It's only fair to share…

**Whilst this article is written by an American about the US system most of the issues apply in other countries too. ** – Dr Joe

Pardon the expletives, I have been wanting to share some thoughts and frustrations about healthcare that I have seen arise over the last few years.

The United States healthcare system is completely broken; it has become a huge money pit, with insurance companies, pharmaceutical corporations and greedy lawyers at the bottom filling their pockets.  Mind you, I do not blame the practitioners or their staff, because they do an exceptional job, even when they are sleep deprived from working doubles.

Is our health a commodity?

Healthcare is a strange commodity. If you are starving, you can’t walk into a restaurant and demand a hamburger, and you certainly can’t walk into a steakhouse and demand a ribeye. If your water gets shut off, you can’t walk into a gym’s locker room and demand a shower and use of their shampoo.
If you can’t afford a cell phone, you can’t bust up into a Sprint store and demand to see Dan Hesse the CEO. But in healthcare, if you think you need care, regardless of actual physical acuity (severity), you can go to a hospital and they have to give you the best care they can provide, by law,and for FREE!.

Without making a value judgment on that fact, you have to admit that devising a system that both capably serves its clients and doesn’t bankrupt its providers is a tenuous ordeal, at best.

11 reasons why healthcare is broken

Today I’m going to talk about 11 reasons why I think healthcare has been down in the gutter for so many years.

1.     Insurance companies – In a short-sighted view, insurance rates are a big problem. They cost so much that people outside of large business plans cannot get coverage unless they’re in perfect shape, under 40, and have no family history of medical problems. Which, given that last qualifier, discounts pretty much everyone. However, simply saying insurance rates are the problem is like saying inflation is the reason things cost so much; you’re actually only describing an effect of a larger system of problems, not the problem itself.

Just like the solution to keeping ice from melting isn’t inventing ice that stays frozen at a higher temperature, making insurance more affordable isn’t necessarily done by demanding insurance companies to lower their premiums.

The fix is to improving communications between providers and insurance companies that would result in less wasted tests, long wait times between care and approvals, (which result in health problems getting worse, which cost us more) Right now most insurance companies use paper fax to authorize treatments and sadly many of these are lost in transit or take many days or weeks to process.  Get with technology guys!

With insurance premiums on the rise again, we seriously need to get our insurance companies on the right track so we can afford to die healthy.
2.     Excessive regulation – Not saying all regulation is bad, but, for example, the criteria for becoming a medical practitioner is way too strict. There is no reason why I should need eight years of schooling to say, “Hey, you have an ear infection. Take this for a week.”

Probably half the nurses at most hospitals could handle a lot of the GP work that gets done, but they can’t, because the government doesn’t allow them to. When it takes a couple hundred grand in education costs to become a doctor, doctors are going to demand a $%#! Ton of compensation for their services.

When doctors demand a %@#! Ton, it drives the cost of health care up. If we opened up certain branches of healthcare to people who can do the work even without all the schooling, it would drive costs down for at least some forms of healthcare. I mean, I can help design a bridge that, should it fail, will kill dozens of people without all that schooling, but I can’t tell someone he has a cold?

3.     Shortage of Doctors – Studies show that there will be a shortage of doctors for the American patient in the next 15 years according the Association of American Medical Colleagues.  But what they do not quote in the WSJ article is that number 2 above is the real reason why there is the lack of people wanting become doctors. If you have gone through the rigorous medical schooling, or know someone who has, you know how tough it can be.

4.     Medical advances – We’re learning how to treat more and more ailments, and these new treatments are pricey. Once upon a time, if you got a certain illness, you just sort of quietly died. Now medical advances are not a bad thing, they just cost a lot more during the first few years of their launch.

Now, you instead rack up a hundred grand in treatments that are paid for by your insurance provider. The insurance providers pay through the nose, and they pass the costs on to you in the form of higher premiums and co-pays.

5.     Paper – Please, stop using 50 year old FAX technology.

Did you know that providers need to fill out an average of 20,000 forms every year? And, 3 out of every 10 tests are reordered because the files are lost?
We also know that paper is the costly, killer of trees, hard to track, and easily misplaced, lost or misfiled…

So why most do doctors still use paper to communicate? Because till recently, it was really the only way for 2 doctors to communicate information, but thankfully that is finally changing with the advent of new applications that help manage the patient referral and insurance authorization process.  Sorry for the little plug – Check out referralMD, it will make you and your staff’s live so much easier.

Want more stats? Check out the full healthcare infographic about American’s broken referral system, the stats are shocking.

6.     Ignorance – Another branch of increased costs is ignorance, which I don’t mean in a derogatory fashion. Just the simple ignorance of patients or their parents not knowing how to treat something at home, or not even worrying about it and coming straight to the ER for care.

Ninety-five times out of a hundred (especially in children), the problem can be solved with medicine available at CVS for $6.99, but instead it now costs several hundred dollars in triage and physicians’ fees. As you can expect, many parents are more concerned with getting their children well than if they can actually pay for the service, and as a result do not pay the bill. They know they do not have to have money to be seen, and that’s all they need to know.

7.     Choice to Die – I feel that we, as a nation, spend entirely too much money on the care of irrecoverably indigent patients, and that euthanasia should be a legal option if granted in powers of attorney and a Living Will. I’ve seen too many middle-aged or older people spend their entire savings keeping elderly parents on life-support for years beyond the point when recovery was medically viable. People with strong feelings on healthcare should have to spend time in ICU wards and nursing homes, watching withered old people sit paralyzed in their own feces, fed by tubes because their vegetative minds can no longer operate their contracted and atrophied hands.

