What is Wrong With Our Healthcare System?
By Nancy Burton L.Ac.
Ask any healthcare professional, hospital or clinic and they will tell you what the politicians aren’t saying: insurance companies are the main problem with the healthcare system in the US.
Granted, if you are working for, or retired from, a company large enough to negotiate a good policy, or if you are a state or federal employee, chances are you have excellent insurance: low deductible, good coverage, affordable premiums. For the rest of us the costs are phenomenal and going up. For all of us the insurance benefits and the quality of our healthcare is declining.
Aside from Medicare, and Medicare supplements, which have strict guidelines, insurance companies can do just about what they want. You (their client), as well as healthcare professionals, clinics, and medical facilities all sign a contract holding you to the insurance companies’ rules. Insurance companies have the right to change those rules at any time. You do not!
Insurance companies can, and do, increase your deductibles and premiums while decreasing what procedures and tests they will pay for, despite what your doctors deem necessary.
At the same time that insurance companies are increasing your premiums, they are decreasing what they pay to healthcare professionals and healthcare facilities. Policies that initially look affordable are often the ones that healthcare professionals and facilities can not afford to accept because they pay so poorly.
The ever increasing amount of paperwork that insurance companies are demanding from healthcare professionals, has become so time consuming that it is drastically reducing the time available for patient care. Many healthcare professionals are retiring early because they no longer have the time to do what they signed up for; take care of their patients.
One of the biggest complaints about doctors is that they don’t listen. But it is the insurance companies who dictate how much time your doctor spends with you. They will only pay for so many minutes. So unless your doctor gives you their time for free, it is usually not enough. The challenge for doctors in dealing with insurance companies is to provide their patients with the tests, procedures and care they deem necessary. The insurance companies have a list of each ailment, procedure or surgery, that dictates your care. We are all individuals with unique health issues and requirements, but that does not factor into the equation. For example, if you have been admitted to a hospital for a certain type of operation then you will be discharged within a predetermined number of days, though you or your medical advocate does have the right to challenge this. Unfortunately, when sick and vulnerable many people are without a medical advocate.
Once you are out of the hospital, round the clock care is not covered by insurance and is expensive. Family members often compromise their own health and finances trying to take care of loved ones. Part or full time care is something provided for in every other industrialized country in the world. This is essential if health, as opposed to profit, is the goal of a healthcare system.
Anyone who has ever had a serious health issue, which requires extensive tests and medical procedures, has learned that you need a medical advocate. It seems an increasing problem that tests ordered don’t get to where they need to go, the scheduling does not get done, the results of those tests are not sent to the various specialists who require them, unless someone monitors, coordinates and prods things along every step of the way.
I learned from my insurance biller that for every doctor or nurse in a hospital, there are five administration people just working on insurance billing. That is aside from the increasing amount of paperwork required from doctors and nurses regarding documentation and pre-approvals. Even a small independent healthcare practitioner must hire either a full time employee, or pay a billing company to deal with the complexities of medical insurance billing. This increases the amount they have to charge you.
Each insurance company pays differently for the same service or item used in their patient’s care. And everything must be recorded individually for billing. It is then up to the insurance company what they will or won’t pay for. Often claims have to be resubmitted several times just to get the insurance company to pay what they have stated in their policy is covered. So your healthcare practitioner has no idea what they will actually receive for the services they have provided, or the equipment or supplies they have used in your care. Payment can take months. Often, insurance companies decide they have made a mistake and they did not intend to pay for something after all. They then ask for that money back from your healthcare provider months after their check has been cashed. Unless the practitioner or facility will absorb that cost, the patient is then responsible for the difference.
To say the entire system is a mess is an understatement. To say the only ones truly benefiting from the confusion and inefficiency of the current system are insurance companies is accurate. This is why our healthcare system is becoming more expensive while care is being compromised.
The excessive time and expense required by insurance companies should be allotted to patient care. Our healthcare system would then have the resources for professional medical advocates to make sure communication flowed unencumbered. Doctors and nurses would have more time with their patients. And we would have the resources for necessary post surgical and long term home healthcare.
Each year insurance companies spend an obscene amount of money for lobbyists to make sure their industry remains as unregulated as possible. This is done by funding politicians to champion their cause to make people believe that any major change in our healthcare system will be a detriment to their care. Where do the insurance companies get this money to spend? From you and me! From companies and corporations, federal and state governments that pay their increasing premiums! Premiums that often equate to the amount of a monthly home mortgage payment and have drastically decreased the disposable income of Americans.
Insurance companies try to blame the increasing costs of their payouts on malpractice claims. Yet each year their entire payout amounts to less than a fraction of 1% of their profits.
High deductible insurance, the only type so many people can afford, especially those who are self employed, is going up again and will now be close to $8,000 for many policies. This means when someone with this type of insurance needs to go to the doctor they often can not afford to. So they wait until they are in crisis and have to go to the emergency room. Uninsured or under-insured people are swamping the system. The ER staff has to take the highest risk patients first and others wait hours for care.
Medicare is a simple system. It pays a set amount for each procedure and therefore requires less paperwork for billing. It is affordable for its members. I have yet to hear anyone say their care is subpar when dealing with serious health issues when on Medicare. It is underfunded. So the amounts Medicare pays often is not enough for many healthcare professionals to take it. But once in the system people are typically happy with the care they receive. Money currently paid to insurance companies with this inefficient system would be more than enough to properly fund Medicare.
Insurance companies are fighting against a Medicare for All option, even with the alternative of keeping your private coverage. Why? Because the option of good, affordable coverage would offer the competition needed to hold insurance companies accountable, and insurance costs down.
We need a drastic change in our healthcare system. We need the money we are pouring into the system to go to healthcare, instead of billing costs, lobbyists, politicians and huge payouts for insurance companies’ stockholders and corporate executives. Until healthcare in this country is about health, instead of profit, it will remain broken.
Health & Happiness,
Nancy Burton, L.Ac.