The Healthcare Game Get Engaged People!

In this age of Healthcare Reform and now mandated health insurance for all Americans, I feel compelled to express my personal views on the issues we face as a nation when it comes to healthcare. First of all, insurance companies are not the root of this problem; it is a collectively complex issue which has been brought about by not only insurers but also, doctors, hospitals and pharmaceutical companies.

At the risk of being “black balled” by my industry, I am going to share some personal experiences in this article to describe some of the problems I see going on, which leads me to believe our medical delivery system issues are not caused primarily by the insurance industry; which, by the way, is taking the brunt of the financial responsibility by this newly enacted law.

First of all, why is it that pharmaceutical companies can flood primetime television with ads prescribing their drugs to consumers literally non-stop from 5:00pm – 9:00pm every night? Is it the television’s and radio’s responsibility to prescribe us medication? I don’t think so. I feel that responsibility falls into the hands of the doctors who treat us for our illness. Pharmaceutical Companies spent in excess of 30 billion dollars, yes 30 billion, in advertising last year alone.

The United States is the most over medicated country in the world, so if you don’t think that doctors and their staff are being compensated to write prescriptions, just walk into your doctor’s office any lunch hour and see who is bringing in lunch. That’s right, pharmaceutical reps provide lunch to those providers meeting their goals for the week, month or quarter in prescribing their company’s drugs. I overheard the receptionist at my provider’s office telling a pharmaceutical representative that she could not get him an opportunity to provide lunch until a date 3 months out. Now that’s pretty scary. Shouldn’t the government be addressing these issues? No, because the pharmaceutical companies are lining every pocket in Washington on Capitol Hill. Why do third world countries pay pennies for drugs we here in the US pay hundreds of dollars for. Is it the US’s responsibility to be researching and curing all of the world diseases? Who else has skin in this game?

Secondly, I received an explanation of benefits (EOB) from a client who experienced a heart attack and the billed charges were in excess of $113,000 for his two day stay. The allowable charge by the insurance company was $11,200; that’s a $101,800 write off for that hospital. How can that be? Is this an abuse of the system or not? You decide! Just for being a participating provider, they are penalized $101,800? I think not, this represents a horrific abuse of the system. Why is it that we can shop for a car, but we can’t get a hospital or doctor to provide us the cost of open heart surgery or a hip replacement in this country? Why can’t we determine a doctor’s success ratio in treating our illness prior to seeing him or her?

I have four boys, two of which have sports induced asthma. Prior to enrolling in a high deductible healthcare plan (HDHP), I was purchasing 3 medications for each of my boys with asthma which cost me $50 per child per month. A lot of money in my eyes, but I did it because of their health. When I went to fill the same prescriptions after enrolling in my HDHP the pharmacist told me I owed $600 per child for the same three drugs. I nearly fell over. After scheduling another appointment with my boys’ physician and asking if there was anything I could do to reduce or eliminate any of the prescribed drugs, he looked at me as if I had three heads and asked, “are you questioning my treatment plan?”. I immediately back peddled and said, of course not, these are my boys and I would do anything for them. I am just wondering if there is anything I can do to improve their health. His response floored me. He said, listen, your two boys have asthma and they will die with the disease. I immediately found another provider who specialized in youth asthma. When I took the meds my boys were taking into his office to show him, he nearly fell over. He stated that two of the meds were counteracting the third and doing more harm than good. He worked with my boys for 6 months and to date, they only use a rescue inhaler that I refill once every 6-8 months. WAKE UP AMERICA!!!! These doctors are not gods, so quit treating them as such. Ask questions; after all it’s your body and you have a right to know what you are putting into it as well as the medication’s side effects.

