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Abuse – behind the scenes look at healthcare costs

March 29, 2010 By 7 Comments

Everyone seems to be talking about how we can fix our “broken” healthcare system. Yet, nobody seems to talk about why healthcare is so expensive in the United States. You can blame it on insurance or the government. But what it really all comes down to is abuse and law suites.

Abuse and law suites are like siblings when it comes to health care. Massive amounts of people abuse our emergency rooms, ambulance services and even clinics. This is allowed to happen because these people can’t be denied medical care as the medical providers will find themselves in legal trouble.

Of course the people abusing our medical system typically have government aid, or don’t pay at all. Medicaid and Medicare programs are only reimbursing 20-30 cents on the dollar right now. That’s pretty bad considering what it costs to do business in healthcare. So what do the providers do to make up this lost revenue? They raise their prices! Which ultimately means that the private insurance companies get shafted with the high rates. When people abuse the system and don’t pay their bills, the healthcare providers lose money on supplies, wages, procedures, etc. It’s no wonder that the majority of private doctors offices and clinics don’t accept government insurance programs. Why would they?

Law suites closely follow abuse on the “rising healthcare costs” scale. Excessive medical malpractice suites have driven malpractice insurance through the roof. Once again, the doctors have to make up this loss somewhere. It is actually rare to find a doctor who has yet to have a malpractice suite filled against them. Whether the suit is legit or not, it is typically easier and cheaper for the insurance companies to just settle and pay up rather than fight it out in court. Excessive malpractice suites then lead to “defensive medicine”. Ordering expensive unnecessary tests to “cover their asses”. Once again, only contributing to rising medical bills. Doctors wont follow their training and instincts in fear of legal repercussions.

Does this mean that a doctor who shows gross negligence shouldn’t be held liable for their actions? Absolutely not. But suing your OB/GYN because your baby came out with 6 fingers isn’t what I would call reasonable.

Throwing more money at the problem doesn’t fix anything. We need to attack this problem from the ground up. Hospitals need to be able to deny treatment to non-urgent patients. They crowd our emergency rooms and eat up useful resources. Perhaps some public education and readily available low-cost clinics and urgent cares would tackle a good portion of this problem. The other thing that needs to be addressed is the idea that being transported by ambulance will get you seen faster. One of the big ideas behind EMS 2.0 is that EMS professionals could offer other solutions, rather than just transport to an emergency room. These are just a couple things that could significantly reduce the cost of healthcare.

Let’s quit covering up these problems and attack the real issues. Think of it like treating an illness. You can treat the symptoms and give some temporary relief. Or you can correct the core of the problem and fix it all together.


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  • Anonymous

    Very good and insightful points. Something that I try to explain to people with mixed reviews. I am all for public edu. Not just proper use of the system, but also preventative medicine and positive lifestyle choices. We also need political and legal edu. There is a BIG misnomer that if we refuse service or treat something somewhere other then the ER, then “there will be people dieing in the streets!”

    People are already dieing in the street… And at home for that matter, because they choose to not call 911 or seek care because of the high cost. The police refuse service all the time. No one thinks there will be riots and chaos if they don’t respond to every call. The public understands that when it comes to the law, there are emergencies and non emergencies. The police can not arrest you mom because you don’t like her. So why should we take you to the EMERGENCY DEPARTMENT for a Rx refill? Is there a law of medicine? Not exactly, but there is common sense and sound, educated, professional, responsible judgment.

    I’m not bitching… I’m just pointing something out. I don’t have the solution to all this, just some ideas. We all have ideas, but they must be given a chance to fail ( or succeed)

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  • http://www.medicmadness.com Sean Eddy

    You make some excellent points. I think we are very well trained at determining emergency vs non-emergency. I don’t quite think that refusing transport and treatment all together is right way to go. Offering other options like transport to an urgent care would certainly benefit the patients in this scenario. It would most likely increase reimbursement as well.

  • Jeramedic

    Very good and insightful points. Something that I try to explain to people with mixed reviews. I am all for public edu. Not just proper use of the system, but also preventative medicine and positive lifestyle choices. We also need political and legal edu. There is a BIG misnomer that if we refuse service or treat something somewhere other then the ER, then “there will be people dieing in the streets!”People are already dieing in the street… And at home for that matter, because they choose to not call 911 or seek care because of the high cost. The police refuse service all the time. No one thinks there will be riots and chaos if they don't respond to every call. The public understands that when it comes to the law, there are emergencies and non emergencies. The police can not arrest you mom because you don't like her. So why should we take you to the EMERGENCY DEPARTMENT for a Rx refill? Is there a law of medicine? Not exactly, but there is common sense and sound, educated, professional, responsible judgment. I'm not bitching… I'm just pointing something out. I don't have the solution to all this, just some ideas. We all have ideas, but they must be given a chance to fail ( or succeed)

  • SeanEddy

    You make some excellent points. I think we are very well trained at determining emergency vs non-emergency. I don't quite think that refusing transport and treatment all together is right way to go. Offering other options like transport to an urgent care would certainly benefit the patients in this scenario. It would most likely increase reimbursement as well.

