Who Is Making My Medical Treatment Decisions?

Health Insurance From The Doctor's Perspective

Went to the doctor yesterday and asked him what he thought about the potential for a government run health insurance system. He said he didn't really follow the argument because it didn't do him any good. He was to involved with trying to make it through the current system.

Some feel that the government should cover everyone, but be careful what you wish for because the standard of healthcare is going to go straight downhill as the ability to make a living comensurate with the time and expense required to become a doctor shrinks even more than it already has. Today for the uninsured, the emergency rooms function as the family doctor. That however, can be the case now even for those that are insured.

What Ever Happened To The Good Old Days Of 80/20?

Remember that? You go to the doctor, they bill you $150.00, you pay them $150.00 and then you send in all of the information to your health insurance carrier for an 80% reimbursement. The onus, the work and the responsibility to make sure you got that money was on you, the patient. One or two months later you would get a check in the mail, and if it was for an amount you didn't agree with, you, the patient took care of it.

Today, with managed care, the onus is now on the health care provider to make sure that they get paid. You walk in and the office will have an accounting and billing department who is responsible for making sure that the bill for services rendered are paid. For the same bill of $150 I pay the front desk $25.00 when I walk in, and the doctor will now have wait the months required to get reimbursed by the managed care company who is in no rush to send it (lots and lots of float). When they do finally receive the money, instead of $125.00 which is the difference between my copay and the actual bill, the insurance company will tell the doctor what the service was worth. Looking at statements I receive from the managed care company I would estimate they would get about $37.00 for my checkup. Add that to my $25 copay and they will have gotten about $62.

Just to do the math. The doctor's office had to hire a billing staff, wait to get paid, sometimes fight to get paid and when they finally did get paid it was $88 less than it had been under the old 80/20 system. That only covers the money part of the equation. How about the medical decision making part?

Just Who Is Making The Decisions

As if the fact that the ability to earn money has been sliced to the bone was not problem enough (I know, don't cry for doctors who spent 8+ years and umpteen thousands of dollars to get to where they are), doctors now have the added battle of trying to get procedures approved for their patients that in their learned opinion are required. They need them to be approved by the liaison at the managed care company whose ONLY job is to look for a reason to deny procedures in order to "save" the company money.

Not the cover your ass type procedures that people who disagree with this will say that doctors will prescribe as a reason for our increasing healthcare costs. No, I am talking about procedures that they feel are required based on the actual symptoms that are presented by the patient.

How much time does the doctor have to spend on the phone fighting for what is believed to be needed? This in a day where time really is money.

Net net, under the conditions that doctors operate under now it will make it more of a challenge to get the "best of the best" to commit the time and money required to become physicians. This would mean that those who do enter the process would be somewhat less than the "best of the best". That is not who I want operating on me.

I leave with the phrase of be careful what you wish for. Government run healthcare may sound good to some, but think about this. What was the last thing that the government managed that turned out well?

Sphere: Related Content