Failure of USA Health Care

I saw a patient this week that exemplifies one of the many problems we are facing in the health care delivery system. The patient was a 30ish year old obese female with medicaid insurance who was told she has cancer of the thyroid and was referred for surgery to remove her thyroid. I was the fourth surgeon she was consulting because all the other doctors declined to operate on her. I like the others also declined to operate on her. Let me explain.

Removing the thyroid for thyroid cancer takes at least a few hours at the minimum. It involves extremely delicate structures of the neck putting at risk nerves that course beneath the thyroid gland that enable the vocal cords to move. It is physically demanding for the surgeon, requires great expertise and skill, and is still associated with potential complications even in the best of hands. It involves postoperative care in the hospital which require serial visits as well as follow up in the office. By the way, postoperative visits in the hospital and in the office are not reimbursed as they are considered included in the fee for the surgery. For all this the surgeon may get paid about 500 dollars. And to top it off, if there are any complications the patient can sue you, which will increase your malpractice insurance whether you win or lose.

So you can see why there are no surgeons willing to take on this case. This represents a systemic failure of our health care system and i believe is just the tip of the iceberg. I see patients all the time who cannot find a doctor to take on their cases and it is just going to get worse as reimbursements continue to fall and expenses go up. Doctors will only take on the safest of cases which have minimal risk.

Government bureaucrats think they are doing the population a favor by swelling the medicaid ranks. What use is it to have insurance if nobody accepts it? Medicare is only slightly better and soon I think the same will happen to medicare beneficiaries. They will not find the surgeons to assume their cases for pennies. When I see a patient who I want to refer out I will typically send them to the local teaching hospital. This is an ideal solution for these patient as they get treated for their problems but at the same time they are educating future doctors. Both sides win. The problem is when I send a patient to them they say we have a waiting list of six months. So here again is a failure of the system and similar to other countries with socialized care there are waiting lists to see specialists. The portion of the USA health care that is socialized has waiting lists at best and no care at its worst.

Bottom line: you get what you pay for. If you don't pay up for surgeons who endure long periods of training to attain the expertise to perform delicate operations. If you subject them to lawyers waiting to pounce on them for any negative result regardless of fault. If you treat us like the plumber that fixes your stuffed toilet but pays us less you can say GOODBYE! You will suffer the consequences.