Medical Care Industry

A person that I know was diagnosed with a general category of illness by her primary care physician and recommended to a specialist for a more targeted diagnosis and course of treatment. In order to prepare for meeting with the specialist, the primary care physician removed from her medications that might have impacted the specialist's findings. Unfortunately, the specialist was not able to see her for two months from the initial doctor's visit. In the meantime, her symptoms worsened, as did her pain and the detrimental effects of having to wait for treatment. She wound up in the emergency room of the local hospital where she lives, barely able to walk, in severe pain, unable to eat more than a few bites of any food, seriously dehydrated and in immediate need of medical care.

This is all too typical a story, and it points to a system that is increasingly inefficient, economically driven, detrimental to patients and dangerous for those who are suffering, sometimes unnecessarily so. Ask around. The tales of medical woe are all around us.

An employee in a local company found, under the Affordable Care Act, medical insurance for herself and her children that was both great quality and much more affordable for she and her company than any that they had found previously. When the policy was to be renewed, a year later, the insurance carrier had been sold to another company. Her premiums increased four-fold, the deductible, both personal and family, was increased significantly and her co-pays went through the roof. The company saw an increase, even over what they had previously paid. They were forced to end her employment and to manage without that position.

Who is to blame, here? Is it doctors? Is it medical conglomerates? Is it insurance companies? Is it an entire industry? What, exactly, is broken and how do we fix it?

In the case of the woman mentioned earlier, the one who wound up in the e.r. instead of receiving the kind of prompt and attentive care that would have treated her illness, she needed one test to determine a more detailed diagnosis. The primary care physician failed to order that test, though it is a common one that is ordered by this physician every day, especially for persons who are over 50. He referred instead of ordering that test. The emergency room doctor was shocked that the test had not been performed. In his defense, the primary care physician was pressured to move people along and through the system, refer to specialists if at all possible, and increase the daily log of patients seen in and through the office.

In the case of the woman who lost her job, primarily as a result of her increasing medical insurance costs, it is clear that the company that underwrote her initial policy was a short-term speculative institution that was designed to make its money, sell its policies, and barter itself on the open insurance market. Tremendous amounts of money were made...millions. The business practice harmed people, however. Perhaps the larger carriers, those who swallowed up the smaller underwriters, consider the damage done to persons as collateral to their profit margins. In their defense, their stock holders have been experiencing greater returns on their investments.

It is this, I think, that is broken. Medical care has become an industry instead of a service. The economic bottom line determines the extent and the efficiency of care. Money, profit and return on investment have replaced excellence in care and timely treatment. The patient has become a commodity, a source of revenue, a product.

Do not misunderstand. I know and respect a great many medical physicians. They do their best. They care about their patients. But they are increasingly limited by a system that is primarily concerned with dollars instead of people.

How do we fix the problem? A number of years ago, I was involved in community dialogues around the issue of health care. The medical community wanted those dialogues to focus on medical issues, like fitness and preventative care. The few participants from the community wanted to know what we could do about the mounting commodification of patients and the economic injustice that is inherent in a capitalistic industry. There was no mediation, no cooperation, no compromise. The medical community wanted to talk about advancements in medicine while the public wanted to discuss the increasing depersonalization of the system. No dialogue took place. Each community talked past the other.

In its current state, I am increasingly convinced that there is no easy fix. Money is the pathology of the medical care industry. It is ill. It is not working at anything approaching an optimal level. But what are its alternatives? What are we to do?

I have none of the answers. Do you? If you do, or if you want to pursue this conversation, please post to the Shiloh UCC Facebook page. I want to hear from you.