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Health Care Musings

 

I have noticed several changes over the last few years in the practice of medicine.  I am convinced these changes reflect the deterioration of the US medical system.   Government intervention, medical-legal liability, advertisement, and a globally worsening economy probably trigger these changes.

Did you Know?

  • Viagra used to cost $10 a pill, a patient recently reported a price tag of $750 dollars for 10 pills??
  • 5 years ago 6% of my practice was cash payment, now 26%. (Less insured, not more since Obama-care??)
  • 85% of the conditions I treat are related to either nutrition or stress
  • Many medical conditions previously, routinely, treated in hospital settings, now get treated as an outpatient.
  • Insurance carriers and government payers are now indirectly practicing medicine by dictating to patients and physicians what they WILL and WON’T pay for.
  • The ER has now become the “catch all” for after-hours care, even minor colds and injuries.
  • Physicians rarely take call anymore, instead many simple leave a message stating, “If sick after hours, go to the ER.”
  • Many medical practices are being sold to large medical carriers or hospital systems
  • Patient’s believe doctors have a “Pill for everything”
  • Patients believe genetics play the biggest role in health
  • Average copay = $3o, more than half the typical charge for a primary care visit
  • As Insurance companies buy medical practices in my community, my colleagues are now working for the same people paying for patient care….hmmm
  • Preventative Care = Ordering routine tests, NOT talking about nutrition, stress, or lifestyle issues.
  • Many of my colleagues warn me they will close their practices when Obama-care is fully implemented
  • Patients frequently express anger over impersonal treatment in hospitals, ER’s and specialty offices
  • Many beneficial treatments (ie. Physical Therapy, psychotherapy, acupuncture, nutritional counseling and massage) are NOT covered by insurance or have huge copay’s to discourage usage.
  • Patients express greater trust in their friends and online resources than health care professionals for health care advice

Do I have an answer for the above comments, a grand plan?  No.

However, I do believe we as a community must look inward and rediscover our own innate understandings of health and actually use those resources.

I believe truly preventing disease requires doctors to address real issues like encouraging lifestyle choices that reverse epidemics like obesity, diabetes, and heart disease.

We should challenge food industries and question what we consume.

We should individually explore why we’re too busy for light routine physical activity.

Individuals should learn how frenetic lifestyles affect our hormones, leading to illness and disease. For my physician colleagues, continuing down the same path will render us irrelevant to patient’s as “standard” treatments simply treat symptoms and not the cause.  Worse yet, our cures are often worse than the disease.

Change is often a good thing.  Change isn’t always comfortable.  These observations from my daily walk in private practice simply reflect change.  The change is coming because our current care model is neither effective or efficient.

The current healthcare model focuses on SICK CARE and not WELL CARE.

My message to everyone? Embrace small lifestyle changes, re-claim your own ability to improve your health.

Health doesn’t come in a bottle.

 

{ 4 comments… add one }
  • Debby Hovda September 7, 2013, 11:30 am

    Well said, Dr. Curtis. How do we gather enough like-minded people to be able to make this change in this impending health crisis??

    • William Curtis September 7, 2013, 12:45 pm

      Since you asked…
      1)Grass-root awareness of problems with our food chain…ie. recognition that foods can cure or kill you.
      2)Individual responsibility for personal health. 100 years ago, people rarely saw a doctor, they relied on folk wisdom, rest, and nutritional remedies learned from their friends and family. We need to find our way back to “owning” our health. In most situations my patients don’t need a “doctor” they need to listen to their body, curb habits that make them feel bad, and become more active. Sounds simple.
      3)Participate in farmers markets, community gardens, and conservation projects. The folks involved in these activities understand the difference between filler and real food. Those communities need to share information via social media.
      4)Legislation banning drug advertisement. Most of the drugs don’t do what they promise and the studies that got them FDA approval are often suspect and biased.
      5)Last, most on point with your question, start with yourself. Be an example. Top down approaches will not work because there are too many hands in the till, industries built around disease care and crappy nutrition. Personally making better choices, increasing activity, then telling people about your success will go much farther than trying to convince the medical industry to change ways.

  • Janknitz September 26, 2013, 7:57 pm

    ◾Viagra used to cost $10 a pill, a patient recently reported a price tag of $750 dollars for 10 pills??
    Wow!
    ◾5 years ago 6% of my practice was cash payment, now 26%. (Less insured, not more since Obama-care??)
    With the exception of requiring insurance companies to cover children of insured parents to age 26, coverage provisions of “Obama-care” have not yet taken effect. Can’t blame Obama care for this. Most insured people still get their insurance from their employers and have no way to afford it on their own. Unemployment and underemployment and the lousy economy we haven’t yet climbed out of are the primary reason.

    ◾85% of the conditions I treat are related to either nutrition or stress
    Agreed.

    ◾Many medical conditions previously, routinely, treated in hospital settings, now get treated as an outpatient.
    True.

    ◾Insurance carriers and government payers are now indirectly practicing medicine by dictating to patients and physicians what they WILL and WON’T pay for.
    This is not new, it’s been going on for the last 20 years at least. Again, can’t blame Obama for this.

    ◾The ER has now become the “catch all” for after-hours care, even minor colds and injuries.
    Again, not new. Some HMO’s (i.e. Kaiser Permanente) provide after hours urgent care. Many insurers cover independent urgent care clinics.

    ◾Physicians rarely take call anymore, instead many simple leave a message stating, “If sick after hours, go to the ER.”
    Hmmm.

    ◾Many medical practices are being sold to large medical carriers or hospital systems
    Not a good trend, but that’s true.

