The crime scene is the US healthcare system scattered in clinics, private practices, and hospitals throughout the country. The system lies in tatters on the ground with evident footprints of politicians and executives nearby. Looking for a weapon is difficult because there are many, from the legislation that turned patients into data bytes and health maintenance organizations whose sharp sword of insurance denials left behind many victims. The malignancy of healthcare delivery now looks more like a CSI rather than a healing soul.
Doctors sit next to the bodies of the victims, with hands and feet tied. Their attempts to order tests and prescribe medications denied. Their patients may be ill, but there is no way the insurance company will untie their hands to save their patients because it costs too much. And duct tape is wound tightly across their mouths, stifling out any sound. Their voices may disrupt the agendas of the health insurance companies and that would be disastrous, for those corporate executives at least.
Patients are the victims of these executive games and political agendas. Filled with illness or despair, they seek help from their physicians. But, when they catch a glimpse of hope, the guilty parties deny them their wellness. Remaining ill and not knowing why seems to be more profitable to them.
Why are Patients Victims?
- Under the ACA (Affordable Care Act), patients are forced to purchase health insurance or face tax penalties. Many simply cannot afford it.
- Many of the insurance plans that rolled out in the health insurance exchanges under the ACA carry very high deductible. Patients must pay insurance premiums, by law, and then the insurance company (who they are paying) does not pay anything until the deductible is met. Many are so high the insurance company does not pay anything at all.
- Even when a doctor prescribes a medication for a patient or orders a diagnostic test, there is no guarantee that it will happen. In this industry these days, many of these services are denied. In essence, the patient is paying for an insurance premium to be denied medical care.
- Patients do not hold any sway in these decisions. The health insurance employees know best.
- Medicine is a profitable business. Many people try to manipulate the patients in a way to make increased profits. If a doctor were to do this, we would be called greedy. If an insurance company does this, they are doing business.
- ‘While most doctors advocate for the needs of their patients, there are not many willing to stand up for them. Who is going to help them when all appeals are exhausted and there remain no more options?
- The system that they are navigating is near impossible to follow. There is no healthcare GPS or maps available. In fact, if you call the insurance company for answers, they often do not know either. Patients are just lost in the system. And those in control are doing nothing to help find them.
- Politicians play political games with Americans health. Mandates spew out of the halls of Congress dictating how the healthcare system should run in the US. These decisions are made out of financial considerations and political needs. Patient well-being is left out of the equation.
Medicine rapidly evolves with innovations and new treatments being constantly discovered. Yet, while more medical alternatives become available, patients are being more and more limited in their ability to gain access to them. Unless something changes, it will only get worse until a true crisis develops. For now, the victim is alive and breathing. Blood rolls down the sides of the afflicted creature and it lies weakly on the stone cold ground. Hope exists as the medics arrive. Will the US system survive? Or is a meltdown inevitable?
Dr. Linda Girgis MD, FAAFP, is a family physician in South River, New Jersey. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year. Over the course of her practice, Dr. Girgis has continued to earn awards and recognition from her peers and a variety of industry bodies, including: Patients’ Choice Award, 2011-2012, Compassionate Doctor Recognition, 2011-2012. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.