What’s wrong with the Healthcare system?
November 15, 2003
by Michael Walls

I’ve come to the conclusion that the healthcare system in this country sucks. Compared to what – you ask? Yeah, yeah, I know – there are some countries out there with no system. But if this system is considered the best in the world, well, that’s just sad.

The problem stems from money. It’s all about money. I’m convinced that the majority of healthcare professionals, all the way from doctors down to administrators, top priority in their careers – is money. It’s not about providing the best healthcare. It’s not about serving their patients. It’s about how much money can they make.

Hey, but that’s the way it is everywhere, right? That’s my top priority in my job. My clients, my job, my responsibilities – all playing second fiddle to how much am I getting paid, and how I can get more. That’s awful, you say? Well maybe. But I’m just being honest, and if you think about it – it’s true for you too. I mean, if your boss said, “we’ve decided to stop paying you” would you continue to work? I don’t think so. There are very few people out there (who aren’t inherently rich) that have the selflessness to work for free – and those people are saints. They’re good people.

And doctors are not among them.

As you might be guessing, I’ve has a recent bad experience and now I’m ranting about it. But this rant isn’t about one bad experience. It’s about a collection of bad experiences and observations over the years.

I would like to preface by saying that I’ve met some excellent doctors, who probably put money first, but manage to put on a good show and instill a bit of confidence that they actually care. My general practitioner is very kind, and my kids’ pediatrician is also very nice. A few specialists I’ve dealt with have been very professional. But, all of these doctors have been cordial when there isn’t an emergency involved. As long as you schedule your appointments 1-2 months in advance, and have insurance – they’re nicer then pie.

I have an ongoing back pain problem. I’ve seen several orthopedics and physical therapists, had an MRI and tried all the latest prescription drugs. The only thing that really heals my pain is certain prescription drugs and two weeks of “dealing with it” until it goes away. But what’s more painful than my back, is getting an appointment to see a specialist when I have an “episode.” I usually go six months to a year between severe back injuries, usually brought on by Fall cleanups around the yard, or summer air conditioner installation time. Either way, calling around for an orthopedic that can see you immediately is like trying to win the lottery. 1-2 months is the standard availability to see an orthopedic specialist. I’ve received recommendations for certain doctors that, when I call to make an appointment, only work on Tuesdays and are booked for six months. Tuesdays? I assume they’re out on their yachts or the golf course the rest of the week.

Early last spring, I pulled the usual muscle in my lower back, and decided to try an orthopedic referred by my general practitioner. Six week later I showed up for my appointment.

“So, what’s the problem?” he asks me. No problem, I say. “Then why are you here?” I threw my back out six weeks ago.

He has me do some tricks. Stand on one leg. Bend over touch my toes. Walk on my heals. He prods by back asking, “does this hurt?” No. “Does this hurt?” No. “Does your back hurt at all?” Today? No. Six weeks ago? Yeah, it hurt like a son-of-a-bitch.

He writes me out a prescription, recommends another physical therapist, then asks his assistant to book me in two weeks for a “follow-up.”

A follow-up? What for? I feel fine, and I’m sure I’ll be fine in two weeks. I’m starting to understand why these doctors are never available for emergencies. They’re too busy booking and seeing patients, unnecessarily, as an excuse to charge my insurance company another $200. Plus – how is the doctor available in two weeks, when it took six weeks to get an appointment when I really needed one? Well…because now they know me, and more importantly, they know I have good insurance.

Two weeks go by, I’ve seen a physical therapist for 5 sessions, who simply showed me how to stretch and exercise, all of which I already knew. They billed my insurance company $95 per session, which I had to pick up $15 of each (totaling $75 out-of-pocket). And now, I’m seeing the orthopedic again. He gives me the same run-down of tricks and prods, all with the same results, totaling 15 minutes of his time. (As opposed to me having to take a half-day off of work, then waiting in the waiting room for an hour, then waiting in the patient room for 20 minutes.) He says I look fine and recommends another “follow-up” in a month.

I tell him that what I’d really like is to see him when I’m in pain, and continue to explain my difficultly in seeing a doctor when I actually need a doctor. He claims to sympathize and says that I should call his office whenever I have my next episode and he’ll try to fit me in immediately.

The day of reckoning came this week, after a busy weekend of raking leaves. I pulled the same lower back muscle and was flat on my back by Sunday evening. Monday morning I called in sick to my office and called the doctor. I was pleasantly surprised that they agreed to see me later in the afternoon.

When I arrived at the doctor’s office, I was not the same patient from six months ago. I was bent over in extreme pain, having difficultly walking, was not able to perform any of the usual tricks and answered “yes” to nearly every “does this hurt” question.

