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Phil Rizzo: Profit motive haunts healthy health care

Full Speed to Port!

Posted: June 23, 2009 7:34 p.m.
Updated: June 24, 2009 4:30 a.m.
 

When I was a kid waaaay back in the late 1920s and early ’30s, when you were sick of all crazy things — you just went to your doctor.

And if your ailment required it the doctor would, without fanfare, come to your house. (That practice is the butt of jokes today, but imagine this: Doctors in the French health care system actually make house calls.)

I recall that when the office visit was over, Dr. O’Connor asked for one or two dollars, or if he was aware you were struggling, as many were in the Depression, he might say, “Forget it. I’ll get you next time.”

Today, “I’ll get you next time” means your medical insurance will be cancelled just as soon as your latest claim is paid.

There were no medical-insurance companies back then to deny you care on some arbitrary issue and force you into bankruptcy.

There was just you and your doctor, who came from compassion, not mainly profit.

So what’s happened in the intervening years, from when I was very young to now, moderately mature?

Well, we know for sure that health care costs have been rising faster than inflation. We also know that industry promises to get control of costs have ended up in the bedpan, time and again.

Americans, strapped and going broke paying unaffordable medical bills, now widely clamor for health care reform.

With 50 million now uninsured and rapidly rising, and the rest of us ill with fear, the idea of serious health reform has entered its time.

Another thing that’s happened since I was a kid is that most other Western democracies initiated universal health care of one sort or another.

But in America, universal care has heretofore been opposed at home, largely influenced by intensive insurance company marketing and lobbying, as most universal plans would severely put the hurt on their profits.

A major stumbling block on our way to reform is that most purveyors of products and services in America’s health care industry run their services primarily with an eye to profit, rather than focusing on the patient’s needs and care.

So, with profit-motive drivers, the U.S. ends up with the most expensive medicine in the world.

I’m not opposed to profit, but when the profit motive becomes a giant national suicide bomb, a grand effort must be made to halt our fiscal trauma and heal our bleeding bank accounts.

We know a lot about health care costs because Medicare tracks all that.

The variance in geographical per capita expense is astronomical. McAllen, Texas is one of the most expensive health care markets in the country.

Yearly Medicare costs per enrollee were recently $15,000 — twice the national average. Yet the care was not stellar when compared to El Paso, with a per capita average of $7,504.

Doctors in McAllen prescribe dozens of unneeded tests and procedures, even though malpractice lawsuits are limited in Texas.

They’re not practicing defensive medicine; rather, they’re keeping their eyes on maximizing profit from their practices.

Let’s make it clear that not all doctors are guilty of making care secondary to profit. But in some respects, many are trapped in a system requiring them to act in strong self-interest.

We know profit-based capitalism works very well. But it is sometimes abused, as we’ve witnessed in outcomes as diverse as the current financial meltdown to runaway utility bills.

Even our own personal fiscal responsibility can be corrupted when we ignore our effect by accepting excessive care since “our insurance company is paying the bill.”

Consider asking your doctor the cost of any tests, procedures or therapies suggested for you, and what they are meant to accomplish.  
If he or she comes from the heart rather than the pocketbook, they’ll be glad you’re interested in your treatment.

While you may have insurance and don’t pay for things directly, all of us pay indirectly when excessive tests are prescribed. Do you really need that next expensive test, or is it just more “piling on for profit?”

We can’t go back to the ’30s and ’40s, but we need to recover the kind of connections patients had with doctors.

We need the accent to be on compassion and care, instead of the bottom line.

Focusing on efficient results, rather than profit, should be the first order of health care reform as we seek to make health care affordable — and universal.

Phil Rizzo is a Santa Clarita resident. His column reflects his own views and not necessarily those of The Signal. “Full Speed to Port!” appears Wednesdays in The Signal.

 

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