We hear daily about the exorbitant cost of healthcare today. We also hear that “if you think healthcare is expensive now, just wait until it’s free.” But that exemplifies it is not an expense issue. It’s an over utilization issue. In our experience, because it’s free, there is an over utilization of more than twice that needed for optimum health care. It is really an entitlement mentality that causes the excessive use and therefore the excessive cost.

Almost every day we hear patients tell us that we shouldn’t worry about the cost because Medicare pays for it. But because Medicare is paying so much of it, Medicare is scheduled to go broke in the next decade. That is why we are experience the increasing denial of medications, tests, x-rays, procedures, and even emergency surgery.

I had a patient with an acute appendicitis. Normally, in America such a patient would have an appendectomy on the same day. However, the HMO took three days to approve it. I treated him with high doses of antibiotics trying to stave off a ruptured appendix for the three day delay. Fortunately, we were able to delay a ruptured appendix which would have caused peritonitis, which was frequently fatal in the days before our current potent antibiotics. Peritonitis is still a serious complication, prolongs expensive hospitalization, can cause abdominal abscesses to form if pockets of pus aren’t cleared by the antibiotics, can cause extreme pain and suffering, resulting in abdominal adhesions and scarring. This may result in prolong abdominal pain and further suffering.

Hence, this delay to obtain Medicare or intermediary approval, was not only life threatening, but could easily have caused significant increased morbidity and increased cost. The cost increase is very significant. To go from a one day, sometimes an outpatient procedure, to a 5 or more day procedure, is a 500% or more increase in costs.

These delays, which lower the quality of health care in the United States, are a result of lack of trust by HMOs and insurance carries in physicians who are the captains in the healthcare team. A health insurance executive, at a luncheon at which wine was served, admitted to me that they could probably eliminate the army of reviewers on every hospital ward and outpatient facility throughout the country, which are a huge cost to them, and just pay the charges that doctors submitted, they more likely than not would save healthcare dollars.

“Then why don’t you do that?” I asked.

He replied, “Why would we want to give up control of the most powerful profession in the country?”

Healthcare is so expensive that we have to return it to the care of physicians and their patients, the only ones that can make it affordable again. That is the next step in Healthcare Reform that will work.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.