In 2013, the CEO of Aetna earned $33.7 million dollars. The average health insurance CEO salary was over $10 million in that same time period. While many will say that is capitalism at work, I really wonder, as I fight to get another MRI covered for a patient, how many MRI’s were denied to generate that kind of salary? And 2014 saw great increases in member enrollment in insurance plans under the ACA. Profits for these plans jumped up 10’s of millions of dollars.
My patients are suffering. They cannot afford the premiums they are now forced to pay, often against their will. They cannot afford the high deductibles most of these plans now carry. I have seen patients decide between two needed medications and which of their family members was the sickest to take to the doctor. They could not afford both.
Every day, I am seeing more and more diagnostic tests and procedures being denied by insurance companies. I spend hours a week fighting these denials. Most insurance companies have now limited their formularies to exclusively generics. And even so, the expensive generics, such as life-saving asthma inhalers, are being denied.
My patients are struggling to afford their healthcare. Many are suffering from bad medical consequences because they cannot afford to get the medical care that they need. I have sent more than one asthmatic patient to the ER who had a severe exacerbation of their disease because their inhaler was too expensive and no longer covered by their insurance plan.
“We need to consider cost but not at the expense of the patient.”
While patients are struggling to get care, the insurance companies are making obscene profits. The CEO’s of these companies make salaries like few other industries. Surely, a financial conflict of interest must exist to deny medical care? Yet, there is no one regulating the insurance companies. They hold free rein in what they approve and disallow. They ignore the medical advice doctors give their own patients and override their decisions. Yet, they are protected from liability.
As more and more care gets denied, the quality of our entire healthcare system is degraded. When I see a patient for a 15 minute visit and then spend days trying to get their medication approved, our priorities have been misplaced. When the insurance company over-rides my clinical acumen based on their predetermined guidelines, medicine and science is tossed out the window to contain costs. There needs to be a collaborative effort to reduce healthcare spending but not at the cost of the well-being of patients.
In our system, patients have now become seen as consumers. While getting them to be advocates for themselves is a great thing, their humanity is getting lost in the process. Having a hip replacement is not the same as shopping for a set of kitchen knives at Walmart. They need to be respected as more than just consumers. So many people talk about Big Data these days. Patients are more than just their medical information. They are real people with real needs and no two of them are exactly alike.
Corporate greed, especially of health insurance companies, is destroying our healthcare system and the medical well-being of patients everywhere. We need to put the person back in the patient and get corporate decisions out of the exam room. Medical decisions need to be decided on the best interests of each individual patient, whether or not they fit onto the insurance companies clinical pathways. We need to consider cost but not at the expense of the patient. Doctors’ decisions serve the best interests of our patients, and we need to be able to practice medicine, not comply with regulations. Do we really want bargain basement medicine or is it time to restore the US healthcare system back to the best?
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.