Fool’s Gold: U.S. Healthcare System Cheats Patients

Mike & Friends Blog

Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

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April 16th, 2012 11:19 AM

Fool’s Gold: U.S. Healthcare System Cheats Patients

In case any one of us needs reminding, the profit-driven healthcare system in America is broken. Driven by its primary motivation to make money, there is little that compels those currently in control to care about patients like you and me. We are most assuredly a necessary component of the healthcare market – they cannot make any money without us – but we are treated like children to be seen and not heard.

The vast majority of us cannot access or pay for the care we need without health insurance coverage through either a private, for-profit health insurance company or through a government program for which we qualify. A small minority of people can afford to pay for care outright with cash or credit.

For that small minority, concierge care is the answer. Wealthy patients can pony up money in advance to assure services that used to be a matter of course – like return phone calls from our personal physicians, a doctor’s visit with our own doctor within a reasonable period of time should we get hurt or sick, or even a call with test results as soon as our doctors learned those results. Some of us remember the days when that was what doctors did for their patients routinely. But now humanity and decency is for sale in our medical system. Our doctors need to have the pot sweetened a bit with a little extra cash in order to deliver services that require extra time and attention like personal phone calls to patients.

Many of us support ending some of this insanity by improving and expanding Medicare coverage to all for life. A progressively financed, single standard of high quality care for all would be an amazing improvement and would put an end to many of patient abuses we endure today. But, sadly, some abuses are spreading through providers so deftly that we come to accept being cogs in the wheel of profit without control of our own health destiny, and simply fixing the payment mechanism will not be enough to fix the broken human interactions or lack thereof.

Like the vast majority of Americans, I do not have easy access or attention from my doctor and I certainly do not have concierge care. I have insurance coverage through my job from one of the giants of the insurance industry. Six weeks ago, I began trying to get a diagnosis and treatment plan after symptoms of cancer returned to my body for the first time in more than eight years. I still do not have my answers or my care. First, the insurance company denied the tests my doctor felt would be best after lab work showed the elevated cancer markers. Then I had the tests the insurance company would approve at that point, though the doctor was sure those tests would not be exactly right. I had to be injected with radioactive isotopes and scanned for four days in a row. A week later, after making yet another doctor’s appointment as is now often required to get any test results, I learned that, as expected, the test results were inconclusive. My doctor referred me on to the oncologist.

Ten days later, I saw the next doctor and he ordered more lab work and the original scans, with contrast die. The insurance company approved this time. I drank one contrast solution, and at the time of the scans, I was injected with another contrast. That was two weeks ago. And I am still waiting for the results. I dropped in to the medical records department of the hospital and requested they send my results to me, but nothing yet. When I called to follow up with the doctor, a visit was scheduled for another week later – his first available appointment. Though I tried to remind both the hospital and the doctor’s office that I am worried and waiting is hard, neither flinched. They are very busy.

Then this past Saturday, I got an email from the insurance company asking if I want to view my most recent claim. So, I clicked on the link to see the claim. Sure enough, every one of the healthcare providers who touched my body and tested me over the past six weeks has already managed to bill the insurance company and the covered portions of the claims have been paid. I, of course, paid my co-pays at the front desks on those providers before I even got through to the exam or testing rooms.

What’s so very wrong with this picture is that the money has changed hands before the patient been cared for. I am still waiting for the results which may well include news about my health that will include a recurrence of cancer. What mattered most to everyone was making sure the money was handled, and so it was. I wait. I am angry. In what other area of our financial lives do we actually give up so many of our rights to fair dealings? I have paid for services I have not received. As far as I am concerned, the contract made with me has been broken. An awful lot of people have made an awful lot on money, yet I still wait for answers.

Anyone who thinks we have a patient-centered or patient first system is seriously deluded. The U.S. healthcare system serves its profit-driven masters – not patients, like you or like me. We’ve been cheated, not treated.