It’s a hard thing to look at, but it’s even harder, for me, to defend the right to keep someone in this cruel condition, especially at the cost of the taxpayer. I have notices in my Living Will dictating theremoval of life support in that situation, as do most of the people I know. And I think that’s the biggest thing about people’s thoughts on healthcare: a volume of experience changes you, and the longer you’re in the field, the more pragmatic you become.

8.     McDonalds – Well any fast food for that matter.  Some of us eat it daily due to it being cheaper, faster to eat, and more easily consumed from any location.  The mentality of eating this type of food is slowly destroying our country. It causes American’s to gain weight, become stagnant, which in turn increases the risk for heart disease and other debilitating diseases. The overall effect is that these diseases are preventable and if kept in check, could lower the cost of healthcare premiums for everyone.

Will we change, probably not; will we get fatter and sicker? Yes….  So unless we make it illegal to eat badly, we will be drowning soon in our own disgust.

9.     Cluster $#@! Of EMR’s – You got me started now… EMR’s (Electronic Medical Record software) are necessary, we know this, the older paper filing system (See number 5 in the list to why paper is bad) was hard to managetime consuming to use, and carried a huge liability if anything were to happen to the patient files.

Once the U.S. government got into the act of bribing doctors to use these newer systems, 1,000s of small under-capitalized EMR’s popped out of no where trying to get in on the modern gold rush that happened over the last few years.

Now the big issue with some of the largest EMR’s are that

  1. They are godly expensive, so most individual practitioners and small groups cannot afford them.  A current EPIC install at a local hospital here in California was well over 75 million dollars
  2. Simply put, installation times are terrible. In some of the larger EMR’s it can take years to be fully integrated. What’s even worse is it usually requires the IT staff to help, which makes it even harder to implement.
  3. Systems are complex and way too hard to use. I have heard so many horror stories fromEPIC, Meditech, and Cerner users that simple hate to use the system but are being forced to.  In some cases to use pieces of the software require you to click on 4 to 10 different areas to process a request.  Who designs these things? You would think that they would ask a focus group first or at least test out different graphic interfaces to make it more useable.
  4. Training is long, and unpleasant – We talked to a few nurses at Children’s Hospital about their Meditech installation and they were so unhappy with the process and how slow and laborious it was.

Developers need to be more caring to the needs of its users and take into account that they will be using this system every day; it needs to work and be simple.

10.     Healthcare Vs. Military – This is a controversial subject, my family/friends have both served in the military and also worked in the healthcare industry. Now I like the fact we help the world with it’s problems (be the police as it is), but you know what? If we save you, pay the bill.

American’s and other countries that come and help should be compensated, Iraq anyone?  The Iraq war started March 20th, 2003 cost us almost 1 trillion dollars in direct costs and possibly another 1 trillion in future care for returning vets over the next 40 years.   So Iraq has all that oil money and they can’t pay America and our Allies back for the assistance?  Stats if you are interested.

So what does that mean for healthcare? Well, if we had that money, we could offer better healthcare services and not be in such a huge hole that will only get bigger as American’s population ages.

11.     Pharmaceutical companies – Now I am not the one to hinder capitalism, it’s great that you can make billions, pay your executives top dollar, and live the good life, but do not release drugs knowingly that are unhealthy for consumers or can cause health problems. This causes massive litigation and increased costs that pharma passes along to consumers and it’s bad business.Say no to drugs! or at least try to…

A great example of a Big Pharma company not doing the right thing is the drug Risperdal. The U.S. Food and Drug Administration (FDA) told the J&J to stop the false and misleading marketing claims not once, not twice, but three times from 1994-2004, but the company reportedly continued to include marketing the drug for unapproved uses right in their business plan.

In 2006, research showed that up to two-thirds of prescriptions for Risperdal were for unapproved uses that had little or no scientific support. Worse yet, elderly dementia patients who were prescribed Risperdal for off-label uses were found to increase their chances of death by 54 percent within the first 12 weeks of taking it!
Read more here.

Top 10 CEO Salaries for Big Pharma in 2011
1. William Weldon – Johnson & Johnson – $26.7M
2. Ian Read – Pfizer – 25M
3. Miles White – Abbott Laboratories -24M
4. Robert Coury – Mylan – 21.3M
5. Kevin Sharer – Amgen – 18.9M
6. John Lechleiter – Eli Lilly – 16.4M
7. Joseph Jimenez – Novartis – 15.7M
8. John Martin – Gilead – 15.6M
9. Lamberto Andreotti – Bristol-Myers Squibb – 14.9M
10. Robert Parkinson – Baxter – 14.1M

Read more: Top 10 Pharma CEO salaries of 2011 – FiercePharma

Access to drugs from other countries.
Another issue. Our esteemed congress people are about to pass legislation that would make it illegal to purchase drugs from other countries (even with a prescription) under the guise of both internet safety and public health. Unsurprisingly, the drug companies and health insurance companies are the ones pushing this legislation. Here is a link to the legislation

My rant has ended – Let’s discuss.
Did I miss anything? Have some ideas to fix the problem? Let us hear your thoughts


Jonathan Govette is the Co-Founder and CEO of ReferralMD, – Simple, Online Healthcare Referrals & Insurance Authorizations w/out triplicates or FAX for any size organization, from an individual practitioner to a large hospital.

Previously, Jonathan has sold innovative products and professional services in the enterprise online and print marketing / web development / software space . Jonathan holds a B.S. in Entrepreneurial Finance from California Polytechnic University San Luis Obispo.

Visit Jonathan here