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This is Why We Persist

March 18, 2012

Since I started the blog American Healthscare, I’ve written nearly 80 posts trying to raise awareness about how inefficient and expensive our healthcare system is, how this reality harms the rest of our economy, which ironically leads to worse health. This is on top of the four years I spent writing and editing my book, American Health$care.

My colleague who I co-wrote the insurance cost article with, Jennifer DeVoe, MD, DPhil, received this email from a man named Arran Webb. Here it is in its entirety (reprinted with his permission):

Thanks for being a doctor and being prepared to challenge the rising costs of health care.

My wife and I are self-employed and we pay our insurance premium each month. Using the Freelancers Union the premium was $650 4 years ago and now it is $980 per month. This is for a high deductible insurance. Why do we have it? One reason only – catastrophic illness or accident. We would happily pay as we go – actually we already do. So we pay $980 per month to cover ourselves and two children simply for a catastrophic loss.

It just is not fair.

It is baffling, strange, bizarre that a premium keeps rising while everything else in the economy is stalled.

It is disheartening, troublesome and faith sapping to see so little done to change this.

The unions have traded off wage rises for benefits for the last decade. So a worker earning the average wage of $41,000 per year is receiving $11,000 of health insurance – but no wage rises. And they have lost their voice as they never see the $11,000 that goes to the health care industry.

The lobbying of politicians, the amount of people employed in the healthcare industry, the legislated laws that enforce healthcare – this is a pink elephant standing all over us.

Some people are benefiting from this. It reminds me of the financial crisis. Some people will go on extracting all the financial gain they can from this system until it simply fails. And then they will skulk into the shadows poker faced.

But thanks for being a doctor and having some voice of reason from inside the system.

FYI – I was recently in Australia and we needed to visit a GP for a look at a small cut on my 3 year old son’s leg. We saw a local GP in private practice. We paid cash in full for the consultation – $45.

It doesn’t have to be this way. We could create a fair and responsive healthcare system that doesn’t bankrupt the middle class and the industries who employ them — or the taxpayers who fund Medicare and Medicaid. It won’t be easy. There are very few services in healthcare that both improve outcomes and save money.

As Mr. Webb wrote, it’s just not fair.

This is why we persist.

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2 Responses to This is Why We Persist

  1. Chris Gregory on March 19, 2012 at 6:07 am

    Dr Young:

    I’d like to second the appreciation that Mr. Webb expressed to Dr. DeVoe, and here I’d like to express my appreciation to you.

    There are those who will read your blogs, and I hope there will be many, many who will have read your book. I have. Three times and each time has been an additional opportunity to learn from the reasoned perspective of a physician, teacher and advocate for the medicine we all need so badly. I have written on my commentaries about it and I have spoken to groups where I have gladly taken the opportunity to “plug” your book. I do so for one reason. Your book is a guide to what medicine should be, and a narrative about all of the things we do so terribly wrong, how we are wasting vast sums on bad medicine and how we are saddling our future generations with a terrible financial albatross health care system.

    I have also had the very good fortune to know you personally, to discuss at length these vital matters of health care, and to mutually advocate for a vigorous, strong and respected primary care system, where family practice physicians can lead us to a better system where people like Mr. Webb aren’t being saddled with more and more medical expense at the hands of a health care system riddled with self-interests and obscene waste.

    What prompted this comment to your blog are two events.

    First, my sister told me tonight about something that outraged her. She was hospitalized up in Seattle for a cardiac procedure. When she brought her medication to the hospital, clearly marked, she was told she could not use that prescription. Instead, she would have to take the medication from the hospital pharmacy. When she got her itemized bill, she about fell out of her chair when she saw the price for the medication – $40 per pill versus just a couple of dollars on her own. This is hospital drug markup on steroids. I understand the liability issue and that hospital charges have to cover the costs of the uninsured – but a twenty times markup??

    Second, at my request you attended a meeting at which a presentation was made to several Dallas/Ft Worth municipalities regarding a highly effective method to manage the extremely high costs of the most expensive surgical treatments. The method involves the option to travel to recognized centers of excellence where demonstrably higher quality treatments could be received, and where both patients and the employing city could benefit from better/lower costs that have been negotiated. The key components of this concept are 1) ensuring that a patient is informed about and aware of alternative options to surgeries and is enabled to make informed decisions, 2) verifying and validating surgical treatment recommendations and 3) when surgeries are required, giving patients financial incentives to use centers of excellence hospitals with demonstrably better treatment outcomes.

    Thanks to some honest and straightforward attendees from these cities, there was a disturbing reaction regarding the notion of providing this program as a part of the municipal health care plans. Namely, the taint of politics. Essentially, if a city offers a plan to travel outside to a center of excellence, the incumbent politicians would get an earful from local doctors and hospitals. As one municipal risk manager said … “the politicians don’t care about the savings – they care about getting re-elected” . What this municipal executive was saying was that in the face of an angry constituency of local doctors and hospitals who will invariably charge more for lesser quality treatments, the politicians would deny employees lower costs and improved quality options, as well as the opportunity to lower municipal costs for health care – all in the name of self political interests.

    So not only do hospitals terribly inflate costs like they did on my sister’s prescription medications, they are also prone to raising a ruckus to protect their turf even if that might mean denying patients the option to travel to centers of excellence at lower patient costs.

    This truth and transparency is what you have fought for, and why I am glad to join with you in the promotion of better medicine from better doctors and better ways to tackle the obscenely high-priced costs of the expensive surgeries like heart, spine, joint replacement and transplants. You advocate for better doctor-patient relationships where primary care doctors have the time to treat comprehensively and time to better coordinate the ongoing spectrum of care – which I think would include guiding patients into informed decisions and centers of excellence.

    It’s too bad that things like greed, turf issues, self-interests and politics are such obvious speed bumps in the road to better health care.

    I look forward to pressing on in the effort with you. Thanks for your good work.

    • Richard Young MD on March 19, 2012 at 10:32 pm


      Thanks for the kind words and your fantastic support. Your stories just add to the litany of absurdities our culture somehow tolerates. I look forward to pressing onward with you.

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