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Personal experiences as a health care consumer in the last two and a half years have significantly changed my perspectives about the health care system in the U.S. From the beginning of these experiences I have realized that, at most, they represent a microscopic view, perhaps better a very high-powered electron microscopic view, of the health care industry. Whether or not anything I put forth with regard to these experiences can be extrapolated to indicate there is widespread similar occurrences, I certainly do not know, but I suspicion the answer is, “Yes.” Being one of cynical disposition, I would bet that my experiences are not uncommon if the truth were known, but that certainly is conjecture and based primarily upon some knowledge of man’s propensity for greed.
I have questioned whether or not some of the points I hope to make are appropriate to iTulip; however, just over a week ago Jane Burns contributed a commentary titled, “Wealth De-redistribution. Can Luxury Taxes Diffuse the Medicare Time Bomb?” http://www.itulip.com/forums/showthread.php?t=930&highlight=Jane+Burns in which she noted, “It is hard to picture an undiminished Medicare, which is the financial time bomb, not Social Security.” I take her comment as license to discuss some aspects of health care, not just Medicare, because as time progresses, also I see the problems of the costs of all health care as she stated: a “financial time bomb.”
During most of my life those immediately around me (specifically my family while I was growing up and three wives so far over the duration) and I have not been large consumers of health care. Compared to many, we have been fortunate to be mostly healthy. Probably the biggest expenses for health care in my family until my younger sister completed orthodontic care were costs associated with dental care for two sisters and myself—growing up back then without fluoridated water, we had lots of cavities. Otherwise, infrequently did my family create expenses to doctors for anything. In part, I became dentist because of my experiences of being a dental patient as a teenager.
By virtue of having been a dental student, then in the Navy, a resident in oral surgery, and finally an oral surgeon, when a wife or I required medical or dental care it was rendered to us while in the Navy as a benefit, then later on the basis of professional courtesy plus whatever our insurance paid the physician when the care was medical. Other than the costs of purchasing health insurance usually with low deductibles, my life has been sheltered from direct knowledge of the costs for receiving care as perhaps experienced by average Americans. I was always spared the knowledge of what were the costs associated with whatever care was provided by other dentists or physicians. I had the relatively minor misfortune of having three hospitalizations for knee cartilage problems and never saw the bills from the orthopedic surgeons, the anesthesiologists, or the hospital. They all took whatever my insurance paid and wrote off the rest. Was my experience with the costs of health care sheltered or not? Other than the knowledge of what I charged for care in my practice, as I see things, I absolutely was very sheltered. It always struck me as uncouth and intrusive to broach the subject of costs by possibly having asked a colleague, “What would this cost me or us were it not for your professional courtesy?”
Near the end of 2004 my sheltered life changed, from the experience of mostly having been a health care provider to that of the experience of what I imagine to be an average American seeking and receiving health care, when my wife for no apparent reason developed a progressive paralysis in some of the muscles in her dominant left hand. As now, we then lived in Fort Worth, a city in which I never practiced and thus had no intimate knowledge of who might or who might not be a good doctor. I don’t know when along life’s path it became obvious to me that all health care providers are not equal in knowledge, skill, or dedication, but it is a fact in my mind that they are not all “good” in these senses. So no mistake is made about what I am writing, I am referencing only the U.S.
My wife’s search for care did not become a personal experience for me until at her request I accompanied her to a follow up visit to a neurologist to discuss the results of nerve and muscle stimulation tests that the neurologist had recommended and performed (it turned out in part) after his initial evaluation of her problem. It was at this follow up visit that I became intimately aware of another variable in what constitutes the definition of a “good” health care provider and that was whether or not a provider will commit fraud in the submission of insurance claims to health insurance companies, or to reduce the variable to a word: honesty.
The interested reader can peruse Blue Cross Blue Shield of Tennessee’s website Fight Fraud http://www.bcbst.com/fraud/ to gain a bit of insight from an insurance company's perspective. This site must certainly insinuate that the insurance industry appears to be dedicated to removing the cost of fraud from being a part of the total expense of health care.
So as hopefully not to make this opening post so long as to create no interest or possible educational benefit to readers, I intend by the time I am finished with subsequent posts to demonstrate how easy it is for health care providers to commit insurance fraud. I shall explain how in my opinion for one who is a medical layperson it is almost impossible to detect such fraud, and finally to recount the total waste of time I experienced in trying to seek remedy for instances of clear insurance fraud through my wife’s insurance company, the Texas State Insurance Commissioner, the Texas State Board of Medical Examiners, the Governor of Texas, and my failure to arouse any interest from the editor of Fort Worth’s newspaper as to the significance of this problem. None of this is about the personal loss of some dollars by us. It is all about calling to attention another aspect of what is wrong with American health care and why in my opinion the system must be changed.
