I think even pharma companies should remain private. However, I do think pharma companies need some offsets to ensure that research is properly funded and that drug trials are done by separate, non-profit labs. The issues surrounding Vioxx seem to indicate an issue with how drug trials and testing are handled. Too many ways to fudge the system.

The only area I think should change dramatically is how everyone in the industry is paid. I don’t think the current private insurance industry works. I would be more happy if there was a separate, non-profit entity in charge of making sure every claim is paid. Basically, it could be a non-profit organization that is semi-regulated by the government and simply processes each claim and makes sure than none of the claims are forged or illegitimate. It’s like a single-payer system except the organization itself isn’t necessarily government controlled and would receive it’s funding much in the same way that insurance companies receive funding now. Kind of a hybrid approach.

When it comes to dealing with insurance companies, I know exactly what you mean. I’ve had some personal experience to back it up too. I do believe that doctors, nurses, and others within the medical profession should be compensated well for what they do. But, just like you said, insurance companies aren’t making it easy.

I had hernia surgery last November and my doctor prescribed me this little medicine ball that fed pain medication intravenously into my incision after the surgery. She felt I needed it. Apparently my insurance company disagreed. They gave no real reason as to why the claim was denied and no one I talked to on the phone could figure it out either. Nine months later and I still haven’t worked it out with the insurance company and now I’m stuck with a $1,200 bill for something that should have already been paid for. Ridiculous.

I can’t think of a physician that doesn’t want sweeping changes to the healthcare system. We all generally feel the current 3rd party pay system is definitely broken. There ends the consensus among physicians…as similarly there ends the consensus among politicians and the general populace. Nobody really knows what’s going to happen with change…which scares all of us. We all have are own ideas and opinions about what would be best, but the reality is that nobody really knows what will happen even if the system they so strongly endorse or oppose comes into being.

I also agree with you that the rampant greed was a major part of the breaking of the system. The fault with this lies with all of us IN the system. Among the healthcare profession, many of us refer to the 70’s and 80’s as the “Golden Years.” The insurance companies paid whatever was billed. Physicians and hospitals made outlandish profits. Then managed care and cost containment came in. By then it was too late…the greed had taken hold and changed a healthy system into something else. That something else is now about the insurance sectors profit margins. It’s almost impossible for physicians and hospitals to make a great living off of insurance. Many of my primary care colleagues have retired because they really don’t need to work anymore…and because insurance reimbursement has become downright painful. The average insurance adjuster is a 36 1/2 old divorced woman with 2 children and a high school education. I read that in one of my journals years ago…so at this point it’s an opinion rather that a fact since I can’t reference it. The point being, they have these huge books that give them guidelines on whether to authorize and/or reimburse a physician for his services. Can you imagine how frustrating it is (for both doctor and patient) when you try to convince an insurance adjuster with essentially no medical training exactly why a patient needs the prescribed service when their “book” tells them to deny it? Like I mentioned earlier though…it was our own greed and dishonesty as a profession that led to these measures. Patients should be just as angry at the hospitals and physicians of yesteryear as they are at the insurance companies.

With regards to you statement about it being “illegal to ask.” That’s not correct. Hospitals aren’t required to ask. There is a big difference between not being required and being illegal. Many latino healthcare advocates feel that if hospitals ask…and especially if they are required to ask…about immigration status, many latino patients will not seek care. Because of this, many hospitals avoid asking these types of questions.

You are correct that patients can’t be denied care based on “race, color, or national origin.” In my opinion, if care can’t be denied based on these identifiers (which is good as far as I’m concerned), why ask anyway? Statisticians love things like that, but as a physician I don’t really care. I’d rather patients came to the ER without hesitation or fear if they feel they need care.

I believe that the main reason why we’re having so many problems with our economy and health care system is due to greed. I think for too long we’ve allowed financial institutions and corporations too much freedom to run their industries as they see fit with very little oversight and regulation. End result? Too many people took advantage of the all the little loopholes and gamed the system for short-term profit and gain. That’s why you have a system where health care costs are rising and not many people capable of affording the ever rising cost of health care insurance.

So, yeah, I can certainly understand the battle to maintain composure in the face of an industry that cares more about terms like growth and profitability than compassion and caring. Granted, I don’t actually believe the industry on a whole is like that; just a certain level of it. A few bad apples spoiling the bunch if you know what I mean. I want to believe that people primarily practice medicine to help people, not to make a bunch of money. Guess it’s just the idealist in me.

The US used to have a migrant worker program. The employer (typically farmer) would pick his workers up at the border, transport them to the work site, and then return them to the border according to the permits time frame. Some of these were day permits. Some were weekend permits. Others were for the entire harvesting season. The employer was responsible for his workers. It wasn’t a jailers job. The workers went home at the end of the permit because there was no concern about “sneaking” across the border to work. Their home was back across the border, and that’s where they wanted to be. As I remember it, illegal immigration became a huge problem only after the discontinuation of this program. As I remember, it was discontinued because the migrant workers were “taking jobs” from US citizens. The problem was…after the government discontinued the migrant worker program, US workers didn’t want the back-breaking jobs the migrants had been performing. Thus began the onslaught of the illegal alien.

As I mentioned earlier…most of the “illegals” I knew/know/grew up with were good people. The stigma associated with being an “illegal” (or any of the other plethora of malignant euphemisms they are referred to as) is a product of our own shortsighted discontinuation of a valuable service/program.

But in practice I’m a harsh realist. I don’t think socialism can function to any degree in our current degree of emotional infantilism as a species. We are selfish, greedy, and completely self serving as a majority. Recognizing these weaknesses limits the degree to which we can realistically change society in large sweeping moves. I support the free market system only in the sense that it seems to be the most effective system of managing our greedy nature in this current millennia.

As a physician it physically and emotionally tortures me that we can’t provide the best…not the most affordable…but the VERY best care possible to every person on the planet. I believe…idealistically…that this should be a right of all inhabitants of this planet. Is this realistic…not in any measure as I’ve seen currently proposed or in practice around the world. How do I reconcile this personally? I support a system that I feel will be realistically feasible while still “supporting” my idealism by volunteering time to the underserved in our country, underserved countries, and disaster relief area.

So while I may throw around words like naive and idealism, I am in no sense berating people for believing in this manner. I also am idealistic almost to the degree of being a dreamer. I wish I could still claim a sense of naivete…however I lost that long ago as a young doctor when I saw again and again that greed and profit consistently won out over human compassion and caring.

Be well and keep up the introspective writing.