When you’re not employed in the healthcare industry, either as a doctor, nurse or administrator, debating the healthcare crisis may seem overwhelming, like performing open heart surgery in the dark.
But three Pickens County healthcare professionals serving as panelists at the September North Georgia Progressives’ meetings pulled back the curtain a bit, revealing elements of healthcare’s slimy underbelly to which laypeople aren’t often privy.
Executive Director of the Good Samaritan Health and Wellness Center Carole Maddux, Dr. John Spitznagel and Dr. Joseph Wilber were asked to discuss the current health crisis, offer their suggestions for reform and speak about how their experience in the medical industry informed those views.
Their diagnosis? Healthcare is going from bad to worse and without massive reforms middle-class America will continue to bear the brunt of the costs while quality of care deteriorates. Every person, they agreed, should be insured --- but turning the ocean liner we call healthcare around isn’t going to happen overnight.
“Reimbursement drives everything in this system,” Maddux said, who once served as a financial consultant for a large hospital where she was paid to analyze each item, from the cotton swabs to the hospital gowns, and calculate different prices based on how much the hospital would be able to collect from the payer.
For those who paid out-of-pocket, she said, prices were hiked up as far as they could push them, meaning those without insurance paid far more for medical care than others.
Maddux began the evening’s discussion by explaining why the medical market, in her opinion, lends itself to these and other internal manipulations.
The market, she said, is inelastic, which means the law of supply and demand isn’t really relevant. If, for example, you wanted to purchase a Twinkie at the grocery store you could easily comparatively shop. A Twinkie at grocery store A is 75 cents. A Twinkie at grocery store B is $1. You, of course, buy the Twinkie from grocery store A.
If you are hit by a car, however, you go wherever the EMS takes you. There’s no time to sniff around for the best price, and even if you do have the time to compare costs for non-emergency services most people don’t go to the trouble. You choose a doctor based on his or her methods or personality, or you choose one that is close by and, for the most part, you do what they recommend --- even if their recommendations seem unnecessary.
Why is it, Maddux postulated, that every time she visits a doctor’s office with an in-house x-ray machine she needs an x-ray?
Maddux says physicians can easily shift the market, in its current state, and this unsavory characteristic is one of the many reasons she feels the system needs a massive, not-for-profit overhaul.
“The market won’t fix itself because the way the market is operated it’s too easily manipulated. I should know,” she said, “because I was one of the manipulators.”
Maddux, who now runs the Good Samaritan Health and Wellness Center in Jasper, feels that she works at one of the best medical facilities in the state, possibly in the country, because they aren’t preoccupied with reimbursement.
The Good Samaritan is a free medical clinic that treats individuals who fall under a certain poverty level and in the last eight years the clinic has served 6,000 patients from Pickens County, which has an estimated population of just over 30,000.
“We don’t give a flying flip about reimbursement,” she said. Doctors who volunteer at Good Samaritan can take as long as they would like with each patient; physicians with different specialties can easily consult with one another, and the pharmacy is just down the hall. “I would rather get my healthcare [at the Good Samaritan],” she said, “than have to go into the market.”
Retired Chair of Microbiology and Immunology at the Emory School of Medicine Dr. John Spitznagel, who also served as an Army Medical Corp doctor, is also weary of the current medical market.
Dr. Spitznagel, who was instrumental in organizing the Good Samaritan, said his career as an Army doctor shaped his decision to pursue medical academia rather than opening a practice of his own. He enjoyed practicing in the Army because healthcare was provided for every enlistee --- no questions asked.
“It was great,” he said. “If someone needed something you just wrote the order…you didn’t have to worry about who pays for what.”
Dr. Spitznagel believes people shouldn’t be forced into bankruptcy because of healthcare costs, as they are in large numbers in America, and he doesn’t feel people should be deprived of food or other necessities because of medical care.
Citing a New England Journal of Medicine study that examined healthcare’s hidden costs, from out-of-pocket expenses to high deductibles, Dr. Spitznagel said a family with a $50,000 income is likely, the study found, to spend nearly 25 percent of that income on healthcare before they pay for anything else.
“That used to be what we paid for rent,” he said.
And with the price of healthcare increasing five times as fast as the pay rate, keeping with the status quo will, he said, hit lower-income families harder and harder with each passing year.
Before opening the Good Samaritan clinic, Dr. Spitznagel said he surveyed large employers in the area regarding their health insurance. He said oftentimes insurance was offered for full-time employees at an additional price, but that employees rarely accepted the coverage because they simply couldn’t afford the extra monthly expense.
“Everyone needs insurance,” Dr. Spitznagel said. “Until then people will suffer deaths and indignity from poor health care,” and further that those who argue to keep the current system, “are suffering what I like to call aggressive ignorance.”
Dr. Spitznagel didn’t pin all the blame on the healthcare industry, however, calling out to Americans to take responsibility for their own wellbeing.
“Every person owes it to the country to maintain their best health,” he said. “It is unbelievable how careless we are.”
Dr. Joseph Wilber, who spent 25 years of his career in private practice in Atlanta specializing in Internal Medicine before becoming the Director of the Infectious Disease Program for Georgia, also volunteers at the Good Samaritan and shared troubling stories of uninsured patients he has worked with at the free clinic.
One man, he said, was diagnosed with diabetes at 19 but wasn’t treated until well into his 30’s.
“His blood sugar didn’t go below 200 in 20 years,” Dr. Wilber said. The man’s eyesight is failing, his feet are numb, his stomach doesn’t function properly and Dr. Wilber estimates the man won’t live another two years.
“We see the ravages of people who are dying, disabled or in severe pain because they have no healthcare,” he said.
Dr. Wilber also said fee-for-service doctors are “a big mistake,” and that they do nothing but enflame the growing healthcare crisis.
Fee-for-service doctors are not paid on a salary, but are paid for each procedure they perform, and Wilber says salaried doctors get better results from their patients and don’t order nearly as many tests.
Wilber believes America should move to a single-payer system, even if it is community or locally based, and that it should not be a for-profit industry. “It should break even,” he said.
During his speech Dr. Spitznagel directed people to a side-by-side comparison of major healthcare proposals at http://www.kff.org/healthreform/sidebyside.cfm.
Maddux advised concerned citizens to contact politicians either by phone, letter or e-mail, but from her experience Maddux says an old fashioned telephone call is the most effective means of getting your voice heard.
“Don’t demonize group,” Maddux said, warning people not to get caught up in pointing fingers at Big Pharm and insurance providers. “They are doing what they are rewarded to do. They do what get paid to do…We the people are the ones who created it.” |
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