May 21, 2012

Abuse – behind the scenes look at healthcare costs

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.


A Boy Named Sue

Once upon a time lived a boy named Sue. He was well known as the bully around town. Sue was quite the perfectionist. It was understood that when you are in Sue’s territory you play by his rules. One wrong look and you better hold on to your lunch money for dear life, because Sue would have you roughed up and broke before you even knew what hit you.

On the other side of the neighborhood lived a boy named Doc. Now Doc was quite the opposite. He spent his days helping people with their various issues. A problem solver if you will. As a matter of fact, other kids were willing to pay Doc to help them with their problems. He was good at what he did and had a heart of gold. Unfortunately Doc wasn’t perfect. Sometimes he made mistakes, and that often made the other kids mad.

One day came and a kid named Pat had a problem that Doc just couldn’t solve. Pat became very upset as he paid Doc all of his lunch money and didn’t get what he wanted. Pat decided to track down Sue and see what he could do to help. Sue assured him that he would get his money back, as long as he got to keep half. Pat couldn’t resist the offer and decided to take him up on the deal. So Sue tracked down Doc, roughed him up and took all his money. As a matter of fact he took more money than Pat gave him to begin with. Pat ended up getting all of his money back and Sue kept the rest.

Now Doc eventually recovered and went back to his business of helping people. That is until one day Pat returned and requested his services again. Not really sure what to do, Doc agreed to help him. Once again Pat wasn’t very happy with the service he received. Pat once again called upon Sue to get him his money back. Only this time Doc called upon his friend Sharky to defend him in his time of need.

Sharky stood up to Sue and saved Doc from losing all of his money again. This continued until one day Sharky realized that he was providing a valuable service for Doc. A service this good was worth some form of reimbursement. After all, if Doc didn’t have Sharky to help, then he would lose all of his money every time Sue came around. Eventually it got to the point where it cost more money to have Sharky help, then to just give Sue what he wanted. This of course made for hard times with Doc.

More and more kids were getting the idea that they could just call Sue to get what they wanted out of Doc. Of course Doc couldn’t stand to lose all of his money as he had to have something to buy his lunch with. So Doc decided to ask for more money in exchange for solving peoples problems. As the cycle continued, many people couldn’t afford to pay Sue anymore and therefore would not seek his services. Even with the small number of kids that were actually paying Doc for his services, his high prices still provided for enough money to buy lunch.

Times were tough, but Doc managed to eat everyday. That is until the kids that didn’t have enough money to pay Doc called upon Sue to help them with their problems. Sue then told Doc that whether or not the kids had money, he was going to help them unless he wanted to get roughed up and robbed again. Unfortunately it got to the point where Doc was helping every kid in the neighborhood and only a couple kids were actually willing to pay him for his service.

Eventually Doc just couldn’t keep helping people. The constant fear of Sue coming around finally got the best of him. He had no choice but to quit trying to help people and find another way to earn his lunch money.