Healthcare in the USA

Quixote from Shakesville recently made an interesting post about our healthcare system. Click the link to read the full article.

As interesting as the post it, I found DW's comments to be particular enlightening. Yes, there's a bit of rant in there, but many good points are made along the way, like why procedures cost what they do, priorities, and the overall structure of healthcare. (Maybe later I'll go back and underline or bold the main points. I can't right now, cause my lunch is over.) DW is one of the people that works at a doctor's office, doing everything except seeing the patients.

***Edit***
I got the chance to bold and underline some of DW's main points in case you just want to skim it.

DW Yesterday 09:06 PM
Today at work, a patient balked and complained about the cost of her exam and how expensive it was. Granted, $229 is a lot of money. The flip side is that she doesn't know what hubby knows. He's the doctor. He went to school for years and years and years. The kicker is that she is my former hair stylist. A cut and a color ran $180 three years ago when I last saw her. I didn't balk at her prices. She's the professional - I am not. Doctors have been devalued to a great degree. Some patients leave us because we no longer accept their insurance. Some return after seeing how poorly they are treated elsewhere and some return because they realize they get exemplary care from hubby. Some never return, but continue to pay $180 for their hair every eight weeks. It's bizarre. No one would stand for managed hair care, would they?

Lets not even go into the outstanding student loans.


DW Yesterday 09:56 PM
Let me also add that I don't think patients CAN control the cost of healthcare and I'm not sure they would want to. We are much more costly than some physicians and much less than others. We DO get price shopped. And often there is someone willing to see a patient for a lot less. Unfortunately, one must then make their wage on quantity, not quality. Some insurance companies, like Oxford, reimburse us a pittance. Sometimes the copay is more than the insurance company deems the exam worth! Others, like Aetna, pay us roughly four times what Oxford pays. Sometimes, I don't get paid AT ALL by the insurance company and eat it. Or I wait none months and have to spend four hours tracking down claims. And then I eat it. And sometimes we just do the service gratis because the patient needs it and has no resources or is in pain or is otherwise NOT getting this treatment unless we do it gratis. As a rule, we tun no one away because that is not what medicine is about. It is a reality that the patients who can pay do pay as it helps us meet payroll and offset the services we perform gratis. We hope for reforms because this way is truly broken and I get to experience that from a provider's point of view every day.

I had a point when I started this rant...


DW Yesterday 10:02 PM
Actually, Wondering, I'm not saying that at all. I'm saying this system is fucked up. It hurts many doctors as much as it hurts patients. Insurance companies fuck us as much as they fuck patients and should be cut out, or minimized, of the equation. My point was healthcare is NOT a commodity, although it is treated as one. It should be a basic right. When it is treated as a commodity, everyone suffers, especially patients. My point with the hair care comparison was to show how doctors are devalued when it IS treated as a commodity.


DW Yesterday 10:07 PM
...and furthermore, patients are also devalued when healthcare is a commodity. All we want to do is provide and treat and serve. Instead, I get a shit pile of denied claims and insurance company BS routinely. That hurts our patient care because we spend so much damn time chasing claims and making phone calls. Insurance is the ultimate scam. That, to me, is a crying shame.

Gah. Long day at the office.


Yesterday 11:08 PM
Yeah, I'm having a bad explaining day. Sorry. I went off on a riff before I got my explanation out.

I gotta tell ya'll, we work hard. We see every emergency, every everyone who can pay or not. What galls me - GALLS ME - about the hair care comparison is that no one would allow a third party to dictate their hair care but we have our healthcare dictated to us. That is STUPID!!!!!eleventy one to infinity, squared for good measure.

It does piss me off that I would pay someone the ridiculous sum of $180 to cut and color my hair and she would turn around and complain that our service fees were too high. Um, hello? Like, almost equal. Some of the hidden costs doctors bear are rent, utilities, staff, FICA, Medicare tax, worker's comp, disability, malpractice, health insurance for our employees, equipment that allows us to practice at the standard of care, pens, paper, soap, computers, EVERYTHING. If Oxford finally pays us 6 weeks later a whopping $46.50 for an exam I'm lucky. I would love, love love, love, love to just know I was getting x dollars for every single patient that we saw even if x was lower than most of the plans we take now. Often, we don't know what testing plans will cover despite calling them before the exam. And it is pretty hard to do that when you have 6 back to back patients and the insurance company phone tree pretty much guarantees you never get a human being on the line. As a general rule, doctors are NOT business people. Nor should they be. Sign us up for a new system, please.

