I was shocked to learn that the largest portion of the cost of healthcare is now borne by patients.  Not the insurance companies.  Not the employers.  Not the government.  The largest portion of all healthcare costs lands with a splat on the wallets, checking accounts, credit cards, and life savings of patients.  Those with health insurance are no exception! To wit, in my practice (of 9973 patients!) I routinely see deductibles as high as $10,000, co-pays as high as $70 per visit, and out-of-pocket expenses written into insurance policies that shove the cost of procedures and services that are needed but are not covered by insurers onto those who are supposed to be served by the system not sacrificed to it.

In most insurance plans, a woman that needs chemotherapy must cough up 20% of the cost before she can begin treatment.  If she elects to preserve her breast, she will have a lumpectomy followed by radiation therapy:  her co-pay will be demanded at every visit to the radiation oncologist – five days a week for six weeks.  How do you think that works out for most patients?  I can tell you, not well at all.

Where has the concept of sharing the risk gone?  It dropped between the cushions of the executives, lobbyists, and bureaucrats that run our healthcare system as if they were manufacturing shoes in China, with patients increasingly factored out of the equation except as coefficients of profit.   The new and daunting, enormously complex and merged hospital systems now sprawling across the country like the shopping malls of old are increasingly in bed with the profit-driven global pharmaceutical and device manufacturers that have monetized and securitized healthcare.  An alien universe of regulators are driving it into the ground in the name of accountability and cost-effectiveness (a joke!), putting happy faces on everything that they want to look nice and checking off boxes whose data are both unnecessary and incomprehensible.  It looks more like the Division of Motor Vehicles than what I once knew and revered as the medical profession.

How can anyone afford healthcare under these increasingly dire circumstances?  How can a woman afford to have breast cancer in this environment?

We must think about this again, from the beginning:  Who wants what?  Who gets what?  Who pays for it?  And really, do we need 100 people pushing paper from one side of the desk to another, for a handsome fee, so that one woman can get her hands on the one pill she needs, or the mammogram she’s due for, or an answer to her question, “Can you help me, Doc?”

Let’s begin the conversation again and from a new perspective, and let’s start with breast cancer as an example. How can we compassionately and effectively prevent, diagnose and treat breast cancer by   sharing the risks and enjoying the benefits of doing it together, like we used to?

For those who want to make a profit, I say, “Good. I’m a capitalist.  Go with God.  Go make a profit.  Just go do it elsewhere.  Here’s a suggestion:  Make a cheap and sustainable iPhone.”

I would love to hear your thoughts.


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