The Patients

As a physician and a patient I’m in the unique position of shouldering two shares of the communal blame. In fact, if I went back to school and got a J.D., went to work for an insurance company, and then ran for Congress I might be able to bring the entire system down by myself. Yes, we the patients are a big part of the problem.

It’s estimated there are about 46 million uninsured, although some debate this number. One source cites 21% of these being “foreign born non-citizens.”

The medical economy is about 17% of the GDP and growing and is governed, like everything else, by the principles of supply and demand. The problem is that demand is growing exponentially, and supply is distorted by reimbursement that’s almost universally provided by third-party payers.

Let’s start with the demand side: We the patients are victims of partial success. Due to steady improvements in medical care delivery on all fronts, we’re living longer and getting chronically sicker. Treating the occasional octogenarian has given way to treating the occasional nonagenarian. You say, What’s wrong with that? Isn’t that the point of medicine? I agree. The problem is we can manage a lot of disease and only cure a little. And if you think costs are rising now, just wait until the tsunami of baby-boomers like me washes ashore in a great crashing wave of chronic illness. “It’s coming to theaters soon.”

Now, because medical care had the illusion of being cheaper thanks to the aforementioned third-party payers, also known as your friendly (or not-so-friendly) insurance company and our rich Uncle Sam (a.k.a. we, the taxpayer), we’ve been conditioned to expect that everything possible be done, and done quickly. If things go wrong, we’ve come to expect our friends the trial lawyers to rush to our aid, where compassionate juries could be depended on to provide outrageous sums of money for “pain and suffering.” This explosion of illness and litigation fuels the money express, driving costs even higher.

So, grandpa and grandma have escaped Death’s cruel scythe at age 75, a good thing, but are now 87 with a weak heart, failing kidneys, and an atherosclerotic circulatory system, i.e., rusted plumbing. What do we do? No one wants to think of the “R” word, or worse, the “D” word when it comes to health care (that’s “ration” and “deny,” in case you were wondering).

Stay tuned.


NEXT: The Patients, Grandma and Grandpa


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