Last week, pocket calculator panting from exhaustion, I explained how my humble pen, along with the pens of the other 899,999 physicians in America, was responsible for paying out about $2.24 trillion every year to thousands of health care “providers.” That’s the amount the US spends annually on our essentially mediocre healthcare system.
The providers include all physicians and chiropractors, all hospitals, nursing homes, pharmaceutical companies, pharmacists, all sorts of therapists (both physical and psychological), all diagnostic labs, and all the companies that sell every imaginable piece of medical equipment. It’s jaw-dropping to consider that this immense number boils down to a weekly outlay of $144 for the “health care” of every man, woman, and child in the US…and that there’s so little to show for it.
By the way, if you think being a doctor in charge of distributing all this money pays off, think again. Any sharing of the wealth is regarded as a kickback and is highly illegal.
However, until they were recently banned by the FDA, little gifts—tchotzkes–to doctors were allowed, things like note paper, mouse pads, and tissue boxes. But by far the most popular little gift? You guessed it: pens! Pens by the boxful, pens by the cartload, each pen embossed with the name of a healthcare company trying to worm itself into the brain of the doctor holding it.
Another interesting point is that doctors themselves are deliberately kept in the dark about the actual cost of everything they order for their patients with their hundred million dollar pens. If you inserted burning bamboo splints beneath my fingernails I couldn’t tell you with any accuracy the cost of a room or urinalysis at Northwestern Hospital, home delivery of an oxygen tank, or a month’s supply of a blood pressure drug. If I ask a drug rep how much a new medication costs, she’s been trained to provide a non-answer, such as “we’re competitive with other drugs in our class.”
This topic is discussed at length in the current issue of Hospitalist, a journal for hospital-based physicians. Clearly, knowing the cost of everything they order might reduce doctors’ inclination to do so, the very worst nightmare of any supplier in the health care industry.
How all this money is spent
Despite all the hoopla surrounding Obamacare, ultimately it’s all your money–whether it gets paid by the Feds or insurance companies or comes out of your pocket. In the current system, your health care provider (doctor, hospital, lab, pharmacy, etc.) directly bills private insurance companies (Blue Cross, Cigna, etc.), the Feds (Medicare or Medicaid, both of which are forms of insurance companies), or you personally. Obamacare would shift some of the cost burden off you and onto all these insurance companies, but the overall dollar amount wouldn’t change. And you’re still the source of the money, either directly via a check you’ve written or indirectly through an insurance premium or your tax dollar.
The reason we burn through so much money every year is that healthcare providers are a lot like sharks at a feeding frenzy of insurance company salmon. The guiding principle behind all US healthcare billing is “whatever the market will bear,” which really means “What’s the very most we can possibly charge for our services (surgical procedure, hospital room, CPAP machine) and receive the most money from the insurance company coffers.”
Note: although it may feel otherwise, healthcare providers are not seeking to empty your pockets personally, but rather the deeper pockets of your insurance company, whether it’s private (Cigna, Blue Cross) or federal. What they’re saying is “We don’t really care about your puny $500 deductible, your pathetic $20 co-pay–that’s chickenfeed. In fact, if it weren’t illegal for us to do so, we’d skip right over this and pay your deductible ourselves. Our eyes are on the big prize, the maximum allowable benefits of your health insurance coverage.”
Revenge of the salmon
However, if you think the insurance companies sit quietly and allow the sharks to nip off their heads and plunder their deep pockets, think again. After all, insurance CEOs don’t reward themselves with mega million-dollar salaries by giving away the farm.
Once the bills from providers start to arrive, health insurers have an incredible number of systems in place to delay, deny, and reduce payments. Ultimately, after weeks and months of back and forth faxes and yackety-yacking between the billing clerks of the “providers” and the “benefits department” of the insurer, a check will show up, and depending on your policy, you may be “balance billed” for the difference. This bill can be quite substantial. The concept of inadequate insurance and its horrific financial consequences to the poor patient were the subject of Michael Moore’s emotionally wrenching documentary film Sicko.
For the health care provider, the very worst revenge of the salmon scenario is the dreaded “chart audit.” Now the salmon become a school of piranhas smelling blood and aiming for the kill. The insurance companies send a team of reviewers into a provider’s business (doctor’s office, hospital, lab, pharmacy, etc.), conclude almost randomly that billing was done “incorrectly,” and demand a refund. Interestingly, Medicare hires former IRS agents to do this work.
For some providers, like hospitals or large medical groups, this audit can cost millions of dollars. Understand this is a demand for the return of money for services already provided. Many a hospital CEO has lain awake dreading how he will break the news of a multimillion dollar audit to his hospital board. The shark-piranha battle gets amazingly vicious and expensive when attorneys, who feel at home in such surroundings, are called in. If the provider refuses to refund the money (because the service was already rendered, the x-ray taken, the operation performed), the insurance company simply cuts off payment on all future services until the dollar amount is returned.
