by Patrick Wagner, MD
I am a doctor who has something to say about the part of our healthcare industry that’s tearing our whole system apart. My hope in doing so is to encourage everyone who cares about their health to view this indispensable system in a light with which they may not be familiar. I’d like to tell you a bit about why I eventually quit my job as a doctor.
I worked as a general surgeon in Sacramento for about 2 decades, serving thousands of average citizens who found themselves facing a wide range of health problems—gallbladder trouble, breast cancer, hernias, and appendix ruptures to name a few. I also patched up individuals with traumatic injuries in operating rooms and assisted them in getting back to normal, healthy lives afterward. This was my life’s work, and I loved every minute of it.
Unfortunately, between the time when I began working as a doctor and when I quit medicine, the healthcare industry changed drastically, and that change was not for the better good of you or me.
Early in my experience as a surgeon, the term “managed care” began to evolve into something that would be seen as much more commonplace down the road. “Managed care” was a plan contrived by health insurance companies and bought into by growing government. The pitch was that medical care was costing people too much, and this plan would effectively solve that problem. This money-saving strategy posited by crafty insurers was that insurance companies knew the best ways to “administer” health care. At the same time, the insurers also knew how to improve the “quality of care” for all patients.
Our government loved this idea—decreased cost, increased quality. Some doctors conceded to the notion too. I watched tentatively as various private practice physicians began to approve of this strategy and were essentially bought out by health insurance companies. Unfortunately, as this happened, doctors also began to evolve into something different as well. Instead of serving as professionals whose primary goal was the better good of their patients, many doctors began to follow a new set of rules laid out by the insurance companies. The old code of ethics that had framed the profession for so long became something that doctors managed to ignore more and more often.
As the healthcare industry shifted its focus from ethical standards of care to the money it would cost to provide it, our SOCIAL insurance programs began to change as well. Medicare—our government’s way of making sure older patients receive the medical assistance they need—slowly started to corrode. I first began to notice this steady decline while being paid for the operations I did on patients. For example, in 1987, I operated on a 67-year-old woman with breast cancer, and Medicare paid me about $800. For the same operation 14 years later, Medicare paid me $400.
I once asked my brother, Kirk, a cabinet maker, what he thought about this scenario. He said that he couldn’t think of another service or goods industry where a worker is paid less as time goes on, especially when considering standard inflation.
This problem began to really rub on me—not just because I was making less money, but because I felt like Medicare was getting flakey as a social service. My colleagues began to agree. Somehow, we physicians had allowed Medicare to get away with this.
As the government continued to further buy into the insurance companies’ “managed care” strategy, it became tougher and tougher for doctors and other medical professionals to make a living. We were being managed as well.
Sadly, this type of management—not just of “care” but of people—became even more egregious as time went on. Do you remember a time when there were no advertisements for medicines on TV—medicines for heartburn, high cholesterol, impotence, obesity, sleeplessness? Or billboards and radio ads pitching HMO’S, PPO’S, IPA’S, even specific hospitals like Sutter Health or Mercy or Catholic Healthcare West or UCD or Kaiser? I certainly do.
It was during this growing propaganda phase—when commercials began urging patients to “Ask their doctor” about the best “care” available—that insurance companies also started radically decreasing the amount of money they paid physicians and other medical professionals for their services. For instance, in 1987, an insurance company paid me $800 for a patient’s hernia repair. Fourteen years later, they paid $160. During some months near the end of my career, I never got paid at all.
Aside from the issue of the exorbitant amount of money being made by these companies at the expense of medical professionals and patients is the unethical nature of business conducted in the healthcare industry. As health insurance companies have increasingly contained their costs—and as government has allowed this to happen—doctors and other medical professionals have found their clinical judgment short-circuited for the sake of insurance savings. Insurance companies demand that doctors cut the days our patients can stay in the hospital after an operation. They demand that we ignore our patients’ risky medical symptoms or pain or sickness so that the company won’t have to pay for the patient’s hospital bed. They tell us these situations don’t matter.
As a doctor, I disagree. That’s why I got out.
As I see it, our healthcare system needs to change in a big way. But one of our obstacles to reforming this system seems to involve the confusion insurance companies have created for patients about the plans they provide—HMOs vs. PPOs.
HMOs are cut-rate insurance plans for huge organizations of workers. According to HMOs, employees save on their healthcare because insurance companies pay a flat rate for services rendered. The PPO—administrated by the same insurance company—is designed for folks who own small businesses, for whom the insurance companies pay around 80% of the bills for services, leaving the patient a huge deductible and 20% of the bill.
While PPO patients have likely noticed a drastically negative change in American healthcare over the past couple of decades, HMO patients have largely been kept in the dark by insurance companies about how things really work. While a PPO patient could end up paying $100,000 out of pocket for a $500,000 car accident, HMO patients rarely see that sort of bill. Many of my HMO patients were school teachers, state workers, public employees, and other civil servants who felt protected by the healthcare offered by their jobs. Despite this comfort shared by some, however, it becomes important for ALL Americans to begin questioning the unfairness that exists for many sick patients—and for the workers who strive to care for them in hospitals across our country. We need to question the way these insurance companies run their businesses and pay attention to the political practices that allow these companies to extend their negative influence.
Essentially, “managed care” has left us with decreased quality and increased cost. And as a result, things are getting less safe, folks. Really less safe. At the same time, however, this system cannot be sustained unless WE sustain it. Piece by piece, we’ve got to knock down this house of cards that’s been strategically constructed over time by business executives and politicians who aimed at—and succeeded in—making lots of money for themselves at the expense of patients and medical professionals. It’s time to reverse this scenario by not only questioning our destructive status quo, but by rejecting it…as unsuccessful, unethical, and un-American.
Patrick Wagner, MD is a retired general surgeon, making his home in Nevada City.