“Spending your time overcoming corporate resistance to creativity-I just don’t want to do that. The only way a show works is you find people who you think are qualified and talented and you give them a chance to do what they do. Interfering does not increase the odds of success if they are giving you money they want to come into the sandbox… but that ruins it.”
Seinfeld, on starting a Comedy on the internet bypassing regular TV corporations.
OK, true, providing Health Care is much more serious business than producing a TV comedy. But, the same dynamics apply. I agree with Mr. Seinfeld: the big boys are entitled to call the shots when they sign the check. So, He and I and MANY other doctors throughout the country are no longer taking Health Insurance. We want to reclaim autonomy over how we render care to patients, especially when the whole system is geared to DISEASE CARE. It does not heal patients; it only manages disease In fact, it only covers 10% of the factors that lead to disease.
“Bridging the divide between health and health care,” JAMA 2013;309:1121
- “Health Care delivery accounts for only 10% of preventable deaths, with the remainder attributable to personal behaviors, social and environmental determinants, and genetic predispositions. As currently constituted the Health care delivery system has little direct control over these other factors. However, consensus is developing that truly controlling health care costs and improving the overall health of Americans will require a much closer partnership, permeable boundaries, and increased interdependence among the health care delivery system, the public sector, and the community development and social service sectors.”
- “To create a culture of health will require creating a market for health, moving away from the current market for treating disease.”
Before proceeding further let me refute the often-quoted refrain that without health care coverage patients will not seek preventive care, such as mammograms, pap smears and physical exams. This may not be the problem the providers of such care warn against. First, there are cheaper and less invasive tests such as Thermograms for breast screening. Second, the frequency of pap smears may be safely cut back to every three to five years in many women, and third, the US Preventive Task Force has repeatedly questioned the need for many “preventive” tests, such as physical exams, much to the ire of those who stand to gain from them. For example, the data the Force looked at is the same data that led the Swiss to stop mammograms altogether: they do not lower the rate of mortality:
“It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice.”
The sad truth is that the system wastes ~$750 Billion per year on unnecessary testing and symptomatic care, $4 Billion of which are wasted on mammograms. All this does not mean that yearly visits and judicious, inexpensive screening are not effective. On the contrary: it is the way to go. But, how should be carried out? By addressing the 90% of issues not covered by the system: lifestyles, nutrition, stress management, mind-body issues, etc.
It is beyond dispute that the Affordable Care Act (which is not very affordable) has resulted in some welcome changes, like coverage for pre existing conditions. But, what is being covered? Again, only 10% of the factors that impact our health. The ACA was and is a boondoggle for the Insurance and Drug companies. Is that not obvious to all by now?
I will no longer play the game. For three decades I have been abused by insurance companies, and so have my patients. At age 62 I no longer have to put up with their insane regulations designed to obfuscate and increase the odds you and I don’t fill out their maddening forms the way they want you to. Then, they are “justified” in denying payment to me and coverage to you.
Many Americans are buying the cheapest coverage they can find as they are FORCED to participate in a broken system. This is having good unintended consequences: patients are getting CATASTROPHIC insurance coverage with high deductibles that cause patients to pay out of pocket for clinic visits and preventive services. No doubt they will look for clinics and doctors who truly understand prevention, and address the 90% of factors that truly benefit their health, instead of only managing symptoms with pharmaceuticals.
There are two questions I recommend you ask yourself when it comes to insurance coverage:
Are you healthier with their covered services?
Do you feel better?
- Salt Lake Tribune October 20th 2015 ↑
- Studies Continue to Show No Benefit From Annual Physicals in Healthy Adults JAMA 2012;308(22):2321 ↑
- Abolishing Mammography Screening Programs? A View from the Swiss Medical Board N Engl J Med 2014; 370:1965↑
- See above ↑
- Unnecessary care: are doctors in denial and is profit driven healthcare to blame? BMJ 2012;345:e6230http://www.theatlantic.com/health/archive/2012/09/how-the-us-health-care-system-wastes-750-billion-annually/262106/↑
- J. Health Affairs April 6 2015↑