The battle goes both ways, as in the $350 million settlement paid out by United Healthcare in a class action lawsuit initiated by doctors who had been underpaid by United for years.
Why change the system if it’s paying top dollar to the players?
Despite this mess, there’s little motive to change. The insured patient is rarely aware of costs. Her health care provider is financially well rewarded to master the insurance game (“Bill high! Higher!”). Instead of battling everything, insurance companies often shrug it off and simply bump up the premiums. If you have inadequate insurance or none at all, you’re basically screwed. You face an outpatient skin cancer removal that in 1985 cost about $150 but now ka-chings upward of $3000. You try to fill a prescription for the popular antidepressant Abilify, discover that one tablet (one single tablet!) costs $17, and feel like hurting someone.
Despite this runaway inflation, well-insured patients love the system, incorrectly equating quantity (“They couldn’t solve my problem at Northwestern, so we’re starting over at Mayo”) with quality (“I’ve had three sinus surgical procedures, came to over $100,000, and I still have post nasal drip. But the doctor threw in a sleep study and two MRIs”). Because of the money involved, there are more healthcare services offered than ever before, all egregiously overpriced. One day last week I had six medical salespeople in my office–three from drug companies and three representing diagnostic “services” like sleep labs, MRI labs, and even a test-at-home ultrasound company, everyone eager to submit their bill to your insurance company. All they was needed was access to my pen.
And do you want to know the real skivvy? Virtually everything foisted on me by these incessant hucksters was, in the grand scheme of your health, pretty useless, pretty unnecessary.
Here’s why: One of the “Aha!” moments that shifted my career into integrative medicine years ago occurred when I was making hospital rounds for our medical group. There were 24 patient charts in front of me and as I went through them, one by one, I realized that unhealthy lifestyle choices had been responsible for every patient’s hospital admission: heart attack, diabetes, emphysema, cirrhosis, and on and on.
We neglect ourselves, for the most part bringing on our own illnesses, and then demand an overpriced healthcare system and a dysfunctional reimbursement system repair the damage. Just about everything in healthcare is geared toward repair of damage (which is very expensive) instead of prevention (which is very affordable). But sadly, for that most unsavory of motives–money–the system is delighted to oblige the lower depths of your personal inattention and self-neglect. And here I am, one of a long parade of doctors with our $100 million pens, ready to schedule your surgery, write your prescriptions, order your tests, and get you admitted to the hospital of your dreams.
Beating the system
Don’t you just want to avoid all this? Do you really want to be a party to these healthcare wars? Based on my previous career in geriatrics, I have a ready solution. Begin this very day to take really good care of yourself, no matter how old you are. Be a “health nut” not by undergoing every single diagnostic test your insurance company will pay for or by having a medicine cabinet filled with the latest prescription drugs, but by getting yourself into such good shape that you don’t need the likes of the dysfunctional healthcare industry.
For years I’ve been the entertainment point for numerous tennis and golf-playing 80 and 90-year-olds who are fit, trim health nuts. I can’t say I’m their “doctor” because I’ve never really done very much for them. They visit me mainly to review their vitamin lists and discuss some article they’ve clipped from Life Extension Magazine. They do like to boast a bit how they’ve never taken anything but vitamins and herbs all their lives. Not long ago, an octogenarian demonstrated her feathered peacock yoga pose. Try it sometime! These folks reached healthy old age without my help, all on their own.
So, for you, if you want to avoid my $100 million dollar pen and the Cuisinart otherwise known as the US Healthcare System, you may want to go back to the drawing board and examine your life. Start today, right now.
Eat real food, exercise regularly, drink moderately, don’t smoke, limit stress, and trust your body to heal itself. If you don’t know what wellness means, get a copy of Ultra-Prevention by physicians Mark Hyman and Mark Liponis. If you’re unsure how to eat right for healthy longevity, schedule an appointment with our nutritionist Marla Feingold.
It’s your life. Don’t use your life to “maximize your insurance benefits” for all the stuff you could have prevented in the first place.
David Edelberg, MD
PS. If you’re really feeling slightly nauseated by the healthcare system, or simply want to inaugurate your lifetime of superb health and well-being with a “detox”, join us at WholeHealth Chicago for a detox open house on Monday, July 11th from 5:00 – 7:00 PM. Sample food and shakes, speak with knowledgeable staff, and learn how to healthfully and simply take care of yourself. Many of the staff will be “practicing what they preach” and posting their own detox experiences, recipes, and thoughts on Facebook and Twitter. Follow us.