What I Know About Health Care Politics
I’m pre-empting my continuing saga on efforts to secure legal counsel with this blog in honor of President Barack Obama’s conference on health care today. If NPR’s Morning Edition is accurate in its portrayal of events, this will be among the first meetings on health care that begins with a discussion on the ways health care delivery or quality of care needs to change in order to lower costs. Personally, I’d like to hear what suggestions practicing doctors have on the subject.
In re-reading yesterday’s blog post on my workers compensation suit against U.S. Health, it was clear to me that addressing how doctors are paid is key to improving patients’ quality of care. The current payment system rewards doctors for seeing lots of patients for short periods rather than for achieving results or helping patients actually get well. The insurance bonus programs designed to reward doctors for having healthy patients only encourages doctors not to take on chronically ill patients and to overlook illness in patients who really need health care.
Patients need to be empowered and brought into the “system” as active participants. This paradigm shift from the deist doctor who dictates patient care protocol in a “my way or the highway” manner will be difficult for many doctors to accept or employ. Such change will likely necessitate doctors hiring patient care coordinators who meet with patients to summarize their questions and concerns so that they may be addressed cost effectively with the physician.
For patients with multiple health issues who are seeing various doctors, the office care coordinator would be tasked with communicating with all of the patient’s doctors to make sure all care providers are versed on the patient’s care and progress. Implemented effectively, such coordination among care providers should facilitate proper diagnosis of the underlying cause of illness and prevent treating only secondary conditions that occur as a result of the undiagnosed, untreated underlying condition.
The position of care coordinator would be analogous to that of a project manager, who ensures that jobs are completed timely and within budget by keeping abreast of progress and troubleshooting glitches.
A rating system should be established so that patients can easily assess the services offered in different practices. Can patients book extra time with the doctor? Will the doctor be open to discussing procedure options? Will the doctor return phone calls from patients with a question or must the patient speak through his assistants? If a patient finds his medical record contains misunderstood or incorrect information, can the information be corrected? If so, what is the procedure?
The intent is to shift the focus to patient care and away from what the doctor needs to do to get paid.
I was quite inspired by U.S. Senator Ted Kennedy’s heartfelt promotion of health care for all in his speech at the Democratic National Convention last year. Still I can’t quite reconcile in my mind the dichotomy between what politicians espouse and the inequities that I find existing within established government health care programs. Take Medicare eligibility for the disabled, for example.
Those found to be disabled by the Social Security Administration are eligible for Medicare coverage after 24 months from the date the person became eligible for SSDI benefits with a few exceptions. Disabled persons requiring kidney dialysis or with ALS and a few other conditions are immediately eligible for Medicare coverage. I ask, where’s the equality in providing health care coverage through Medicare only for those with these certain illnesses?
I am disabled — not because insurance refused to pay or because of a botched procedure, but because my spine and central nervous system severely degenerated due to doctors’ failure to diagnose and treat the infections that were caused by my undiagnosed and untreated Hirschsprung’s disease. The sooner I can get access to real medical care, the greater the chance there is for me to get well enough to go back to work and become a productive, tax paying member of society again.
How hypocritical is it that our government sees fit to only allow those with certain disabling illnesses to access medical care immediately upon being awarded disability benefits? Multiplied by the thousands affected, have our legislators chosen to sacrifice tomorrow’s future to save pennies today?
Those who suggest seeking medical care at the few low cost health clinics in this area are obviously uninformed about chronic illness. Any health clinic official will tell you that such clinics are not equipped or intended to address chronic or complicated illnesses. In fact, under our current health care system, it seems no doctor is set up to address chronic illness. ER doctors complain that too often internists have resorted to sending their non-emergency patients to the ER for medical work ups rather than conduct the necessary tests and take the time to diagnose their patients’ illnesses on their own.
When I approached my elected representatives about the dilemma, I couldn’t get beyond their staff, who suggested I hire an attorney or just couldn’t relate. In Virginia, you need a doctor’s backing to file a malpractice suit. I think that’s unconstitutional. Why should I need a “treating” doctor’s testimony when I have test results to prove my case? Even the Social Security Administration realized that many doctors refuse to participate in their patients’ disability applications and so will arrange for some patients to see assigned SSA-paid doctors to help with the disability determination.
I’m hopeful and fearful about our new Congress’s ability to move beyond its self patronizing environment and start addressing topics until now considered too risqué to tackle publicly — like what are we getting for our health care dollars.
With so many conceding that our health care system is broken, I can’t understand why politicians have refused to address the quality of health care. The focus has all been on funding. My insurance paid for the majority of my tests. Doctors, on the other hand, went on strike and didn’t tell anyone so they could keep collecting fees.
Consumer laws protect us from shady contractors who don’t perform per their contracts. Why is it okay for doctors to get paid for simply trying to help a patient? Who decides how hard they have to try? Contrary to HMO policy, my internists relinquished care to the specialists they referred rather than act as care coordinators per their contracts with the insurer.
The focus of nearly all the doctors I saw was on how to finagle the diagnosis to the insurer to expedite payment rather than on patient care. I found there was a pattern among doctors, in general, to downplay a patient’s condition to the insurer to expedite payment. At first, this didn’t faze me. But then, the doctors forgot what the real diagnosis was, hence making it impossible for me to get the care I needed. If doctors persist in massaging their diagnoses as they’re taught to in classes held on how to expedite insurance payments, they should at least keep two sets of books to separate reality from fiction.
Under our current money focused system, our medical community is playing Russian roulette with an aging population. It’s causing people, like me, to become disabled unnecessarily. Refuse to change and just watch our nation’s social security fund being drained at a much faster rate by the increased numbers applying for disability because no one would address the impaired quality of care largely caused by our health payment system.
Outpatient care should be designed around a center in which internists and various specialists work together to come up with a comprehensive diagnosis. All would know how to read radiographs and be required to consult each other and come up with a comprehensive diagnosis before the first prescription was written. Liability for patient welfare would rest equally on the shoulders of each member of the diagnosing team, thereby creating an internal peer review check to reduce errors.
This would prevent a patient who started taking medication prescribed by one doctor from skewing test results ordered by the next specialist, seen weeks later. This would lead to faster and more accurate diagnoses since specialists are trained to only look for disease within their respective fields. Using the combined knowledge of all specialists upfront would drastically reduce the number of specialists who unsuccessfully treat a patient’s secondary symptoms while the root cause of disease goes unaddressed. This would mean less administrative paperwork, less test duplication, less wasted gas driving to all the different specialists’ offices and testing facilities and would drastically reduce the overall cost of health care. This would lead to greater patient health outcome and satisfaction.
The last few years trying to be heard or get help, I contacted all kinds of folks and tried all kinds of things to get through. I kept getting kicked downstairs to the admin or staff more concerned with protecting their realm than with truly assisting anyone with anything. It’s quite a statement about human nature.
When you get that many no’s, you begin to start wondering what it is about yourself or your approach that turns people off. Then you look around at the rooms full of people in the same boat, and you realize no approach can affect change if the recipient lacks the knowledge or experience required for you to get through. You feel like you’re Al Gore trying to get across the concept of global warming. You wonder if you have the same quality that enabled him to persevere. Then you think of the alternative — give up, die.
How loudly can someone yell H E L P!!! and still be ignored? All the while, you feel the cognitive dysfunction from your illness increase. You think you might wake up one day too alzheimerish to remember enough to care. That’s why I had to write down my experiences with outpatient care doctors and the medical community before I forgot. The stories are compelling and shed light on the chasm between medical research and the practice of medicine that hasn’t altered its robotic, deistic ways in over 30 years despite mind blowing advances.
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