Friday, July 19, 2013

The Silent Majority

There is so much entropy in health care right now.  So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock.  Shock at prices, shock at waiting times, shock that doctors don't know how to increase referrals, shock that doctors aren't doing more to help.  What gives?

In triage, you don't spend time with the expectant.

Doctors are keeping their heads down.  They are still seeing patients.  They are still going to work and taking the calls. 

But they are tired.  They are frustrated by the system that puts the system of care before the people doing the caring and those needing care.  They are tired of the empty promises.  Like the promises that staring at a keyboard will fix things, do things better, save money.  It's complicated, this health care thing, right?  We are told we need more automation.  We need more quality managers.  We need more safety officers to see more people with less to keep it safe.  We need more administrators to implement the rules: more people willing to take less to make it work.  Complicated, I tell you.

But the promises, we're learning, have been part empty, for they have enriched the system for the system's sake while leaving the people the system is supposed to help, increasingly broke.  We're $500 billion over budget so far and counting. 

Promises are for politicians and business people.   Real health care workers don't make promises, they do the best they can with what God gave us.  As patch after destructive patch of interweaving laws and back-slapping favors are handed out in Washington, corporate board rooms, and union meeting halls, a silent health care majority watches from their peripheral vision, trying not to notice, trying not to be disgusted, for the work for them never ends.  The silent majority is waking to the fact that the business part of health care was, is, and somehow forever shall be, broken.  There is simply too much money involved, too much economic return that can still be made, too many opportunities to deceive others for personal gain, too many people, too many workers, too much of our economy, to accept that things will ever really change.  Too very, very big...

... to fail.

Like Detroit.

I sit before a computer screen that says "Order entry:"   I no longer need a pen thanks to handsome government subsidies and a push to centralize and nationalize.  Let others do the deciding.

I type in an order.

Five choices instantly appear based an a sophisticated word-search algorithm.  I find what my patient and I, as their caregiver, need.  I click on the item.

But a price never shown.  So there is never a discussion about cost.   That's the intent.  There is never a word about the difference of retail price and what it really costs or what you'll really have to pay.  Like a shopping spree without the prices.  Because, according to others, doctors should not think of these things when health care is involved, nor should Congress - it's about your health, remember? 

So thousands and thousands of your dollars are put at risk, dear patient, with a single click of a button. Courtesy of government subsidies.  And you will never know.   Nor will I, as I load the gun of your economic destruction.

So efficient.  So clean.  So tidy.

How was I supposed to know I ordered a collection agency for you, too?

But the silent majority is stirring.  They are upset they must pay their mandate, upset the corporate guys don't.  The are seeing the bills, the denials, and the undecipherable bills.  They are seeing the cost.

The Silent Majority is stirring.

Because they have a check box, too.

In November, 2014.



Lisa said...

Thank you. I wouldn't shop at a store that doesn't post the prices. Neither do I eat at restaurants where there is no price given for each entree. That's just stupid. It says I have more money than brains. I knew that cancer treatment was going to cost 60 grand to extend my life for 7-10 months, would I take it? I only got a defibrillator after I'd blown through my out of pocket for the year. I knew it was ungodly expensive and I also knew that chances are that it will never fire a charge. I hope it doesn't. Would I pay the 80 grand that it took to have it installed, probably not. Real reform will come in health care when patients are told what they are spending. I'm sure that what I alone have spent in care that was repetitive and most likely unnecessary, or could have been achieved with a cheaper therapy is approaching a million. But I'm not given the option to either know what I'm spending or even know that there is a cheaper, usually easier way to do this. I have a difficult time getting my doctors to share blood test results. I'm sure that it doesn't change that much over the course of a few days. But they don't like to share. Doc A has to turn over the result, but but Doc B thinks he needs a new test. It's infuriating, maddening. I'd love to jump ship, but then what?

Anonymous said...

Thank You for this writing.
Now I feel I am not alone.
It seems the system has decided the patient
and the doctor (or care worker, as we are now called), are both left out.
No knowledge of the cost of what we are ordering, no knowledge of whether the patient will actually be able to
afford what we are ordering: and therefore no ability to even have a frank discussion about the cost.

Once, when I had my colonoscopy screening, I asked the GI physician if I could forgo the anesthesia as I wanted to watch the video monitor, and I had no one with me to guide me home (a requirement by the hospital).

When I received the EOB I noticed my insurance was billed 298.00 for the anesthesia that I did not have.

Although I tried my best to correct this inaccurate bill, I was told by the hospital billing and accounting department that these two items (the screening colonoscopy and the anesthesia) are LINKED. And in his 12 years of experience, he has never been able to unLINK them-even if the anesthesia was never given.

I was unable to keep that insurance as the premium became too high for me to bear, eventually.

Anonymous said...

Doc, you may rail against Obama, but if not for him we would still be doing it the old way with no concern for the cost. You either had insurance or you didn't. If you didn't you got your health care at the ER. Take note of the two above comments. Their complaints originate with the hospitals and their contracts with insurance companies.
I've been asking about prices for years. Every doctor was clueless, and worse, was contemptuous of the question. Well, god bless Obamacare for beginning to put an end to such ignorance.

Anonymous said...

Great post! Your analysis of the current bureacratic economic morass of unnecessary overhead and and conflicting political agendas is right on. More than providers are waiting to pull the lever in 2014. Thank you for your insight and articulate picture of where we truely are in health care delivery and how doctors have been systematically pushed aside in the all important patient doctor personal encounter.