July 30, 2007
I sat in the dermatologist’s office the other day waiting for 56 minutes to get to a treatment room, where I waited another 25 minutes. The next day, I waited over 1½ hours to see my internist. So I’ve had lots of time to think about what’s wrong with the health care system.
Very simply, the person who receives the treatment is not the same person who pays the bill. The result is a system where there’s rarely a personal connection between doctor and patient any more.
Because of insurance companies and government agencies telling physicians what they will pay for certain services, and therefore what the doctors must charge, there’s less attention to providing quality medical care and more to handling money.
It’s a far cry from a time, over 50 years ago, when I whacked the top of my big toe with an axe—doing something I shouldn’t have, of course. I clearly remember the image of six stitches in my toe and watching my dad pull out a ten-spot to pay the doctor.
Throw in the lawyers in our new litigious society, and physicians are far more likely to get sued for what they don’t do. My big toe doctor didn’t even take an x-ray; today, he’d send me to the hospital for MRIs, blood tests and God knows what other kinds of tests.
Yet, in the end, was I less served then than I would be today? We need more participation in medical decisions between doctor and patient, not less.
As I sat in the waiting room this week, I watched about two dozen people shuffling papers for two doctors. The doctor who treated my big toe had a single nurse; he did the paperwork himself.
As the waiting room fills up with patients, and you start to multiply the hour you’ve waited by the number of other patients, it’s easy to think crazy things. Do doctors really think their time is so valuable but that of their many waiting patients isn’t? Probably not.
Both of my doctors are fine people, very knowledgeable and respected in their fields. Both gave me plenty of attention when it came my turn, answered my questions, asked for more and offered their advice. If they weren’t “good doctors,” I’d go somewhere else.
One was clearly having what he called “a bad day,” but it was mostly because he discovered complications with one patient that may have saved that patient’s life.
You also start to wonder how many of these patients are visiting the doctor because something is really wrong. In my case, one visit was a follow-up after minor surgery, and the other was a routine, every 3-4 months exam.
I would guess that most of the people I saw in the waiting room were in the same boat.
All these extra tests, extra medical people, extra records and extra procedures cost a lot of extra money. Ask yourself who pays for this, either in higher taxes, higher insurance premiums or higher prices for everything—or in jobs going to China, because things cost less there.
I’m guessing, too, that over-testing and over-examination are quite common, and I’d bet that certain tests—dental x-rays, for instance—are scheduled as they are, because that’s how often the insurance policy will pay for them.
I found out, for example, that a “bone density scan” is covered by my insurance every two years. Do I need one that often? I don’t know.
I’m not interested in backing up medical science 50 years, but was America really that bad a place a half century ago? After all, Dwight Eisenhower was president! All he did was beat back Hitler and save Europe. (And my wife is a distant relative.)
What would happen if Americans had a certain “budget” they could spend on their health care—whether provided by government, employer or insurance company—and they could call the shots on how they spend it?
The budget might cover certain kinds of accidents or illness. After it’s spent, you spend your own money on additional services, just like copays and deductibles now. For truly catastrophic situations, you get help from a “safety net” like Medicare.
If you have a doctor you don’t like for whatever reason, you fire him or her and go on to another. If you want to schedule your routine exam for six months, or just wait until “something hurts,” the decision should be yours and your doctor’s.
You have a bond of trust you develop with your doctor. You respect his advice, and he understands that you may not have unlimited financial resources. You and he decide, not an insurance company or “the government,” or worse, a lawyer.
Sure, there’s a possibility of more risk, but what about life isn’t risky, even today?
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