Think back to the last time you went to the doctor. Were any tests run? Did the doctor seem to guess at what was wrong? Were you prescribed medicine that didn’t work or you didn’t need? It seems that any more, when you visit your doctor, you are really being treated by your insurance company. Two weeks ago, my husband and I woke up with sore throats. In the two weeks that followed, my husband began coughing up blood and I developed a persistent cough. After multiple visits to various doctors, the ER and the Urgent Care Center, we are still not sure what is wrong. This entire time almost no tests have been run to ascertain the actual problem and what medication to prescribe for it.

First, we were told we probably had a virus since a strep test came back negative. For this we were each prescribed Tamiflu, an anti-viral, and a special gargling solution. Within two days we were back, my husband’s throat in such pain, he could barely swallow to eat. He was given pain pills (which didn’t work) and steroids to reduce inflammation. He was also prescribed Valtrex, another anti-viral medication.

Within two days, he was in the ER, asking for something to stop the pain. Another strep test was run which, again, came back negative. The nurse and physician’s assistant were rude, barely listened and useless, while the floors and general state of the ER was filthy. We were not the only ones to receive sub-standard care. The patient in the bed next to us was informed that a cab was waiting outside to take her home. “Wait,” she yelped, “what do I have? What do I need to do about it?” The nurse informed her that she had most likely had a panic attack but couldn’t tell her anything about what that meant, how to recognize the attack if it recurred or what to do about it. It was left to the security officer who was keeping the woman company to explain what a panic attack was, what they felt like and why they occur. My husband and I were appalled that this woman would be released from the hospital without anyone bothering to tell her the diagnosis or how to manage it. To add to this disgrace, my husband became infected with pink-eye in both eyes after coming home from this ER visit.

By the weekend my husband was at the Urgent Care Center coughing and sneezing blood. We were told it was most likely a sinus infection and were prescribed an antibiotic. While this has helped, we still have no idea what was actually wrong and have spent approximately $400 on doctors who have rushed through a minimal exam, have run almost no tests and have prescribed whatever medication correlates with their current theory, the majority of which has not helped us at all.

While my husband spent two weeks in pain, I spent that time deteriorating into a persistent, frequent cough that continues to make breathing difficult when a long coughing “fit” occurs. First, I was prescribed viral medication. After a week, the cough was so uncontrollable I went to the Urgent Care Center where I was told I probably had Whooping cough. I was given the test and prescribed antibiotics and cough suppressant syrup and pills. Within three days I was back to the doctor, the cough suppressants having failed. This doctor said I probably had a simple sinus infection and I was prescribed a steroid and a different cough syrup.

These stories do not recount isolated events. A family member also went to the doctor complaining of sinus problems. The doctor refused to run any tests to determine exactly what the problem was. Instead, he wanted to prescribe an antibiotic based on what he thought might be wrong. After the patient persisted, however, he finally ran a test. Of course, the doctor noted in the medical records that the test was run “at the insistence of the patient”. It was lucky that our family member knew which test to ask for since the results caused the doctor to change the antibiotic prescription. The pharmacist noted the original prescription would not have worked for the infection our friend actually had.

All of this leads to the questions: why are doctors so resistant to running tests and why do they prefer to guess at how to treat their patients? The answer seems to lie at the door of the insurance companies. Unfortunately, healthcare is a business. This means the insurance companies are constantly watching their profit margin and trying to pay out as little money as possible. The doctors end up answering to the insurance. Rather than the doctor doing what they believe is medically prudent, they guess at diagnoses in order to keep the insurance companies at bay. This is why the note “test run at insistence of the patient” was added to the files. This system allows those in insurance who have no medical training to direct doctors who are supposed to be in charge of their patient’s well-being, not the insurance company’s bottom line.

Healthcare is a big business. William McGuire, the former CEO of United Health Group, walked away with $124.8 million as compensation in 2005. After a financial scandal he was forced to return $400 million of his stock options which total $1.6 billion. The rest remains frozen. In 2005, McGuire was the third highest paid CEO on Forbes list of 500 highest paid executives. This seems more than unfair; it seems almost criminal that while many patients are driven into debt or bankruptcy, insurance executives have made off with huge paychecks. If health insurance is a business, then business is good.

Pharmaceutical CEOs are reaping profits too. Merck, responsible for Vioxx, recalled the medication when it was found to increase the risk of stroke and heart-attack. While Merck’s stock price dropped, their CEO, Ray Gilman, received a bonus. He made $37.8 million in 2004. In 2007, many top CEOs took a 15% pay cut. This was, however, only after their average pay raise of 38% in 2006. Even after this pay cut, the top 500 executives still had a combined profit of $6.4 billion, or $12.8 million each. As for the new CEO of United Health Group, Stephan Hemsley, he ranked 346 out of the 500 top paid CEOs on Forbes 2008 list. This means in 2007 he was paid $4 million.

In 2007, $2.3 trillion passed from patient’s pockets to the healthcare industry. This was 16% of the gross domestic product and 4.3 times what is spent on national defense. Insurance premiums for plans offered by employers rose 6.1% and for small businesses with 24 employees or less, premiums rose 6.8%. To meet the insurance premiums, employees spent 10% more in 2007 than they did in 2006. Since 2000, premiums have risen 100% while wages have only grown by 21%. In 2005, a Harvard University study found that of those filing for bankruptcy, 50% were doing so due to medical bills.

It is unlikely the government would run the healthcare system any more competently, efficiently or inexpensively (look at social security, welfare and the government set-up Fannie Mae and Freddie Mac). However, it seems something needs to be done. While people should have insurance and should not foist their bills onto other tax payers, they should not be taken advantage of. Nor should their diagnosis be guessed at by doctors more concerned with saving time and money to appease the insurance conglomerates than their patients. There must be a better way other than allowing the insurance business to hold patients hostage within a system that has basically formed a monopoly. Either insurance is obtained through the large insurance companies or your family remains uninsured. There are no other options available.

With the type of Mafioso-style stranglehold insurance companies hold over doctors, one must wonder if insurance-for-all, with insurance in its current form, is the solution that many seem to regard it as. Rather, it must be asked if giving insurance companies more power over decisions that only doctors are qualified to make will truly garner the best outcome for the patient. Perhaps we should consider reforming our insurance system and doctors rather than expanding insurance’s reach to every American.

References:

1. Providence Journal

2. McGuire Appeals Freeze on Stock Options

2. Forbes 500 List 2005

3. Top Paid CEOs 2008

4. Forbes 2008 Top CEO Rankings

5. Poisal, J.A., et al, Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact. Health Affairs (21 February 2007): W242-253.

6. California Health Care Foundation. Health Care Costs 101 — 2005. 02 March 2005.

7. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2007 Annual Survey. 11 September 2006.

8. Himmelstein, D, E. Warren, D. Thorne, and S. Woolhander, “Illness and Injury as Contributors to Bankruptcy”, Health Affairs Web Exclusive W5-63, 02 February , 2005.