The New York Times published a piece, "Fed Up With the Frustrations, More Doctors Change Course - NYTimes.com," about how the difficulties of getting insurance and administration to pay for prescribed care affects their ability to do their work. To get a gist of the article:
In a survey last year of nearly 2,400 physicians conducted by a physician recruiting firm, locumtenens.com, 3 percent said they were not frustrated by nonclinical aspects of medicine. The level of frustration has increased with nearly every survey.
“I’d write a prescription,” [the doctor] told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.”
He continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ”
Recently, he confessed, he has been thinking about quitting medicine altogether and opening a convenience store. “Ninety percent of doctors I know are fed up with medicine,” he said.
The article also points out that plenty of people are self-educating on the internet and demanding irrelevant procedures, and that doctors have to deal with that. (I'm certainly guilty of "educating" my doctor. But then again I tend to send him medical journal articles about my diagnosis, not whatever I see in O Magazine that month. He says he appreciates it, but he may just be being polite.)
A friend of mine, who works at a high level in health care operations, mentioned recently how pricing has to cover those unable to pay their copays as well as those who are outright uninsured, and so of course the degree to which ones practitioner covers the un(der)insured affects their overall pricing structure.
Nearly simultaneously, I heard about someone who simply refused to pay for health insurance for his family (astronomical for the self-employed), and negotiated terms on everything. He noted that for now, he's getting such good discounts from medical care providers that he's content to carry on this way. It's a sensible conclusion, assuming he didn't know and so hasn't thought through the consequences for other peoples' medical costs.
That conversation was tangentially related to a recent experience where I was involved in a conversation about alternative mechanisms to fund private health care. Once again, human beings can do without money, but we can't do without health, social support, and whatever knowledge we need.
It's only because the wealthy have access and the poor don't that we continue to measure money so carefully and other assets only minimally: if the only way to have access to private practitioners who aren't overworked and to have medical procedures done in a hospital in a timely way is to pay for them; if the only way to be considered part of some groups is to have shared (costly) experiences; if the only way to get a good education where teachers can teach and students can focus on class (and not outside obligations) is to "buy in"... well, then yes: we will continue to live as greedy people.
Let's let Chuck Jones do the narrative via Daffy (circa 1957, for those who keep track).