  • Anonymous

    ‘Abuse & Law Suits’ brings up great points, but it dances around the core issue. To properly assess the impact of “abuse,” one needs to take an accurate look at who the worst “abusers” are. And the undeniable fact is, just over 1/3 of all 5,750 public hospitals, and well over 100,000 doctors (since 1985) have pillaged & plundered insurance companies for over 50 years.*

    When 2 cardiac surgeons are found to have performed over 600 heart surgeries At Redding Community Hospital, for no other reason than their own greed; when a New York surgeon confesses in court to performing 10,000 unnecessary eye operations; when a single MD was recently convicted of stealing $18.3 million from Medicare in false charges – and when these travesties repeat themselves to the tune of what the U.S. D.O.J. reports as 1/2 trillion dollars per year in fraud – by what measure of logic might anyone view the fractured health care system as a ‘victim?’ It is only a victim of its own excesses.

    The sad fact is, physicians and their creation called modern medicine have had 120 years to get it right. Have they performed an enormous service? Of course they have. But 2,490 of them were convicted of serious crimes just last year – 11,000 doctor-convictions over the past decade.

    According to Public Citizen, there are 237,000 physicians they consider “Dangerous” or “Questionable.” Among those are the 204 in prison for murder, and at least 29 others preparing for murder trials.

    As a physician misbehavior researcher, I can verify that NO profession in our society generates more crime, causes more suffering, hides more sins, nor kills more people – than errant physicians. And there are literally thousands of them.

    I am trying very hard to imagine a scenario where, say, the airline industry, would be responsible for the same amount of citizen death (which is 350 patients who die every day due to medical errors) and then have the unmitigated gall to be upset when lawmakers step in and – flawed efforts or not – try to repair the mess. That number of 350 is coincidentally about the same volume of a single 747 crashing everyday of the year. Does anybody believe the airlines could logically dispute outside intervention?

    We can discuss the matter of medical malpractice lawsuits at another time. The fact is, these too, are severely overblown. It is a myth that it is an easy matter to find an attorney who will take aMed-Mal case in the first place. The reason? They know that – contrary to popular fantasy – most juries side in FAVOR of the doctor. And the typical “award” when the physician loses, is pretty small indeed.

  • PatricParamedic

    'Abuse & Law Suits' brings up great points, but it dances around the core issue. To properly assess the impact of “abuse,” one needs to take an accurate look at who the worst “abusers” are. And the undeniable fact is, just over 1/3 of all 5,750 public hospitals, and well over 100,000 doctors (since 1985) have pillaged & plundered insurance companies for over 50 years.*When 2 cardiac surgeons are found to have performed over 600 heart surgeries At Redding Community Hospital, for no other reason than their own greed; when a New York surgeon confesses in court to performing 10,000 unnecessary eye operations; when a single MD was recently convicted of stealing $18.3 million from Medicare in false charges – and when these travesties repeat themselves to the tune of what the U.S. D.O.J. reports as 1/2 trillion dollars per year in fraud – by what measure of logic might anyone view the fractured health care system as a 'victim?' It is only a victim of its own excesses.The sad fact is, physicians and their creation called modern medicine have had 120 years to get it right. Have they performed an enormous service? Of course they have. But 2,490 of them were convicted of serious crimes just last year – 11,000 doctor-convictions over the past decade. According to Public Citizen, there are 237,000 physicians they consider “Dangerous” or “Questionable.” Among those are the 204 in prison for murder, and at least 29 others preparing for murder trials.As a physician misbehavior researcher, I can verify that NO profession in our society generates more crime, causes more suffering, hides more sins, nor kills more people – than errant physicians. And there are literally thousands of them. I am trying very hard to imagine a scenario where, say, the airline industry, would be responsible for the same amount of citizen death (which is 350 patients who die every day due to medical errors) and then have the unmitigated gall to be upset when lawmakers step in and – flawed efforts or not – try to repair the mess. That number of 350 is coincidentally about the same volume of a single 747 crashing everyday of the year. Does anybody believe the airlines could logically dispute outside intervention?We can discuss the matter of medical malpractice lawsuits at another time. The fact is, these too, are severely overblown. It is a myth that it is an easy matter to find an attorney who will take aMed-Mal case in the first place. The reason? They know that – contrary to popular fantasy – most juries side in FAVOR of the doctor. And the typical “award” when the physician loses, is pretty small indeed.