The US Healthcare System vs…….South Park ?!?!
I have to admit that I’ve never watched an episode of South Park. However, this clip was sent to me by another Direct Primary Care (DPC) doctor, and I thought that it was well done and that it deserved to be shared! Although the medical focus of this video is obesity, I was intrigued by the other highlighted theme – the endless spool of red tape in healthcare. I would guess that most of you can identify with the frustration shown in this clip.
Insert a different medical problem and a different medicine, and this situation repeats itself daily in a primary care office. For instance, in May, I prescribed a diabetic medicine for a patient. The patient was unable to pick up the medicine due to the cost (about $1800), so I prescribed the other diabetic medicine in the same class. The cost was also above $1000 so the patient left the pharmacy empty handed. A few weeks later, I received a letter in the mail from the patient’s insurance company saying that their records indicated that the patient was not taking one of the diabetes medicines in that class, and that they recommended that I prescribe one of those medicines. I felt like I was in an episode of The Twilight Zone! I called the insurance company to give them a piece of my mind, and magically the price went down at the pharmacy.
There are a lot of things to comment on in this video, so I’m going to take a few of the examples of healthcare red tape that I identified with as a primary care physician and highlight them below.
Let’s start with the scene where Kyle and friends walk into an office to try to get his friend’s medicine paid for. Did you notice the typewriter, rotary phone, and printer from the 1980s sitting on the employee’s desk? The medical field has a well-earned reputation of being behind the times technologically, especially when it comes to the admin/business side of things. I would hazard a guess that we are the only industry left who still regularly faxes documents. And who still has a CD-ROM drive on their computer to look at imaging studies?
Let’s start with the scene where Kyle and friends walk into an office to try to get his friend’s medicine paid for. Did you notice the typewriter, rotary phone, and printer from the 1980s sitting on the employee’s desk? The medical field has a well-earned reputation of being behind the times technologically, especially when it comes to the admin/business side of things. I would hazard a guess that we are the only industry left who still regularly faxes documents. And who still has a CD-ROM drive on their computer to look at imaging studies?
I’d also like to talk about the insurance medical director’s denial of the obesity medication without wanting to know anything about the patient’s medical history. Insurance companies tend to lag behind current medical research. It seems that no medical director wants to be the first to agree to pay for a “new” medication, even if it has been on the market for years and has been shown to be the most effective medicine out there! In this case, Kyle was right – obesity has been considered a chronic medical condition requiring long-term treatment for many years. Insurance companies have been slow to agree with this though, and therefore, have not readily paid for medications to treat obesity. Of course, obesity may not need to be treated with medication (especially as the first line treatment), but then shouldn’t your gym membership and meetings with a registered dietician be expenses covered by your health insurance plan??
Next, I’d like to talk about the song. I’m not sure about you, but I have never felt like the US healthcare system is something to sing about, except in parody format, so bravo South Park 😊 How many of you have been frustrated by filling out forms at a physician’s office? Similar to Kyle’s experience, the more offices you go to, the more forms you need to fill out. While some medical offices have changed to electronic forms, many still require that you put pencil to paper. And get this – even though I do not file insurance claims at my office, Medicare still requires all patients with Medicare to sign a form (in ink!) to say that they understand that Noreta does not take Medicare! This is red tape at its finest if you ask me!
Now, I want to be clear that by writing this blog, I am not saying that health insurance companies are evil! However, why are there so many layers of red tape to cut through in order for my patients to get care that has been recommended by me, a licensed and board-certified family physician? It has always rubbed me the wrong way when insurance companies deny or question my ordering of an imaging test or medication for a patient. As a family doctor, I feel that I have the medical version of a “fiduciary responsibility” to my patients – to do what is in their best interest. Perhaps a difference between the financial definition of fiduciary and my medical version is that patients aren’t just handing their care completely over to me the way they may hand over their money to a financial institution. My patients have a say in their care. Nonetheless, I take my role in my patient’s care very seriously. Let’s be honest, I’ve built my direct primary care family medicine office around the concept of cutting through red tape, so my opinion here is likely not a surprising one 😊
Here’s one more ironic story about red tape that I’d like to share. I was on the phone with an insurance company trying to obtain an authorization for an imaging test. I was talking with a doctor who worked for the insurance company. She was complaining that there was so much paperwork for her to do. I laughed out loud! I said “YOU’RE telling ME?” I’d been on the phone for 20 minutes at that point, after receiving a fax telling me to call…
Finally, I will close by saying that I closely identify with “Astronaut Butters” feeling lost in the vastness of the US healthcare system. That feeling of being lost and out of control is really the reason I opened my own direct primary care office. I admit that I still deal with authorizations for my many patients who have health insurance and want to use it for their medicines and imaging studies (hence the stories I noted above). However, I do not deal with insurance companies when it comes to office visits. Therefore, I have more freedom when it comes to treating patients in the way that I feel is best for them. My patients and I can create treatment plans that we are both comfortable with. This freedom comes with a big responsibility, and I take it seriously, still adhering to the recommended treatment guidelines for medical conditions and not overprescribing or overordering testing.
I’d like to add a final scene to the South Park clip. I would grab Butter’s floating astronaut body and gently guide him back down to Earth and into a DPC office. We’d fight the healthcare red tape fight together!
Have a good week! Feel free to contact me with any questions.
Melissa Boylan, MD, FAAFP
Family Physician and Owner of Noreta Family Medicine
