Message From The President

“Health Processing – the Demise of American Health Care”

By Dr. Hans F. Lessmann

Many of my patients report to me that the only doctors that really help them are the doctors they pay directly outside their insurance plans. Why would that be? Aren’t the plan doctors good too? Of course they are. They are well meaning and well trained. So what could be the difference? Simply, their attention has forcibly been divided between patients and insurance or government bureaucrats. He who pays calls the shots, so doctors have lost their freedom and autonomy and guess what so have the patients. How has this happened?

Plan doctors are restricted in the type, scope, and depth of services they can provide. They are only able to offer options approved by the plan and only after doing a number of qualifying tests that may or may not be necessary. This takes more time, it is less efficient, and often the doctor and patient become distracted from the original problem. Often these options change as unaccountable bureaucrats and system analysts try to macro manage service utilization and costs. This is frustrating for the doctor as he or she tries to match patient needs with a limited and shifting scope of services. Additionally, the doctor is discouraged if not reprimanded for suggesting services that are not covered yet may benefit the patient. So the doctor and staff are torn between two concerns of the patient and the plan and they often may conflict. If the doctor provides an uncovered service, he will not be paid and he is prohibited by contract from charging the patient even if those services help the patient. So even if he knows how to help he cannot because of contract prohibitions.
What is the result? The healing arts are reduced to “Health Processing”. Health processing is where the process is oblivious to the result. What is important is that the proper protocol was followed for a patient passing through the system. The process may evaluate the costs and actions of the participants to modify the protocol, but the result as viewed by the patient is rarely considered and may be considered a distraction.

In contrast, private pay non-plan doctors have only one concern to you the patient; hence the relationship between the doctor and patient is simple, confidential, and direct. The doctor is free to offer the best available options relative to his or her knowledge and skills and the patient is free to choose which if any of these services they are willing to pursue.

Health and healing is all about relationships. The integrity, confidentiality, and mutual accountability of that relationship are vital to its effectiveness. Third parties like health plans and government insurance disrupt and compromise the most important aspect of health care, the doctor-patient relationship. We at SEPP (the Society for the Education of Physicians and Patients) have long advocated for the preservation of this relationship through free market policies that empower the patient to own their plan and allow them to contract and pay directly to their chosen doctor as they see fit.

Evidence of this eroding relationship is escalating rapidly. Locally here in Pittsburgh we have two health plan titans that are threatening to shut out one or the other members from their facilities. Regardless of who is justified in these actions, obviously the patient’s consideration is secondary at best. What is important to the processors is the process. This has spurred huge advertising expenses as each entity tries to justify itself to the public, again having nothing to do with health but all about the process! As health care costs rise and outcomes fall, patients will have fewer options and more frustrations. Government and plan administrators will not take any blame but will assign blame to the participants namely the doctors and patients for not behaving as their models predict. This will further harm the doctor-patient relationship, making American health care less effective. God help us as we march deeper in government and third party intervention. At SEPP we encourage you to take control of your health relationships. Health savings accounts offers one of many consumer driven health plans that provide the means for you to directly choose and pay for your health services. Additionally, we encourage you to be informed of legislative actions and contact your representative and senator. Visit our website for more information and links on this pressing issue at www.sepp-online.com


Hans F. Lessmann, OD
President
Society for the Education of Physicians and Patients