Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Thursday, September 10, 2009

Silly Season

I wish that the President could simply have declared that the Silly Season was over, as of last night.


At the first commercial break, however, some PAC or other ran an ad with a woman actress telling how Canadian health care denied her life-saving treatment, and she had to come to the US for top-of-the-line care. It ended with a tag-line to the effect that no government should come between us and our doctors.

There are three lies in this:

#1. We are not replicating the Canadian system, thank you very much. The public option as currently proposed is not government-run healthcare, but a single-payer model.

This would, by the way, save a metric shit-ton of money. Unless you are in health care yourself, you have no idea how much time and money we fritter away verifying benefits for a dozen of different insurance plans every day, applying for pre-authorizations, recording pre-auths in the billing software, getting re-authorizations every few weeks, billing, re-billing, going to different websites to bill different payors, printing hard copies of all these transactions, paying for electronic billing services' monthly charges plus transaction fees, tracking payments, filing appeals, entering different insurance company discounts in each policy-holder's books, applying to be on panels, renewing memberships on panels, submitting to audits by insurance companies of our books and clinical charts, billing patients for the portion insurance does not cover, and explaining patients' benefits (or lack thereof) to them. We spend on staff, training, computers, printers, storage systems, phones, software, paper, postage, and space (a portion of our overhead expenses such as rent, utilities, tenant's insurance) for this work in addition to the time away from patients and continuing education. And after all that, we write off thousands of dollars in uncollectible fees when it turns out that the insurance companies won't pay for what their policies and pre-auths indicated that they would and the patients don't have the resources.

But I digress.

#2. We do not have the best care in the world, as the ad claims. We spend more than other industrialized countries, for some of the worst results in the Western world. Higher infant mortality rates, for example, than anybody in Western Europe--or Canada, for that matter.

#3. The current system does not give you and your doctor complete control of medical decisions, people. Ask anybody who's ever been denied coverage by their private-pay, nonsocialist, for-profit insurance company for the medication their doctor prescribed, or a treatment their doctor recommended. Ask anybody whose private-pay, nonsocialist, for-profit insurance company dithered about pre-authorization until a critical treatment window was missed. Ask anybody who's gone bankrupt paying for their own treatment because their wonderful nonsocialist, private-pay, for-profit insurance company refused.

Heck, some of you have never even met your primary care physician. Our current system is so expensive to the practitioner and pays so poorly that they all use so-called "physician extenders" now. You see a nurse-practitioner or a physician's assistant. Not that there's anything wrong with them, but let's don't pretend we have direct relationships with our physicians under the current system, ok?

And the ad conveniently forgets that up until Congress made it illegal, it was our citizens organizing bus trips over the border to Canada to get affordable medications. It also conveniently overlooks the recent 'health tourism' trend, in which U.S. citizens go abroad for affordable surgeries.

No, I'm afraid the silly season is far from over.

1 comment:

mamie said...

Brilliantly said. I will put a link to this post on my blog today. Thanks, VA!