Ippel: When Your Doctor Was Your Doctor

July 28, 2014

By Bruce Ippel, M.D.

Go to school. Get a license. Practice medicine — I’m one of the few who remember when this was actually possible.

Just me and the patient in the exam room. I give my best care, and the patient pays a fee. If the patient likes me and I like him, we develop a relationship that can last a lifetime. To the benefit of both of us, God willing.

Forty years on, it’s a different landscape. You now have to sign up with a healthcare plan. You may still call it insurance, but those of us who know realize that you are now a small piece of a multi-layer mega-system. What used to provide funding for unanticipated illness and injury to a relatively inexpensive doctor or hospital was, in the good old days, your financial insurance against that possible rainy day.

Nowadays, “The Plan” is in charge of what, when, where and how much healthcare you can get. It tells you where you go and who you see and controls what kind of tests, treatment and medication you can have. Your “provider” is on a temporary contract basis. If he or she doesn’t follow The Plan’s rules, he or she doesn’t get reimbursed, which is worse than getting fired, at least for the large clinic where he or she works.

If you haven’t recently felt this kind of straitjacket when you go to your doc, believe me, it’s there. Whether they tell you or not, that clinic knows how to make sure you get only the stuff allowed. And all these rules aren’t of the devil. They’re from people whose job is to bring you the least-expensive and best healthcare possible.

And this exceedingly complex, expensive and intrusive bureaucracy — like the similarly complex, expensive one running the “war” on drugs — is a spectacular failure.

Your doc may still give you reasonably good healthcare but that is despite, not because of, your health plan. There is a constant battle going on for The Plan to pay the least amount possible and everyone else trying to extract as much payment as possible. There is a highly trained group of expert money extractors facing a similarly expert group of money hoarders at each level of the system.

For sure, someone has to try to rein in the exploding health budget. It’s just that we’re going at it in the wrong way.

American politicians know they can’t get elected proposing a realistic system. Too many regulators and their lobbyists could lose money. These people would scream scary stuff to the media, who would then destroy the reputation of any politician stupid enough to try to do the right thing.

No, I’m afraid we’re headed for the crash and burn of our sick healthcare system — an extreme case of the Winston Churchill quote: “You can always count on Americans to do the right thing . . . after they’ve tried everything else.”

My hope is that the government gets so knotted up that it has to completely back out of healthcare. Then people would have to shop around for the best healthcare for what they want to spend. The free market and private charity would sort it out, and the U.S. healthcare system would again be the envy of the world — as we are in other areas that the government hasn’t messed with . . . yet.

Bruce Ippel, M.D., is a solo rural family physician in central Indiana. He and his wife of 42 years have 10 children. For the last 38 years Dr. Ippel he has run a private “hardscrabble” clinic serving the under-served.



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