December 6, 2008
How do you fix health care, it is simple. Provide the highest quality care to everyone at affordable prices. First, I think we need to look at what is wrong with the system. I can tell you what I see from a consumer’s perspective.
There is no way for the average American to know what an “affordable” price is because we don’t know what the profit margin truly is regarding pharmaceuticals, insurance, and doctor fees. Anyone who has looked at a bill from a hospital knows how screwed up the system really is. Just try and match up a claim from your insurance company with the hospital bill. The seemingly simple explanation is more complex than a Gordian knot. There is no way you can audit these bills to ensure you’re not paying for items you didn’t get or services not received. Then there are the negotiated prices, I’ve seen services billed to our insurance company being paid significantly less, fifty to seventy percent less. Why is it that the people who don’t have insurance must pay “full price” and insurance companies pay significantly less?
Then there is the issue of quality care, a glaring example of how uneven our current system is the “unneeded test” you hear about all the time. But I don’t know anyone who has had an “unneeded” test. I’ve heard plenty of people who didn’t get a test that might have made a difference. Two come to mind. My ex-husband died one year ago today. About 18 months ago he was suffering from a severe case of diverticulitis at least that was the “official” diagnosis from his primary care physician. One night, it was so bad that he could not stand it anymore he went to the hospital and within hours he found out he had liver cancer. His primary care physician had done an x-ray and they had seen a shadow on his liver but they did not follow up. I can’t presume to know why his PCP didn’t follow up or even tell him about it. He learned much later about it.
Another case in point, today on the one year anniversary of her brother’s death, my ex-sister-in-law is attending a funeral of an old friend. Apparently she died of a heart attack. She had a battery of tests – in truth I don’t know all the details except that she had a stress test. I feel fairly confident that the autopsy will show that had they done an exploratory cath test they would have found a defect that could have been fixed, instead because they couldn’t “justify” the test by the previous results, she was denied a crucial test and now her granddaughter will grow up not knowing her grandmother. And, to add insult to injury – the media has ran plenty of stories stating that heart disease is a leading cause of death among women – mainly because it is under diagnosed and doctors still tend to blow off a woman’s complaints. This I know for a fact as I’ve been the recipient of their disdain in the past. Luckily for me, they were not issues that would have killed me.
The first time it happened to me I was about nineteen; I had a severe back ache and couldn’t stand upright. The first doctor I saw dismissed my pain, I believe he thought I was just too young to have any “real” problem and he ignored the fact that I had fractured my back at sixteen in a car accident. For over three years I suffered on and off from debilitating back pain never going back to the same doctor twice because it was obvious to me they didn’t know or care what was really wrong. Then when I was about twenty-two I was walking across a field and my back seized up, I literally on hand and knees I crawled back to my office. This time I was lucky to find a good doctor. Even his staff was different – I didn’t feel like I owed them my first born child for the honor of being allowed the grace of sitting on a rock hard chair in the waiting room. Within an hour I knew what was wrong with my back and hips. Because of the car accident I changed the “wear pattern” on my spine, I had a bone spur. There is no cure for what’s wrong but now I know how to prevent it.
The last time a misdiagnosis affected my life happened two years ago. I found out I was pregnant and had an ultrasound. A week later I felt my water break and I speed to the hospital. They did an ultrasound and they said my placenta was intact, the fetus was active and had a strong heartbeat and his fluid levels were normal, but I had a clot. They told me it was the clot that was causing the bleeding but they didn’t believe there was amniotic fluid. What they did not do was test the fluid, one test and they would have confirmed what I figured out – I had lost a twin. I didn’t know the test existed until it was too late or I would have requested it be done. The test is a simple and cheap litmus strip, but because they had not seen two babies when they did the first ultrasound, because they did not detect two heartbeats all the doctors told me it was impossible. That clot never went away; it never got bigger it never got smaller. About a minute after my son was born, my OB said, “It was a twin pregnancy.” The “clot” was my son’s sister.
In each of these instances, a diagnostic test or follow up would have made all the difference in the world. For my ex-husband, he might have managed to get another year or more with his girls had they followed up on that shadow. For Joyce, she might be recovering from surgery and planning for Christmas if they had done one more test. I think the term “needless tests” are greed related by-products of the insurance company and causes one of the most expensive aspects of healthcare – lawyers.
Edited to note: Joyce could have survived but treatment was too late.