In my mind, the answer is very simple: corporate greed. These third party payers work hard to decrease reimbursements to doctors and maximize their own profits. The greed of corporate players is perhaps the most powerful warring faction against doctors and it is destroying our healthcare system.
In 2013, the CEO of Aetna earned $33.7 million dollars. The average health insurance CEO salary was over $10 million in that same time period. While many will say that is capitalism at work, I really wonder, as I fight to get another MRI covered for a patient, how many MRI’s were denied to generate that kind of salary? 2014 saw great increases in member enrollment in insurance plans under the ACA. Profits for these plans jumped up tens of millions of dollars.
My patients are suffering. They cannot afford the premiums they are now forced to pay, often against their will. They cannot afford the high deductibles most of these plans now carry. I have seen patients decide between two needed medications and which of their family members was the sickest to take to the doctor. They could not afford both.
Every day, I see more and more diagnostic tests and procedures being denied by insurance companies. I spend hours a week fighting these denials. Most insurance companies have now limited their formularies to exclusively generics. Even so, the expensive generics, such as life-saving asthma inhalers, are being denied.
My patients are struggling to afford their healthcare. Many are ending up having bad medical consequences because they cannot afford to get the medical care that they need. I have sent more than one asthmatic patient to the ER who had a severe exacerbation of their disease because their inhaler was too expensive and no longer covered by their insurance plan.
While patients are struggling to get care, the insurance companies are making obscene profits. The CEO’s of these companies make salaries like few other industries. Surely, a financial conflict of interest must exist to deny medical care? Yet, there is no one regulating the insurance companies. They hold free rein in what they approve and disallow. They ignore the medical advice doctors give their own patients and over-ride their decisions. Yet, they are protected from liability.
As more and more care gets denied, the quality of our entire healthcare system is degraded. When I see a patient for a 15-minute visit and then spend days trying to get their medication approved, our priorities have been misplaced. When the insurance company over-rides my clinical acumen based on their predetermined guidelines, medicine and science is tossed out the window to contain costs. There needs to be a collaborative effort to reduce healthcare spending, but not at the cost of the well-being of patients.
In our system, patients are now seen as consumers. While getting them to be advocates for themselves is a great thing, their humanity is getting lost in the process. Having a hip replacement is not the same as shopping for a set of kitchen knives at Wal-Mart. They need to be respected as more than just consumers. So many people talk about Big Data these days. Patients are more than just their medical information. They are real people with real needs and no two of them are exactly alike.
Corporate greed, especially of health insurance companies, is destroying our health care system and the medical well-being of patients everywhere. We need to put the person back in the patient and get corporate decisions out of the exam room. Medical decisions need to be decided on the best interests of each individual patient, whether they fit onto the insurance companies clinical pathways or not. We need to consider cost, but not at the expense of the patient. Doctors’ decisions serve the best interests of our patients and we need to be able to practice medicine, not comply with regulations. Do we really want bargain basement medicine or is it time to restore the US healthcare system back to the best?
Third parties over-stepped their boundaries in the treatment of patients. They practice medicine without medical licenses and restrict what care patients are allowed to receive. their decisions are made without any direct knowledge of patients and without ever performing physical exams. Yet, their decisions are law and the treating doctor’s hands are all too often tied by this system. Isn’t it time to get these money-starved war-mongers to stop practicing medicine? Do patients want to be medically treated by a greedy organization? Or do we want doctors helping us decide the best medical options for us based on direct patient knowledge and physical exams?
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
