems to be armies of staff at doctor’s offices and insurance companies, we as patients still have to waste a ton of time sorting out missing paperwork, wrongly charged items, referral letters that should have been sent but were never sent, tests that were sent to the wrong places, etc? A snobbish explanation I have heard frequently is that if these people were smart and competent, they would not be working in those jobs. I got a bill from Quest Diagnostics for $799 for a test ordered by my doctor, which was denied by my primary insurance company, which is a PPO. Since Quest does not accept any HMO (which is my secondary insurance), I made the decision that I would ask the doctor to send my tests to be done at a place accepted by my HMO as well. The office staff simply could not understand this simple request, saying that they would always send patients whose insurance is PPO to Quest. I asked, “just pretend that I only have HMO. Where would you send my tests?” – They looked at me as if I were stupid, and said, “but you have PPO as well.” I changed the question slightly, “For a patient that only has HMO, where would you send her tests?” They said, “ the hospital.” – I said, “Okay, that’s where I want my tests to be sent as well.” – So they put a note into my folder. Guess what happened next time the doctor ordered a blood test? – They sent me to Quest again!

On that $799 bill from Quest that was denied by my PPO, I paid for it first because I just could not stand the idea of having outstanding bills. Then a friend of mine said that I ought to call and check, as these companies make mistakes all the time. I called PPO, and sure enough, after many people’s involvement in checking on this one bill, they realized that they should have paid for it. So they told me to wait for a few weeks. A few weeks later, I got a statement from the PPO stating that it’s been paid and Quest would refund me. Now two months later, I still have not received the refund. So I called Quest twice – the first time, I got hold of someone who could hardly speak English and categorically denied that it was paid. The second time, I got hold of someone who has a normal IQ, and she said, “Thanks for calling us about it. Now that you have brought it to our attention, we will initiate the refund process, which is going to take another 30 to 60 days.” – I thought to myself, “ had I not called, they would never have activated this process!” Basically, they are just relying on people getting lazy or fed up to not have to pay!

Besides, the pricing scheme seems to be a scam. A bill from Quest could be as high as $799, but the PPO would claim to have a saving of $600, and pay just $150 of it. That means the test really cost at most $199, if at all. So why do the diagnostic labs charge so much? Or in general, why do doctors and hospitals charge so much? – From talking to friends, I have come to realize that because many people do not pay at all, and they don’t care if their bills get into collection agencies, those of us who can pay will have to shoulder their share of the burden. Those of us who do not have the patience to spend hours on the phone will certainly have to shoulder even more of the burden than others!

So why are there so many people who get “expensive” medical services that they either cannot pay or refuse to pay? – Maybe in a way, the complete lack of respect for a subject like health economics is the root of the problem in this country. There is no price associated with one’s life, so the doctors and hospitals have to treat those who cannot pay at all. And for those people covered by insurance, 90% of the cost is incurred by at most 10% of the most sick patients. In a way, an insurance system that receives contribution from members should probably set its mission somewhat differently in that it should emphasize preventative care, basic care and emergency care, and leave the super-expensive cancer treatments that would prolong one’s life by at most 3 months to individuals’ discretion. Our own lives are indeed invaluable to us, but not to others. Health economics should not be portrayed as a heartless subject. On the contrary, the practice of health economics will result in much more conscientious decisions, and will reduce the blatant abuse of this healthcare system by irresponsible lifestyles (like overeating), or uncaring doctors (who prescribe a lot of unnecessary tests since there is no downside to them anyways).

A friend of mine who works at a health insurance company once told me that the system was so inefficient and broken that she did not see the reason for the payor sector to exist at all! – On the other hand, now that we have been living with this system, I am rather pessimistic about seeing any real changes happen in this country. Often, it is harder to change or reform a broken system than to start something from scratch.

I talked about changing doctors forever – my doctor and her office staff have awful reviews on the web, for very good reasons. But just the idea of having these incompetent staff handling transferring files has made me wonder if I might get myself into new troubles.

The healthcare system is about the closest thing to an absolute monopoly that does not answer to any external feedback or pressure. We may be fed up with it, but we have no other choice either.