The Short Shrift of Healthcare: Inefficiency Pays

I feel they picked my pocket! Consider what happened to me—I broke my leg (a 4" fibula fracture). An orthopedist inserted a 4-inch plate, but the surgical wound wouldn't close. After a month of therapies, Anthony, my wound specialist ordered the KCI’s proprietary V.A.C.® Therapy System. He got "prior approval" from Oxford, and I was given the necessary equipment—a suction device to wear on my belt, 24 hours a day, specialized coverings that breathed, tubing, waste canisters, etc. These "supplies," were integral, mind you to V.A.C. therapy. Nevertheless, Oxford hit me for $1700 saying they were an "uncovered benefit" (whatever that means).

Are these supplies any different than requiring a spacer for a child's asthma medicine (puffer) or tubing and a mask for their nebulizer treatment? Is that different than how insurance companies weasel out of their responsibility with the infamous pre-existing exclusion clauses? Here's a patient-ER scenario, all too commonplace in the callous world of health insurance: Insurer, not saying, but implying: "We'll decide later if it was medically necessary. Start your chemo. We'll review the indications, and we're sorry" if you died/suffered/deteriorated in the process!"

P.S. Why are the "supplies" so expensive? Because KCI sterilizes and packages this equipment—5 packages to a cardboard boxes that they claim they sterilize. In other words, you must buy five even when you need one; they charge the patient who is already hurting too much to argue, $237.45 or even $253.30 per box. Thus, this suppler gets their money and, like the insurance companies, they are escalating the cost of care.

I need to add that while I was at the Wound Center, I saw a number of patients in need of extraordinary wound care (diabetics, peripheral vascular disease) being denied necessary care by their insurers because of contract exclusions, preexisting conditions, bureaucratic delay, or insurmountable hurdles—I am dismayed when it's profits before patient care!

Inefficiency Epitome

Quality, cost and access are the legs of a proverbial three legged stool—remove one or two and the value of healthcare can neither be maintained nor improved. Paul Krugman, PhD in an op-ed piece, "Do the Right Thing" said: "Bear in mind that the horrors of health insurance—outrageous premiums, coverage denied to those who need it most and dropped when you actually get sick—will get only worse if reform fails." Here are poignant examples of how quality will suffer and inefficiency will increase the cost of care when access is so compromised:

1. Delayed diagnosis and treatment making diseases and suffering worse

2. Emergency room care for those without a medical home

3. Generic meds that taste bad, refused

4. Specialists doing primary care; economic disincentives to primary care

5. The 'red herrings' of medicine as can result from over testing or testing too early

6. Relapsing into adverse lifestyle choices

7. The 'worried well' who don't give permission for their doctor(s) to cease testing.

8. The vicious cycle: sick or disabled leading to job loss and loss of access to affordable health care

9. Diets deficient in protein resulting in overindulgence in the more affordable carbohydrates

10. Sedentary lifestyles