David Louis Edelman David Louis Edelman

Why Is Health Care So Fucked Up?

The American health care system is fucked up. And I’m not talking about health care on the macroeconomic/social policy scale here — right now I’m more concerned with the average Joe/Jane’s trip to the family practitioner or the emergency room.

  • Why do so many doctors still schedule appointments in a black ledger book on the desk instead of in a shared calendar on the computer?
  • How come they can’t e-mail you to confirm or reschedule your appointment?
  • Why is it that every time you go to a new doctor or hospital, you have to fill out that same damn patient information form on a clipboard in the waiting room and wait for someone to type it in to the computer?
  • Why do they actually need to photocopy your health insurance card?
  • Why is that the doctors all scribble notes on pads of paper that can easily be lost or damaged (or misinterpreted) instead of using a PDA or a tablet PC?
  • Why do you get handwritten prescription slips that you have to physically shepherd over to a pharmacy in your car?
  • Why do you have to wait another week or two for the cryptic paper statement to arrive in the mail from my insurance company?
  • Why do supplementary bills come trickling in from various medical labs a couple of weeks after that?
  • Why are there constantly mistakes in the billing that need to be corrected with a million phone calls and faxes?

It’s simple: American health care practitioners haven’t caught on to information technology. It’s an industry that’s stuck in the Stone Age.

I’m not saying that your doctor’s office shouldn’t be conservative. Obviously when lives are on the line, you don’t want to be experimenting with the latest techno-fad simply for the sake of being on the cutting edge. The last thing you want during an emergency is to have all of your PCs taken over by some Russian hacker’s spambot.

And of course, let’s not forget that health care practitioners have to maintain a higher standard in terms of privacy and accountability. It would be very easy for the government to build a national database of health information that holds a record of all your allergies and illnesses — but very difficult to actually secure that information against hackers, nosy employers, religious zealots, thieves, etc.

Still, these are excuses. If your local hospital and family doctor believe that they’re immune to the competitive pressures of the marketplace, they’re gravely mistaken.

Most private-sector businesses have learned that a simple rule: either adapt to new technology or die. That’s why when I go to Jiffy Lube to get my oil changed, the folks behind the counter know who I am before I’ve even gotten out of my car. If I go to any Starbucks or Borders or Harris Teeter, I can whip out my loyalty card and get instantly recognized. (Granted, I’m not claiming that Borders gives a damn about my privacy or would hesitate to sell information about my purchasing trends to a third party. But Americans are starting to catch on to the whole privacy issue, and I think a sea change is coming in the next decade.)

So who’s going to drive these Luddite small practitioners out of business? The big pharmaceutical companies, of course, who would rather sell you their products directly over the counter at CVS instead of through an unreliable agent like your doctor.

Want to know if you’ve got pneumonia or herpes or acid reflux disease? No appointments or primary care physician referral required — just pick up the do-it-yourself testing kit at the local pharmacy. Having trouble interpreting the results? Visit the website and talk about your symptoms in an online forum. Unsure of what to do next? Discuss your case with a doctor from India or Japan via teleconference. Need antibiotics? Merck will Fed Ex them right to your door.

Sound expensive? Not really, when you consider the hours you’ve saved dealing with red-taped doctors and pharmacies — and when you factor in the monthly savings of cutting your health care plan to the bone. Who really needs doctors anyway for most of our day-to-day illnesses? Why not just hire a health care broker or independent medical consultant to do all this legwork for you?

Accountability? No, I’m sorry, we’re just an independent health advisor, we’re not doctors. Didn’t you read the disclaimer on the website before you confirmed your purchase?

I can see certain advantages to a system like this, but DIY healthcare would just put more strings in the hands of the pharmaceutical companies that sell you these products. And we all know that pharmaceutical companies rank right up there on the ethical scale with oil companies, government lobbyists, and that guy in Nigeria who keeps asking me for financial assistance for my long-lost relatives.

But if your family doctor can’t learn to adapt, I’m sorry to say that he’s headed for the endangered species list.

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  1. Rob B on April 21, 2006 at 2:49 pm  Chain link

    All those bullet points you list at the beginning? Those archaic practices are in place so thy can charge a $200 new patient fee just to walk in the damned door.

