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My Turn: The great health care sinkhole

The bizarre and tragic loss of a Florida man a few weeks ago, slipping to his death from his bedroom into a sinkhole, offers up a fitting metaphor for the great abyss between cost and value in health care and how it has the potential to swallow us up without warning. The periphery of that huge health-care sinkhole is occupied by guys in suits – insurance companies, Big Pharma, and overpaid hospital executives and their legions of lawyers and lobbyists. In Steven Brill’s recent Time magazine expose, “Bitter Pill,” he shows how the elite of a separate health-care economy are all doing quite well, while middle-class folks with serious illness are going bankrupt as a consequence of being under insured or just plain priced out of the market. Equipped with shovels on the edge of the great sinkhole, health-care executives contend that they are filling up the hole. In reality they are digging it deeper to everyone’s peril.

In the world of for-profit medicine, doctors also need to be held accountable, particularly among sub-specialties, as the gap between the pay of primary-care physicians and specialists continues to grow. The five minutes during which an orthopedic surgeon applies a cast to a broken wrist, a dermatologist freezes a couple of barnacles on someone’s face, or a radiologist interprets an MRI are still reimbursed vastly more than a family physician might charge for an hour of managing a patient with multisystem disease, sorting through the pharmacy the patient has brought into the office in a brown paper bag, and making referrals where necessary, all while being trying to enact evidence-based medicine and maintaining an awareness of cost/benefit ratios. The much reported deficiencies relating to the care of the mentally ill would certainly be better addressed if we applied a fraction of the reimbursement for a broken foot to the care of a broken mind.

While the Affordable Care Act attempts to improve the lot of primary-care physicians by marginally enhancing reimbursement and recognition of the effort going into a “Patient Centered Medical Home,” the attendant costs, regulations and overall bureaucracy effectively erode the gains. Indeed, the sheer number and complexity of rules and regulations generated by the Affordable Care Act and Accountable Care Organizations have made it well nigh impossible for solo physicians, lacking in resources, to venture into private practice.

And so we witness the ascent of great and powerful hospital executives, modern-day health overlords charged with developing local networks of care, financed by the now famous “Chargemaster” system described by Brill. Two-dollar Tylenols, $70 gauze pads – it’s enough to make you cry into your $50 “mucus recovery system,” aka Kleenex. But it all adds up to million-dollar CEO salaries, even in community hospitals. No doubt that these are bright, clever and caring people, but no hospital CEO deserves to make a multiple of the salary of the president of the United States.

The perversity is ratcheted up another notch when one contemplates the multimillion-dollar salaries of CEOs of health insurance companies. But instead of making money on gauze pads and Tylenol, they prey upon individuals and businesses. A family of four may expect to pay over $25,000 for a year of coverage, complete with an $8,000 deductible in some markets, given the lack of major cost controls in the ACA.

While Obamacare may have expanded the safety net by encouraging the expansion of Medicaid, coverage of kids up to the age of 26, enhanced coverage of preventive services, coverage in the presence of preexisting conditions, and lack of lifetime limits, plenty of folks are still going to fall through the net and into bankruptcy or worse. There will be those in the great medical-industrial complex who would dispute the notion that U.S. health care is in desperate shape, who would offer their own numerical analysis to support the status quo. These are the people who use statistics the way a drunk uses a lamppost, for support rather than illumination.

While acknowledging and promoting the gains of the ACA, we need to resume the journey toward a single payer, where everyone enjoys the security and dignity of being covered by insurance. We’re not talking “free” care, just quality care at a truly affordable price. Where there are excessive profits, there cannot be compassionate and accessible care for all. Let’s fill in this enormous sinkhole, so that everyone gets a good and safe night’s sleep.

(Dr. Robert S. Kiefner is a family physician in Concord.)

