Maybe I’m just missing the hot topics of the recent midterm elections, or maybe I just want to complain.
What could be better than someone else paying your medical bills? You slice yourself open, get stitched up, pay your deductible and the rest is covered. Great right? I’m not so easily convinced.
Now, I’m not saying that paying for the services health insurance companies offer and having your medical expenses paid for isn’t a necessary and overall good thing. But I ask you this, “What have we lost along the way?”
By bringing a third party into health care besides patient and practitioner, we have effectively removed personal responsibility.
I work in health care, I am an acupuncturist by trade. Generally acupuncture is not covered by insurance. I know what you are thinking, “He’s just pissed because he can’t get paid.” Yes, that’s true. I think that limiting a patient’s options by excluding certain modalities and not including coverage for alternative care while we pump our patients full of pharmaceuticals is just wrong. But, my irritation with which modalities insurance companies chose to cover is for another day. My argument is that reimbursement for medical procedures has changed the mindset of today’s medical patient.
I work in a hospital and see this everyday. At my hospital I am paid a salary, there is no charge for a patient to receive acupuncture. Each day I approach patients to see if they would like treatment. I almost always have to reassure them that there is no charge, they usually will flat out turn me down as soon as I offer because they think there will be a fee. Most of these are orthopaedic patients who are racking up thousands of dollars in hospital expenses without the blink of an eye, but when asked about a treatment which outside of this hospital would cost (this is an average) $50, that could reduce their pain, nausea, and a number of other problems which make for an uncomfortable stay, they refuse. To further illustrate my point, in the last week I have done about 50 treatments and out of those only one patient was ready to pay for my services before I told him it was free.
The development of companies who, for a fee, will usually have your back and cover the cost of pricey medical procedures was a brilliant idea, it makes a few people filthy rich, creates jobs and saves the rest of us from going bankrupt with the occurance of a medical emergency. But we have become so dependant upon reimbursals that most people have lost the ability to decide what is in their best interest. We turn what we should value most, our health and well being over to those with the money.
You would think that it would be in the insurance companies best interest to cover whatever modalities are needed to keep their customers healthy, especially since preventative medicine is cheaper than hospital costs. You can be damn sure that the insurance companies don’t care about what’s best for you, they just care about the bottom line.
Since you know my position I would now like to turn this topic over to the Skunk Think Tank. I want to hear what you fellow skunkers have to say about my ranting. Agree or disagree, any ideas on how to get people to personally value their health and well being would be greatly appreciated. William and Sesquipedalian, I know you guys have something to say about this!
Also, if anyone could find out the difference between average medical expenses before the development of health insurance and after and how it related to average income, I would really like to see those figures.
mongo
5 responses so far ↓
1 william // Nov 22, 2006 at 11:54 am
I agree with you to for the most part on the insurance issue. I have been told that there are a few insurance companies out there that will cover acupuncture treatments at the standard 80-20 which most other medical professions are covered. Personally, I’m on the line with the insurance issue. If acupuncture were covered by all the big ins. companies then the ins. companies would start dictating the treatments you give and how you give them. The problem in which I’m referring to is that your service becomes a la carte. You have to break down everything you do and have a seperate charge for each modality. Insurance companies shouldn’t have the right to tell any practitione what to charge or what the patient needs at that particular time - the insurance companies sure as hell don’t have the educational background to back it.
I know I’m gettting away from your point here but I will try to get back to it!
There are 3 things that I attribute to the ridiculous prices of western health care. The first is the fact that we live in a sue happy culture that wants to blame everyone else for their problems - when a Dr. does something wrong, even if it is menial, he is going to get it (now, I’m not defending incompetent Dr.’s that make more mistakes than they ever do good and medical institutions that think they are god and if they can’t find something wrong with you - then supposedly there’s nothing wrong with you - yes, I’m referring to one very well known institution).
The second is to run a western medical facility and the equipement they use costs an incredible ammount of money, I can’t imagine the restrictions and guidlines they have to follow - they charge the patient for all of this no matter how much or little you use.
The other is the fact that most insurance companies are in existence for high profit, not for the people (see Blue Cross Blue Shield).
Now, back to your topic -
As far as the insurance companies taking away personal responsibility, I’m not sure I understand what you mean. I think that the people who are paying for their insurance coverage are excepting more responsibility for their healthcare than the person who doesn’t have insurance. I completely agree that the high prices of healthcare is clouding peoples judgment of what exactly is in their best interest.
I do think that people in general have lost their accountability when it comes to their health, and modern medicine is probably mostly to blame. I’m not saying modern medicine is bad, I’m just saying that people depend on their MD too much when it comes to their health - they know they can run to the Doc. and get a quick fix if needed. They think they have a cold or the flu because they “caught” it. Wrong place at the right time mentality. It couldn’t possibly have been due to poor diet, staying up too late, drinking too much alcohol, and a combo of all 3, etc.
Most people don’t value their health until they are really sick, then it’s quick fix time - there are too many options in healthcare that allow for peoples lackadaisical mentality. That is why we live in a society that doesn’t embrace preventative healthcare.
One of the biggest issues I have concerning insurance is that it makes people believe a form of healthcare is valid if it is covered by insurance. This “validation” would be the biggest thing I see acupuncture gaining by accepting or being accepted by insurance companies.
