Category Archives: Ethics

Medicine over the years has become increasingly entrepreneurial and money driven.  Health care, efficiency and value have become secondary aims  being overshadowed by the quest for money.   In health care, the product you are buying is not usually discretionary, predatory billing is common and an uninformed naive patient can literally lose his shirt.  These patients experiences while extreme are not unique.

Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

and

Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition.

Read the article for more details.

Medicynical Note:  Medicine is simply following the lead of a deregulated culture that seems to believe that anything  goes and that in time the problem will sort itself out.  In health care that policy has left a trail of people who are “uninsurable”, neglected medical problems, medically related bankruptcies (we lead the world), exploding  costs and a non-sytem of  care whose primary focus is generating revenue. Some drug costs have increased 1000 percent in the past 30-40 years…has your salary kept up? 

The Affordable Care Act is already helping but we should not underestimate the reactionary forces that believe the money driven non-system is the “best in the world.”

We’ve talked about America’s high costs.  One reason is our overuse of ER’s for outpatient care.

The medical mafia makes a big deal about the “sacred” patient doctor relationship.  My experience the past several years is that first, there is nothing sacred going on here and second that the relationship is a somewhat romantic figment of our imagination–it no longer exists.

You realize, of course, that the solo practitioner has gone the way of dinosaurs.  For virtually everyone your family doctor (of one sort or another) is part of a group practice.  When you become ill more often than not you family doc, the guy/gal you have the sacred relationship with, is normally fully booked and you see another practitioner/nurse/physicians’ assistant.  Your doc may or may not even be aware that you have had a problem.  If you are hospitalized your care is turned over to yet another provider, the hospitalist.  Another doctor you have never met.

It’s even worse than implied above.  If you should have an emergency of one sort or another, real or not so real, you are advised to go to  the ER.  That shifts the responsibility for your care elsewhere and quite remarkably escalates our costs to unimaginable levels.  The “sacred” relationship is nowhere to be found.

Elizabeth Rosenthal of the NY Times discusses ER costs here.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

Medicynical Note: Read the article for the gory details.  But it is a fact that hospitals like other players in the health care game have little to no interest in fostering efficiency and cost savings–except to benefit their bottom line.  In regard to patient’s charges, their goal is to maximize them.  They inflate their charges to unimaginable levels then cut deals with high volume insurers.  Should you be uninsured they will  stick you with the full non-discounted amount.  To the little guy it’s as confusing as dealing with a used care dealer (no insult intended) and is nothing more than a legalized scam.  Horrifying as it is, that’s what’s become of my profession and American medicine. 

Health reform while not perfect is a start on rationalizing costs, providing universal coverage, and opening up the mystery of health care costs.

The U.S. is the only industrialized country without a national health care insurance scheme for  it’s citizens. We have more uninsured than the rest of the industrialized world combined.  We leads the world in costs by a large margin–it’s not close. And finally we lead the world in bankruptcy from health care related debt.

Meanwhile with the notable exception of the elderly, who are covered by a government program, Medicare. our health statistics are in the middle of the pack so to speak when compared with other industrialized countries.

We seem to have institutionalized a system that assures excellent revenue and incomes for the health industrial complex but costly mediocre outcomes to patients.  We can and should do better.

The following links  compare our non-system of health care with the national health program of Canada.

It’s a stark contrast and  explains why so many American are forced into bankruptcy by health care expenses.

This talks a bit about the costs of having a baby in the U.S.  even if you have “good” insurance–several thousand dollars.

As opposed to Canada where the total medical cost of childbearing appears to be  $25.  The interviews in this article also highlight the satisfaction of Canadians with their system of health care.

In health care, we’ve developed a system of money making that’s unprecedented.  What once was a profession that at least gave lip service to patients and health care–remember the “sacred patient doctor relationship?” or the “ethical” pharmaceutical industry?–has evolved into a money grubbing borderline ethical business.

Gaming the billing system has become the norm.  When our local “non-profit” hospital (run by a Catholic hospital conglomerate) bought out medical practices in our area, costs dramatically increased.  Coding for visits moved to more expensive levels.  The hospital  billed an additional facility fee even while the practices remained in the same location as before.   Procedures previously done out of the hospital were moved into their facility.  Instead of finding ways to provide efficient economical care, providers (and suppliers) even so-called non-profits seek to maximize revenue.  This is happening at every level of our health care mess and is one of the major causes of our  ridiculous cost inflation over the past 20 years.

More on gaming our non-system here:

Between 2001 and 2010, doctors increasingly moved to higher-paying codes for billing Medicare for office visits while cutting back on lower-paying ones, according to a year-long examination of about 362 million claims. In 2001, the two highest codes were listed on about 25 percent of the doctor-visit claims; in 2010, they were on 40 percent.