Get To Know Your Doctor

Healthcare is wealthcare. Even the ancients had ideas about healthy living. Plato advised, “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.”

If you are a good earner and are covered by health insurance, Medicare, or some other plan, we may take health services as a given. But we shouldn’t.

Two events got me thinking. First, my wife and I decided to remodel two upstairs bathrooms and update our circa 1993 kitchen. We have detailed estimates from the design firm with a solid grasp of costs.

The other event centered around a sudden intense pain down my right arm, resulting in cervical spine surgery to remedy a problem driven by bone spurs. While briefed on the hazards of surgery, no estimate of costs was provided. Final bills have yet to be received, although the tab for the anesthesiologists approached $6,000. That’s part of the problem with medical costs. We have no idea going in of the costs or who does what. There are no cost comparisons or competitive bidding.

The good news is an excellent outcome from the procedure. My doctor is rated as one of Atlanta’s Top Docs, a neurosurgeon much in demand. He performed two of my four spine surgeries dealing with arthritis of the spine. In chatting with him about the state of American health care, he told me that because I was a patient prior to going on Medicare, he would continue to accept me as a patient. He regrets that his large medical group must limit the number of Medicare patients they accept due to low reimbursement rates. He did not mention Medicaid, but reimbursement rates there, too, are low. Increasingly, there are practices that no longer accept government insured patients.

The point?  Before you go on Medicare at age 65, establish a solid and long term relationship with a primary care physician, and specialists as needed. You may have trouble finding a practice that accepts Medicare.

We face a growing shortage of physicians over the next decade. Increasingly, care is being delivered by nurse practitioners and physicians’ assistants. Getting an appointment with your doctor is not easy, especially when you are sick! A patient recently complained that it was hard to see his doctor. Most of the time he saw a nurse practitioner and often it was not the same one. The doctor said he regretted that, but turnover in nurse practitioners was high as they are in high demand. Drug stores with in-house clinics and stand alone “drop in clinics” are competing with doctor’s offices and draining off personnel and revenue.

The sad fact is that practices are driven by “volume” with only a short time available for each patient, again due to low reimbursement rates. For those that can afford it, we are seeing an increase in concierge medicine, paid for with hefty fees. The upshot is being treated by someone who knows you as a person, knows your medical history, and understands your needs, is growing less likely.

Is a government takeover of health care, Medicare for all, an answer? Politics aside, cost projections are massive, with questions as to the feasibility of the higher taxes required to pay for it. A while ago on a cruise ship, I had a fascinating conversation with a top French doctor, a famous researcher in his field. With state run healthcare in France, the shortage of doctors is a major challenge. He says, young people are not going to get all of that education and training if they are not paid well. “They don’t want to work for the state,” he said.

Check the growing doctor shortage statistics for Great Britain, Canada, etc. In countries in Europe, and India, for example, there’s a two tier system: a state run system with long wait times and poor employee morale, and a privately run system for those who can afford it. Are we headed in the same direction?

At the top Veteran Affairs hospital in Washington, DC, reports of unsanitary conditions and high rates of bloodstream and urinary tract infections are disturbing. An Inspector General report noted, “A culture of complacency and a sense of futility pervaded offices at multiple levels.” (“VA staff plea: ‘Stop this…incompetence,’” USA Today, 8/3,18). Is this our health care future?

Costs for medical care have increased steadily since 2000: prescription drugs, +69%; hospital care, +60%; physician and clinical services, +23%. (The Wall Street Journal, 8/1/18). Whether just starting a family or planning for retirement, consider medical care inflation in your financial planning assumptions. Healthcare is wealthcare!


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