Saturday, December 28, 2019

Why Bureaucracy, Not Your Doctor, Is Making All Your Medical Decisions

The Federalist
With the current third-party payment structure, you doctor does not practice as much medicine on you as insurance executives and federal bureaucrats do.
"Americans, who practices medicine on you? The answer may seem self-evident, but it is not. In our current health-care system, millions of nameless, faceless government or private insurance bureaucrats practice medicine on you without a license for medicine.
"You may think your life is in your doctor’s hands, but it is not. The bureaucrats, not you or your doctor, make your medical and financial decisions. Consider these health-care decisions:

  • Diagnosis
  • Treatment: what, when, where, by whom
  • Medications
  • Paying for care
"Your doctor does not express your diagnosis in words such as arthritis, asthma, or heart failure. If a physician or hospital wants to be paid, they must use a letter-number diagnosis listed in the International Classification of Disease (ICD-10) code book, which turns 1,400 human ailments into more than 68,000 codes. Examples of these “diagnoses” include: W55.21 (bitten by a cow); W61.33 (pecked by a chicken); V00.01 (pedestrian on foot injured in collision with roller blader); Z63.1 (problem with in-laws); and my personal favorite, Y92.146 (injured at a swimming pool within a prison).
"Once a diagnostic code is established, you expect the doctor to recommend the correct treatment by the most experienced operator in the best facility at the optimal time given your medical condition. In reality, you will receive whatever the insurance carrier allows, whenever the carrier allows it, at a contracted facility, by a specialist on the insurance carrier’s panel. All those medical choices are made by nameless, faceless bureaucrats, not your personal medical caregiver.
"Doctors Don’t Get to Make the Decisions  
"Clinical advisories and guidelines written by federal administrators have become medical mandates. These treatment plans generally work well for large populations but do not allow for the specific idiosyncrasies, variations, or allergies of individual patients that only their personal physicians know. Although wanting the best care for you, if the doctor deviates from the approved treatment plan, he or she risks reprimand, financial penalty, and even loss of clinical privileges." . . .

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