Saturday, October 17, 2009
Bottom line: For-profit care drives up costs
From the RoundTable blog
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Arthur Poskocil
Poskocil is an educator living in Southwest Roanoke County.
A few months ago, I visited a local podiatrist because of some numbness in a couple of my toes. After a few minutes of examination and discussion, the doctor suggested a series of alcohol injections, promptly administered the first one, and scheduled me back in a month for a second injection.
A couple weeks later, I received a copy of the bill that was sent to my insurance company. It was for about $700 for surgery. I immediately called the podiatrist's office to explain that there was a mistake, that no surgery had been performed. I was told there was no mistake, that any time the skin was broken, that was surgery.
I canceled my upcoming appointment for my second round of surgery and called my insurance company to inform them about the rip-off artists they were dealing with. The representative with whom I spoke seemed slightly amused at my righteous indignation, and assured me that this charge, and defining a simple injection as surgery, is accepted as legitimate across the health insurance industry. I insisted on registering a complaint and she, in a resigned tone, said she would pass that along. That was the end of it.
I offer my experience as a cautionary tale to anyone who might believe that our private health insurance operates with any acceptable degree of oversight in spending our medical insurance dollars. If you have been denied coverage for a physician-prescribed medicine, as I have, or a medical procedure, you may have thought otherwise.
I don't understand the particulars of insurers' decision-making with respect to denying this and allowing that, but I am certain that for all of them, their bottom line is company profit and not our health. Indeed, anyone who followed the recent congressional inquiry into insurers' routine denial of even life-necessary care for insured individuals on whom they could save bundles by trumping up charges of pre-existing conditions could be left with no doubt: Profit, even at the cost of someone's health or life itself, is their first priority.
Years back, many of us welcomed the advent of HMOs and their ilk, because we subscribed to the truism that profit-driven corporations were far more efficiently run than government or nonprofits. Such companies could make their profits, and we'd still benefit by better and cheaper health care, we believed.
We were wrong for a lot of reasons, but fundamentally because the greatest profit does not result from the most effective and efficient health care. Actually, the more we spend on health care the more insurers make.
An especially hideous example of all this relates to diabetes care. Many diabetics reach a point where their lives depend on a limb amputation. However, aggressive and effective preventive care often can indefinitely forestall such amputations.
For years, New York City (to focus on only one venue) had several hospitals with units directed to just such diabetic preventive care, and they were highly effective. Despite their success in saving thousands of diabetics sufferers from limb amputations, these clinics have all been closed by hospital management. How incredibly awful. Why?
The answer is a no-brainer to anyone who understands profit-driven medical care. It lies in the fact that the average charge for treatment at a preventive-care center was less than $1,000, whereas limb amputations typically bring in more than $100,000. Good preventive care was simply not profitable enough to warrant hospital space.
Whatever level of ineptitude one might fear in a government-run health care system, it would nevertheless be one in which no incentive existed to discourage the ounce of prevention that, in the case above, avoids the 10 pounds of cure. And not a cure at that.
If your current health care plan works for you, and for that reason you simply don't care about the nearly 50 million Americans who cannot afford health insurance, or about the kind of profit-first decisions that have and will continue to cause misery and death for many diabetics and countless others whose illness it is more profitable to treat later than prevent now, then I stand in awe at the profound level of your selfishness.
