When did doctors turn into big business? Was it when HMOs came in back in the 1980s, with managed care? Are large court awards for malpractice to blame, causing doctors’ costs to go up? Was it when doctors had to pay more attention to their paperwork than their patients? Was it when the Affordable Care Act (ACA) caused confusion for everyone? Has any of it really helped in bringing medical costs down? The answer to the last question is obviously no.
Medical costs continue to rise, while at the same time, more and more Americans find themselves unable to afford medical insurance, even with ACA. Even those with insurance are having to dig deeper into their already-slim disposable income to pay the cost of going to the doctor. As a result, those going to the doctor are either the haves or the have-nots – those with insurance who can also afford the co-pays and co-insurance fees or those on public assistance, whose medical care is paid by the government.
The Affordable Care Act, entering its third year, was designed to bring health insurance to everyone, mimicking the healthcare systems in Canada and most European countries. Statistics are only available for the first year, which show a 25-percent increase in the number of people with health insurance. Of those who signed up the first year, 85-percent qualified for subsidies, according to a report from the New York Times. But premiums are expected to increase as the program enters the third year, with available subsidies going down; for younger, healthier insureds, the costs will increase dramatically.
In the meantime, doctors are losing why they went into medicine to begin with. The shift began in the 1980s, resulting in doctors becoming big business, which has caused hardship for both doctors and patients alike. Doctors who truly have the patients’ best interests at heart are unable to spend the time they feel they need to take optimum time caring for those patients. Increased costs of doing business, including the skyrocketing costs of malpractice insurance, office overhead, etc. far exceed what insurance companies are willing to pay. Then add in Medicare and Medicaid; in order for a doctor to get reimbursed for seeing the growing number of people on Medicare and Medicaid, they have to accept, in some cases, as little as 45% of their regular charge for services. Insurance companies then want doctors to accept the same reduction when it comes to being reimbursed under insurance plans, leaving the uninsured to make up the shortfall, resulting in grotesquely higher charges for the uninsured or underinsured just to see a doctor. We won’t even go into electronic medical records (EMR).
As a result, doctors who truly want to care for patients – who make up the majority of the field – have been lulled into large clinics, thinking their overhead will be lower and they’ll be able to spend more time with patients. If they were fooled by that con, they were definitely wrong. The large corporate clinics regulate how long a doctor can spend with each patient. They see so many patients during the day, there’s little time to get to know those patients personally, which also impacts patient care. They end up having to prescribe the treatment most common for what’s going on instead of taking time to really diagnose a patient’s condition. Most in this boat are family practice doctors who still have dreams of Marcus Welby.
Then there are the doctors who went into medicine just for the money. No matter how much they whine and moan about their expenses going up, these are the guys who are raking it in, the ones who really should be the target of insurance companies. They prescribe expensive treatments designed to bring in the most insurance payments rather than really listening to what the patient says, regardless of whether or not those treatments are really helping.
Tomorrow, we’re going to look at one patient and the appalling treatment she’s received at the hands of one doctor. Why we accept rotten customer service from doctors that we would never accept from any other business is sad.