Legacy Comments20

Reply to GWTW: The article stated "Doctors overwhelmingly support either a public option or a public system". It doesn't break out the amount of support specifically for government-run single payer. Here is an article from Reuters stating 59% support and 32% opposition to legislation establishing a national health care system aka "single payer". And you can see the trend is increasing.

If one was to ask me if I would rather have the US government sink $Billions and $Billions into railroads just so it cost some people a little less to ride , FAA towers for the elite to fly around in private jets or build military weapon systems that the military does not even want "OR" pay for healthcare for every legal citizen in this country -- I would pick healthcare. Aside from food and water, medical care is the next most important thing for survival. You can live without fancy cars, fancy homes, fancy clothes but this country has allowed pure greed to overtake a basic survival need - medical care.

I am appalled that super educated people fall for the myth about our health care system. Yes, it is expensive to get procedures done and yes, without insurance it is almost impossible. But Obamacare or single payer are not the answer. It would be far better to incentivize employers to provide health insurance to all employees. Under Obamacare, you will be able to be covered by the government once you fill out a 61 page form which dissects your entire life. Under Obamacare, our health records will be able to be accessed by government bureaucrats. Under Obamacare, contrary to promises from Obama himself, you will not be guaranteed to keep your primary care physician. Under Obamacare, there will be rationing and a "board" of bureaucrats will decide if you get treatment in late life or just pain killers. Under Obamacare some privated insurance policies paid for by you personally may be taxed. Employers are confused by all of the rules and regulations and the government is just chomping at the bit to fine people. Under Obamacare, 18-30 year olds will pay a disproportionate share of the cost to cover a small segment of the population. Under Obamacare your employer can and probably will drop the level of coverage and it will cost. Under Obamacare, entrepreneurs will pay 50% to 80% more for premiums and that will mean hiring less employees, which will result in higher unemployment. Under Obamacare, those who have taken the responsibility for their own families will now pay for people who have made different choices. Obamacare will be one of the most unpopular programs in American History. It will take 90% of the population already happy with their health care and negatively affect it in the name of covering the 10% who have no insurance or can access care through the emergency room. Obamacare is 2300 pages of garbage, hidden rules, overreaching government regulation and it was a dirty deal all the way around from the way it was passed to the lie that it would cost only $900B, now the cost is over $2.5T. Obama lied about being able to keep your own doctor, the fact that it would save everyone money and on and on.

Yes...excuse me gracchus...that is incorrect. We are the brokest nation in the history of forever. I believe if you add it all up, national, state, local, each one of us owes about $200k. So a family of four owes a collective $800k. Not even Greece beats that.

There is no comparison between the US and Greece. It is ridiculous to even bring it up. Their economies are not even in the same stratosphere. Greece also brought alot of their problems on themselves by not collecting taxes. You cannot run acountry wo revenue.

I read your response and thought of the commercial on TV where the blonde lived by what was on the Internet and then she says: "here comes my date, I met him on the Internet, he's a French model. Gillie you can't believe what you read on those leftist sites.

How many cities in Greece have declared bankruptcy?

GWTW, now those folks are in what another poster on here calls the "deniosphere".

Thank you Dr. Kiefner. You are just one of many, many physicians who are in favor of a single-payer system. In fact, the majority of American physicians support some kind of single-payer system. Our current health care system is a house of cards slowly crumbling piece by piece. Some people receive no health care at all. Some receive too much health care because of our fee-for-service system. As the Dr. pointed out, profits are obscene for some. Administrative costs are 30% for health insurance companies. Drug costs are exorbitant. The Affordable Care Act is such a watered-down piece of legislation but it's all we could get through Congress. Even now Republicans waste time by bringing it up for vote knowing full-well that it will not be repealed. They do not want to give this president a single accomplishment to hang his hat on--the health of the country be damned. At some point in the future there WILL be a single-payer system in this country (like every other modern country in the world) because it's the only feasible alternative. And we'll wonder why it took us so long.

