Healthcare is Human

Healthcare is human, yet our healthcare system is increasingly inhumane.

Last month (December, 2024) was a hard month in healthcare for many reasons. Some were shared across everyone in healthcare, and some were closer to me personally. 

First, we saw the media machine go berserk with exaggerations and clickbait headlines to exploit a major healthcare insurance company's plan to change how it reimburses for anesthesia services. Regardless of the social media jokes about walking out in the middle of the surgery, or the assertion that insurance companies are evil for seeking to standardize payment models, or the bizarre twist to the other end of the spectrum suggesting this was a good thing because it might reduce payments to those rich and greedy docs... all this payer was seeking to do was introduce a prospective and predictable payment system for anesthesia services -- which is how most other services in healthcare are provided. If the general surgeon is reimbursed a standard amount to remove a gallbladder, why isn't the anesthesiologist reimbursed a standard amount to provide anesthesia for such a procedure? It's a reasonable thought process to me if they work out some details, but I digress. The doctors pointed the finger at the insurer, the insurer pointed the finger at the doctors but ultimately caved to the pressure of the media preying on the public's emotional connection to the fallacy that doctors and insurers are rich and greedy by pointing the finger at everyone involved. What the media and the doctors left out of the banter was the fact that the new process was to be based on data from CMS (the largest third party payer). A hidden gem of a reminder that the most incompetent and inhumane third party involved in healthcare is the federal government. 

Next, almost as if intentionally timed to reload the ammunition of conspiracy theorists, the CEO of America's largest insurer was assassinated in a close range execution. Although there's almost always more to the story than initially reported, it seems he was murdered for no other reason than being the figurehead of a large health insurance company. He was murdered under the notion that making a profit as a health insurance company is punishable by death. He was a 50 year old father trying to do his job. His wife and kids won't see him again. His coworkers won't see him again. No one will see him again. And this was celebrated? Given my interest in connecting the clinical, administrative, and academic worlds of medicine to improve patient care and make it a better world for everyone involved, I've sometimes thought working for a third-party payer might be an avenue to have a substantial impact... would that make me a target for assassination? While UnitedHealth has a profit of about $20 billion dollars, it's only about 6% of its revenue. Tell me, would you run a business with a profit margin of 6%? For reference, the technology sector has an average net profit of about 15%, with the premier companies we know so well (Apple, Microsoft, Alphabet, Oracle, etc.) routinely posting net profits of 20-30%. UnitedHealth isn't an evil company led by evil people, it's a company led by people who are trying to pivot a heavily regulated and forever changing business within a slim profit margin. It's hard for most of us to wrap our minds around dollars in the billions, but it's an actually a rather slim margin when converted to a percentage. If we want these companies to carve out less profit from our healthcare system, let's stop asking them to pay for more stuff by pretending it's insurance. 

Look, our healthcare system is broken, but profit isn't the problem, nor are insurance companies. Our healthcare system is broken because separating payment for care from provision of care changes who the system is serving. Lower costs come from having to look a patient in the eye and say "I'm going to charge you X for Y today". That's rare in today's healthcare system, but it's hard to be greedy when looking someone in the eye. 

Meanwhile, I saw a loved one personally experience the unintentional, but very real emotional disconnect that happens between healthcare teams and patients. We shouldn't have to wait weeks in the US for a skin biopsy result. In healthcare we also need to slow down and realize how important our words are. When we say 'cancer' the patient's world stops turning, even if what surrounds that word is 'pre' as in 'pre-cancerous' or if we say 'possibly cancer' or any other variation. The way we allow uncertainty to fester in the minds of our patients is perhaps the biggest tragedy of modern healthcare in the United States. 

Throughout all of this, it was a hard stretch caring for patients in the hospital. There were very sick patients requiring multi-specialty teams joining together to connect the dots of complex medical problems. At times, I was frustrated that I couldn't get the care team or 'the system' to give our patients what they needed or wanted in a timely manner. There were times I felt patients were taking advantage of the system. There were times I didn't give my patients what they needed or wanted in a timely manner. As an educator, these were great opportunities to teach the disciplined and methodical approach we must take to diagnose and treat illness. Still, the resident physicians on our team kept me grounded -- they haven't been jaded by the inhumane machine yet. My family kept me grounded -- my daughter kept asking me about how my patients were doing when I'd tuck her in at night. And my patients kept me grounded -- one evening a patient and his wife asked me about the origin of my name and we ended up talking about music for 45 minutes in the midst of a real hard time for the patient (they didn't know it was therapeutic for me too). 

Physicians uniquely experience the healthcare system by holding many stakeholder vantage points at once (which is why I think we have the best opportunity to improve healthcare). Through those vantage points last month I learned that at the end of the day, healthcare is human... and we need to hold on tight to that as the central theme for all efforts to improve our system of care.