America Doesn't Have a Health Care System

While here in Denver, I visited with a group of doctors. (No, I'm not sick). I had the opportunity to discuss with them our nation's health care system and the discussions under way in Washington to overhaul the system. One of the doctors said something that I think is rather profound. He said ...

"America doesn't have a health care delivery system. We have a disease management system."

I probed for clarification and learned that all insurance carriers (which includes government programs such as medicare and medicaid) require medical diagnoses for reimbursements. What that means is that if a person goes to a doctor and isn't sick, but simply wants to have a check up and a discussion with the doctor about what lifestyle changes, dietary changes and nutritional changes he should make in order to stay healthy, insurance will not cover that visit. If someone goes to the doctor and has abused his health all his life, however, and now needs medicine to manage a disease created by lifestyle choices, insurance will reimburse the doctor for that visit.

ObamaCare will not change this model.

In spite of the rhetoric you may have heard during the campaign a year ago, everything that's coming out of Washington now indicates that the system that is likely to pass through congress later this year (if one does) will simply operate much like medicare, only be available to more people. It will also have more "quality control" features and "cost saving" features.

"Quality control" features, I'm told, are essentially additional work for the doctor to report to the government that he is following all the correct procedures and doing all the correct tests for a given disease state. You should understand, that most doctors probably already do these tests and procedures, but now they have to report to the government that they are doing them, and they will be penalized for not reporting (whether or not they actually do the test.) This is supposed to save us money.

"Cost saving" features are essentially reduced reimbursement rates for tests, and the more frequently a test is done, the greater the chance that reimbursements will go down for that test. This is supposed to improve the quality of our care.

Most of the doctors that I visited with today are opposed to the proposals coming out of Washington. Some of those doctors even admitted to being registered Democrats and having voted for Obama. I did not find out from them what kind of system they would like to see or what changes to the current system they thought needed to be made.

I wish I had more time to discuss this with them. I'd like more answers.