Steven Brill’s March 4 article in Time, “Bitter Pill: Why medical bills are killing us,” puts the microscope on healthcare, one of the most important issues of our time. The article chronicles his careful research into medical costs. He investigates surgery, medication, non-surgical procedures, supplies, medical devices, hospital stays, professional costs and payments. His report renders a damning conclusion. I am by no means an expert on healthcare financing or hospital administration. But, like Mr. Brill, I have studied and published articles about the demise of our healthcare system for a number of years. (Please visit my website to download my published articles—http://www.drpeggyrothbaum.com; click on WRITER)
I would like to refocus the lens a bit. A few years ago, I wrote about how our overused, underfunded hospitals are dying. They aren’t what they used to be, and that fact hasn’t improved in the intervening years since I first wrote about it. A close look at a day in the life of a hospital, particularly an urban hospital, reveals that our hospitals are mostly a combination of nursing home, mental health center, drug rehab, specialty clinic and primary-care drop in center. It’s killing them. Not having spent the amount of time as Mr. Brill researching hospital financing, I can’t comment on the price of an acetaminophen tablet, how the hospital bills break down, or how the cost of training professionals is covered, or overhead. I can tell you, however, that what goes on every day in our hospitals is alarming. In short: The pill is even more bitter than you think.
A large part of the problem is payment. Insurance companies don’t want to pay for benefits that we have purchased and therefore are entitled, or should be entitled, to access. There are cuts in government programs that used to fund physician training as well as healthcare for poor patients. There are those of us who refuse to work, refuse regular healthcare, do things that harm the rest of us, make destructive decisions, and of course, “medical tourists.” Currently, healthcare, often via “charity care” can be received by anyone, often by going to a hospital emergency room. The working poor, the barely middle class, or the working but currently unemployed, are often in worse shape than those on public assistance. They are held responsible for co-payments of often inadequate health insurance policies. These payment issues affect hospitals, outpatient psychotherapy, and practicing physicians.
When I talk with my physician colleagues about why they too often keep silent about money, I get interesting answers. Many of them tell me that they are too busy in their offices taking care of their patients and trying to keep afloat financially. They often say that they went into medicine to help people, and find it disillusioning to be expected to participate in the political process. Some of them have told me that the hopelessness of our current situation is overwhelming. Some of the “Letters” in the March 18 issue of Time, responding to Mr. Brill’s article, or other responses easily found on the internet, address these points. Mr. Brill touches on them. But they need careful investigation and the findings need to be coordinated with some of Mr. Brill’s findings.
I just co-authored an article presenting data from the New Jersey Psychological Association (“NJPA”) Insurance Complaint Registry (“ICR”). The website, http://www.speakyourmindnj.org, states that “New Jersey’s largest health insurance plan routinely delays or denies access to outpatient mental health services, asks therapists to disclose confidential patient information, and spends up to half of every dollar on administration and profits instead of patient care.” Patients (consumers) and psychologists are invited to “register complaints about your insurance company” using the ICR. People have been affected by the mismanagement of outpatient mental health care and it needs to be documented.
We reported in our article that there are currently 215 complaint entries by providers and 86 complaint entries by consumers, each reporting multiple examples of negative experiences with insurance companies that illustrate how access is restricted, necessary care is denied and approved treatment is withheld.
So far, 51 percent of ICR entries are related to Horizon Blue Cross Blue Shield (BCBS) NJ Direct. Other complaints include other BCBS plans, Cigna, Aetna, Oxford and United Healthcare. Overall, 69 percent of all complaints are related to Horizon Blue Cross Blue Shield.
So part of the problem is the insurance companies. And part of the problem is us. We don’t want to pay either, or at the very least, we want a discount that does not take into account the human and financial costs of professional training, running a practice, working extraordinary numbers of hours, or performing with the demands, risks and sacrifices of healthcare delivery. In addition, we want perfection. Excellence and good faith efforts are not good enough for us. We have so much resentment built up towards doctors, juxtaposed with completely unrealistic expectations for what they can do. We expect high performance for “those rich doctors,” who actually have decreasing incomes and the work under the pressure of ever looming threats of malpractice suits and with the burden of uncompensated time spent dealing with time-wasting, unnecessary health insurance nonsense. We want inexpensive quick psychotherapy fixes. It’s hard to work under those circumstances, and fewer of our best and brightest are willing to do it. Again, Mr. Brill mentions some of these concerns, but the focus needs to shift to magnify them.
Somehow, we ignore the human part of the healthcare crisis. Of course there is incompetence and waste. Unfortunately, this is part of our consumer culture. It needs to be addressed. But until we see that the healthcare system is populated with many dedicated professionals, until we all take more responsibility for ourselves in terms of our healthcare and payment, and until the insurance companies are properly regulated, healthcare is going to continue to be a bitter pill to swallow in so very many ways.
Peggy A. Rothbaum, Ph.D., is a psychologist, writer, researcher, and consultant based in Westfield, NJ. Visit her website at www.drpeggyrothbaum.com.