- Del Meyer, MD - https://delmeyer.net -

Managed Care & the Patient

A Fortune 500 company reports that their health plan documents permit them to accept or reject assignments at their discretion. This simple maneuver has saved them millions of dollars. They report, “There is an abundance of evidence correlating fraud and abuse with assignments. . . We see this most commonly in the areas of chiropractic, physical therapy, mental health. . . When we spot what we strongly believe to be billing fraud, one tool available to us is to prospectively disallow assignments to the provider. When we notify a given provider that we will no longer accept assignments, the claim abuse stops on the spot. This particular class of abuse exists because the patient is told that he will not be balance billed and will have the deductible or co-payment waived. In the last 5 or 6 years, since we have used this approach, our plan has saved millions of dollars. Moreover, we have managed to do so with virtually no disruption in patient care. . .” Patient financial responsibility again appears to be the most effective cost-containment tool. But, of course the idea is still so politically incorrect that the company remains anonymous. By extension, all Medicare fraud could be instantly stopped by eliminating Medicare assignment. Why aren’t we interested in saving billions of dollars in alleged fraud and billions more dollars in cost of policing, harassing, and sending doctors into bankruptcy and jail?

The Hastings Center published a report by John Hardwig, “Is There a Duty to Die?” Dr Hardwig, of the Philosophy Department of East Tennessee State University, has previously published, “Dying at the Right Time; Reflections on (Un)Assisted Suicide.” He feels that as medical advances wipe out many of today’s “killer disease,” then one day most of us will survive long enough to become demented or debilitated. These developments, he states, could generate a fairly widespread duty to die. . . I mentioned this to a psychoanalyst, and she responded, “You tell Dr Hardwig that he can go first. . .” A nurse recently told me that they had another patient in their CCICU with a coronary bypass who was so demented that she didn’t recognize her own husband. . . Before non-medical lay people push us into (Un)Assisted suicide (euthanasia) and lawmakers regulate us even more, shouldn’t we as physicians agree that when the brain goes, we should let some of the other organs wear out rather than rejuvenate them?

The International Cellar: Professor Richard Epstein, a law professor at Chicago University, feels that more people will have access to health care in an unregulated medical environment than with all the helpful legislation that is being passed. Why do we support universal access when some very learned minds feel it will actually decrease access? . . . Epstein also presented data indicating that poor people were experiencing a higher rate of increase in income than the wealthy for the first two-thirds of this century until the federal “War on Poverty” came into being, since which time the rich got richer and the poor got poorer. . . Since the federal government added a department of education and has gotten involved in primary and secondary education, the best and the brightest of our high school seniors have now slipped to near the international cellar in math and science. Parents and leaky roofs are being blamed. . . Shouldn’t our profession recognize that government help will place American Healthcare into the International Cellar?

The impact of regulation is more commonly misunderstood. The portability provision of the Kassebaum-Kennedy legislation was predicted to raise insurance rates by only 2 to 3%. According to the Government Accounting Office, the increases by five different carriers ranged between 29 and 125%. Moreover, these were standard rates that applied to generally healthy individuals; carriers might charge higher rates to unhealthy individuals. The premium hikes will only get worse as healthy people flee. . . One of the scenarios that Hardwig referred to in the aforementioned “Duty to Die” was that losing all your savings, your home, and your career at age 55 was worse than a 50 percent chance of six more months of life at age 87. . . Maybe the end result of all medical regulation will be that doctors will want to be euthanized. . . Getting rid of the excess doctors should make a lot of people happy–of course then they would be left to deal with all the lawyers and insurance carriers without a buffer. Maybe they’d want us back.