    The way my (actually my wife’s) healthcare provider works is we get reimbursed for our prescriptions, etc. We moved in July and after telling the company on at least three occasions about the new address, reimbursement checks and general paperwork is still being sent to the old address. The companies are so big they can’t even communicate effectively with themselves, and all this unnecessary paperwork drives up the price inflicted upon the customers/patients.

    Anyway, great rant David. I’m really looking forward to Infoquake!

  2. David Louis Edelman on April 21, 2006 at 3:09 pm  Chain link

    You said it, Rob — I’ll bet we could fill up the blogosphere with stories about health insurance idiocy. I just hope you and I are around to see history steamroll right over these punks (and give us real health care too).

    Glad you’re looking forward to Infoquake. I’m looking forward to seeing a hefty review of it (praising or damning) on your blog! 😉

  3. Horia Nicola Ursu on April 26, 2006 at 5:54 pm  Chain link

    I can understand what you are complaining about (until recently, I have been working as an assistant manager of a private medical mini-clinic, being in charge of handling the patients’ data), but to most of my compatriots (I’m from Romania), this would sound like science fiction.
    In Romania, the Health Insurance system is unique (that is, there are no alternatives to it), non-liberalized, and largely controlled by the Ministry of Health, who’s dictating its policy. Every medical practice has to report to this institution the number of patients it has treated, monthly, and is reimbursed for the care they provided, but only for a strict number of patients (a limit that is being revised only once a year).
    In these conditions, it would appear easier to impose to the doctors a forced centralization of the patients’ data. But instead, these idiots are still asking the doctor’s practices to bring the data for reimbursement ON PAPER!!! Only one in five practices posssesses a computer!!! And most doctors are still computer illiterates!!!
    I’m still wondering how long would it take for your problems to become our problems… For us, Romanians, that would be a major progress…

    PS (totally off-topic): I’ve read the chunk of INFOQUAKE you have posted on your site and a very good review of the novel, at Rick Kleffel’s Agony Column. Congratulations, you’re the first of next year’s most serious competitors for the major awards I’m reading.
    I can’t wait for the novel to come out, when and if I can get my hand on it, I’ll review it for my own Newsblog, but also for FICTION.RO, Romania’s only F&SF magazine (of which I am one of the staff reviewers).
    And a final question: as you may have noticed, my webpage is in fact Millennium Press’s webpage (Millennium Press being a less-than-one-year-old publisher of great SF & fantasy, owned in part by your truly). Is there any chance I could get an early copy of Infoquake, and your agent’s e-mail address, so we could discuss the possibility of a Romanian translation?

  4. David Louis Edelman on April 27, 2006 at 11:50 am  Chain link

    Horia: I can only imagine how many problems that must cause in Romania. I’m beginning to wonder if the medical profession is always going to be three steps behind everyone else no matter what. Here’s hoping that your doctors (and mine!) get with the times soon.

    Re Infoquake: Thanks for the compliments! I haven’t seen the Agony Column review and can’t seem to find it on the site — do you have a link? As for the Romanian translation and the review copies, I’ll contact you over e-mail with that info.

  5. Ryan on March 19, 2007 at 10:11 am  Chain link

    Week 1: Injure my knee on and schedule an appt…2 days later!!! So that’s two days I can’t walk.

    Get a referral to see an orthopedic surgeon that same week. He wants me to get an MRI.

    Week 2: Get the MRI exactly 1 week after my inital doctors appt. 1 week I can’t walk. Results take another week

    Week 3: Haven’t been able to walk for 3 weeks!!! I don’t even know how bad my knee is. I get the results and he wants me to start some PT.
    Still haven’t heard back from the doctors for a referral so I call the ins co. They tell me to call my PCP not the orthopedic surgeon for the referral. My PCP says it will take another 3 days. WTF? No one can take 5 minutes out of their schedule to make a phone call and get things rolling. Why is this so difficult?

  6. Maurie on April 15, 2009 at 7:51 am  Chain link

    I will never understand the the health system in the United States,
    It is the most complicated and backward system in the world.

    I don’t get why health insurance should be tied to employment
    that is one of the most bizzare systems in the world.

    Thank god i live in Australia !
    If you need to go to hospital for anything, its free cost’s nothing zip zilch nada.
    Most doctors appointments are covered by Medicare, and all visits to hospital
    whether you need surgery or not.
    All totally free, and over here health insurance is not tied to your employment.

