Chapter 1
The American healthcare system has been the best in the world. The level of innovation was inspiring. The standard of the care received was unsurpassed. The number of bright minds wanting to train here and the compassion toward those not as fortunate was high. But much of that has changed. The insurance companies continue to post profits while those trying to make a living are paying astronomically rising premiums for less coverage. In my state, the average person on the Affordable Care Act (ACA) exchanges must pay over $4000 a year in skyrocketing deductibles before getting a single dollar of benefit. The bureaucrats and their mandates have taken the decisions regarding your life and health out of yours and your doctor’s hands. They’ve inserted into the system their little profit-making machines that add no value but greatly increase the cost. The administration of healthcare, and the companies that come between doctors and patients, have raised the cost of healthcare with little if any benefit to patients.
According to bizjournals.com, United Health Group CEO Stephen Hemsley made over 100 million dollars in 2010. In 2011, Forbes estimated his earnings at 48.8 million, and his compensation in 2016 was 33.4 million dollars. Anthem, which sells Blue Cross in California and 13 other states, paid CEO Joseph Swedish 13 million dollars in 2015. “Nonprofit” Kaiser Permanente pays more in compensation to its CEO than the “for profit” Blue Shield. Did these people do any surgeries, write any prescriptions, or deliver any babies? Did those CEOs provide any healthcare service that improved the quality of healthcare for anyone? The answer to those questions is no. Did any of you out there get a 22% increase in your salary and benefits last year like one prominent CEO of a major healthcare company? I didn’t think so. While I will admit that these CEOs evidently provided a service to their company’s shareholders that made them feel they were worth that much, and I will defend to the death their right in a capitalistic society to make what the market will bear, that money had to come from somewhere. I believe it should not be from the pockets of the taxpayers.
According to the Centers for Medicare and Medicaid Services (CMS), healthcare’s portion of the U.S. gross domestic product was 17.8% this year, up from 17.1% the previous year. The total amount spent is about $3.2 trillion! According to CMS, the U.S. healthcare expenditure reached $10,000 per person in 2015 for the first time. As you can see, if you follow the money, which nearly always leads you to the answer to any governmental question, there is a lot riding on us improving this system.
I don’t care on whom we lay the blame. Blame it on the Affordable Care Act, which has added astronomically to the burden of the patient on the individual market and the costs to small businesses. Blame it on the Republican or Democrat obstructionists. I know there are those of you out there who can make that case. Blame it on corporate America, gloming on to an industry that is a significant portion of the economy and skimming the profits off the top. Blame it on the rich, a very popular trend today. Blame it on capitalism; however, I would urge you to try to get your health care in a communist country before you make that case. I really don’t care on whom you lay the blame. Lay it on the doctors! After all, many of you would consider private practitioners of medicine rich doctors who just want to feather our own nests at the expense of the payors of the healthcare system. Never mind that we are small business owners who provide health insurance for our employees when we don’t have to and pay these rising premiums and deductibles ourselves.
Has any of this name calling and blame laying resulted in anything but rancor and increasing intolerance of other people’s views? My answer is no, and this book is my attempt to suggest another direction. It is a collection of ideas I’ve gleaned from three decades of experience in healthcare. I’ve borrowed some thoughts that I consider the best from our lawmakers, think tanks, industry leaders, providers and consumers of healthcare, while adding a few of my own.
I’ve said for many years that the most liberal of us and the most conservative of us could be put in a room with a good moderator (or perhaps just an excellent babysitter or mom!) and made to discuss many of the issues and principles complicating and governing our healthcare system today. If we could break that session down, there would be many more things that unite us than divide us. I will put that hypothesis to the test in this book.
Let’s first try to agree on some grounding principles. The attributes of fairness and compassion are good places to start. Fairness includes being sure that one group of people is not put upon by another group of people, but that everyone is given an equal opportunity. If you are someone who believes that wealth should be redistributed because if one person has more, it means there is less available for the others, then this book will not make you happy. I am of the school that there is plenty to go around for everyone, and that the universe is expanding and waiting to give all of us good things if we let it. I think almost everyone would agree that we prize compassion and don’t want the truly needy to suffer. We want them to be able to get health care, and we are happy to share our resources with them. I think most of us would also agree that those who are able bodied and just taking advantage of a generous people should not be given everything for free. The balance between these extremes will be addressed in this book.
I am going to give you a lot of examples from my 30 plus years in the medical field. Let me preface these ideas on the fact that I have given away about 40% of my time and resources to indigent and non-reimbursed care in my career. And I’ve done so happily. But the government has made it more and more onerous to provide care for indigent patients. Before I met my husband, who is also a physician, he worked with an orthopedic surgeon that had been in his community for many years. That surgeon used to let my husband assist him during surgery, knowing that my husband was going to medical school. That orthopod would often talk during those surgeries about what medicine was like in his community early in his career. This was before Washington, insurance regulators, JCAHO (Joint Commission on the Accreditation of Healthcare Organizations), and other bureaucrats and politicians created the stifling regulations around healthcare. That surgeon spoke of “charity call”, where the doctors would take turns giving their time and talent to take care of people who couldn’t afford to pay for healthcare. Often these were farmers or ranchers that had other resources or abilities, just not money. The doctors would provide their services without the patient paying at the time of the visit. When able, the patient would give the provider eggs, or plan to mow their lawn, or babysit a grandchild, or another service to pay off their medical costs. Most of you probably don’t realize that if a doctor wanted to do this today, he or she would be unable to do so, as they would be committing a crime. If a doctor wants to write off all or part of a bill, he or she is unable to do it, because they must do the same thing for all their patients or face governmental punishment. Only in Washington does it make sense to have to offer the same discount to everyone, even to the wealthiest among us who don’t want or need the discount.
We’ll start with what, in my opinion, the federal government should be doing and what it should not. Then we’ll get to what can fix this mess, and the controlling interests who will do everything in their power to keep the fix from happening. Then we will shift gears and move to the empowerment part of this book: what you can do maximize your own health and how you can help make the changes needed to give everyone that opportunity.