Thank you for giving me the space to further rant and explain. I am completely stressed out over our office situation and I'm trapped there because I work for peanuts in this family business because we couldn't afford to pay someone else to do what I do which is everything but actually see the patients.

DW Yesterday 11:24 PM
A Sniper - I can explain some of that. As a provider, I MUST bill everyone at the same rate. But each individual contract we sign with individual carriers reimburses us at a different rate. Often, there is a cap on rates for a geographic area. If I set my fees too low, I don't get reimbursed the maximum for my area which, btw, is usually substantially less than the billed amount. I am not permitted to discount based on carrier. Which puts us all in this conundrum. So all those providers bill outrageously high amounts hoping that they will capture the prevailing maximum fee which is ALWAYS less than is billed. The shitty side is that no discount is then applied to the private payor who ends up with the crazy bills. We bill every insurance company $269 for a routine exam. We accept anywhere from $45 to $195 for that service depending on the contract. Outlandish, no?

A few years ago, I saw a top thyroid specialist in NYC. He took one plan - Oxford. I didn't have Oxford. He charged me $500 out of pocket to see him. He would have billed Oxford the same $500 but accepted $125 from them for the same service. Totes not even remotely sensical.

DW Yesterday 11:27 PM
I meant @ Sniper. I'm on a roll today. I'm going to stop posting these epic comments. If anyone has a question about insurance, please ask me. Unfortunately, I know more than I'd like to know. :(

DW 32 minutes ago
@MomTFH, my point about the hair dresser was to show how docs are devalued, not to compare their services, where you have choices, to medicine, where you do not. It was also to demonstrate that as Americans, we have a skewed priority system. And patients expect that once they hand you their insurance ID card, they are abdicated of all financial responsibility. And they are not because roughly 1/3 of the time, there is a non covered service or a deductible or a coinsurance that neither we, no they, are aware of. YES, there are docs who do expensive things JUST for the reimbursement. Some are greedy and some are just tired of constantly fighting the insurance company to receive a fraction of what they bill and what they deserve to be paid. The system is inherently unfair and completely skewed towards profit for the one controlling the checkbook - not in the best interest of patients OR docs.

After being with my sister in labor and delivery twice, I know just how hard C-sections are pushed. At the convenience of the doctor, in her case. Was it necessary? I bet three different docs would give you three different answers. The next baby, she used a mid wife. It was a vaginal birth. Go figure.

Rest in Peace Dr. Tiller

"This is the first time an abortion provider has been murdered in over a decade. I have friends who work in abortion clinics. This is terrorism. And right now, I just don't have the words." -Cara (at Feministe)

For those who don't know, Dr. George Tiller was an outspoken advocate for abortion rights and one of the few late-term abortion providers in the country. He was shot and killed in church this morning. He faced opposition and violent attacks throughout his life in order to protect a woman's right of choice. May his courage always be remembered.

***Additional Information***

1. Kansas law "only allows late-term abortions if two independent physicians agree the procedure is necessary to save a woman's life or prevent "substantial and irreversible" harm to "a major bodily function." - Reuters

2. Dr. Tiller was charged with performing 19 illegal abortions and aquitted of all charges. - Los Angeles Times

The above mentioned are facts that I have been able to research and personally verify. I've been informed that there is a Pro-life website condemning Dr. Tiller and accusing him of breaking the above mentioned law, among other things. Since Dr. Tiller's website is not currently working, I haven't been able to check the Pro-life website's allegations and the context of the quotes used from Dr. Tiller's own site. What I do know is that Dr. Tiller was never convicted of performing illegal abortions. I also want to clarify that I do not support late-term abortions, unless it is "necessary to save a woman's life or prevent "substantial and irreversible" harm to "a major bodily function." We have laws for a reason. I don't not personally agree with all of them, but I do agree with this one. Now it is 3AM and I'm to leave this post where it stands at the moment.

Another edit: Jill wrote an article for The Guardian.

Yet Another Edit: Stories from the women who went to Kansas to see Dr. Tiller, the reasons why, the emotional horrors of the experience, and how Dr. Tiller was able to provide the care these women desperately needed.

