Most industrialized nations have recognized that limiting access to healthcare increases the risk of premature death and longterm disability for its citizens. The United States has long experienced the adverse effects of restricted healthcare, but its government has persistently resisted changes to healthcare coverage that would offer everyone medical, surgical, and public health programs that are already available in most democratic countries. In America the most persistent and prominent barriers to healthcare have been insurance costs and coverage.
Even though most Americans favor continuing the support provided by Medicare, Medicaid, Obamacare, CHIPs, and other publicly funded healthcare programs, there are perennial efforts to trim or kill these programs by state and federal elected officials. These publicly funded or supported programs compete with private insurance programs, and our private insurance companies do not appreciate the competition. Having failed to kill the competition, private medical insurers have adopted numerous strategies aimed at reducing their expenses and maximizing their profits.
Trimming costs and expanding profits is what ‘free enterprise’ businesses are supposed to do, but there are areas of national interest that cannot and should not be monetized. Our form of government was created to “establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty…” There is no mention in the Constitution of the need for private corporations to make profits based on their participating in the management of healthcare. There is explicit reference to promoting “the general Welfare.”
Over recent decades, private healthcare insurers have increasingly dictated how medical and surgical care will be managed and distributed. These companies and the elected officials they subsidize determine what will be paid to healthcare providers. Our elected officials have been complicit in this war of economies by not disallowing corporate maneuvers that deny, delay, or obstruct the payment of claims. There is no penalty for requiring extensive and oftentimes inaccessible paperwork before a claim will even be reviewed. Once reviewed, there is no certainty that it will be paid. In fact, the rate at which private health insurers deny claims ranges from 12 percent to 33 percent.
Anthem Blue Cross Blue Shield is just one of many companies that have aggressively looked for ways to cut costs without regard to the risks associated with those coverage reductions. In the case of Anthem, they proposed setting a limit on the time for which anesthesiologists could bill, according to the procedure being performed. This would mean there would be a specific fee paid to the anesthesiologist based upon the type of surgery performed, regardless of how long the surgery took or what problems the anesthesiologist had to deal with during the surgery.
Anthem would decide what was a reasonable amount of time for performing an appendectomy or heart valve surgery. If the procedure lasted longer than Anthem felt it should, the physicians, such as the anesthesiologists, who were routinely paid according to the time spent managing and monitoring the patient, would not get paid more than the procedure-related fee, a fee determined by the insurance company. Consequently, if the insurer decided that the procedure required one hour of anesthesia and the operation lasted three hours, the person delivering the anesthetic and monitoring the patient’s heart rate, blood pressure, blood oxygen level, etc., would not get paid for two of the three hours spent keeping the patient alive and anesthetized.
Since the person delivering the anesthesia and monitoring the patient’s condition while under the anesthesia has no control over how long the surgeon takes to do the operation, the inequity, indeed, the absurdity of this proposal was violently opposed by the physicians affected. The company insisted that its plan had been misconstrued and that it would continue to pay for the time anesthesiologists spent keeping patients alive, even if these doctors spent more time monitoring the patients than the insurance executives felt was necessary.
Only the most naïve physicians believe that this payment plan will not re-emerge as the standard practice for all major insurers over the next few years (or months). Only the most pessimistic insurance executives would doubt they will get support for this cost-cutting measure from their congressmen and congresswomen and increasingly friendly courts. If you have surgery and the team seems to be skipping safeguards and ignoring warning signs as they rush to finish up, you can thank Anthem Blue Cross Blue Shield. Checking for errant sponges, misplaced clamps, and subtle bleeding and waiting for blood pressure, pulse, breathing and other vital signs to fully stabilize are, after all, very time consuming.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the U.S., as well as in England, Germany, and France.