If you have any interest, please stay tuned.
I have questioned whether or not some of the points I hope to make are appropriate to iTulip; however, just over a week ago Jane Burns contributed a commentary titled, “Wealth De-redistribution. Can Luxury Taxes Diffuse the Medicare Time Bomb?” http://www.itulip.com/forums/showthread.php?t=930&highlight=Jane+Burns in which she noted, “It is hard to picture an undiminished Medicare, which is the financial time bomb, not Social Security.” I take her comment as license to discuss some aspects of health care, not just Medicare, because as time progresses, also I see the problems of the costs of all health care as she stated: a “financial time bomb.”
During most of my life those immediately around me (specifically my family while I was growing up and three wives so far over the duration) and I have not been large consumers of health care. Compared to many, we have been fortunate to be mostly healthy. Probably the biggest expenses for health care in my family until my younger sister completed orthodontic care were costs associated with dental care for two sisters and myself—growing up back then without fluoridated water, we had lots of cavities. Otherwise, infrequently did my family create expenses to doctors for anything. In part, I became dentist because of my experiences of being a dental patient as a teenager.
By virtue of having been a dental student, then in the Navy, a resident in oral surgery, and finally an oral surgeon, when a wife or I required medical or dental care it was rendered to us while in the Navy as a benefit, then later on the basis of professional courtesy plus whatever our insurance paid the physician when the care was medical. Other than the costs of purchasing health insurance usually with low deductibles, my life has been sheltered from direct knowledge of the costs for receiving care as perhaps experienced by average Americans. I was always spared the knowledge of what were the costs associated with whatever care was provided by other dentists or physicians. I had the relatively minor misfortune of having three hospitalizations for knee cartilage problems and never saw the bills from the orthopedic surgeons, the anesthesiologists, or the hospital. They all took whatever my insurance paid and wrote off the rest. Was my experience with the costs of health care sheltered or not? Other than the knowledge of what I charged for care in my practice, as I see things, I absolutely was very sheltered. It always struck me as uncouth and intrusive to broach the subject of costs by possibly having asked a colleague, “What would this cost me or us were it not for your professional courtesy?”
Near the end of 2004 my sheltered life changed, from the experience of mostly having been a health care provider to that of the experience of what I imagine to be an average American seeking and receiving health care, when my wife for no apparent reason developed a progressive paralysis in some of the muscles in her dominant left hand. As now, we then lived in Fort Worth, a city in which I never practiced and thus had no intimate knowledge of who might or who might not be a good doctor. I don’t know when along life’s path it became obvious to me that all health care providers are not equal in knowledge, skill, or dedication, but it is a fact in my mind that they are not all “good” in these senses. So no mistake is made about what I am writing, I am referencing only the U.S.
My wife’s search for care did not become a personal experience for me until at her request I accompanied her to a follow up visit to a neurologist to discuss the results of nerve and muscle stimulation tests that the neurologist had recommended and performed (it turned out in part) after his initial evaluation of her problem. It was at this follow up visit that I became intimately aware of another variable in what constitutes the definition of a “good” health care provider and that was whether or not a provider will commit fraud in the submission of insurance claims to health insurance companies, or to reduce the variable to a word: honesty.
The interested reader can peruse Blue Cross Blue Shield of Tennessee’s website Fight Fraud http://www.bcbst.com/fraud/ to gain a bit of insight from an insurance company's perspective. This site must certainly insinuate that the insurance industry appears to be dedicated to removing the cost of fraud from being a part of the total expense of health care.
So as hopefully not to make this opening post so long as to create no interest or possible educational benefit to readers, I intend by the time I am finished with subsequent posts to demonstrate how easy it is for health care providers to commit insurance fraud. I shall explain how in my opinion for one who is a medical layperson it is almost impossible to detect such fraud, and finally to recount the total waste of time I experienced in trying to seek remedy for instances of clear insurance fraud through my wife’s insurance company, the Texas State Insurance Commissioner, the Texas State Board of Medical Examiners, the Governor of Texas, and my failure to arouse any interest from the editor of Fort Worth’s newspaper as to the significance of this problem. None of this is about the personal loss of some dollars by us. It is all about calling to attention another aspect of what is wrong with American health care and why in my opinion the system must be changed.
If you have any interest, please stay tuned.
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