    We can take out what we call private insurance, but its not really needed
    as government pays for all your medical needs via the good old medicare card
    each of us carry.

  7. Patriia Rogers on May 2, 2009 at 11:39 am  Chain link

    I have had Medicare for One year- I was very ill. Thought I was depressed. No energy. No anything. Watched hours of The history channel and OPB on TV- Could not concentrtate to read. Could not sleep. Could not even eat. I went to a medical school. The communication was horrific, The attitude of the doctors was fantasically arrogant. Third year residents speaking to me, a 66 year old intelligent woman as if I were a two year old. And what was even more despicable, three cardiac doctors did not communicate with each other. I told all of them they were on the wrong track. This nonsense continued from June 2008 through August 2008. My 28 year old son, almost finished with earning a BA in Psychology kept saying MOM, Mom MOM!!! Try an acupuncturist. He made me an appointment; Knowing me very well, he told me how much fun it would be.. I went. She diagnosed me accurately; I went not being able to walk more than 10 steps without sitting down to rest, shortness of breath edema and “anemia” to walking , hiking, climbing stairs with no problem. The problem was not a “bleed” for which the Traditonal Doctors searched relentlessly and were paid thousands of $$$$ by medicare, nor was it ” heart failure” (more expensive tests- all negatative, except a false positive) It was so simple, years of stress due to dealing with schools and institutions regarding our daughter who was born with trisomy 21 in 1974, had caused my liver and kidneys to be stressed out. There are many more details, but suffice to say- my “five year plan” is to hike from Georgia to Maine on the Appalachia Trail, a dream of mine for years. Please, people out there, research some alternative medicine. Medicare will not pay for most of it but DO THE MATH !!! It is not the money but the value. Acupunture, sports massage, a nutritionist, a “mindfullness therapist” and I will no doubt live another 30 years if the proverbial truck does not run me down. It is so simple, “brain washing” and apathy are the real killers in this country. Get out of the mainstream and live to see your granchildren go to college!!!! Sincerely, A grateful woman who got”lucky” (smiles) Patricia

  8. David Louis Edelman on May 3, 2009 at 4:31 am  Chain link

    Thanks for this, Patricia.

  9. Sky Walker on December 21, 2011 at 9:09 pm  Chain link

    Fucking USA healthcare is stone age.

  10. Anna on November 19, 2015 at 5:31 am  Chain link

    So as it started, we shifted recently from India to US. One fine morning i noticed pimples/boils all over my face, may be allergic reaction to some food. So i called up nearby primary care centers , i called 3 of them almost 5-6 times leaving message to their answering machine as suggested but none of them called back. 2 days passed, finally one of the centers picked up and told me they can book me an appointment after a week all doctors are booked unless i get referrel from urgent care.
    So what do i do, go to urgent care for pimples all over my face ??? Crazy ?
    So i thought of trying the dermatalogist , another daunting task.. the lastest i can get is dec 15th or i shd visit urgent care.
    So after 5 days of struggle, im going to barge in to the nearby health care center tomorrow and ask them , how the hell im suppose to contact them ?
    Or should i wait my condition to worsen so that i can go to urgent care and they can charge me hefty money.i dont know if its a good idea but i dont know what else to do ?
    I belong to a developing nation and im surprised we never had this problem of contacting a general physician.
    I mean i could just walk in and some one would be available, at least my
    Phone call were answered and appointments were made.
    What can i say, we r struggling with peditricians and doc here. Established pediatrician dont take new patient, new pediatriciana are rotating so cant be my kids pediatrician. So everytime im charged as new patient.
    I used to wonder why so many foreign nationals flocking to india for expensive surgeries ..how the medical tourism started in india?
    Its because of the erratic bills , complicated systems, apathetic customer support at front desk here.
    Despite so much of technology, leverage frm govt., mnc pharma companies and insurance companies are making healthcare difficult for common man.
    Our last visit to pedi costed us 400$, we still dont know for what? They never sent the bill or explained what it is, 2 week later we got some bill, out of which 400$ we needed to pay rest covered by insurence. All pedi did was prescribed antibotic and took sample from the skin infection she was suffering, which they said negative( nothing to worry) after culture. Same infection was treated in india by her pediatrician in Rs. 300 ( 80 times cheaper) !!!

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