On Healthcare

I watched The Daily Show last night (Aug 20th episode), and while I usually like Jon Stewart, he really annoyed me this time. I was excited to watch it because it was about health care reform, but he just talked over his guest and disagreed with everything she said. It's ok to disagree, but gosh, if you have a guest, at least let them speak their opinion before you disagree. 

He just couldn't believe that there could be such a thing as a sliding-scale payment system for doctors that depends on how closely the government's recommendations are followed. And while I agree that the idea is absurd, it actually is already happening.

When I worked in the family practice, it went like this: The insurance companies pay doctors on a tiered pay scale. If your patient shows up for all the suggested well-visits, follow-ups, etc, you get paid almost (although not quite) what you charge. If they don't, your pay drops, and if they really don't ever show up and then just come once, your pay is basically crap. 

While I understand the incentive to get patients to be healthy (although I seriously disagree that going to a doctor suggests you're healthier), it really is an unfair system. We had patients who we'd call a dozen times, schedule a dozen appointments, and they'd either cancel or no-show all of them. Then the doctor and the office manager would meet with the insurance company, show the insurance rep the patient's record of no-shows, and beg to get paid. 

The big whoop about all of this, of course, stems from the fact that in this healthcare bill, one on the things on the list that doctors must do is discuss end of life choices, and they will get a higher pay scale if you sign a living will. This isn't necessarily a bad thing. The tricky part is that you can't change it. So, if Josh signed a DNR tomorrow (Do Not Resucitate), and then had a car accident the next day, and the doctor said to me, "I really think that he's going to be ok, but we're going to have to put him on a ventilator for a little while," according to the government health care plan, I would not have the option to do it because Josh had signed "no."

All that said, I think that our problem is not healthcare, but culture. We rely on doctors for too much of our health, we are so scared of death, and we refuse to take responsibility for ourselves. Have a headache? Take a pill. Having a baby? Don't worry, we'll do it all for you.

Personally, I'd like to read this heathcare bill. After all, I'm going to be paying for it.