Wednesday, February 17, 2016

Why the healthcare and health insurance industry in the United States is screwed

A little more then 2 years since my last post, It's been a long hiatus but it's time to get back on the horse and blog.

Some of my best and most visited posts have been when I share personal experiences so that's what I'm going to do today. I want to share a healthcare service issue I've been dealing with for my two year old daughter. It's small potatoes as far as I'm concerned but I think it properly illustrates just how messed up our current health care/insurance system is and why we may all be better off without any health insurance at all.

My little one has had a couple of issues with her arm. I'm told it's commonly called nursemaid's elbow. Basically it's a minor dislocation of the forearm, really nothing major but it's painful and for a parent of a two year old it can be a little scary to see your child in pain. Her mother has had this issue with her once before so I was not completely unaware of what was going on, but seeing your child cry is still never easy so when it happened while we were playing I got nervous and took her to a walk-in health provider just a few block away from my house.
Upon arrival after checking in which took 10 to 15 minutes we were waiting in the waiting area for another 10 to 15 minutes before they called us in. Then after being shown to a room we waited again for about 10 minutes before we saw the doctor, the pediatrician. It took me about 5 minutes to explain the situation and her history and he began to rotate my daughters arm, at which point she stopped crying. Correcting this Nursemaids elbow "dislocation" is actually quite easy and if I had know this prior, I could have done it myself. The Doctor then spent about 5 minutes explaining to my how important it was to be careful while playing with a toddler and asked if she had any other issues, at which point I said no and he didn't think there was any reason for even an x-ray. He weighed her and checked her temp and sent us on our way. The whole time with the Doctor in total was about 20 minutes.

Now the real fun begins.

About 2 months later I get the first bill, from the wrong insurance company, because this health provider apparently submitted it to my old insurance, rather then the new insurance even though I gave them all the information at check-in. It took 5 months to get this part cleared up by the way... But more disturbing then that is the amount of money we are talking about. The Health Provider (Carle Clinic) is charging Blue Cross Blue Shield $97 for the visit, and $650 for what they are calling "surgery". I spoke to them about this, that I felt the amount seemed rather high and was probably inaccurate, but alas, this is the final determination. the $747 bill is correct and the billing code, "surgery" is what they call this type of service. They finally get the insurance billing part corrected so at least Carle is not coming after my ex-wife or I for $747, but now I am only responsible to pay $50. Remember I only spent 20 minutes with an actual Doctor and all he did, literally, was rotate her little arm. No x-ray, no medicine, no tests and certainly no cutting or stitching or anything like that.

Let's break this down, shall we. If a health care provider is billing $747 for each 20 minutes worth of work their doctors do. I'm going to be conservative and assume that the doctors are not spending 100% of their time seeing patients, so I'll assume a doctor is only able to see 3 patients an hour. Of course we all know that they probably see many more times this in a busy clinic or office, but let's keep the math somewhat simple. If a doctor is working an 8 hour day, they would see 24 patients in a day. That means they would be billing almost $18,000 for one doctor in one 8 hour day. Now obviously, some visits are going to be more complicated, but I can't imagine they would be less complicated then this visit. Again, he literally rotated her arm and we spent less then 20 minutes with him. I feel I should add, that he was really a nice man, and seemed like he was really a good doctor, but he spent 20 minutes of his time with us, and most of that time he was talking to me.

Let assume that Carle has 12 Doctors on duty in a day, I know they have more and less depending on demand, but on average this is probably pretty close. And they are open longer then 8 hours, but let's assume for the sake of argument that they only work a doctor for an 8 hour day, and they only see 24 people... (LOL) that would mean they are billing north of $200,000 a day just for regular visits. This doesn't include all the other services they perform. Sounds like a pretty good deal huh. Well no one ever said Doctors were poor right? After all they do deserve to make a good living, I'm not knocking them for that and Carle deserves to make a profit, after all they are paying the bills to have a clean and safe facility. And this is why we have insurance right? But wait a minute, what about the actual costs? I mean it's well know that Doctors make good money, but are they all millionaires and Billionaires? $200,000 a day means this little facility in a town of less then 30,0000 peps, is billing $72,000,000 (that's 72 Million to those who learned common core math) to insurance companies in a year, and remember this is a conservative number.

According to all the benchmarks Doctors make about $200,000 a year, on average, Obviously some make more and some make less, but this is taking all the listed areas and specialties on payscale and and does not include Boutique or emergency services and the like. Plain jane medical doctors, nothing more nothing less. Now let's look at what they could be making...

Remember I'm still responsible for $50 out of my own pocket, because insurance is a good thing right? Well imagine if instead of going to see Carle that day, I went to go see Doctor NiceMan, at his own private practice out of the living room of his own home and I paid Doctor NiceMan $50. Now let's assume Doctor NiceMan only works Monday through Friday and only works 8 hours a day and only sees the same 3 patients an hour. Doctor NiceMan would be working 260 days in a year and would be making $312,000.00 Not bad, over 100,000 over the national average. Now keep in mind Dr. NiceMan is really a nice man and he might not charge everyone $50, maybe he only charges $30 to some people or even donates some of his time to those less fortunate or takes trade for his services. Oh wait, that would be illegal according to our government overseers. Oh well...

So why do we have health insurance again?



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