Wow, I feel like a ramblling idiot right now. I’m not sure if any of which I wrote even addressed what you are asking… Oh, well.
William
2 william // Nov 22, 2006 at 2:56 pm
I just want to make it clear that I have a lot of respect for western/modern medicine and the docotors who practice it. I’m not blaming western medicine entirely for the high cost.
And when I made the statement that “western medicine is to blame” I didn’t mean that in a negative way. It is a statement that the medicine tends to be so effective with some illnesses that the patients don’t even realize that they have a responsibilty of promoting their health.
3 mongo // Nov 22, 2006 at 9:37 pm
What I am saying is that by not having to physically pay out of pocket for an expense such as a medical bill, I just don’t think people value their care as much. (You should know this William, I would bet you see people that value their care every day because it is costing them money out of pocket.) Which do you value more, something that is given to you or something that you had to work hard for?
By letting someone else dictate what is covered by insurance and what is not also plays a huge factor in which modalities they chose, whether or not the covered modality will help.
This all makes sense in my head. I’m not so sure it works in words though. This is a hot topic for me, an emotionally charged subject. This is because I hate to see patients not get the care they need whether I can provide it or not. The bottom line for me is quality of care and the patient’s best interest and I’m not sure people are getting that these days.
4 william // Nov 23, 2006 at 12:24 pm
First of all I’m not completely disagreeing with you. I agree that people who have to pay for their health care out of pocket (as you state it) = without the help of insurance are taking more initiative in their health and they feel the pressure of having to pay a lot more than most other people.
I know this and I hate collecting money, I can honestly say it is the worst part of my job.
The point that I’m making though is that people who have health insurace are usually paying a good sum for it as well. I know when I was in college my wife and I were paying over $200 per month for our health insurance out of pocket. That doesn’t even include the deductibles. That is over 2400 per year whether we used it or not - and more if we used it.
The people who are willing to do this are obviously putting their health first.
I think is hard to compare paying $50 per treatment to a $25,000 surgery or even a $300 office visit,etc. There is no possible way the average person could afford to have the surgery.
I have had to go through 2 $23,000 to $25,000 surgeries (including cost of therapy) in little more than a years time. There was one more surgery that was probably somewhere around 10,000 in between the those 2.
I have had 4 major surgeries on my left arm and around 8 months of occupational therapy costing somewhere around $80,000. I can tell you first hand that I highly value every one of those surgeries and there is no possible way I could have ever paid for them out of pocket.
If I could, I would probably accept insurance(accepting insurance isn’t even an option for me due to lack of legislation in ND). I don’t truely believe that the insurance is in the patients best interest. My dad accepted insurance for the first couple years of his practice and found that the insurance companies still worked against him and the patient - told them that they only needed x number of treatments (how the hell would they know) - that is how most insurance compnaies work. If you cost them too much money they drop you, if you need more care than they are willing to provide they cut you (the patient) off.
I guess I’m wondering what you think the solution would be to this? Is it to get rid of health insurance so everyone has to pay out of pocket? Or would health insurance be acceptable if they were accepting of acupuncture? I know my patients would still value their acupuncture if it were covered by health insurance.
5 oddnoteccentric // Nov 30, 2006 at 5:01 pm
I have been discussing this matter with a few people in the healthcare field. Here is my synopsis, with a little of their influence:
1. Too much specialization is utilized. People like to self-diagnose and seek the care that they find necessary. If instead we would seek treatment from our primary care providers, medical costs would be lower: specialists charge higher rates for more or less the same service than primary care providers. Furthermore, primary care docs are better at diagnosis than most any lay person (maybe because they are trained rather than “educated” by network TV?).
2. Health insurance, while perceived as necessary, is a sham. The whole insurance industry was formed for profit. A few wealthy, business savy folks got together, pooled their resources, and formed an investment pool. The result was an insurance company. They compare the risk of providing service to an individual or group to the financial reward for doing such. I don’t mean to portray this as bad, just that we all think of health care providers paternalistically, and therefore see insurnace companies in the same light, which is a mistake. Insurance companies are not in existance for anything except to make money, just like most other businesses.
3. Insurance experts are just that. They are not health care experts. Insurance companies have basic rules regarding treatment (see second to last paragraph above, for example) based on what they want to pay, rather than on what a patient needs. This is completely counter to why we purchase health insurance. The solution here is for insurance companies to hire some former health care providers or others who are knowledgable in the matter, rather than only salesmen or businessmen.
4. We all need to realize that health care is not a right, it is a privalege that is payed for. The entitlement mentality is not good for much, including the health care industry. Neither is the notion that we will seek huge settlements from insurance companies for small errors. For instance, a jury awarding millions of dollars to someone for spilling hot coffee on himself while he is in his car after he ordered the hot coffee. Don’t kid yourself into thinking that awards like that don’t cost us all.
So, attitudes and behaviors seem to make as much impact on the solution to this problem as insurance rates or the costs of education even equipment. If we treat the health care industry with respect, we will all continue to benefit. If we continue to run the system into the ground, we are in for major headaches and changes, including a possible shift (or continuation of the current shift) toward centralized health care, where no one gains except where Big Brother gains control.
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