My Turn: Out for blood
Bleeding has been associated with the practice of medicine for centuries. Doctors in ancient Egypt and Greece claimed that bleeding helped to “restore the balance of the humors” in the human body. The practice and the logic behind it continued throughout the Middle Ages and well into the Industrial Age. There may have been some validity to the practice: Since most cooking vessels were made of iron, bleeding may have relieved many patients of hypertension and iron overload. However, many doctors used the practice in excess and caused more harm than good from the process.
Doctors are still bleeding their patients today in an attempt to diagnose and treat patients through the analyses of blood. It would be a fairly safe bet to assume that anyone reading this column has had blood taken from them at the request of a doctor within their lifetime and probably within the past year. Blood work is important not only for screening for diseases but also to follow up on the effectiveness of treatment and the risk of unwanted side effects.
In our American “for-profit” system of health care, there is another kind of “bleeding” that accompanies lab work, namely the cost-shifting onto patients. Private medical insurers have found that they can increase their profits by forcing patients to pay for their own lab tests, even if lab work is covered by the insurance. Since most states, like New Hampshire, have outsourced their Medicaid and Medicare benefits to private companies, this practice is now universal, although the application is not.
For example, doctors ordering blood work need to code the tests according to the reason those tests were ordered. Most private health insurers will cover the cost of “routine” blood work, or tests ordered to screen a patient for a particular illness or disease. However, a blood test ordered for a medical problem or a specific disease state (such as diabetes or hypertension) may be seen as “non-routine” by the insurance company and the patient will be forced to pay for the test out of pocket.
If that weren’t confusing enough, the private companies that cover outsourced Medicare and Medicaid use the opposite principle. They will only pay for non-routine tests connected with a specific disease or medical problem. Those patients will pay out of pocket if the doctor codes the test as a screening test.
Why should it matter to an insurance company if a doctor orders a test for screening or to follow a known medical problem? If the doctor believes that a blood test is needed to benefit a patient’s health, then the insurance company should pay for that health care. Just imagine if your car insurance would only pay for collision if you got into an accident with a black or blue car, but not pay if the collision was with a red or white car. The difference is arbitrary and designed to shift more of the health care costs onto consumers.
This type of profiteering can have devastating consequences on patients. Most people would rather not have anyone sticking needles in their arms to take blood to begin with. If they are then faced with a medical bill in the hundreds of dollars for that “privilege,” then they may postpone or skip the blood work altogether. That could result in the delay diagnosis of an infection or cancer, or the continuation on a dose of medication that could lead to a more severe medical problem or even death.
If the “cost savings” (read profits) on this kind of chicanery could be justified by cheaper, more affordable health care for more people, then the cost-shifting practice might be understood. However, the sad truth is that the only beneficiaries of this financial bleeding are the CEOs and corporate executives who earn a couple of extra million dollars in their annual bonuses.
In the lab and elsewhere, Americans are “twice bled” victims to financial predators in the medical field because of the emotional factors associated with health care. Very few of us can approach medical decisions (especially if it involves ourselves or our loved ones) in a calm, objective manner. There is an emotional component influencing our choices. As long as the practice of medicine remains a “for profit” enterprise, there will be an inherent conflict of interest between what is necessary for health care and what will improve profitability.
(Dr. James Fieseher is a
family physician in Portsmouth.)