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A conceited emperor hires two tailors who promise him the finest suit of clothes. The fabric, they say, is invisible to anyone unfit for his position or who is just plain stupid. When the deceitful tailors present the suit to the emperor they mime dressing him, and even though the emperor cannot see the cloth himself he pretends he can for fear of appearing unfit for his position.
The court and his friends do the same as the emperor proceeds to strut stark naked before his subjects with pride. Only the innocence of a child reveals the false pretense as he blurts out “the emperor has no clothes” and the cry is taken up by others. The emperor suspects the truth but continues the false procession as though the truth is still hidden.
Our current health care crisis reminds me of Hans Christian Andersen's tale of the emperor, stumbling blindly along even though the futility of his efforts were revealed.
Andersen exposed the hypocrisy and snobbery of the 17th century Danish elite while our current leaders and legislators are remarkably similar with their myopic efforts at solving anything related to health care. Their efforts amount to rearranging the deck chairs on the Titanic as though it will prevent the looming disaster.
A delusion is defined as a “fixed false belief.” We are under the delusion that the current health care system deals with health, and physicians have control of how that health care is dispensed. In the current paradigm we are simply puppets of the insurance, government, and pharmaceutical industries. Physicians have become experts in “sick care” and not health care.
Step one toward solution is restoring insurance to what insurance is meant to be, a means to mitigate catastrophic risk. Car insurance doesn't pay for an oil change or a flat tire — they pay when the car is totaled. Homeowners insurance doesn't pay for a new coat of paint or fixing a leaky faucet — they pay when the house burns down. Our current health insurance system is not insurance but rather health management and we are paying dearly for it in more ways than dollars.
The health insurance industry is a multi-trillion dollar industry that contributes nothing to direct patient health. If every U.S. citizen converted to a high-deductible catastrophic health insurance, it is estimated 90% of them would not reach their deductible in a given year. That means the majority of insurance system costs would disappear. Then we'd see premiums drop, health care costs drop, patient freedom of choice and responsibility increase, while physician reimbursement returned to the free market based on our success at actually treating and preventing disease. Insurance companies could be less discriminatory with pre-existing health conditions and exclusions as the actuarial numbers would get much simpler to predict and afford.
In my insurance-based practice I estimate that 40% of our revenue is lost because we contract with insurance companies. We pay 10% of revenue right away to a professional billing company that we must employ because the insurance system has become so complex and ever-changing. Add another 10% to staff fees as they waste hours of time simply processing claims and getting permission for various treatments we think our patients need. Then another 10-20% is lost to reduced reimbursements and withholdings. If you want to treat patients then you sign a contract to play by their insurance's rules. Here's a secret: Doctors don't determine their fees — insurance companies tell us what we may charge. Where does that 40% go and who does it benefit?
Congress will likely postpone, again, the next cut in Medicare reimbursement to physicians and hospitals. Rather than admit the paradigm is broken we are treading water harder than ever and being asked to grovel with our legislators for exemption from hard cuts that need to happen. What do they expect the 29% cut in Medicare reimbursements will do for quality and available care for our elderly? And, if the cut doesn't happen then where is all this money going to come from?
The real “sleeper” issue with insurance playing the role of health managers is now we have “invited them into the bedroom,” so to speak. They increasingly dictate what procedures and medications are best for patients. Suddenly, doctor and patient have less say in what methods they would choose to treat or more importantly prevent disease. Only the conventional path is allowed thus limiting treatment options and stifling the individual creativity that leads to innovation and advancement of practice.
In my second office, the IMC, I don't accept insurance and I set the fee schedule. This allows me the time and resource to do what I feel is in the best interest of my patient. My new patient visit is often two hours long, involving myself, medical assistant educators, nurses, and an exercise physiologist. I order the tests necessary to get my patients results, not just the ones approved by the insurance industry. My patients and I can address health issues at a much deeper fundamental level without the yoke of the insurance paradigm weighing us down. Instead of simply starting medications I can actually take a holistic, time-consuming approach to patient care integrating a team of professionals to help me reverse and prevent disease.
The second solution goes along with the first — health care savings accounts (HSA). Only available when tied to a high deductible insurance, the HSA is a tax-deferred savings account linked to health care expenses, and if not used is allowed to accumulate. The accrued money is allowed to be spent on a wide range of health-related products and services, even alternative providers and natural supplements. Imagine — a government program that actually allows stepping outside the conventional system while encouraging saving and personal responsibility!
The third solution is national tort reform. Colorado leads the country in wise legislation that prevents frivolous lawsuits while other states languish under ridiculous claims that benefit no one but the greedy trial lawyers circling like sharks around the suffering of the unfortunate. Malpractice insurance is a necessary and appropriate need for physicians, designed to serve those for whom a mistake leads to loss. However, leaving physicians in the “crosshairs” of excessive and easy lawsuits steers the medical industry toward the defensive. Physicians and hospitals have become so paranoid that we feel obliged to order excessive tests in order to prove every case to the nth degree, when our skills of history and examination are usually quite sufficient.
