Back in the old days, doctors used to do a certain amount of what they called “charity care”. They would care for people who were truly poor. They knew that they were not going to get paid in cash.
Sometimes a church, a school or some other organization would raise money to help pay some of the costs of that care. People paid what they could. They paid in chickens or pigs or apple pies. If you couldn’t pay with money, you might come by and mow the doctor’s lawn or do some other work that needed to be done.
Martha who kept the doc’s books would kind of figure out when your bill was paid. Everyone (except possibly the IRS) was happy.
Sometime after WWII, employers started offering “health insurance” instead of increasing employee’s wages. Doctors didn’t mind, because they got paid what they charged in real money.
Then Washington decided that the government needed to get into the insurance business. Medicare and Medicaid were born. The government decided that it was not going to pay the whole bill. Instead they would pay what they wanted to pay.
More and more people qualified for these programs. As the cost of the programs went up, what the government paid went down. Doctors at first made up for this by working harder, and by charging other patients more.
Insurance companies decided they didn’t want to pay the whole bill either. They started to demand the same discounts as Medicare. Doctors worked harder. Patients got less time for each visit. Our hours got longer. Your waits got longer.
Medicare and insurance companies developed more rules and regulations like prior authorizations, formularies, preferred providers and ICD and CPT codes. Did that sound like a bunch of garbage to you? Until I started “doctoring” it did to me, too. They didn’t teach you all that stuff in medical school when I went, either.
Doctors had to hire people just to do the billing and “chase down the payments”. Then they weren’t payments, they became “reimbursements”. “Patients” became “Insureds” and office visits and surgeries became “claims” and “procedures”. Insurance companies started “bundling” all your care. Surgeons get paid the same no matter how many times they see you in the three months around your surgery. OB doctors get paid the same for the entire pregnancy and 6 weeks afterwards. It doesn’t matter how many times they see you in the office or the hospital. The only thing that increases the fee is a cesarean section. Some insurance companies won’t pay extra for that.
There isn’t enough room here to discuss what happened when the lawyers got their fingers in the mixture. Besides, my doctor wants me to watch my blood pressure. Let’s just say that a lot more testing goes on these days to keep from being sued. It costs lots of money and doesn’t add much to the answers we get. Lots of paperwork ensues.
Patients – pay attention here – that’s you! – are now so far removed from what things cost that they don’t care about what tests are done. They want the CT scan or the MRI. They want all the blood work, all the nuclear medicine testing, and all the consultants. The insurance is paying for it after all.
Not really. If you have private insurance, your premium goes up if you keep getting tests. If you have “public insurance” the taxpayers pay for it. Either way, it’s busting our system.
Ask people who don’t have any insurance. I have lots of them in my practice. You see, I don’t take insurance any more. I have gone from 4 employees to 1. We will give you the papers to submit your insurance, but we won’t fight it for you. That saves us hours on the phone. I don’t participate in Medicare and Medicaid. I don’t have to take those huge discounts. So I get paid for my time.
I get to spend more time with my patients. My overhead is a whole lot less. So I don’t have to charge for all those people that used to work here. We have time to help figure out where the least expensive place for an MRI is and help our patients find other doctors to help them. I also found a lab that gives discounts for cash. We also decide what tests we really need, not what insurance will pay for.
This is what I went into medicine for.
Here’s another blog with another version of this: