Given that most of us would sooner change spouses than doctors, the public’s lack of enthusiasm for the Obama healthcare proposals seems entirely understandable. As I have noted before in this space, most people are crazy about their doctors. You probably have someone in your office who just came back from some near-catastrophic medical procedure. “My doctor was great,” your co-worker might have said. “He explained everything.” As for the cases in which things don’t work out, then — in the worst case outcomes — the patient isn’t talking.
As a small business owner and risk-taking entrepreneur, as well as a 62-year-old male who makes the rounds of various medical practitioners with increasing frequency, I feel compelled to add my own two cents to the medical discussion. My bottom line: My doctors are great, they explain everything, and I wouldn’t want to change a one. But the system that I pay into to acquire all this care is, in a word, sick.
For the past few months I have been on a medical merry-go-round. I had my first colonoscopy a few years ago — it went well and I can’t believe anyone who qualifies doesn’t get one. This year, in addition to my regular six-month cardiology appointment (I have two stents and a subsequent angiogram that revealed a 50 percent blockage), I also underwent a bi-annual nuclear stress test.
I did sufficiently well on this year’s stress test that the cardiologist did not discourage me from seeing an orthopedist to take care of a longstanding knee problem that suddenly got worse.
Along the way I got a notice for my bi-annual dermatological visit (more preventive care); I visited the dentist, who installed a new crown over a tooth that had given up its 50-year-old filling; and I underwent the annual prostate examination. (Not just the PSA blood test, but also the old-fashioned digital exam; don’t rely on the former because you don’t want to suffer the minor indignity of the latter.)
All the doctors (and nurses and nurse-practitioners) seemed thoughtful and deliberative. I wouldn’t want to change a one.
It all sounds great, but if you spend enough time in doctors’ waiting rooms, you begin to realize that some of the wonderful virtues ascribed to our present healthcare system are not all they are cracked up to be.
Critics of health care reform say that if the government is involved in medicine, we won’t be able to choose our own doctor. In the early days of U.S. 1, with a younger staff, a leaner budget, and a bargain basement health insurance plan, we had almost no choice of doctors. We took anyone who would accept the plan.
Under government-financed medicine, the critics say, we will have to wait for the most expensive procedures. Last year I suddenly realized that my kids needed physical exams for their summer jobs. I called one pediatrician after another: all were booked solid for at least a month, well after the jobs began. Finally I called Princeton Primary & Urgent Care on Alexander Road — they squeezed them in within two days. But I was lucky: That practice accepted my insurance, and our current insurance requires no referrals.
Obama talks about streamlining medical record keeping. Here again, I will pay a compliment to our current system: It’s getting better. I no longer have to call my neighborhood pharmacy, CVS, to renew my Zocor, Plavix, Prevacid, Niaspan, Metroprolol, or whatever else I happen to be “on.” And now I don’t even have to call the doctor’s office now for the reauthorization — CVS is doing that for me.
But information flow is one aspect of my otherwise excellent medical care that I would like to see improved. The orthopedist needs the cardiologist to sign off on the knee operations. I schlep the paperwork to the cardiologist’s office, which then asks me when I was last seen and what procedures were done. Shouldn’t they know that? At Princeton Radiology for the MRI, the technician had no source other than me for information on what kind of stents I have and when they were installed. Wouldn’t it be great if I could refer them to a web-based database where they could obtain all data relevant to my health?
Zweena, a company based at 51 Everett Drive, is working on a system of web-based personalized health records. But there are obstacles: formatting data from a wide variety of sources, getting doctors and medical departments to talk to one another (emergency rooms are said to be inefficient in getting records to the main hospital), and — of course — privacy concerns.
Here’s an idea: Allow individuals to opt out of any privacy protection in their pursuit of healthcare. That’s right: No privacy. Put all my records in one place, make them accessible to anyone (especially to all healthcare providers), and I will deal with the fallout.
Why am I so cavalier? First because, unless you are Michael Jackson, no one would care. Second because you can just look at a 62-year-old American male and pretty much guess everything medically he has wrong with him or is about to have wrong with him. And if you can’t guess, just turn on the television and take stock of the commercials.
One downside is that you will get flooded with E-mails trying to sell you something. But hasn’t Viagra already, well, hardened us to that possibility? Another potential downside for a 62-year-old is that a prospective employer might gain access to the records. But I suspect 62-year-old job hunters already carry the burden of their age into many interviews.
Given a freer flow of information, I believe a reformed healthcare system could also be a more efficient system. E-mail communications with doctors and nurses and schedulers would be helpful. Some things are getting easier: This year, five minutes after the MRI on my knee, I was given a CD to take to the doctor’s appointment.
So my plan, though not exactly a paragon of efficiency, is not so bad. And it connects me with a group of highly skilled doctors and nurses working in top-flight facilities.
And what does it cost? Critics of “Obamacare” rail against the 8 percent levy that might be imposed on business owners who don’t provide healthcare for their employees. Just three years ago a single employee in our plan cost $399 a month, or $4,788 a year. Now it’s $562 a month or $6,748 per year — an increase of 41 percent in that period. For a single employee making $50,000 a year our company is now paying an extra 13.5 percent in health costs. And yes, it’s a high deductible plan so that these costs could be worse.
If government will cover workers at 8 percent, that comparison ought to encourage entrepreneurs, not discourage them. In addition, how many would-be entrepreneurs remain stuck in the employ of large corporations because they are afraid of leaving the corporate healthcare safety net? (And how many disgruntled spouses stay married because they don’t want to give up their health coverage and their favorite doctors?)
My patient rounds take me to urologist Sidney Goldfarb, a physician who has more than the usual interest in politics (he ran for Congress as a Republican in 1994). I ask him about the proposed healthcare reforms and he refers me back to the column he wrote for U.S. 1 in January of this year, when readers offered their advice to the incoming President Obama:
“We do need to replace our current health insurance system and managed care disaster with a nonprofit private sector company to transfer payments between patients and doctors,” Goldfarb wrote. “This could be considered a utility company, mutual company owned by the enrollees, or a co-op. The current insurance companies operate with a profit margin of 14 percent and other overhead expenses that total 20 to 40 percent of total premium dollars spent.”
Goldfarb continued: “A new system would get rid of the adversarial billing that we and patients currently experience. A new system should have the patient owning the policy, not the employer. The employer still could subsidize the costs of valued employees as is done currently. This would make the insurance transportable for life and obviate pre-existing conditions. We could then emphasize prevention which eventually would save more money.”
“Malpractice and the fear of a lawsuit on the part of doctors leads them to practice defensively,” Goldfarb wrote. “This cost can only be estimated, but approaches 20 to 25 percent. Most defensive medicine consists of expensive technology, such as MRI and CAT scans. A better system would be mandatory arbitration of all encounters with patients.”
I would have stayed longer to chat with Goldfarb, but he had patients in the waiting room. And back at the house I had another appointment notice from a physician: The gastroenterologist announcing that it has now been five years since that colonoscopy and urging me to schedule another. The medical merry-go-round — like the talk in Washington — continues.