Category: Healthcare Insurance

Freedom’s Last Stand

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We’ve been trading freedom for security.

One day at a time.

The former previously defined us—the “Land of the Free”—but apparently that’s less so, now.

They tell us we’ve dwindled down to being the 15th most free nation in the world.  Fourteen other countries provide their citizens more personal freedom.

There was a day when someone said if we lost freedom here, there would be no place to escape to. That we were the last stand on earth. But, our actions seem to suggest we find freedom to be over-rated.

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Two things that are frequently misconstrued about healthcare came to my attention after reading a recent article by a writer I respect.

I don’t agree with this author on everything. Far from it. But, she comes across as someone you can discuss legitimate issues with—regardless of your point-of-view.

She’s a self-proclaimed Liberal, who apparently voted for Trump. (Seems she wasn’t the only one.) In her article, she provided healthcare advice to our next President.

My intent is not to refute it. Much of it, in fact, I agree with. But, I want to elaborate on two things that came to me after reading a quote in this article. I will examine the concept of (1) shopping for healthcare, and (2) how it relates to your life.

Here’s the quote:

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What the *Beep*?

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“Beep,” went the machine.

I left a message and hung up.

My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.

I was leaving a message on his behalf.

You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers every day. It’s the system we’ve come to expect for both the extreme and the routine in our medical care.

Most of us dislike it.

But, we’ve been taught we can’t afford it any other way. The cruel paradox—of course—is that the majority of us are being out-priced by the status quo.

Mr. G’s medicine was working fine. It’s the only one of its type that he has tolerated without side effects. The insurance company covered it last year. They changed their mind about it this year. And, until we accept the logic that entrusting third parties to pay for our health might be harmful to our health, they will be the ones who keep getting to decide.

I was told I could appeal the decision waged upon Mr. G by getting in touch with a “doctor” working for the insurance company.

If you read that again, it’s an unbelievably humorous statement.

Physicians, scientists, and researchers are routinely condemned by the most virtuous of stone throwers for having even the slightest lean toward a conflict of interest. Yet, having me appeal your insurance case to someone who works for the insurance company remains noticeably absent from their aim.

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Less-is-More… for Tortillas

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There is a single CT scanner in town.

A certain number of scans are done with it each month.

Suddenly, a second scanner is installed at a new location across town.

True or False:

The total number of CT scans being performed will remain the same with two scanners now available.

The answer is false… at least within our current system. Someone has studied it. Adding another scanner increases the utilization of scanning.

Is this a good thing or a bad thing? Careful, now. It’s an entirely different question. The answer, of course, is maybe, or maybe not. You need more information.

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Accountable Care & Its Productivity Complex

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It is absolutely absurd to reward someone for being less productive.

This entire principle is befuddling to me.

But, a government think tank has decided this is the future of American medicine. “We’ve discovered a better way to muddle with the healthcare market,” they say.

The previous (and also ridiculous) system, built upon an UNKNOWN fee-for-every-service, is now being replaced by a more accountable one.

Accountability, like safety, is an easy concept on which to build support. Why? Because we need accountability in healthcare.

If the term, Accountable Care Organization (ACO), is not commonplace for you yet, it will be. In fact, you may already be receiving your medical care from one right now.

ACOs are networks of doctors, hospitals, and other medical providers that share responsibility in the care and cost of a large population’s health.

Think of them as being the It.

And, It may be caring for you.

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Understanding What You Pay For

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Many health insurance plans will see double-digit rate increases this year. Whether it’s Obamacare or employer-based commercial insurance, it doesn’t really matter. Your monthly premium will likely go up. Even if your employer pays it for you, your deductible will probably skyrocket yet again.

People want you to believe that YOU are finally paying for healthcare.

And, it’s a lie.

You are not.

You are paying for insurance.

And, until you understand the difference, you will never understand the problem.

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Escaping the Fog

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I wish someone would have told me I didn’t have a clue what I was saying. That I didn’t have the foggiest idea what the heck I was talking about.

I was an upper-level medical resident. Confident. Running a team of internal medicine physicians who were also in training.

“You need to order a CAT scan on this patient,” I told the resident doctor working underneath me. “At least, for medical-legal reasons,” I said.

The patient was having some vague chest pain. It clearly wasn’t a heart attack. I knew that. It was probably a twinge in the chest muscle. The patient could have probably gone home from the emergency department with reassurance, but the doctor there had already decided the patient should spend the night in the hospital.

“We need to rule out pulmonary embolism,” I told the young physician on my team. “The attorneys would have a field day if we missed that.”

At that particular moment, I had only seen the inside of a court room once before. And, it wasn’t for medical reasons.

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