These are some of my ideas on where the future of health care should go from a legal and monetary perspective. Next week, in part 2, I'll share my thoughts on where physicians, particularly those of us in primary care, can improve the way we practice. I believe we can do much better for our patients while putting health and joy back into primary care.
===================
Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician-supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
The court and his friends do the same as the emperor proceeds to strut stark naked before his subjects with pride. Only the innocence of a child reveals the false pretense as he blurts out “the emperor has no clothes” and the cry is taken up by others. The emperor suspects the truth but continues the false procession as though the truth is still hidden.
Our current health care crisis reminds me of Hans Christian Andersen's tale of the emperor, stumbling blindly along even though the futility of his efforts were revealed.
Andersen exposed the hypocrisy and snobbery of the 17th century Danish elite while our current leaders and legislators are remarkably similar with their myopic efforts at solving anything related to health care. Their efforts amount to rearranging the deck chairs on the Titanic as though it will prevent the looming disaster.
A delusion is defined as a “fixed false belief.” We are under the delusion that the current health care system deals with health, and physicians have control of how that health care is dispensed. In the current paradigm we are simply puppets of the insurance, government, and pharmaceutical industries. Physicians have become experts in “sick care” and not health care.
Step one toward solution is restoring insurance to what insurance is meant to be, a means to mitigate catastrophic risk. Car insurance doesn't pay for an oil change or a flat tire — they pay when the car is totaled. Homeowners insurance doesn't pay for a new coat of paint or fixing a leaky faucet — they pay when the house burns down. Our current health insurance system is not insurance but rather health management and we are paying dearly for it in more ways than dollars.
The health insurance industry is a multi-trillion dollar industry that contributes nothing to direct patient health. If every U.S. citizen converted to a high-deductible catastrophic health insurance, it is estimated 90% of them would not reach their deductible in a given year. That means the majority of insurance system costs would disappear. Then we'd see premiums drop, health care costs drop, patient freedom of choice and responsibility increase, while physician reimbursement returned to the free market based on our success at actually treating and preventing disease. Insurance companies could be less discriminatory with pre-existing health conditions and exclusions as the actuarial numbers would get much simpler to predict and afford.
In my insurance-based practice I estimate that 40% of our revenue is lost because we contract with insurance companies. We pay 10% of revenue right away to a professional billing company that we must employ because the insurance system has become so complex and ever-changing. Add another 10% to staff fees as they waste hours of time simply processing claims and getting permission for various treatments we think our patients need. Then another 10-20% is lost to reduced reimbursements and withholdings. If you want to treat patients then you sign a contract to play by their insurance's rules. Here's a secret: Doctors don't determine their fees — insurance companies tell us what we may charge. Where does that 40% go and who does it benefit?
Congress will likely postpone, again, the next cut in Medicare reimbursement to physicians and hospitals. Rather than admit the paradigm is broken we are treading water harder than ever and being asked to grovel with our legislators for exemption from hard cuts that need to happen. What do they expect the 29% cut in Medicare reimbursements will do for quality and available care for our elderly? And, if the cut doesn't happen then where is all this money going to come from?
The real “sleeper” issue with insurance playing the role of health managers is now we have “invited them into the bedroom,” so to speak. They increasingly dictate what procedures and medications are best for patients. Suddenly, doctor and patient have less say in what methods they would choose to treat or more importantly prevent disease. Only the conventional path is allowed thus limiting treatment options and stifling the individual creativity that leads to innovation and advancement of practice.
In my second office, the IMC, I don't accept insurance and I set the fee schedule. This allows me the time and resource to do what I feel is in the best interest of my patient. My new patient visit is often two hours long, involving myself, medical assistant educators, nurses, and an exercise physiologist. I order the tests necessary to get my patients results, not just the ones approved by the insurance industry. My patients and I can address health issues at a much deeper fundamental level without the yoke of the insurance paradigm weighing us down. Instead of simply starting medications I can actually take a holistic, time-consuming approach to patient care integrating a team of professionals to help me reverse and prevent disease.
The second solution goes along with the first — health care savings accounts (HSA). Only available when tied to a high deductible insurance, the HSA is a tax-deferred savings account linked to health care expenses, and if not used is allowed to accumulate. The accrued money is allowed to be spent on a wide range of health-related products and services, even alternative providers and natural supplements. Imagine — a government program that actually allows stepping outside the conventional system while encouraging saving and personal responsibility!
The third solution is national tort reform. Colorado leads the country in wise legislation that prevents frivolous lawsuits while other states languish under ridiculous claims that benefit no one but the greedy trial lawyers circling like sharks around the suffering of the unfortunate. Malpractice insurance is a necessary and appropriate need for physicians, designed to serve those for whom a mistake leads to loss. However, leaving physicians in the “crosshairs” of excessive and easy lawsuits steers the medical industry toward the defensive. Physicians and hospitals have become so paranoid that we feel obliged to order excessive tests in order to prove every case to the nth degree, when our skills of history and examination are usually quite sufficient.
These are some of my ideas on where the future of health care should go from a legal and monetary perspective. Next week, in part 2, I'll share my thoughts on where physicians, particularly those of us in primary care, can improve the way we practice. I believe we can do much better for our patients while putting health and joy back into primary care.
===================
Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician-supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
