Dear US Healthcare workers: I don’t really hate you. I’m sorry I said that. The vast majority of healthcare workers are kind and wonderful people; there because they really want to help.
I still have bad experiences though, and I marvel at that: almost everyone involved is a good person. People are trying their best. Yet for me, results seem 50/50 at best. Statistically, my criticisms of US healthcare are valid: we really do pay twice as much per capita as every other civilized country for healthcare, yet have some of the worst outcomes.
I have my opinions about why: Our chosen cost control and fraud prevention mechanism has become the fraud, and cost, in the system.
It all started with Ross Perot back in the 70’s. Medicare hired his (at the time) tiny little firm, EDS, to implement an electronic record keeping system. Back in the infancy of computing, memory was expensive. A coding system was implemented to represent descriptions of things to save memory. It was also implemented as a cost control measure; since it was all standardized, and computerized, they could easily search for and reject procedures that didn’t “match” with diagnostic codes, and reject any other errors or perceived discrepancies as well.
This government contract is where Ross Perot got all his money.
The private insurance industry quickly followed suit. Almost immediately, administrative warfare developed. Doctors and institutions had to hire staff to code and submit claims; insurance companies hired legions of claims processors to scrutinize and deny anything they could. The grain and complexity of the coding system quickly multiplied with growing computing ability and everyone’s vested interest in trying to either get paid, or not pay, for every little thing.
Today, this is known as the ICD-X coding system, where X is the current version. We are currently transitioning from ICD-9 to ICD-10. In this dictionary of medical procedure codes is virtually every single individual pill, poke, prod, pad, process, procedure, etc. that exists in the medical world. And it all has to be tracked, submitted, scrutinized, rejected, argued about, resubmitted… every. tiny. little. detail. This is why a tylenol costs $10 at a hospital; the pill is dirt cheap, but… the tracking of it is insanely expensive.
Today, this administrative warfare costs us about 25% of our total healthcare bill. What was supposed to prevent fraud and waste, has become the fraud, waste, and useless expense in our system.
What’s worse, the system seems to have grown to absolute dominance. Everybody is trapped in the belly of this beast. This is why, despite the best intentions of the vast majority of healthcare peeps, the outcomes remain poor.
I am sorry I spoke so harshly about so many people trapped in the belly of the beast. I do not hate any of you; you are truly wonderful people.
I just want the beast to die, and for all of us freed from the madness.