***Update*** Facts about Late Term Abortions Click Here for Full Story

"As a result, the dominant narrative is one which perpetuates an assumption that people are electing to have late-term abortions for the sake of convenience. This public perception is shaped by the constant intonement that Tiller was "killing babies" coming from irresponsible journalistic hacks like Bill O'Reilly, the suggestions by Chris Matthews that women are blithely electing to abort fetuses that are viable outside the womb, and the statements of inconsistent moralizers like Will Saletan that "there are cases where there's no real medical situation other than some teenager in denial and it went on for five months [where the argument is] you should make an exception because of the so-called mental health of the girl.""

There is a vast gap between the descriptions of Dr. Tiller by members of the extremist right -- who incite lunatics to violence by protraying Tiller as a mass murderer -- and the many women and men who have been served by Dr. Tiller, who refer to him as heroic, kind, compassionate, professional. This gap speaks to the fact that very few -- not least the mainstream media -- understand what he was doing and, and more to the point, why we are asking the wrong people to comment.

In the words of one of the hundreds of people writing messages on the memorial website to Dr. Tiller:

Dr. Tiller was a hero, plain and simple. I am thankful for his life and the gift of high quality health care he provided his patients. My thoughts are with his family, friends and community and my thanks to you for your support of Dr. Tiller despite the tough circumstances.

Dr. Tiller was one of the few doctors providing late-term abortions to people in need in part because he was a committed, ethical, moral medical professional who took seriously his oath to serve the best interests of his patients, and because he was dedicated to supporting women's rights even at the risk of his own life and even under unimaginable daily pressure and threat.

"As the Guttmacher Institute points out in a brief on this issue, the Supreme Court has held that:

* even after fetal viability, states may not prohibit abortions "necessary to preserve the life or health of the mother;"
* "health" in this context includes both physical and mental health;
* only the physician, in the course of evaluating the specific circumstances of an individual case, can define what constitutes "health" and when a fetus is viable; and
* states cannot require additional physicians to confirm the physician's judgment that the woman's life or health is at risk."

********Update (more)**********

Who was Dr. Tiller? Read the story here.

"But these weren’t the only particularly vulnerable women who Dr. Tiller treated. The second major type of procedure he performed was therapeutic abortion, generally for fetal anomaly. These abortions are performed late in pregnancy not by the woman’s choice, but because severe anomalies incompatible with life outside of the womb are not generally discovered until late in the pregnancy. The women who seek out these abortions often have to make a gut-wrenching decision between ending the pregnancy or giving birth to a baby that will not live.

These abortions are not carried out lightly or for frivolous reasons, and they are had by women who very much wanted their pregnancies. Ironically, these women have also been subjected to the most vitriolic anti-choice scorn."

"Despite the slanderous references to him as a murderer, Dr. Tiller saved countless lives. In addition to caring for women whose fetuses had unsurvivable anomalies, he also treated women whose pregnancies could result in their own deaths due to conditions ranging from cancer to pre-eclampsia. In fact, since it’s illegal in Kansas to perform an abortion when a fetus is viable unless a woman’s life is at risk or her health is facing irreparable harm, all the abortions Tiller performed were necessary to protect a woman’s health, or involved a nonviable fetus. This fact invalidates anti-choice claims of indiscriminate abortions, as does the fact that Tiller was repeatedly acquitted of a wide variety of baseless charges brought by ideologically driven attorney generals who wanted to put him out of practice."

"Value" Added Tax

Contact your senator today! Here's my open letter (that I sent using the following link.

Senator Voinovich,

We may not see eye to eye on most issues, but I believe even you should be able to see through the Value Add Tax. Adding a 5% federal sales tax to all products in the future will not help our current situation now. The Washington Times seems to think it will boast the economy by increasing current spending. (You know, so we don't spend as much when we get yet ANOTHER unfair tax burden placed upon ours shoulders.) I say that you cannot buy your way out of debt, which is what is going on uncontrollably in the government right now. Yes, I know the tax is supposed to go to health care, but really... how many Americans do you think would honestly and willing trust their life in the government's hands. I don't trust my money, let alone my life. Do the right thing and work to stop this before it's too late.

Sincerely,

[Lynne Skysong]