Some 63 years ago, my wife and I had started our family. Shortly after that I was in graduate school in engineering at the University of Michigan and working part-time at their Willow Run Research Center, so my income was only adequate. Two of our children were born in the hospital in Ypsilanti, MI, where I lived because it was cheaper than living in Ann Arbor.
I paid the hospital bills out of my income after the birth of each child. Before the first child was born we selected and called a physician who delivered the children and who then would come to our little house, park his Cadillac in our driveway, and come into the house with his bag of instruments to examine the children. I paid him as he left, and again out of my income from working at the research center. Whenever he wrote a prescription I took it to the local pharmacy and paid for it before I left. Medical care was simple and direct.
That was then—before government interference and stupidity.
This is now. Now I first must find if the physician I selected will take new patients. If he does, I must then fill out a long questionnaire including any and all medications that I take or have taken, any allergies that I am aware of, any and all past surgeries, illnesses, diseases, etc., employment history, perhaps my income bracket, and the carrier of whatever medical insurance I have. That takes my time and also some of the money I paid to my insurance carrier for the receptionist who handles the resulting paperwork.
Medical insurance, incidentally, began as an employer benefit when our stupid government tried to limit salaries in the private sector. Then the government stepped in.
Next, after I have shown that I am financially able to pay the physician and his staff and that I am not exposing the physician to a greedy tort lawyer, his nurse records my weight from the electronic scale and records my blood pressure. My money will pay for the nurse’s time but I have yet to see the physician. But if no additional information is needed, I am now qualified for a visit from the physician.
My attending physician will then give me a battery of tests for what I probably have, along with a variety of tests on what I could have in spite of the vanishing small probability that I might have any of them. However they do raise the probability that the physician will not be sued by a tort lawyer for a poor diagnosis and an incorrect treatment.
After receiving treatment, from a list of approved treatments that been numerically coded to satisfy insurance and government regulations and verified by the physician’s nurse, I am given a completed form that lists everything that was done for my treatment. The nurse, of course, is paid for the time required to find the code for the selected treatment or treatments. I am also given a date to come back to see the physician for a checkup, perhaps to avoid any future tort action for carelessness.
If I need medication, I am urged by my insurance provider, such as UnitedHealth Care, or Cigna, or whatever, to have my physician fax my prescription to the pharmacy company, such as Optum (or optumrx in the internet), Express Scripts, or whatever other online pharmacy has a deal with my insurance provider. Depending upon the organizations involved, I later may also get notices that urge me to have an annual physical in addition to the better care that I get from the various specialists that I visit on a regular basis. These notices also urge me to refill prescriptions at various times, apparently because they believe that I am not smart enough to follow my physicians’ instructions but will follow theirs instead.
All of those notices had to be written or programmed by someone and mailed by someone and the postage had to be paid, all ultimately at my expense. None of that paperwork made me any healthier; it did not improve my diagnoses, did not make my physicians richer, or improve their treatment methods.
Improved treatments come from pharmaceutical companies, medical device makers, medical schools, and private research organizations. They come not from insurance companies, not from online pharmacists, not from government. But all in this latter group take money from me all along its circuitous route from me to my physician.
All of these intervening people need to be paid and that raises my medical bills to the extravagant level that they are now as compared to when I had no medical insurance, no government interference, when there were no tort lawyers eager to sue physicians, and when I paid my physician’s reasonable fees out of my income, with perhaps a small amount from savings for more expensive procedures.
Simplifying medical care now may be difficult because all of the people who take from the money stream as it flows from the patient to the physician will lobby their legislatures to maintain the system that supports their income and perhaps that of some of their legislators as well. Since governments also may profit from the existing system it will require a determined and sustained public outcry to improve medical care by making it less expensive. Can we do that?
RSS
Medical care and expensive bureaucracy
Posted on May 9, 2014 by William Orthwein
Some 63 years ago, my wife and I had started our family. Shortly after that I was in graduate school in engineering at the University of Michigan and working part-time at their Willow Run Research Center, so my income was only adequate. Two of our children were born in the hospital in Ypsilanti, MI, where I lived because it was cheaper than living in Ann Arbor.
I paid the hospital bills out of my income after the birth of each child. Before the first child was born we selected and called a physician who delivered the children and who then would come to our little house, park his Cadillac in our driveway, and come into the house with his bag of instruments to examine the children. I paid him as he left, and again out of my income from working at the research center. Whenever he wrote a prescription I took it to the local pharmacy and paid for it before I left. Medical care was simple and direct.
That was then—before government interference and stupidity.
This is now. Now I first must find if the physician I selected will take new patients. If he does, I must then fill out a long questionnaire including any and all medications that I take or have taken, any allergies that I am aware of, any and all past surgeries, illnesses, diseases, etc., employment history, perhaps my income bracket, and the carrier of whatever medical insurance I have. That takes my time and also some of the money I paid to my insurance carrier for the receptionist who handles the resulting paperwork.
Medical insurance, incidentally, began as an employer benefit when our stupid government tried to limit salaries in the private sector. Then the government stepped in.
Next, after I have shown that I am financially able to pay the physician and his staff and that I am not exposing the physician to a greedy tort lawyer, his nurse records my weight from the electronic scale and records my blood pressure. My money will pay for the nurse’s time but I have yet to see the physician. But if no additional information is needed, I am now qualified for a visit from the physician.
My attending physician will then give me a battery of tests for what I probably have, along with a variety of tests on what I could have in spite of the vanishing small probability that I might have any of them. However they do raise the probability that the physician will not be sued by a tort lawyer for a poor diagnosis and an incorrect treatment.
After receiving treatment, from a list of approved treatments that been numerically coded to satisfy insurance and government regulations and verified by the physician’s nurse, I am given a completed form that lists everything that was done for my treatment. The nurse, of course, is paid for the time required to find the code for the selected treatment or treatments. I am also given a date to come back to see the physician for a checkup, perhaps to avoid any future tort action for carelessness.
If I need medication, I am urged by my insurance provider, such as UnitedHealth Care, or Cigna, or whatever, to have my physician fax my prescription to the pharmacy company, such as Optum (or optumrx in the internet), Express Scripts, or whatever other online pharmacy has a deal with my insurance provider. Depending upon the organizations involved, I later may also get notices that urge me to have an annual physical in addition to the better care that I get from the various specialists that I visit on a regular basis. These notices also urge me to refill prescriptions at various times, apparently because they believe that I am not smart enough to follow my physicians’ instructions but will follow theirs instead.
All of those notices had to be written or programmed by someone and mailed by someone and the postage had to be paid, all ultimately at my expense. None of that paperwork made me any healthier; it did not improve my diagnoses, did not make my physicians richer, or improve their treatment methods.
Improved treatments come from pharmaceutical companies, medical device makers, medical schools, and private research organizations. They come not from insurance companies, not from online pharmacists, not from government. But all in this latter group take money from me all along its circuitous route from me to my physician.
All of these intervening people need to be paid and that raises my medical bills to the extravagant level that they are now as compared to when I had no medical insurance, no government interference, when there were no tort lawyers eager to sue physicians, and when I paid my physician’s reasonable fees out of my income, with perhaps a small amount from savings for more expensive procedures.
Simplifying medical care now may be difficult because all of the people who take from the money stream as it flows from the patient to the physician will lobby their legislatures to maintain the system that supports their income and perhaps that of some of their legislators as well. Since governments also may profit from the existing system it will require a determined and sustained public outcry to improve medical care by making it less expensive. Can we do that?
William Orthwein is a retired engineer.