The Eclectic One

…Because labels are a poor substitute for thinking

How the American Healthcare System Is Broken

Posted by Bill Nance on August 9, 2009

The healthcare system in the U.S. is broken in dozens of fundamental ways. Over dinner last night, a friend said: “We have the best healthcare in the world with the worst delivery system in the world.” More accurate words could hardly be spoken.

Another way in which the system is fundamentally broken is the way defensive medicine adds billions of dollars to the cost everyone pays in increased insurance premiums and tax dollars.

I thought I’d share a personal story on this subject that happened to me not too long ago.

I have what is called Cystic Acne. I’ve had it since my early 20s. I don’t get many pimples, but every few years I get a Sebaceous Cyst. These are large, unsightly and usually painful boil-like pimples that will harden into a large nodule.

Two things can be done about these. One is antibiotics, which sometimes helps. But in my personal experience, I’ve never had success. The other way to treat these is to lance them and drain them, and on occasion, cut out the infected tissue.

Now treating a cyst like this is something that until relatively recently was done by your general practitioner. The process is quite straightforward and technically speaking, is well within the capabilities of any first-year resident, much less someone who’s completed residency.  I’ve had these removed by a GP before and it’s about a 15 minute process.

I hadn’t had one of these in almost 20 years, so I was amazed when I went to my excellent GP and was told yes, it was a cyst, but no, she couldn’t treat it. Apparently the medical board and her malpractice insurance insist that anything more complicated than a fever be treated by a specialist. That office visit was $50.

My next stop was at the dermatologist, who looked, remarked that it was a cyst and a rather large one at that, but then shook his head and said he couldn’t treat it either, because it was someplace he thought yet another specialist was better qualified for, due to the regulations and malpractice insurance requirements. That visit was billed at $200.

My next stop was the “specialist.” Yet again I was told that my observation was 100% correct. HE could treat the thing. the consultation was $350, the fee to do the 15-minute procedure was $900.

So the end result was that I completely wasted my time, and wasted the time of two specialists who could have been treating people with far more complicated and serious medical conditions, and paid $1500 for a procedure that my GP could have performed effortlessly for perhaps $200 at most.

Fortunately, I have rather good insurance and the out-of-pocket expense was minimal. But I didn’t get away without paying for the entirety of that procedure, and if you have Blue Cross, neither did you.  I didn’t pay it all up front, and you won’t either. What will happen is that this situation will be played out thousands and thousands of times and for each one of those, the cost of insurance premiums will rise. Since 1999 employer-based plans have had their premiums rise by 120%, compared to an average 44% cumulative rate of inflation.

Medical costs aren’t magically “absorbed.” Whether it’s my $1500 cyst or the $800 emergency room visit by an uninsured person with the flu complications, someone has to pay, and that someone is you and me.

So there is my story. And I personally want to thank each and every one of my friends opposed to serious reform of the system for paying their share of the $1,500 cyst removal that should have cost $200.  Get used to it, it won’t change unless the system itself gets an enema.


2 Responses to “How the American Healthcare System Is Broken”

  1. Mark Baird said

    Is defensive medicine practiced because of the fear or the probability? The answer to this question matters.

  2. Bill Nance said

    Defensive medicine is, by definition, out of fear of repercussions for the doctor if the outcome of a non-defensive approach is less than 100% successful.

    What I described in this article had nothing to do with ability or difficulty of the procedure. It was simply because the doctor had been trained to refer ANYTHING other than a short list of procedures to a specialist. If that’s the way it’s going to go, why have someone spend 6 years in residency to do work that could easily be performed by a well-trained nurse?

    If your doctor refers you to a specialist, it should be because the doctor who refers you simply isn’t equipped to do a good job, not because they are afraid that a 1 in 10,000 piece of bad luck will get them sued.

    What’s amazing to me is that this same doctor who can’t lance a cyst(something that any jackass on the street could do competently with a dozen hours training) wouldn’t hesitate to prescribe anti-depressants, even though the chances of medication side-effects or misdiagnosis is very high because GPs get a total of perhaps a few hours/days training in psychiatric illnesses.

    It wasn’t long ago that a competent GP’s office would set a broken bone, perform x-rays, do their own lab work and perform simple excisions and surgeries in their office. However a patient exhibiting signs of mental illness would get referred to a psychiatrist immediately because the field is so specialized. Now it’s the exact opposite, even though the GP has more and better training on treating illness or injury and hardly more than passing mentions of psychiatric illness in their training.

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