    ◾Patient’s believe doctors have a “Pill for everything”
    Many doctors believe that if there’s not a pill for it, the problem doesn’t exist. And if there is a pill for it, it is a problem (e.g. LDL cholesterol)

    ◾Patients believe genetics play the biggest role in health
    As you point out, patients don’t yet take responsibility for their own care in most cases.

    ◾Average copay = $3o, more than half the typical charge for a primary care visit
    Not around here–it’s well over $100.

    ◾As Insurance companies buy medical practices in my community, my colleagues are now working for the same people paying for patient care….hmmm
    As a patient who can ONLY get insured by a big HMO, my doctor works for my insurance company–a scary conflict of interest.

    ◾Preventative Care = Ordering routine tests, NOT talking about nutrition, stress, or lifestyle issues.
    Even with big HMO’s (I’m looking at you, Kaiser) who could save themselves MILLIONS if they understood nutrition is not calories, in calories out.

    ◾Many of my colleagues warn me they will close their practices when Obama-care is fully implemented
    And do what?

    ◾Patients frequently express anger over impersonal treatment in hospitals, ER’s and specialty offices
    Agreed.

    ◾Many beneficial treatments (ie. Physical Therapy, psychotherapy, acupuncture, nutritional counseling and massage) are NOT covered by insurance or have huge copay’s to discourage usage.
    This needs to change.

    ◾Patients express greater trust in their friends and online resources than health care professionals for health care advice
    Because most health care professionals don’t think outside the box they have allowed insurers and drug companies to put them in.

    With all due respect, there’s an entire population you NEVER see because they are uninsured–often because of a pre-existing condition or working poor who can’t get insurance through their employer and can’t afford their own policies. They cannot afford to come and see you–they are invisible to you. After “Obama Care” begins in 2014, they will have insurance and they will be able to come and see you, instead of waiting for a crisis and going to the ER for very expensive care on all of our dimes. I won’t have to worry that my daughter (who inherited the same genetic condition I have) can never be insured on her own because of a pre-existing condition that is not her fault, and I don’t have to worry about losing my own insurance because my older husband will retire before I do (my insurance comes from his employer–as a self-employed individual, I have been unable to purchase my own policy because of my genetic condition). Why are you against that????

    • William Curtis September 28, 2013, 8:47 am

      Thanks for the thoughtful points. It seems we have similar observations in many areas. I am responding on a few points for the sake of discussion.

      Regarding your comment, “With the exception of requiring insurance companies to cover children of insured parents to age 26, coverage provisions of “Obama-care” have not yet taken effect. Can’t blame Obama care for this. Most insured people still get their insurance from their employers and have no way to afford it on their own. Unemployment and underemployment and the lousy economy we haven’t yet climbed out of are the primary reason.”

      **I would disagree with this assessment. While your correct that many of the “benefits” of the Affordable Health Care Act (Obamacare) have not been fully implemented the healthcare and health insurance industries have long since began changing their behaviors and policies in preparation for the mandates in the law. The unarguable increase in cost and increasing patient responsibility insurers have begun are specifically done to prepare for the inevitable loss of revenue and increased coverage (payments) these companies will make under the law. Our medical office has long been making plans to hopefully make sure we stay solvent and available for patient care in preparation for the Law’s implementation. Businesses also have constrained budgets, minimized expansions, forgone hiring new employees or generally expanding their businesses (hence worsening our economy) precisely because increased expense, regulations, and taxation are anticipated in the 2014 budgets and beyond. I’m not making a political point, I fully accept Obamacare is the “Law of the Land,” but it doesn’t occur in a vacuum and it does cost more money. Business / Healthcare must adapt, and adapt now.

      Regarding your statement

      “◾Insurance carriers and government payers are now indirectly practicing medicine by dictating to patients and physicians what they WILL and WON’T pay for.
      This is not new, it’s been going on for the last 20 years at least. Again, can’t blame Obama for this.”

      **Insurance carriers and government payers are not the same. The insurance game is based on the probability of someone being sick. The greater the risk of disease (You smoke, have diabetes, high blood pressure, cancer, etc.) the obvious statistical increase in the insurance company “paying out” big dollars. Therefore they charge more. (It’s kind of like Vegas, the house never really loses) By mandating that insurance carriers “MUST” pay for pre-existing conditions that takes away the gamble. THEY WILL PAY FOR THE CONDITION THEY NOW KNOW YOU ALREADY HAVE. What do they do? They pass that cost to the patient in the way of higher deductibles (Which is what we’re already seeing now) or higher premiums (Which have already gone up dramatically in anticipation of the Law’s effect).

      Regarding your final comments, I am fully aware of the plight of un-insured and under insured. Your assumption that I don’t treat them or understand their situation is a bit off-base.

      There are a significant group of people in my practice that meet those criteria. I also understand the “Pre-existing condition” dilemma many face. In our county, tens of millions are spent for those individuals, and they do have health care, via Nueces Aid County Health, CHIPS, Medicaid, and Medicare. Those varying safety nets actually do provide care via government payers. It’s not perfect but they do have access to care (and resources from tax-payers to cover their expenses). I agree with your statement we’ve been paying for healthcare for a long time (directly).

      Lastly, your characterization that I’m “Against” coverage or care for folks that are un- or under insured is not accurate. I must point out, the point of the article was not to bash or oppose the Affordable Health Care Act. The point was to inform my readers of interesting changes I see happening in healthcare. Right or wrong. Good or bad. They are valid, from the trenches observations.

      I appreciate your thoughtful answers to my post and I hope you find my response both respectful and informative.

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