Health care: desperate measures
erik steele

Health care: desperate measures


This is the first of two articles about the good and bad impact of progressively desperate efforts to control health care costs. First up: the bad ideas.

With a urinary catheter sticking out of a hole cut into his windpipe, this guy was proof that desperate times call for desperate measures. He had been sent to the emergency department from his nursing home because a piece of food went down the wrong way and blocked off his breathing. Unable to Heimlich it out of there, a family doc on the scene cut open the old guy’s windpipe and jammed in the first hollow tube he could lay his hands on — the catheter.

America is now like that old man; gasping for relief from rapidly rising health care costs, with health care reform stuck firmly in our windpipes. With no national answer on the horizon, we are all turning back to our own desperate measures to keep alive each patient’s or family’s ability to afford their care, each employer’s ability to insure its workers, each insurer’s ability to sell affordable health insurance, and our state and national governments’ abilities to insure the poor and the elderly.

Irrational behavior becomes the norm when the norm is irrational and threatening. In the absence of a comprehensive, rational, national alternative for controlling health care costs on our behalf, we will be ever more likely to cut each other’s financial windpipes in order to save our own necks. We will sacrifice the long-term interests of our country, our health care system, anyone else, and even ourselves, for our short-term relief from financial — and other — pressures. We will tell anyone who objects to go suck air through a catheter.

Consider examples of this kind of response to desperation:

• A patient I saw in the ED recently told me how he pulled his own ingrown toenail out with a pair of pliers in order to avoid a doctor’s bill for the treatment.

• The internationally known Mayo Clinic, which takes patients from all over the world, has recently announced it will not take Medicaid patients from anywhere but Minnesota and its five neighboring states. Its primary care clinics in Glendale, Ariz., will no longer accept new Medicare patients. Both limits were put in place because Mayo does not make enough money on Medicare and Medicaid patients.

• The equally famous Cleveland Clinic recently announced it will not hire anyone who smokes. While its CEO said it was doing this because it wants to hire employees who model healthy behaviors, the real effect of the decision is to lower the Cleveland Clinic’s long-term employee health insurance costs.

• Many businesses are reluctant to hire back permanent, full-time employees as the economy recovers because of the cost of health insurance for those employees.

• In the last year, 33 states have cut or frozen Medicaid pay rates to hospitals and physicians, and 15 have cut benefits to Medicaid patients, according to the Kaiser Family Foundation.

• Medicare, desperate to rein in costs in order to avoid insolvency in the next five to eight years, is shifting more costs to Medicare recipients and ratcheting back payments to doctors and hospitals.

• Doctors and hospitals whose payments are cut by insurers may offset these cuts by taking privately insured patients over Medicare and Medicaid patients, ordering more tests and procedures and growing their way out of their bind.

• The state Senate of Virginia has approved a bill that would ban any mandate that everyone must be insured. If approved there and elsewhere, the effect could be to kill universal insurance, because affordable health insurance for all means even the healthy must buy insurance.

These have in common short-term gain for one party over another, lack of a long-term strategy to reduce health care cost drivers and potentially adding cost over the long haul. They have in common a fearful response to desperation instead of a thoughtful response. It’s time for us to think about what comes after the catheter for a breathing tube.

(Next: Good ideas born of desperation)

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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Comments
14 comments on this item

Yet another good argument for a single-payer system.

when Im sick I go to a doctor and he tries to help

try getting that from blue cross or any insurance company

doctors heal the sick

insurance companies make money for the investment class

Let's just remember the the same "investment class" is the same ruling elite (this includes Dems and Republicans) that is trying to reform the system.

Again and again I read comments about the rates of pay for physicians. I don't know about those who make such comments, but I have to say that I want the most qualified and experienced physicians treating me and my family. Such experience, training and education is costly, but worth it.

The issue here is not what a physician earns (which is exponentially higher than my earnings). The issue is that those with insurance have been covering costs for those without insurance. Until recent years, hospitals have raised prices for the rest of us to cover losses from providing care to those on medicare. The problem now is that those extra costs have grown to a level that the rest of us can no longer sustain, and hospitals can no longer raise rates and expect insurance companies to go along with it.

Malpractice liability reform, pay for medical outcomes, realistic reimbursement rates are all possible sources of savings.

We need to move past the socialist "Robin Hood" mentality of some who become irate at the thought that professionals who have spent years of their lives and hundreds of thousands of dollars to become physicians don't deserve high income levels. If it is so unfair, they should go to medical school themselves and reap the reward. As for the rest of us, lets roll up our sleeves and get to work making the system better so hospitals and physicians can survive ... we can afford the care that we all need and demand from them.

Physicians deserve to make high incomes. I'm not convinced that the same is true for insurance executives.

My Daddy used to Say ~ If you listen to big money talk ~ you will get lost

PRO SINGLE PAYER / JUST THE BEST FOR AMERICA

Lets have "Performance based pay" for doctors like many here advocate for teachers. The butcher here in Machias installed a super-pubic catheter in my father, while his SUV was running in the parking lot. He finished the operation, jumped in his car, and took off on vacation. My father died of a hospital acquired infection a week later. A month after that we got the bill for $37,000+ dollars. I called our insurance company and told them NOT to pay, they said they have a policy of not contesting any bills under $100,000. I told them I, the executor of my father's estate was telling them NOT to pay, they said the policy holder has no say in the matter of what bills are paid and what bills are not paid. In other words, all they want from us regular folks is the premium payment/on time.

On a performance based system we would have owed nothing. They still have not received, nor will they ever, the $3,700 co-pay/deductible.

We're moving in the wrong direction when Medicaid and Medicare patients are turned away. Recently I had claims denied by 2 insurance companies, when both were clearly responsible to pay. Who get stuck in the mess? Me, the one who always paid premiums promptly.

Harry, I'm sorry for your loss. I too learned a long time ago that paying premiums gives me no rights other than the right to pay on time. God help you if you're a few days late. They generate that cancellation letter faster than they ever paid a claim.

One of the problem with Medicaid is states see it as a way to fill their budget holes. Every year Maine "balances" the budget by delaying or reducing Medicaid payments to the hospitals. I don't blame the hospitals at all!

I also don't think people are willing to pay enough for quality insurance. I know MANY people who either opt out or take the cheapest insurance option, own a snowmobile or 4 wheeler and then cry foul when they get hurt and rack up a 100K bill (not you HarrySnyder). I pay ~$400/month for an 80/20 family plan, and I think it's a deal. I pay more for my house. More for my car. Hell, I pay more in entertainment. I think my health is at least as valuable as any of those.

If hear one more person with a flat panel TV complain about the cost of health care, I think I'll vomit...

This mess will get sorted out eventually; not by extremists on the political front, but by rational people who are honestly interested in solving the problem. The democrats have gone off the deep end with a plan that they themselves cannot even get approved; a plan that most Americans do not want.

66readerwriter, when claims are denied by insurance companies, don't bother to call the customer service line. Send them a letter asking them to explain the denials in writing. Add that you believe the denials were arbitrary and capricious. At the bottom of the letter, indicate that copies were sent to the state's attorney general and to the consumer care unit of the state department of insurance.

"A patient I saw in the ED recently told me how he pulled his own ingrown toenail out with a pair of pliers in order to avoid a doctor’s bill for the treatment." Then don't charge him so much, Doc!

More whining by elephants about the peanut supply.

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