Dr. Kiefner and you have stated my sentiments exactly. I realize my observations and experiences are purely anecdotal. But I am among those who straddle both the VA and private medical practices for my chemistry and treatment. And, I am at least mildly impatient with those who would suggest that it's only "the bottom of the class" being attracted as professionals to the public sector. I've lived too long and experienced too much to believe that. Competence and incompetence exists on both sides. And, where I have the opportunity, I pick and choose. BTW, a knowledgeable poster here listed the non-competiveness feature of medical services as one of the problems among many he enumerated. And, I would add that some of it is our fault -- litigation as well as financial ambitions among parents and exploiters being other prominent problems. I'm here still standing as a getting-older-geezer because of the good work of medical and pharmaceutical professionals in both the private and public sectors. But quality analysis of hard historical data tells us that commercial interest fees associated with private services as well as hospital charges are outrageous with private services. And medical outcomes frequently don't compare very well on a worldwide basis. I know I'm "preaching to the choir" and I apologize for that -- just venting, I guess. As human animals, have we eroded to the point that whether you live or die depends on your level of financial comfort?

"As human animals, have we eroded to the point that whether you live or die depends on your level of financial comfort?" Whose level of financial comfort is more comfortable? Our governments? We are the brokest nation in the history of the world. I'm not feeling too comfortable with that, James.

"We are the brokest nation in the history of the world." When a comment contains such nonsense as that, isn't the entire post not credible by process of contagion?

James, your comments always appear to be well thought-out and based on decades of real-life experience. There is tremendous support for Medicare by folks your age. And that's basically what a single-payer system is. It's Medicare for all. I don't know why so many people are OK with having Medicare only if you're over 65. As to your point about living or dying depending on your wealth--yes it may come down to that today. But it's not just living or dying. It's receiving any medical care at all. 50 years ago a poor person could have gotten basic medical care for say a broken bone for a reasonable cost and paid the medical bill. Do you really think a poor person today can afford to get a broken bone set at a hospital? How much would that cost? Thousands, I'm sure.

So you want the collective to pay for your broken leg? What about doctors visits for a persons child who has the sniffles? I have been insured since graduating from college 35 years ago and I wouId have taken jobs I did not want just to be insured. I never took a job without insurance and when I was an entrepreneur I had private insurance. An employer plan today can cost a single worker $200 per month. A family plan $400. Many people have $600-$700 car payments. Should we pay those bills as well. When they need new tires they can pay $1000 and on and on.......... So why should people not drive a used car and pay health insurance? Many do not, many choose to NOT spend on insurance and will now gladly take that free ride.

"In fact, the majority of American physicians support some kind of single-payer system." Link please to this study. Did you mean public option?? Be specific. Also "The Affordable Care Act is such a watered-down piece of legislation but it's all we could get through Congress."..What?? Why is that? "You" had all the votes you needed. No republican voted for it, and it passed. What was stopping "you"??

Here's a Washington Post article on physician support for national health care: This one has 75% of primary care doctors supporting a public option or public system. There's many more out there if you look. Here's a Reuters article comparing the quality and cost of our health care versus several other European nations. Note that we spend at least twice as much and get worse results. Now, as to why it was the ACA is so watered-down, it's because it was so difficult to get support for it even among Democrats. See, some of the most liberal Dems wanted a single-payer option. Some of the more conservative Dems are still unconvinced that health care reform is needed. Every Democrat wanted to have their say in crafting the legislation. We're talking about 200+ representatives and 59 senators. If there's one thing Republicans have over Dems, it's their united opposition to Barack Obama.

OK I read that piece, a fluff piece to support Obama and Obamacare, now read this link:

You said "In fact, the majority of American physicians support some kind of single-payer system." And you linked to an article that made no such claim. The "public option" and single payer are not the same. You do know that right?

"we spend at least twice as much and get worse results"......that is a true statement when applied to the single payer BIG Govt monopoly know as PUBLIC SCHOOLS

Very well done. Thank you very much.

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