🍗 Food for Thought 🍗
Alright, you might want to store this topic away for Thanksgiving dinner discussion. Although be careful. It could get political depending on how far you take it.
I am currently living through the most bizarre healthcare phenomenon, one I certainly didn't fully appreciate during my training years.
It's the DEDUCTIBLE time of year.
Let me quickly summarize before your eyes glaze over. When you buy health insurance, there's a portion of the costs your insurer wants you to pay upfront. It has to do with something called moral hazard — a thought that if your healthcare were free, you would go spend endless amounts of money, rather than making judgment calls on what you do and don't need.
So insurance wants you to 'feel the pain' of your healthcare expenditures. For most, the first 3/5/7/10K of healthcare spending each year is YOUR responsibility. After that, insurance helps you out.
But because this amount resets each January 1st (essentially an arbitrary date), it creates all these weird incentives in Q4. In truth, this exactly proves the moral hazard theory.
I currently have streams of patients pouring into my clinic wanting every little cyst surgically removed or lingering arthritis pain finally cut out.
It. Is. Wild.
And when I bring this up with my OB/GYN friends, they have no idea what I'm talking about. People don't try to have extra babies in December. So different fields experience this in their own ways.
The classic patient is the one I maybe saw in March. At the time, they had a little painless wrist cyst pop up. I told them that many of these go away after 6 months to a year and to just watch it.
Well, come Q4, they've had some other health issue over the summer. Maybe an illness that landed them in the hospital. Or a broken leg that needed surgery.
Now that deductible IS MET. Baby, bring on the healthcare spending. That cyst has got to go, and it's got to go BEFORE December 31!
So here's your Thanksgiving dinner topic of conversation: Is this what we really want from our healthcare system?
What happens when that cyst never really needed to come out? And that patient then suffers the 1 in 500 post-surgical infection? Did our system just incentivize them to have it out for no reason? Where does that fit in the moral hazard decision tree? Did we save any money by the time that patient has multiple surgeries and weeks of antibiotics for their infection?
Here's another crazy scenario. And this one's personal.
A few years ago, I came down with a nasty impacted kidney stone...on December 28th. The only way to get it out was with surgery.
But here's the kicker. The surgeon had to leave a stent behind to allow my ureter to heal up. You know, only for a week, nothing too crazy.
Except now I needed a second procedure. On January 4. So...
Who has two thumbs and got to pay TWO YEARS of full deductibles, only a week apart? This guy.
All because I happened to get sick around the arbitrary January 1 turnover date.
Woot woot.
K, wrap it up Dr. G, you're getting punchy
I obviously don't have the answers. I can't think of a topic more complex than healthcare.
But I do look around at my bursting-at-the-seams clinic and OR these days and can't help but wonder.
Are we doing this right?
Feel free to send me your thoughts, and if a good discussion comes from this, I'll continue it in the next issue. But please, let's keep politics out of it. Just like best practices at the Thanksgiving dinner table :).
