11/29/2022
11/29/2022

Government Healthcare - Not For Me

By Rich Rostron
11/30/2021

Government healthcare degrades the dynamics of the doctor-patient relationship

"You're late."

Those are words you might expect to hear from your boss or maybe your spouse. But should you hear them from your doctor? It poses the question of whom is working for whom? It also raises some questions about the idea of government involvement in healthcare, as well as the role of insurance companies.

As it turns out, I'm just old enough to remember doctors carrying their little-black doctor's bags. That's because I'm old enough to remember doctors making house calls. The doctor would sit on the edge of my bed and examine me up until I was about 7. I say '7' because that's when everything changed in the medical world.

I turned 7 in January of 1964. That's the year that LBJ kicked off his 'Great Society' program that instituted Medicare and Medicaid. With those two programs, the government became actively involved in the healthcare of American citizens in a big way.

According to a chart I saw in 2010 when I first saw Glenn Beck, the cost of healthcare in America rose gradually, adjusted for inflation, from 1783 until 1964. With the creation of Medicare and Medicaid, the cost of healthcare skyrocketed. Looking at the chart, it went almost directly up.

Healthcare didn't double or triple; it exploded 10-times over and more, and then kept on going. But, beyond the cost, healthcare changed in dramatic ways.

It wasn't just that doctors stopped making house calls, no doubt in response to an increase in the number of times they saw patients; the change also pertained to the relationship between the doctor and the patient.

During the Obamacare debates of 2010, it was pointed out that the new healthcare program would give the government a seat in the office when doctors spoke with their patients. That has proven true as the government is playing a larger and larger role in determining what procedures and medications are offered to patients. But the government was already in the room, along with the insurance companies.

The change may seem subtle to some but it's really not. The changes probably appear subtle since, unlike the costs, they have occurred more slowly over time. The subtlety has to do with who is paying the bill.

In reality, when I purchase health insurance, I am paying the bill even if the insurance company is writing the check. It's my insurance purchased explicitly for the purpose of providing payment for my healthcare needs. However, insurance comes with caveats. This procedure is covered, this one is not. This much is available for this but only that much for that.

The dysfunctional dynamic described above is on steroids when the government has imposed itself as the provider of payment for my care. Those who hold the purse strings have incredible power, and all the more so when they have a greater voice in loosening or tightening the strings. And this is the essence of what was wrong in the doctor's office when I was told, "You're late" (the doctor then explained that we had to wait longer because she took another patient first).

In reality, I wasn't late. If the appointment was at 2 p.m., I was there a few minutes before 2 p.m. But, as the doctor pointed out, we should have arrived 15-minutes earlier.

I've heard of that but only in the context of the initial consultation with the doctor (this was not the initial consultation with this physician). But we did have to fill out paperwork at the front desk. And the patient, an elderly loved one, is new to a walker and that slowed us down getting in and out of the car more than I expected. But can I complain?

I should be able to complain. Our taxes and insurance premiums are going to provide the coverage for our healthcare, even when the government is involved. But that's not how it works. I miss the time when doctors made house calls and bedside manners counted for something.