I had to work this Christmas holiday, the most important day of the year for me personally. An emergency (it happens). Not only did I drive to the hospital at my inconvenience; miss dinner with my family (hey, it’s a doctor’s life); get a ticket (bad luck); wait for tests and paperwork; give instructions in two languages; repeat the ER doctor’s exam; render treatment; stabilize the patient; remain at bed side until the symptoms resolved; fill out another round of paperwork, but I would not get paid for this work.
No payment. No reimbursement – not even a holiday fruitcake. “100% Charity” read the Emergency Room Intake Sheet. 100% Charity, translation: “You ain’t gettin’ paid”.
I thought this an appropriate metaphor for tonight, a religious eve of giving or just some cosmic joke.
Before I continue, I must clarify this is not meant to be a “poor me” or “pity the doc” rant. Indeed, the payment from my previous ER examination (missing a celebratory dinner for the NYC Marathon) on a patient with “good” private insurance barely covered my gas and parking. The story is not about the money, as much as about the system and its need for reform.
Ironically, reform of the healthcare system in this country is a matter that so many people are aware of; want’; demand; need; crave; holler and scream for; and, yet progress moves more like a glacier than a revolution.
At a time when voters are calling for reform, they are frightened that they may lose the benefits they already have. Rescuing the 20% without insurance will sink the other 80% with insurance is a natural fear which is nurtured by the Guardians of the status quo.
The public is told of potential government “death panels”, when the private insurance companies have denied life-saving medical treatments for decades. Denzel Washington in John Q raged against the for-profit, All-American HMO long before Obamacare.
At a time of government “bail outs”, leaning toward a central structuring of healthcare is a mudslide into Communism. There is always the patient with Medicaid, Medicare or government-subsidized plans spewing bile at Socialism.
When the government is bloated, it is called 6% waste; when the private sector is lean, it is called 15% profit. Either way the patient and doctor get less. When a politician promises a 30% reduction in healthcare costs, Congress (which, enjoys the finest health insurance) threatens to cut healthcare providers payments by 30%. When a for-profit company in the private sector actually pays that provider, that payment is called a “loss” on their balance sheet. There is more fear than logic thathigher taxes always comes with reform, but what is the difference between paying $10,000 to the U.S. Government or $1,000 a month to U.S. Healthcare?
People want reform now, but do not support those supporting change. Immobilized by fear, the populous actually seems relieved when reform is blocked. Doctors themselves are historically resistant to change. The advent of Medicare was Armageddon to the medical community a long memory ago. The specter of this Federal reform resurrects and haunts every year. At a time when physicians threaten to “drop” Medicare, there are large and famous hospitals which dropped all insurance carriers except Medicare.
Those affected most (patients and physicians) by a dysfunctional healthcare system must realize that reform is controlled by those affected, i.e. harmed the least. In fact, there is a core group that benefits from the fears and delay which maintains the current system.
“The System is Broken!” has become a mindless cliché. No, it is not broken…at least not for some. If someone is paying a $2 trillion dollar medical bill, someone else is making $2 trillion dollars. Those with a larger stake in that take are doing quite well with the system just the way it is. Reform is a risk and possibly an end to a lucrative racket. Even drug dealers are against legalizing drug reform.
Back to Christmas in the Emergency Room: I do not know what the end of year bonus was for Aetna‘s CEO, but he sent me a check for twenty bucks this holiday. Certainly, as a worker, I wish to be paid for working; but as a doctor, I want every patient that enters my door to be covered by insurance. I want to practice medicine; I want my patients to get care.
I do not want a crap shoot when someone enters my office of whether I am getting paid or whether that patient is getting treatment. No one tells me how to practice medicine, but “No Coverage” often dictates how caregivers render their skills and how the patient seeks medical care. I did the math: getting paid all of thetime is better than getting paid some of the time. And covered patients seek care sooner …and do not tend to appear in an overcrowded ER at 2:00 am with a runny nose while another patient waits 6-hours with a bleeding finger.
I vote for whoever is going to get me my Fruitcake.
Disclaimer: Author still takes Medicare, liquor, lasagna and does not know what ObamaCare really is.