What is your best option for being healthy in America? Don’t get sick. America’s healthcare system is suffering from its own malignancy, and there is no guarantee it will be able, or willing, to help you if you get ill. Let’s take a look at six uncomfortable truths about the American healthcare system today.
It is not you and your doctor making decisions about your healthcare.
Physicians are under pressure to make healthcare as profitable as possible for the organizations they work for.
Profit as the primary motive means that corporate executives decide what tests are offered, what medications are available, treatment options, and even the instruments available in the operating room with no medical education. Those executives make their decisions based on one primary principle, profitability. Not physician preference, best care, or patient decision. The only question these corporate leaders are asking is how to make your care more profitable for their bottom line.
Doctors do their best to navigate this beaurocratic mora and to advocate for their patients. But there is often little you physician can do. In some cases, your doctor may even be actively discouraged from suggesting better treatments not approved by your hospital or insurance. If your doctor violates these injunctions, they could face penalties.
Healthcare companies track physicians on metrics like how many referrals they make out of network. Doctors who do not meet an arbitrary threshold face fines and even the loss of their job. Your doctor wants to do what is best for you, but they need to balance that with what is best for their family as well. Your doctor sees you as a person they want to help, but that is not how corporate healthcare sees you.
Corporate healthcare sees you as a source of revenue and not as a person.
In the for-profit American healthcare system, medical centers need to move people through the door and do things to them to make money. This means that you’re not seen as a person. Instead, you are a billing opportunity. Once you are in their system, the healthcare organization does not want to give you up. Doing so would mean the loss of a potential source of revenue.
The patient as a billing opportunity means the corporation will direct you to the doctor they have for your problem, who may not be the best doctor available. If they do not have someone who can care for you, then they will direct you to an out-of-town physician within their network — even if there is a skilled physician in your community but outside your network. Most likely, they will not even inform you that you had an option.
The goal of healthcare corporations is to turn larger and larger profits. The way to do that is to pull in more sources of revenue (i.e.; patients) and not to part with any of the ones they have. For corporate executives, providing quality care is secondary to capturing as many sources of revenue as possible.
This primary drive to keep people coming back is to bill them repeatedly, which has proven deadly.
The drive to make patients happy is killing them.
Two central problems in healthcare are antibiotic resistance and overuse of prescription narcotics. These problems are fueled by the desire to make patients happy and keep them coming back.
Healthcare organizations score physicians on the likelihood that patients will return to see them again or refer a friend or family member to that same physician. Those doctors who fail to meet arbitrary cutoffs face financial penalties and could lose their jobs. This can put a lot of pressure on doctors to keep their patients happy, and one good way to keep those patients coming back is to give them what they want.
A decade ago, I received an email from the CEO of the healthcare company I worked for with the subject line, “The Customer is Always Right.” The main thrust of the memo was that we should give our patients what they want. Not because it is the right thing to do, but to keep them happy and coming back. At the time, a group of us in the Surgeon’s Lounge laughed about it.
“What! Are we just supposed to give patients all the oxycodone they want?” asked one orthopedic surgeon rhetorically.
The rest of us laughed.
Unfortunately, the answer to that question proved to be “Yes” for many physicians. Now we have a nationwide epidemic of prescription narcotic abuse. Since I received that memo, more than 100,000 patients have died from overdosing on prescription narcotics. And the deaths are continuing.
Antibiotic-resistant bacteria are becoming more of a problem every year. Again, the fault is in prescriptions given to keep patients happy. If a person with a cold goes to their doctor because they want an antibiotic, they won’t be satisfied leaving with an explanation for why they don’t need the medication. So to keep patients happy, doctors have been prescribing medication they know the patients don’t need. The result is a rise in harder-to-treat infections caused by the misuse of antibiotics.
What makes patients happy and keeps them coming back is not always what is good for them. What is profitable for the healthcare organization is not what is safe for the individual.
Malpractice concerns increase your risk of injury.
The rationale behind a robust malpractice system in the US is that it protects patients from poor doctors and substandard hospitals. The reality is that it puts patients at risk from tests, procedures, and treatment intended to protect the provider and not the patient.
The constant risk of malpractice suits drives physicians to perform tests and procedures, not because they are indicated, but to protect the physician from the accusation they did not do enough. It is a practice supported by healthcare corporations for two reasons. The first is that it limits the liability of the corporation. The second is that all those unnecessary procedures generate more money for the corporation.
These tests include x-ray exams that expose patients to unnecessary radiation and invasive test (like heart catheterization) that risk internal injury. When these tests are done to protect the providers, it is the patients who have all of the cost and risk shifted onto them. That is because hospitals and physicians are rarely sued for doing too much, even when they harm.
I placed a feeding tube in one patient who could not speak or eat after one of these tests. She was considered low risk for coronary artery disease. Still, she underwent a cardiac catheterization, “Just to be safe.” Her heart turned out to be 100% clear, but she did not wake up from her anesthetic. During the procedure, she suffered a stroke due to her low-risk catheterization.
The truth is that all medical tests carry some risk and expense. The question is who should bear that risk. The medical institution through the danger of a malpractice suit, or the patient who risk their health and their pocketbook? Right now, the majority of that risk is going to the patients to protect the healthcare system.
You might hope that the doctor you trust would not do this to you, but things are changing.
Changes in the practice of medicine are forcing physicians to join large medical institutions.
If you think you can avoid some of the problems outlined above by sticking with your good old independent doctor, you may be out of luck. The expense and complexity of the electronic medical record and the health system are making it prohibitively expensive for physicians to stay in private practice.
Doctors have no choice but to sign on with healthcare corporations to defray the new expenses for licensing compute software and IT support. Being forced to sign on with health corporations means they are subject to the same rules restricting access to referral providers and medical treatments. The doctor you have always trusted to do what is best for you may now have their hands tied and their options limited. Even if they still practice in the same office, they may be part of a larger organization, thus limiting your access to the best care without your even knowing it.
We are all one medical illness away from bankruptcy.
The corporate healthcare beast has an insatiable appetite for money. Once it gets its teeth into you, it will not let go — even when your health insurance and bank account have been bled dry.
You may think you are safe from losing everything because you have good insurance. Think again. I have seen many people with medical insurance driven to financial disaster because they needed treatments not approved by their insurance plan.
I have also witnessed severely ill people who spent the maximum amount covered by their policy in just one stay in the ICU. Once they hit that limit, it is up to the family to find a way to continue to pay thousands of dollars a day or else… I have seen families forced to decide between selling their house to pay for medical care versus letting a loved one die.
What does your policy cover, and what limits in coverage does it have? My guess is that you have no idea. Worst of all, you have no way to find out. I have not seen a printed policy for my insurance in years. The only way to find what is and is not covered is to get sick and then learn the hard way.
Conclusion
These problems have one theme in common; they all put the profitability of the healthcare organization ahead of the health of the patients. Perhaps it’s time to stop measuring the success of American healthcare based on how profitable it is.
Of course, profitability is the only criteria where America is doing better than other first-world countries. Americans suffer a higher chronic disease burden yet receive fewer medical visits than comparable nations. We are paying the most money for the worst health.
American healthcare is a bad bargain. It is not going to get better on its own. People need to realize that profit as the motivation in healthcare is injuring and even killing them. It is time to demand better. If every other country can do it, then we can too.
