Healthcare is Broken

I was trolling through “YouTube” one day looking at healthcare-videos and came across this one, if restaurants behaved like Healthcare. I have a lot of experience in the Healthcare world. As a result I have had, and continue to have, an interest in the statement that I hear frequently. The Healthcare system in the U.S. is broken. That’s right, I said “broken”. So, allow me to give you some insight into what some of the causes and effects might be that lead to a “broken” healthcare system.

What’s Broken?

Navigating the journey for access to healthcare in the United States is the challenge at hand. Accessing healthcare in many other countries is not quite as easy as it is here, but how does it function compared to the U.S.? One thing to keep in mind, though, is when you are feeling well, you don’t really think about those challenges. As a result, there’s no concern for functionality at that time. I really didn’t realize that Healthcare is broken until I started accessing it.

You may ask what’s “broken”?? Let’s start by defining broken. Simply said, not working properly. Healthcare is multifactorial, so it would make sense that there are many different moving parts. Let’s try and present some of those parts in the next few paragraphs. In order for this conversation to make sense it might be reasonable to set a few categories to look at. As stated, there are many players in healthcare but there are three major areas where the “broken” in my opinion may occur:

  1. Providers – Hospitals and Healthcare Professionals
  2. Payers (Insurance companies)
  3. Patients (most important and they tend to be the “victims”)

Let’s look at the following non-inclusive list of areas that are “broken”, not working well, causing the system of healthcare to get more and more expensive.

Lack of cost transparency

When you purchase a car or home insurance, you typically receive a quote to evaluate your options. If you purchase the actual car/home you, again, get a quote. You can haggle about the price. You can decide what accessories (options) you want. Purchasing a service, such as getting your car repaired, will provide you with an estimate. And, in most situations, if more is required you typically are notified and can decide to accept or refuse.

This does not happen in healthcare. You’re scheduled for a CT scan or MRI or an operation. Are you told ahead of time what the cost of the procedure is? How much will be out-of-pocket costs for you? NO!!! In addition, the fact is that you’re going to get multiple bills: one for the facility, one for the person performing or interpreting the results, and the cost of the event itself. Most times you are not given that information ahead of time, nor offered any options?

Excessive drugs costs

What’s “broken” here? I see several parts to this. First thing that comes to mind is the generic vs. brand drug battle. It is claimed that the generic is less expensive than the brand name but are they as effective? I don’t really know the answer to that, but I have heard so many times from patients that the generic doesn’t work as well. Even with that, insurance companies will charge a higher co-pay if you insist on getting the brand name, or they don’t cover the payment at all. Who suffers – the patient?

Next, we pay higher prices for the same medications in the USA than they do in other countries. We carry the burden of the Research and Development costs. Again, who suffers – the patient.

Finally, for this bullet point, physicians tend to prescribe the most recently produced medications which are generally more expensive or have no generics available. Drug companies need to recover their research and development costs. Yet, many of the older medications still work well, but the drug company sales people push the new ones. Again, who pays the price – the patient.

Reverse incentives

Both providers, the hospitals, and the physicians get paid on volume, not quality or outcomes. Traditional Medicare is moving towards payment for outcomes and hopes to have this program fully in place by maybe 2025. If you bring your car to a mechanic for a problem, and you have to bring it back because the repair was inadequate, you don’t get a charge for the redo. When you are readmitted back to the hospital for a complication of the previous visit or procedure, you get another full bill from them and your doctor. Hopefully, your expensive insurance will cover it, but you might end up with an additional co-pay, or deductible. Not to sound redundant but, who pays the price – the patient.

Inflated billing including medical billing errors

This may also fall under the reverse incentive category, but provider bills are inflated. What does that mean. I am sure that you have seen from your EOB’s (Explanation of Benefits) a couple of categories; the provider billed amount, what’s allowed, reduced fee payment, and patient responsibility. Little known fact, providers of all types inflate their billing fees, knowing that the payment will get reduced. So if they charge a higher fee, they might get paid more, especially if the amount allowed is a percent of the charged amount. It’s a game for better reimbursement. And who suffers? You already know that answer.

How about the charge for a missed office visit? There are many providers that will charge you for a missed appointment that you did not show for. I ask you; what other professions do that? There is a cost to doing business and that may be a no show for an appointment. You may think that I sound anti-provider or harsh. How many times have you had to wait for your scheduled appointment. Isn’t the cost of your time for waiting for your visit, procedure, etc. worth something. It just says that their time is more important than yours.

Doctors missing diagnoses

A great book has been written by Dr. Lawrence Weed and his son, called “Medicine in Denial”. The Weeds point out in this book what seems to be obvious. When referring to physicians, “there exists far too much medical information for the human brain to keep it all in mind, and apply it in a consistent and thorough fashion during a medical encounter”. The concept of a physician as we know it is not viable” and Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted.” two quotes from this Healthcare Blog. Sounds a little scary but makes one think. As a physician myself, I can understand it.

Just one more example

Here is one more to watch. If you have ever accessed different aspects of healthcare, you will totally identify with the content. It really isn’t much of an exaggeration.

If air travel behaved like Healthcare.

In conclusion

Lastly, one may say if we have all of these “broken” elements, why can’t they be solved or corrected. Remember what Albert Einstein said: “We cannot solve problems by using the same kind of thinking we used when we created them.” We need to change our way of thinking, but how does that get done?

Why we can’t fix our healthcare system| Ayesha Kalid – TED talk

Dealing with Cancer or Chronic Illnesses – visit or read

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