Medical Tuesday Blog
Health Insurance, Including Medicare, Eventually Leads To Gluttony
During the 45 years that I’ve been in the practice of medicine, there is one item that raises its ugly head almost daily. It’s a comment that a Psychoanalyst from the Menninger Foundation taught us as second year medical students as to how infants respond. “I want what I want when I want it.” It’s always the wise mother who responds that they will get what their mother decides they need after she decides. To do otherwise, will spoil the child who then will grow up “uncivilized.” With too many such Brats, our country will become uncivilized also. There are many such examples around the world. Why would we want to join them?
Hence our future depends on training a child in the way that he should go and when he becomes an adult, he will not depart from it. The Socialist Society has little third grade girls peal a banana and then gives them a condom to roll down over it. What are they trying to instill in prepubescent minds that should be interested in more healthy play? Our immediate goal should be to eliminate these Democratic Socialists from power before they do more damage to young minds.
More important we should teach our children the heritage which is America, our Constitution, our Declaration of independence. Check out the Hillsdale reference at the bottom of this newsletter and take their free courses to help us teach and train the next generation of Americans. Enroll our children in Parochial or Home Schooling to avoid the deviant behavior of our public education system. Don’t give Hillary a chance to eliminate these approaches which she has threatened to do.
BTW, such behavior is manifest in many Medicare Enrollees who want what they can get when they want it. I observe patients doubling and tripling their health care costs for tests and procedures that did not improve their health. Insurance and HMOs expect doctors to be the gatekeepers, the cops that prevent excessive use. However, we doctors are caught in a bind. The HMOs refer to our patients as “members” and the patients really consider themselves as part of the healthcare family. If we are restricting their requests more than they accept, they will call their HMO, their family patriarch, and complain. If the HMO sends us a letter of reprimand, we can spend hours trying to justify our decision that will pass legal muster.
Health care attorneys advise doctors to never respond to any letters from our insurance carriers, their HMOs, from the Hospitals, or from the Medical Board. They emphasize to us in conference that none of those are our friends. Once an adversary wins a case, their feet are in cement. Attorneys advise us that it is better to for them to spend 10 hours to prevent the cement to harden because then it will take 100 hours of their time to fight this and the chances of winning less than 50%. Hence, every letter I have ever gotten, I gave the facts to my health care attorney who would write the letter for me to sign. Depending on the complicity of the nature of the complaint, an attorney can easily spend five to ten hours to review all the facts, review our contracts with the HMO, the Hospitals, and the rulings of the Medical Board. At $300 to $500 dollars an hour, this becomes a significant cost of practice. If an ex-partner or adversary sits on the Hospital Medical Executive committee, one could get one of these letters almost monthly. This has bankrupted some physicians I’ve known personally.
Thus Medicare, HMOs or any medical insurance program increases health care costs through pure gluttony. In many cases this exceeds doubling or tripling of costs. If the doctor tries too hard to control those costs, and the patient complains to his insurance carrier or the state, he may lose his insurance coverage or hospital privileges, the venue where he makes a good share of his income. If a law suit occurs, the costs would increase from 10 hours to fight a letter every month or three to 10 hours every day for several years or until he becomes indigent. These contingent damages to our profession are largely unknown. One healthcare attorney told me that he knew of five doctor bankruptcies that year that he or his associates represented; five physicians who essentially lost all their assets, their medical license and thus would not practice medicine again. Many involve some practice deviation that made them a felon, and thus would never vote again. Frequently it causes a family breakup and the doctor loses his house, wife and children. Losing the respect of his children is sometimes more than his psyche can handle. The doctor is looked upon as a pariah and loses not only his stature in the business and professional community, but those he thought were his friends and colleagues, now shun him. If his parents are still alive, the ones who invested a quarter million dollars in his education, he has trouble facing them, even if they don’t blame him. Some commit suicide, the worst tragedy of the risks of medical practice. Subsequent review of the charts, which an adversary physician felt were so egregious that they voted that the accused physician should not be allowed to practice, other reviewing physicians and faculty members felt there were no significant errors or deficiencies.
Since most legislators, attorneys, and government agencies, don’t understand medical practice, physicians will continue to suffer this sort of abuse until they no longer deal with the long arm of a hostile government. Many physicians consider this an insurmountable goal. However, there is no alternative in a free society. Otherwise our forefathers who fought and died for these 200 years of freedom, fought and died in vain. The greatest tribute we can give them is to extend their efforts, their cause, their lineage for a third century of freedom. Are we up to it?
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.