I’m no dummy. I know that this specialist isn’t some sort of voodoo doctor who is going to rub his hands together and heal my back. He is simply the middleman between me and the real healers of pain. The pharmaceutical companies. He wrote out my prescription, filled out an order for more physical therapy, booked me and my insurance company for another “follow-up” in two weeks and sent me on my way.

I called the physical therapist, told them I had an emergency back “issue” and would like to see someone tomorrow. They laughed (really!) and said nothing was available until Friday and they would like to book me for 5 more sessions. Of course – they don’t want to see me for one emergency session – not when they have the paperwork approval for 5 billable sessions. I told them that if I was still in this much pain by Friday, that I wouldn’t need a physical therapist, I would need a priest – and hung up.

This is just one of the many frustrating sagas I’ve had in my dealings with the healthcare industry. There is such a racket going on between the medical professionals, the pharmaceutical companies and the insurance companies – that I find it hard to believe that this is the best system we can come up with.

Prescription drugs are astronomically priced, which no one can afford without an insurance plan, and are unattainable without a doctor’s prescription, which you can’t get without a $200 insurance-paid appointment, which you need to book six weeks in advance, because the doctors are so busy with unnecessary appointments to pad their schedules and overcharge the insurance companies.

So I guess the question is, what’s my point? This is the way the healthcare system has been forever and everybody knows it and there’s nothing we can do about it, right?

Well, I don’t really have to have a point – this is a rant. But I guess if I had to find a point to all of this, I’d say the point is – even though I think this healthcare system sucks, I don’t believe it’s all the system’s fault. It’s the doctors and drug manufacturers and insurance companies who are taking advantage and exploiting the system, that makes healthcare expensive, difficult to get, and overburdened.

I’ve heard explanations blaming the welfare system, HMOs, and patient abuse of emergency services. But when I get booked for appointments that I don’t really need, I find it hard to believe that doctors can’t control the amount of unnecessary medical visits they’re taking on. (I’ve cancelled all of my scheduled follow-up visits, citing they should use my time slot for someone who really needs to see the doctor.)

So, let’s not put these doctors up on that high pedestal as great individuals contributing to the goods of humankind. Doctors are business people – they are in business to make money. Just like lawyers and politicians and sanitation workers. The difference between a really good doctor and really bad doctor is how much they can make you believe they really care.

(Michael Walls is a volunteer staff writer for 2 Walls Webzine)

Response from: Chris Orcutt
December 1, 2003

I can completely sympathize with Mike's plight, as I'm sure everyone can. I can also shed a little light on how truly evil pharmaceutical companies are. For two years, I worked for a company that was in a very unique business: taking money from the big pharmaceutical companies to help get their drugs through the daunting process of FDA approval.

The company I worked for (I can't really say the name as I still have friends there) was a huge conglomerate that ran the clinical trials, coordinated huge meetings and conferences to introduce influential doctors to the drugs, and even owned medical journals in which to publish the results of the trials. I was a managing editor responsible for different kinds of editorial content, like slide presentations for conferences, and take-home workbooks for meetings. I usually worked on 5 or 6 different drugs at a time.

One project, that I think really tells the most about how drug companies are 100% geared around money, was a series of scientific papers that were to be 'authored' by high-powered doctors and placed in specific medical journals. The particular drug for this project was running into some trouble in clinical trials (these are called 'adverse events' or 'AEs' which is often sanitized medicalese for 'death'). So before the project got off the ground our team was summoned to the drug company's headquarters for a meeting. There I met the project manager for the drug, who explained to us that if the drug got FDA approval but had to be pulled eventually because of AEs, the company still stood to make a ton of money. He cited a similar case where a drug of theirs had to be taken off the market because it had killed people, but was still considered a success because the company had made so much money.

So that's pretty much where the ethics stood. The scientific papers were actually written by freelance medical writers and then reviewed by the pharmaceutical company and then whichever doctor was putting his name on it. Some doctors would review them thoroughly and some would just take a cursory look and sign off. The papers would then be submitted to the journals under these high-powered doctors' names. And our company would get a ton of money for this. The pharmaceutical companies treated the doctors like rock stars – after all, a doctor who was considered a thought leader in his field could often make it much easier for a drug to get through all the steps to FDA approval.

Our project came to a grinding halt when the drug was sent back to clinical trials because of AEs. The pharmaceutical company looked at the costs and killed the drug because, financially, it wasn't worth persuing anymore, and they canned the entire division working on the drug.

So don't let those fuzzy, feel-good, "ask-your-doctor-so-you-can-get-better" commercials fool you. From my experience the drug companies could care less about anyone's well-being. It's all about the cash.

(Chris Orcutt is a volunteer staff writer for 2 Walls Webzine)