It slipped up on me. I guess I missed the engagement party. I thought I was going about my career taking care of patients as I planned to do when I decided to be a doctor. But today I find myself worrying more about whether I’ve met my billing quota and my RVU (relative value unit) target for the month. The relative value unit measurement tells administrators whether we are seeing enough patients, keeping our schedule full.   I don’t blame administrators. They’re cogs in the wheels of a totally dysfunctional system. They are doing what they can to keep our doors open.

When I interviewed for a position in medical school, I was asked whether I thought that medical care was a right or privilege. It was a common interview question at the time, and I had been forewarned that it might come up. I had no hesitation in answering that question though. I felt then, as I do now, that access to medical care is a right, not a privilege. I wonder if that question is even asked anymore.  Apparently, the correct answer at the time was that medical care is a right. However, I don’t see that organized medicine has ever truly supported that philosophy because if they had, I don’t think we would be in the mess that we are in now.

Somehow, insurance companies got involved in healthcare. I also remember that when I first started working and had to pick an insurance plan, I was advised to look for a plan that had the best catastrophic coverage, because that’s what insurance was really for. The idea then is that you could still pay cash for doctor’s visits and medications. We’ve come a long way from that.

Why have we tied the ability to access health care to a job? Until the Affordable Care Act, if you didn’t work, you didn’t have insurance unless you met fairly restrictive criteria for a state Medicaid plan or you were wealthy enough to buy a private insurance plan or just pay for your healthcare.

At one time, healthcare companies were nonprofit for the most part. But now they don’t claim to be non-profit. Let’s look at the salaries of the CEO’s of the top healthcare insurance companies. This is public knowledge. You can find it at fiercehealthcare.com.


Humana CEO Bruce Broussard $10.3 million

United Health CEO Stephen Hemsley $14.5 million

Cigna CEO David Cordani $17.3 million

Anthem CEO Joseph Swedish $13.6 million

Aetna CEO Mark Bertolini $17.3 million


So these guys are paid millions of dollars to find ways to deny the medications and procedures that your doctor orders. Of course, that is an oversimplification of what they do – but not much of an over simplification.

I find it interesting that patients are so against a single payer system, yet are willing to have their healthcare essentially dictated by an insurance company with a CEO paid 17 million dollars to rip them off. Go figure. By the way, we already have a single payer system for those over 65 – Medicare.

Doctors and the AMA have some responsibility for the negative view of single payer systems. For many years, the American Medical Association very opposed to any single payer system, also called socialized medicine. That really is not an accurate label for a single payer system. The AMA’s stated mission is “to promote the art and science of medicine and the betterment of public health,” (ama-assn.org). However, in my opinion, the AMA sometimes seems more interested in protecting doctors than in the interests of patients. Don’t get me wrong. We all benefit from organizations that protect our interests, but healthcare is not like any other entity. It’s life and death for patients. Sometimes, what is good for doctors also benefits patients, but not always. I’ve never joined the AMA.

In future blogs I’ll take a look at healthcare systems in other countries. I believe in gathering data before judging something as bad or good. No healthcare system is perfect, not the single payer systems (which are not all the same) and not our insurance-driven system.

I would recommend a book coming out on April 11 by Elisabeth Rosenthal, MD, called An American Sickness: How healthcare became big business and how you can take it back. Dr. Rosenthal has been a practicing physician as well as an author. She has traveled widely, and she is familiar with other healthcare systems. I was able to hear her on a podcast, and I’m looking forward to reading the book as soon as it comes out. One of her messages is that patients can have a role in taking more control of their healthcare and dealing with insurance companies. I have found that insurance companies sometimes listen to patients more than they listen to us. They will often say that they’ve denied something because the doctor didn’t provide enough information, but in reality they are playing the blame game. The doctor probably filled out the confusing, redundant paperwork, but the request still didn’t meet the insurance company’s criteria for approval. I’ve had insurance companies refuse a request 3 times because they sent us the wrong form to fill out 3 times.

Don’t forget Dr. Rosenthal’s book coming out on April 11. It should be a good read if you care about our healthcare system. I found it on amazon.com.

And I still believe that in our country access to food, education, and healthcare are rights. How they are used is up to the individual.




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