What I Do Know

Pardon me while I adjust my soapbox. This month's dissertation is serious. (I'm not all sarcasml, you know.)

I listen to and read all about what politicians- currently in office, and hopefuls- have to say about healthcare. As a nurse working well before "managed care", at the beginning of it and still in the game, with some considerable time on both the insurance and the hospital side, gives me some credence, I feel.

First off, to those who think the doctors should be able to do what they want without any outside input, I'f like to remind people why we got managed care in the first place. Duh, because we were bleeding money.

So, OK, things are a mess, today. WHO should we blame? The doctors? Insurance companies? Consumers? Legislators? Hospitals? Answer: ALL of The Above.

DOCTORS I'd like to believe that most doctors want to do what's right for their patients. And I've met some terrific, smart, compassionate ones. But....there are those who do unnecessary surgeries, tests etc or refer patients to entities that they have financial interests in. Some do not practice efficient medicine. For example, a patient could go home today, but the doctor hasn't written the order, and can't or won't be reached by the nurse trying to get that order. I've been told the doctor has to see x number of patients that day because "the insurance company says." Can anyone possibly be buying this? Or, is it really that the doctor needs to see that many in order to keep up his/her lifestyle. Lots of things get blamed on the insurance company. It's not unheard of for doctors to send requests for absolutely stupid surgeries or treatments for the express purpose of having insurance deny so they won't have to be the heavies. I believe doctors should have a decent income consistent with their education, long hours and responsibilities, but not millions and millions...

INSURANCE COMPANIES Insurance companies actually have to "credential" physicians and organizations before they accept them. At least there's some accountability. And they do use guidelines developed by medical experts. Negative decisions can be reviewed and overturned by a neutral party. But companies are only as good as their employees, and navigating the process can be frustrating and confusion. Also, some upper management can make processes so hard that the consumer wants to give up sometimes. Also, if your policy is thru an employer, READ it. Some things may not be covered . PERIOD. So, no matter how much you need a kidney transplant, if your employer did not buy that coverage, you're out of luck. P.S. If you think insurance is expensive, try getting care without it!
HOSPITALS I kinds feel sorry for them. In order to stay in business, most must contract with managed care/insurance companies for greatly discounted rates. At the same time, they must treat the uninsured AND find a safe place for them to go when they're discharged. Which happens more than you think.... They must be, and they are, learning to be more efficient. I'll insert nurses here: they MUST learn the importance of efficient nursing - including prompt follow-through on orders for tests, consults, etc. At the same time, I see more, and more work and paperwork piled on nurses.....

LEGISLATORS GET a clue! Do something with our crazy sue-crazed climate so there'll be less paperwork, and fewer tests that doctors feel they must order to protect themselves. Realize that "tax credits" will not encourage the poor to buy health insurance:they would rather have food on the table and a car that runs. Revamp Medicaid so that there is no loophole that allows children born in this country of foreign students, etc can not be covered while their parents are allowed to fly back and forth to their own countries for a holiday. And make Medicaid recipients more responsible for knowing what the rules are: they get away with stuff that our private insurers would never allow us to do.

ALL OF US We need to stop acting like our healthcare has nothing to do with us. The days of "doctor knows best" are over! Stop thinking, I don't care how much it costs; my insurance will pay for it. Stop being taken in by the drug ads on TV. My insurance company recently denied a medication for a similar generic one, with the understanding that if the generic didn't work, the doctor could write a explanation and request the first one. Sounded sensible to me. If your insurance company requests a second opinion, be thankful. At least consider it might not be a bad idea. If the doctor suggests an expensive test, medicine, surgery, ask if there are alternatives. Check your bills (A piece of equipment was paid for twice by my insurance. I'm going to let them know. Also, if you have skin cancer (and I'm sorry if you do) don't insist on being sent to the premier cancer center in the country. Save your request for something really rare.
I'm getting off my soapbox now. Hope somebody will comment....