I am a physician with a small family practice in Central Maine, and I love my job.
Our health care system in the U.S. is amazing, and yet it is also dysfunctional, expensive, inefficient and needs to be changed. Let me offer an illustration.
About a month ago at a Maine hospital I had a new type of scan done that can spare people like me from invasive cardiology procedures. That is the great part.
The bad part is that although I have excellent health insurance, and the procedure was fully approved, my out-of-pocket expense was $1,029.84 – well above my $180 co-payment. The reason, I learned, is that I was given one dose of nitroglycerin – we all know what nitroglycerin is, people with angina keep it in their pockets – but this was part of the protocol for the test as it is used to dilate the coronary arteries. If nitroglycerin is purchased at a pharmacy, insurance will cover it. If you don’t have insurance at all, it might be a few dollars. The hospital charge, my out-of-pocket expense for this one dose of nitroglycerin, was $849.84.
I was taken aback, as a consumer and as a physician. After a number of hours of research and many phone calls, I learned that it was considered a “self-administered” medication, so not covered by insurance while in the hospital. The reasons for the charge of $849.84 has to do with our health care system and how it functions, or doesn’t. I want to emphasize that the hospital was just doing what all hospitals in the United States do as they struggle to make ends meet in our current system.
I am hoping to reverse this charge. I’m working with hospital and insurance company employees, all of whom are getting paid for their time, while I do this on my own time. I am a physician who knows the system and can make the appeal. For many Maine families, pursuing the appeal would be challenging and the charge could break the family budget. This is just one example of a problem in our health care system and I know that many readers have similar tales – I hear about them daily from my patients.
We have some of the best care and yet some of the worst. The United States is by far the most expensive health care system in the world and yet we have health outcomes for this investment that are embarrassing.
As a society, we must respond.
The Maine Medical Association is a professional organization of more than 4,000 Maine physicians, residents and medical students and almost all our members believe that our current health care system does not meet our needs and requires comprehensive change. We do not all agree on how to fix the system, just that it needs to be fixed.
The association has issued a revised statement on reform of the U.S. health care system that reviews the problems we face and offers some principles for change. It is not perfect, but I promise it will make you think. I encourage you to read the statement on the MMA website: www.mainemed.com.
Maine physicians, MMA members and members of other physician organizations urge change. Change can’t happen without more understanding from everyone of the problems, and the potential solutions, and then we’ll need help from our elected officials.
In the meantime, my heart test was OK. I will keep working on fixing that $849.84 charge.
Send questions/comments to the editors.