My third son fell snowboarding and hurt his wrist. It was a Saturday night so we visited an Urgent Care the following day. The Urgent Care took x-rays and stated that while they felt the wrist might be fractured, they did not have a radiologist on staff to accurately read the x-rays and recommended that my son see an orthopedic specialist. They handed me the x-rays and said I could take those with me to show to the specialist. We made an appointment and as we were sitting in a room waiting for the doctor, I overheard the conversation in the room next to me. A doctor entered the room and inquired to the problem and the patient said he had hurt his shoulder when he fell from a ladder. The doctor said, “Well then, let’s take a look at these pictures”. A couple minutes later he said “yes you have torn some ligaments and done some real damage to this shoulder, I would like to perform surgery on Thursday.” I really didn’t think much more about what the doctor said until he came into our examination room. He again asked what happened and my son stated he fell snowboarding. He said he wanted to take some x-rays.  I said that I had x-rays from the Urgent Care we visited the day prior. The doctor said he would not look at those films and took my son to have several more x-rays taken. Upon review of the x-rays from this BEAUTIFUL computer in our room, he said, “Yes, you have fractured your wrist and I want to schedule you for surgery on Thursday. He said the surgery center would be contacting me with more information. We couldn’t get out of that place quick enough. A second opinion showed a fracture however this specialist stated he would like to cast the arm for 6-8 weeks. When I told him about our first experience, he smiled and stated he was of the old school. He didn’t feel right cutting on a 16 year old and putting foreign material in his body which might cause further issues down the road until he allowed the body to repair itself. By the way, my son’s body did heal itself.

When I got home that evening, there was a message on my phone from the surgery center scheduled to perform the surgery on my son’s wrist and they asked me to return the call, so I did. The woman I spoke with rambled on about having to inform me under federal law about certain things, blah…. blah……blah, and the final statement out of her mouth was, “and you have the right to know whether the doctor ordering this surgery has an interest in this surgery center. So I asked, “Well, does he?” She replied, does he what? I said, well does the doctor that ordered this surgery have an interest in the surgery center. Her response was, “yes, he owns it”.

My point in sharing these stories is to illustrate, we as consumers are caught up in a GREAT BIG GAME and we’re being used! I am not saying all doctors are this way, but if you question a treatment plan and get a push back, find another doctor. There are a lot of great providers out there! Take the ball back people, let’s move it down the field in the opposite direction. If your doctor won’t answer your questions, find a new one who will. If you’re scheduled for a surgery and feel it is necessary, force the hospital where the surgery will take place to provide you with the cost associated with the procedure, including anesthesiologist, operating room, surgery and recovery. Until we demand these answers, our system will remain in the same state it is today.

I am honored to live in this country and feel we have the most comprehensive medical treatment anywhere in the world. I am saddened by our current state of affairs and do not feel health care is an entitlement in this country. While I agree with some of the legislation in this bill, there is a lot of it which should be discussed further.

The results of the November 2 elections produced results in Washington like those of the time during the Viet Nam War. I think the American people spoke loud and clear that we are tired of what is going on at a national level and if things don’t change, there will be hell to pay in 2012. What’s next? The federal government takes control of all our hospitals and physician groups? That’s exactly where we are headed and if you think that’s a good thing, take a look at the Social Security and Medicare systems which we have all paid into our entire lives and tell me this is what you want.

“When the people fear the government there is Tyranny, however when the government fears the people, there is Liberty” Great words spoken by one of our founding fathers Thomas Jefferson!

Keep the faith people and get re-engaged in our medical care delivery system. We as consumers are the only hope for survival.

913.754.5913

About the Author:

Mike came to Power Group in 2000. Prior to joining PGC Mike served as a regional manager with United Dental Care from 1995-1998, and was Vice-President of Sales and Marketing with Dental Source of Missouri and Kansas. Mike was instrumental in the development and state approval of cutting edge dental products as well as working with the dental community to provide affordable dental care to consumers.

Mike specializes in core benefit packages – Health, Dental, Life & Disability Products, and consults with more than seventy clients in the Greater Kansas City Area.

Mike received his Bachelor of Arts in Business Communications from Rockhurst College. He currently resides in Shawnee, Kansas, with his wife Jill and four boys Adam, Justin, Sean & Patrick.