My answer to this problem, in the short-term, is to take ownership of my health in any way I can. That’s one reason why wrote a book – if you can’t afford to be sick, then do your darn best to stay well.
All this said, I think a fundamental problem of our healthcare system is that it treats illness, rather than promoting wellness. Here’s a true story which beautifully illustrates my point.
I have a good Friend X who has stomach problem Y. (I’m obviously doing my fair share of complying with HIPAA regulations). He goes to the doctor to see what’s wrong and the doctor prescribes medication Z. Great news! Medication Z solves his problems! Better yet, this medication, which costs $W/month, is paid for by his health insurance company (clearly his policy is better than my catastrophic one)! Problem solved? Here’s my synopsis:
- Doctor is happy because patient is better.
- Pharmaceutical company is happy because they are getting monthly revenues from this patient, which could, theoretically at least, continue till eternity.
- Insurance company is happy because they are likely getting a cut from this whole medication/treatment program.
- Patient is happy because he is feeling better. Right?
Well, actually Friend X is glad he’s feeling better but not excited about the prospect of having to take prescription medication the rest of his life. So he decides he wants to go back to the doctor and determine why he is having the medical problem in the first place, a step that was inadvertently skipped on the first doctors’ visit.
Guess what?
The insurance company won’t pay for Friend W to go back to the doctor to find out what is causing stomach ailment Y. After all, his original doctor has found a treatment that worked, so why bother finding a solution that might pre-empt the need for medication at all?
Crazy? I think so.
Despite the cost and hassle, Friend X sees a different MD with a more holistic background and has some tests to figure out the root cause of stomach ailment Y.
He pays for these tests from his own pocket. Shortly thereafter, the doctor has determined that his stomach is deficient of some critical bacteria needed for proper digestion, and then treats Friend X with probiotics, a natural remedy, that somehow puts the proper bacteria back into his stomach (medically speaking, I might be able to use better terminology, but you get my point).
What’s the net result of this?
- Original doctor probably doesn’t even know, because he/she was only interested in a treatment for the ailment.
- Doctor #2 is very happy because she found the root of the problem and is effectively treating the patient with a natural remedy (which, by the way, Friend X has to pay for).
- Health plan company didn’t pay for any of the follow up tests anyway, so what do they care?
- Pharmaceutical company is likely bummed because the lifetime revenue of Friend X was taken away from them.
- Patient is very happy because tummy is well without the necessity of prescription medication.
This story perfectly illustrates how the reimbursement protocol of our healthcare system supports treating a sick patient, versus keeping the patient well in the first place
– thus demonstrating the power of pharmaceutical and insurance companies in this healthcare debate. I personally think the physician is caught somewhere in the middle. Regardless, for us patients, if we can’t afford to research the root cause of illnesses, may be stuck with an expensive prescription (or possibly surgical) solution which our insurance policy will cover but may not actually be in our best interests
long-term.
Depressing, I know. But it puts more onus on us – as patients – to take better care of ourselves.]]>
